Self inflicted corneal abrasions due to delusional parasitosis.

The authors report a case of self inflicted bilateral corneal abrasions and skin damage due to ophthalmic and cutaneous delusional parasitosis. A male in his 50s presented with a 10 year history of believing that parasites were colonizing his skin and biting into his skin and eyes. The patient had received extensive medical evaluations that found no evidence that symptoms were due to a medical cause. He was persistent in his belief and had induced bilateral corneal abrasions and skin damage by using heat lamps and hair dryers in an attempt to disinfect his body. The patient was treated with olanzapine along with treatment for his skin and eyes. His delusional belief system persisted but no further damage to his eyes and skin was noted on initial follow-up.

Differences in the self-reported reasons for adolescent drug use reported at admission vs. reported at discharge.

UNLABELLED: There are several possible reasons for adolescents' alcohol and drug abuse. While genetic, social and cultural factors all play a part in influencing their behavior of using alcohol and drugs, their self-reported reasons may also offer insight into why they use. Adolescents reported using alcohol and drugs to self-medicate their emotional symptoms, due to peer-pressure or their desire to get high. However, it is not known if receiving treatment of their substance use disorders changes these self-perceived and self-reported reasons for use. In this study, we identified self-reported reasons for the adolescents' abusing alcohol/drugs at the time of admission to a drug treatment program and at the time of discharge from this program. METHOD: This is a retrospective chart review of all adolescents admitted to a long-term substance abuse treatment program in one year. A total of 86 charts were reviewed. Demographic information and their self-reported reasons for abusing alcohol and drugs at the time of admission and at the time of discharge were collected. Data was analyzed for significant patterns. RESULTS: There was a significant change in the self-reported reasons for use by adolescents from the time of admission to time of discharge, suggesting that treatment might change their self-rated perception of the reasons for their use. CONCLUSION: This study suggests that alcohol and drug treatment programs can impact the adolescent's self-reported perceptions about why they use alcohol/drugs.

Are medical students assigning proper global assessment of functioning scores?

OBJECTIVE: This article seeks to determine whether medical students can estimate the appropriate score for the Global Assessment of Functioning (GAF) compared with psychiatry residents and staff psychiatrists. The authors hypothesized that medical students' estimations of GAF scores for patients in clinical vignettes would differ from those assessed by the psychiatry residents and staff psychiatrists. METHOD: The authors designed a cross-sectional confidential survey of medical students, psychiatry residents, and staff psychiatrists. Consenting participants were asked to provide demographic information and then complete the accompanying questionnaire after reading two vignettes. One of the vignettes described a depressed patient and the other a psychotic patient. The subjects were asked to estimate the GAF scores for the patients in both vignettes. Then the subjects were given the GAF scoring guide to review and were asked to re-assess their initial GAF scores for the patients in the vignettes. RESULTS: Medical students assigned much higher GAF scores for the patient in the vignette with less severe symptoms than the psychiatry residents and staff psychiatrists. The GAF scores of all three groups for the patient in the vignette with more severe symptoms were comparable. CONCLUSIONS: The ability of medical students to assign proper GAF scores needs to be studied further. Our study suggests that current 1-month rotations in psychiatry, without specific training on assigning GAF scores, may not provide medical students with enough information to assess GAF scores accurately. This might need to be addressed in psychiatry clerkships.

Use of alcoholic beverages in VA medical centers.

BACKGROUND: Benzodiazepines are the first-line choice for the treatment of alcohol withdrawal syndrome. However, several hospitals continue to provide alcoholic beverages through their formulary for the treatment of alcohol withdrawal. While there are data on the prevalence of this practice in academic medical centers, there are no data on the availability of alcoholic beverages at the formularies of the hospitals operated by the department of Veteran's Affairs. METHODS: In this study, we surveyed the Pharmacy managers at 112 Veterans' Affairs Medical Centers (VAMCs) to ascertain the availability of alcohol on the VAMC formularies, and presence or lack of a policy on the use of alcoholic beverages in their VA Medical Center. RESULTS: Of the pharmacy directors contacted, 81 responded. 8 did not allow their use, while 20 allowed their use. There was a lack of a consistent policy across the VA medical centers on availability and use of alcoholic beverages for the treatment of alcohol withdrawal syndrome. CONCLUSION: There is lack of uniform policy on the availability of alcoholic beverages across the VAMCs, which may create potential problems with difference in the standards of care.

Risperidone monotherapy for post-traumatic stress disorder related to sexual assault and domestic abuse in women.

Post-traumatic stress disorder is a common, chronic, and often disabling mental illness. Selective serotonin reuptake inhibitors are the usual first-line treatment for post-traumatic stress disorder, but many patients fail to respond adequately. Thus, other treatment options, including the atypical antipsychotics such as risperidone, need to be tested. Women between the ages of 19 and 64 years with post-traumatic stress disorder were enrolled. Symptom severity was rated at baseline using the Treatment Outcomes Post-traumatic Stress Disorder Scale-8, Hamilton Rating Scale for Anxiety, Hamilton Rating Scale for Depression, and Clinician Administered Post-traumatic Stress Disorder Scale. After washout from other psychotropic medications, 20 participants were randomized to either risperidone or placebo. Total score on the Treatment Outcomes Post-traumatic Stress Disorder Scale-8 served as the primary outcome measure. Repeated-measures analysis of variance was followed by Newman-Keuls tests. A significant main effect exists for visits using the Treatment Outcomes Post-traumatic Stress Disorder Scale-8 raw score. For the treatment group, the difference between baseline Treatment Outcomes Post-traumatic Stress Disorder Scale-8 scores and treatment visit scores was significant beginning at visit 6 and continued through visit 11. No significant difference observed between baseline and any treatment visit for the placebo group. The Clinician Administered Post-traumatic Stress Disorder Scale, Hamilton Rating Scale for Anxiety, and Hamilton Rating Scale for Depression data revealed a similar pattern. In this small pilot study, risperidone monotherapy was more effective than placebo in the treatment of post-traumatic stress disorder.

To commit or not to commit: the psychiatry resident as a variable in involuntary commitment decisions.

OBJECTIVE: To study whether psychiatry residents' personal variables (such as age, gender, level of training, previous experience with patient suicide, or lawsuits) and their temperamental predispositions have an impact on their decisions to seek involuntary commitment. METHOD: In a prospective pilot study, all psychiatry residents in Massachusetts were surveyed using a questionnaire that assessed their risk-taking behavior and clinical vignettes of patients with risk of harm to self or others. Data were analyzed using chi-squares and t tests. RESULTS: Level of training and the residents' risk-taking behavior may be linked to their likelihood to seek involuntary commitment. CONCLUSIONS: Psychiatric residency training should address nonpatient variables that might inappropriately influence the residents' decisions to seek involuntary commitment.