An Overview for the General Psychiatrist Evaluating Patients With Obstetric and Neonatal Complications and Perinatal Loss.

When neonatal and obstetrical complications occur, the identification and management of mood and anxiety disorders become complex with an ever-expanding array of psychiatric needs that include the management of grief- and trauma-related disorders. With high rates of maternal morbidity and mortality in the United States and laws in many states restricting reproductive health access, psychiatrists must be proficient in managing psychiatric sequelae in this context. High-risk groups for peripartum mood and anxiety disorders, posttraumatic stress disorder, and complicated grief include those with neonatal intensive care unit (NICU) stays and those who have experienced infertility and recurrent pregnancy loss. Groups who have been historically marginalized by the medical system (e.g., Black, Indigenous, people of color) and those from LGBTQ+ communities are at similarly high risk, and more interventions are needed to support these groups. Strategies emphasizing trauma-informed care, psychotherapeutic approaches, and using patient-centered language are recommended.

A Pilot Study of Ketamine Infusion after Suicide Attempt: New Frontiers in Treating Acute Suicidality in a Real-World Medical Setting.

Ketamine, in research settings, rapidly reduces suicidal thoughts 2-24 h after a single infusion in patients with high suicidal ideation. In this study, the authors investigate ketamine's effects on suicidality in a real-world sample of recent suicide attempters on a tertiary-care Consultation-Liaison (CL) psychiatry service. Using an open-label design, 16 transdiagnostic CL patients were recruited, 18-65 years old, to receive a single dose of intravenous ketamine (0.5 mg/kg) in the acute medical setting. All were psychiatrically hospitalized post-infusion. Baseline suicidality and depression measures were compared to ratings taken at 24 h, 5 days, 12 days, and 1, 3 and 6 months post-infusion using paired t-tests. Across all measures, rapid, statistically significant decreases (p's < 0.001) were observed with large to very large effect sizes (Cohen's d's: 1.7-8.8) at acute timepoints (24 h; 5 days). These gains were uniformly maintained to 6 months post-infusion. Open-label ketamine appeared to rapidly and robustly reduced suicidal symptoms in an ultra-high-risk, heterogeneous, real-world sample. Ketamine infusion may therefore be a safe, feasible, viable method to rapidly reduce suicidality among medically hospitalized patients after a suicide attempt, with potentially enduring benefits. The current pilot findings suggest ketamine could be readily integrated into the settings where high-risk CL patients already receive healthcare, with the potential to become an important and novel tool in the treatment of suicidality.

Sexual dysfunction in female cancer survivors: A narrative review.

OBJECTIVES: Due to improvements in earlier detection and expansions in available treatments, the number of individuals surviving with cancer is steadily increasing. Sexual dysfunction is a common and often persistent complication for cancer survivors, affecting >60% of women diagnosed with cancer. Although highly prevalent, issues related to sexual health are often not addressed among survivors, with women reporting less discussion with providers compared to men. METHODS: In this narrative review, we present a case series of three women seen in a psycho-oncology clinic who experienced sexual dysfunction following a cancer diagnosis. We then review existing literature on the presentation and management of sexual issues associated with cancer and its treatment. RESULTS: The three cases highlight different mechanisms of sexual dysfunction after cancer, including anatomic changes, hormonal alterations, psychiatric conditions and medication side effects. The literature review includes discussion of the prevalence and course of sexual dysfunction in female cancer survivors. Tools for screening and assessment are then reviewed, as well as contributing factors and common presenting symptoms. We conclude with a discussion of both pharmacologic and non-pharmacologic approaches to management. CONCLUSIONS: Despite its high prevalence and considerable impact on quality of life, the complication of sexual dysfunction after cancer diagnosis and treatment is still under recognized and undertreated. Improving awareness, communication, and screening, as well as appropriate referral to treatment, could have a profound impact on the ever growing number of women surviving with cancer with sexual health concerns.

Cognitive behavioral therapy for cancer-related cognitive dysfunction.

PURPOSE OF REVIEW: To provide the reader with an overview of the cognitive-behavioral conceptualization of cancer-related cognitive dysfunction (CRCD) and how cognitive behavioral therapy (CBT) can play an important role in treatment. RECENT FINDINGS: Recent findings show that Memory and Attention Adaptation Training (MAAT), a CBT developed to help cancer survivors develop adaptive skills to improve daily cognitive performance and emotional coping, may be an efficacious treatment of CRCD and can be delivered through videoconference technology to improve survivor access to care. SUMMARY: The etiology of CRCD remains largely undetermined and likely is produced by multiple mechanisms. This can include neuronal death, microvascular damage, inflammatory processes, and psychological factors of perceptions of inadequate cognitive capacity to meet performance demands and related emotional distress. As a result, there are a variety of treatments currently being researched. More research with larger sample sizes, multiple clinicians and multiple sites are needed to confirm efficacy, but CBT approaches such as Memory and Attention Adaptation Training that address multiple psychological factors involved may offer a flexible nonpharmacological approach to CRCD that optimizes quality of life outcomes.

Priapism and renal colic in a patient treated with duloxetine.

Antidepressant medications are associated with a variety of genitourinary and adverse sexual effects, such as urinary hesitation, priapism, and delayed ejaculation. Here, we report a case of priapism and renal colic following initiation of duloxetine in a patient with history of tolerated selective serotonin reuptake inhibitor treatment. To our knowledge, this represents the first report of priapism and renal colic associated with duloxetine use. This case contributes to the current body of evidence describing adverse genitourinary and sexual effects associated with antidepressant medications.