Psychiatry in the Deep South: a pilot study of integrated training for psychiatry residents and seminary students.

OBJECTIVE: The authors describe an interdisciplinary training experience developed for psychiatry residents and seminary students that assessed each group's beliefs and attitudes toward the other's profession. The training was designed to enhance awareness, positive attitudes, and interaction between the disciplines. METHODS: From 2005 to 2008, PGY-2 general-psychiatry residents and PGY-5 child-psychiatry residents (N=30) participated alongside psychology interns (N=13) and seminary students (N=41). The intervention consisted of two 3-hour sessions. Measurements addressed demographics, participants' spirituality, and attitudes toward mental illness, mental-health practitioners, and clergy. RESULTS: The psychiatry residents' knowledge regarding the training of clergy was significantly increased by the training sessions. The seminary students' attitudes and knowledge of psychiatry/psychology changed significantly in a positive direction. CONCLUSION: This pilot course had a positive impact on both groups of participants. This model could be modified for other psychiatry programs, to include clergy students of different religious faiths as relevant to the demographics of the training location.

Stiff-person syndrome presenting as eating disorder: a case report.

OBJECTIVE: To report a case of a 35-year-old female initially treated for anorexia nervosa who was found to have Stiff-Person Syndrome (SPS). METHOD: Case report. RESULTS: The patient reported panic attacks at meal times that were found to consist of tetanic contractions of the axial musculature. Swallowing initiated reflexive painful muscle spasms that consequently resulted in cibophobia and significant weight loss. Her serum tested positive for anti-glutamic acid decarboxylase antibodies, and she subsequently improved with appropriate treatment for SPS. DISCUSSION: SPS has not been previously reported in the context of eating disorders, although it has been linked to other psychiatric disorders. Often the psychiatrist may be the first physician to diagnose SPS. We present this case to alert practitioners to the potential co-morbidity and symptom overlap between SPS and eating disorders, to aid in early recognition and appropriate treatment of this rare illness.

A tale of two comorbidities: Understanding the neurobiology of depression and pain.

The comorbidity of chronic pain and depression has been consistently associated with a poor prognosis and greater disability in patients as compared to those suffering from each illness alone. This further has implications on significant financial costs to the patients and to our society. The biological underpinnings of major depression and chronic pain have considerable overlap in the areas of genetic, structural, functional, neuroendocrine and neurotransmitter functionality. Although the field has evolved in the past decade, more efforts should now focus on understanding the biological underpinnings of this shared comorbidity, while shedding light on treatment implications for these two devastating conditions.

Commentary: core competencies and the training of psychiatric residents in therapeutic risk management.

The treatment of patients who, due to their clinical presentation, pose potential liability risks to the psychiatrist is one of the more stressful aspects of modern psychiatric practice. The need to educate psychiatric residents about the principles of risk management that guide the safe provision of good patient care in such patients is paramount in the current malpractice environment. In this commentary, we discuss the teaching of therapeutic risk management, as described by authors Simon and Shuman, in general psychiatry residency, particularly as it can be integrated within the existing core competencies established by the Accreditation Council on Graduate Medical Education (ACGME). A model outline of this integration for suicide risk management within each of the existing core competencies is presented.

Speaking out for mental health: collaboration of future journalists and psychiatrists.

OBJECTIVES: The authors assess the effects of an educational intervention on the attitudes and understanding of psychiatric residents and journalism students, review how collaboration between these disciplines affects these attitudes, and propose the development of similar programs within residency to enhance systems-based learning. METHODS: A collaborative curriculum involving a workshop, didactics, and team projects was conducted over 6 months among journalism students and psychiatric residents. Attitude assessments were obtained before and at the conclusion. RESULTS: Data support that a brief interdisciplinary curriculum can affect the attitudes of both psychiatric residents and journalism students regarding mental illness and the media. Attitudinal changes and areas of focus for the future are identified. CONCLUSION: Psychiatrists should be familiar with the relationship between media and stigma. Focusing on psychiatrists and journalists in training may change attitudes between disciplines to promote future collaboration, and innovative curricula within residency training may increase the comfort level between physicians and the media.

Depression in women of reproductive age. Considerations in selecting safe, effective therapy.

The understanding of biologic and psychologic underpinnings of depression in women of reproductive age continues to grow. Overall, the news is good. Increased knowledge, safer treatments, and early identification have combined to reduce the morbidity of depression in this population. Many treatments appear to be safe and well tolerated by mother and infant alike. No matter how safe the treatment, however, a poor perinatal outcome will prompt both physician and patient to second-guess the intervention. Women who are pregnant or breast-feeding and have a history of depression or are currently experiencing symptoms need to be educated about the risks and benefits of treatment and nontreatment. Whenever possible, another family member should be involved in this discussion. Ultimately, the decision to medicate or not comes down to whether the risk of treatment outweighs the risk of no treatment. Untreated depression is not without its own risks and morbidity. Psychotherapy remains an important tool that can be used independent of or in addition to medication. It is especially helpful for the many women who refuse any and all medications when they are pregnant or breast-feeding.