ABSTRACT
PURPOSE OF REVIEW: Clinical track faculty within psychiatry may struggle to meet goals for academic scholarship, particularly publishing. In this review, we explore potential barriers to publication and solutions to support early career psychiatrists. RECENT FINDINGS: Current evidence highlights challenges for faculty throughout academic practice, including barriers at the individual and systems levels. Within psychiatry, publication has favored biological studies with significant gaps in the literature serving as both an opportunity and challenge. Interventions underscore the importance of mentorship and propose incentivization to facilitate academic scholarship among clinical track faculty. Barriers to publication within psychiatry exist at the level of the individual, system, and field itself. This review shares potential solutions from across the medical literature and an example of an intervention from our own department. More studies are needed within the field of psychiatry to understand how to best support early career faculty members in their academic productivity, growth, and development.
Subject(s)
Efficiency , Psychiatry , Humans , Fellowships and Scholarships , PublishingABSTRACT
Olanzapine is linked to asymptomatic, transient elevations of liver aminotransferases but is historically thought to rarely cause significant hepatotoxicity. Underlying liver disease is a risk factor for drug-induced liver injury and may complicate the differential diagnosis of acute transaminitis in patients taking medications associated with hepatotoxicity. Ms L presented with 2 months of new psychotic symptoms resulting in hospitalizations. Although psychosis previously improved with haloperidol, she reported symptoms concerning for akathisia. Restlessness improved and psychotic symptoms resolved after initiation of olanzapine. Concurrently, her alanine aminotransferase (ALT) was elevated, prompting further workup and new diagnosis of acute hepatitis C. Over the course of hospitalization, her ALT increased exponentially. Initially attributed solely to acute hepatitis C infection, ALT rapidly decreased after holding olanzapine, implying it was contributing to her liver injury. Subsequently, given her prior response, haloperidol was retrialed with close monitoring for adverse effects. Her subjective restlessness was treated with additional agents, and she was then transitioned to monthly haloperidol decanoate injections to further assist her adherence. Prior to discharge, she had resolution of psychosis and transaminitis. Olanzapine may contribute to hepatotoxicity with concurrent viral hepatitis, and clarity can be obtained by a trial of stopping the suspected medication. Furthermore, olanzapine, when combined with underlying liver disease, may have an additive effect on liver injury, resulting in accelerated elevations in liver aminotransferases.
