Practice Resource for Forensic Training in General Psychiatry Residency Programs.

Full Document: Alonso-Katzowitz JS, Cardasis W, Cerny-Suelzer CA, et al: Practice Resource for Forensic Training in General Psychiatry Residency Programs. Journal of the American Academy of Psychiatry and the Law Online Supplement 2019, 47 (1). Available at: http://www.jaapl.org/content/47/1_Supplement.

Translating Into Practice Data About Violent Women.

There is a growing body of medical literature supporting the presence of unique risk factor profiles in women who are violent, of much higher violence risk, and who are psychiatric inpatients. Building on the existing literature on violence risk in women, Beck and colleagues contribute an excellent example of how skilled analysis of violence risk factors and typology of violence can translate to evidence-based strategies for management and treatment of aggression. Beck et al. postulate a possible unrecognized syndrome of cognitive impairment, chronic and severe aggression, and self-harm in a subgroup of highly aggressive women inpatients. This commentary locates new and old findings in Beck et al, in the context of some relevant prior research and highlights some challenges in clinical translation, especially in the setting of intellectual disability and personality disorder.

Outpatient Psychiatric Documentation Use by Primary Care Physicians Following De-Sensitization in the Electronic Medical Record.

OBJECTIVE: The authors assessed the ways in which primary care physicians (PCPs) utilize outpatient psychiatric documentation that has recently become accessible to non-psychiatric providers in the UC Davis Healthcare System electronic medical record (EMR). METHODS: The authors distributed a nine-question paper survey to 71 PCPs on the UC Davis Medical Center Campus in Sacramento, California. Questions addressed awareness of changes in accessibility of psychiatric documentation, which parts of the psychiatric note were most useful, and ways in which reviewing psychiatric notes changed providers' practice and perception of patients with mental illness. RESULTS: Survey return rate was 100 % due to in-person distribution and collection of survey. More than half (58 %) of respondents were unaware that they had access to psychiatric notes. Within the psychiatric note, providers focused most on plan, diagnosis, and assessment components. Those who were aware reported improved understanding (97 %) and comfort with discussing mental illness (79 %), increased consideration of side effects of psychiatric medications (79 %), and improved efficiency in encounters with psychiatric patients (97 %). Responses about likelihood to contact psychiatrists directly varied considerably. About 45 % of respondents were more likely to consider psychosomatic etiology for patients who were also seen by outpatient psychiatry. CONCLUSIONS: Overall, PCPs reported that accessibility of outpatient psychiatric notes significantly enhanced their experience of caring for patients with mental illness. Future goals include increasing awareness and education about availability of psychiatric notes as well as optimizing communication between psychiatrists and PCPs. The authors recommend future studies focused on changes in perceptions among providers as a result of continued use of psychiatric documentation.

Characteristics of female homicide offenders found not guilty by reason of insanity.

Until recently, there has been little information regarding female offenders who commit homicides that are motivated by psychosis. We investigated gender differences in the characteristics of psychosis and crime variables in psychotically motivated homicide. In the study, conducted at a large U.S. forensic facility, we reviewed the records of women (n = 47) found not guilty by reason of insanity (NGRI) who were hospitalized between January 1991 and August 2005 for a homicide offense. A random sample of 47 men who were committed during the same period for the same offenses was selected for comparison. Religious delusions were found more often in women who killed infants (0-1 year of age) and children between the ages of 2 and 18. Women were more likely to have a diagnosis of an affective problem and borderline personality disorder. The results indicate gender-specific areas to focus on during clinical and forensic assessments of the risk of violence in women with psychosis.

Lessons from psychiatry and psychiatric education for medical learners and teachers.

Medical learners, teachers, and institutions face significant challenges in health care delivery and in training the next generation of clinicians. We propose that psychiatry offers lessons which may help improve how we take care of patients and how we teach others to care for patients. Our objective is to discuss what learners and teachers can learn from psychiatry, organized around (1) how we make decisions, (2) how we learn, and (3) how we reflect on our practice. Information from clinical care, education, neuroscience and other aspects of life (e.g. business, creativity, and research) help us on these processes. We make 'good' decisions in concert with patients and learners, by listening to their experiences, asking questions and exploring subjective and objective information. Our learning has a neurobiological basis, and is effectively furthered by personalization, reinforcement, acquisition of critical thinking skills, and assessment of our limitations and errors. Our ability to reflect is determined by attitude, skill, tolerating ambiguity or dissonance, and planning for the unexpected. These processes - in addition to knowledge and other skills - will help physicians be successful in practice, learning and teaching, research and leadership.

Autism profiles of males with fragile X syndrome.

Autism, which is common in individuals with fragile X syndrome, is often difficult to diagnose. We compared the diagnostic classifications of two measures for autism diagnosis, the ADOS and the ADI-R, in addition to the DSM-IV-TR in 63 males with this syndrome. Overall, 30% of the subjects met criteria for autistic disorder and 30% met criteria for PDD-NOS. The classifications on the ADOS and DSM-IV-TR were most similar, whereas the ADI-R classified subjects as autistic much more frequently. We further investigated the relationship of both FMRP and FMRI mRNA to symptoms of autism in this cohort and found no significant relationship between the measures of autism and molecular features, including FMRP, FMRI mRNA, and CGG repeat number.

The Prader-Willi phenotype of fragile X syndrome.

The Prader-Willi phenotype (PWP) of fragile X syndrome (FXS) is associated with obesity and hyperphagia similar to Prader-Willi syndrome (PWS), but without cytogenetic or methylation abnormalities at 15q11-13. Thirteen cases of PWP and FXS are reported here that were identified by obesity and hyperphagia. Delayed puberty was seen in 5 of 9 cases who had entered puberty, a small penis or testicles in seven of 13 cases, and infant hypotonia and/or a poor suck in seven of 13 cases. Autism spectrum disorder occurred in 10 of 13 cases, and autism was diagnosed in seven of 13 cases. We investigated cytoplasmic interacting FMR1 protein (CYFIP) expression, which is a protein that interacts with FMR1 protein (FMRP) because the gene for CYFIP is located at 15q11-13. CYFIP mRNA levels were significantly reduced in our patients with the PWP and FXS compared to individuals without FXS (p < .001) and also individuals with FXS without PWP (p = .03).