ABSTRACT
This case provides support for electroconvulsive therapy as a safe treatment in adolescents with a feeding tube. The patient presented to our hospital with symptoms of catatonia with minimal oral intake. She had stopped eating, had minimal interaction with her environment, and spent weeks with a nasogastric tube for nutritional support. She had been referred for electroconvulsive therapy but was unable to find a local provider who would perform it on an adolescent with a nasogastric tube. She came to our hospital and received 9 rounds of electroconvulsive therapy with improvement of her catatonia and no aspiration or adverse events.
Subject(s)
Catatonia/therapy , Electroconvulsive Therapy , Intubation, Gastrointestinal , Adolescent , Female , Histiocytic Necrotizing Lymphadenitis , Humans , Treatment OutcomeSubject(s)
Bipolar Disorder/history , Bipolar Disorder/therapy , Deep Brain Stimulation , Electroconvulsive Therapy/history , Transcranial Magnetic Stimulation , Adolescent , Catatonia/therapy , Child , Depressive Disorder, Major/therapy , History, 20th Century , History, 21st Century , Humans , PsychiatryABSTRACT
Compared with other medical specialties, psychiatrists have been slower adopters of health information technology (IT) practices, such as electronic health records (EHRs). This delay in implementation could compromise patient safety and impede integration into accountable care organizations and multidisciplinary treatment settings. This article focuses on optimizing use of EHRs for clinical practice, leveraging health IT to improve quality of care, and focusing on the potential for future growth in health IT in child and adolescent psychiatric practice. Aligning with other medical fields and focusing on transparency of mental health treatment will help psychiatrists reach parity with other medical specialties.
Subject(s)
Adolescent Psychiatry/methods , Child Psychiatry/methods , Medical Informatics/methods , Adolescent , Child , HumansABSTRACT
STUDY DESIGN: An in-vitro study. PURPOSE: The current study is aimed at investigating the differences in stability between short posterior fixation (SPF), hybrid posterior fixation (HPF), and long posterior fixation (LPF) with and without anterior column augmentation using calcium phosphate bone cement (CaP) for treating burst fractures (BFs). OVERVIEW OF LITERATURE: The ideal treatment for thoracolumbar BF is controversial regarding the use of short or LPF constructs. METHODS: Seven human thoracolumbar spines (T9-L4) were tested on a six degree of freedom spine simulator in three physiologic planes, flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Tested surgical constructs included the following: intact, injury (BF), SPF (T12-L2), HPF (T11-L2), LPF (T11-L3), SPF+CaP, HPF+CaP, LPF+CaP, and CaP alone (CaP). Range of motion (ROM) was recorded at T12-L2 in FE, LB, and AR. RESULTS: THE REDUCTION IN MEAN ROM TRENDED AS FOLLOWS: LPF>HPF>SPF. Only LPF constructs and HPF with anterior column augmentation significantly reduced mean ROM in FE and LB compared to the intact state. All instrumented constructs (SPF, HPF, and LPF) significantly reduced ROM in FE and LB compared to the injured condition. Furthermore, the instrumented constructs did not provide significant rotational stability. Injecting CaP provided minimal additional stability. CONCLUSIONS: For the injury created, LPF and HPF provided better stability than SPF with and without anterior column augmentation. Therefore, highly unstable fractures may require extended, long or hybrid fusion constructs for optimum stability.
ABSTRACT
Anxiety is an innate emotion that all humans experience, especially during early childhood in periods of significant growth and development. Treatment strategies exist for anxiety disorders that cause significant dysfunction and impairment in youth. This article provides a current overview of the literature on psychopharmacologic management of pediatric anxiety disorders. Potential side effects and complications of psychotropic medications are reviewed. The treatment of anxiety disorders in patients with comorbid conditions is explored, addressing the impact on treatment course and pharmacologic recommendations. A clinical vignette describing a 10-year-old boy with increasing anxiety is presented describing in-hospital and outpatient treatment and therapies.
Subject(s)
Anxiety Disorders/drug therapy , Psychotropic Drugs/therapeutic use , Adolescent , Anxiety Disorders/psychology , Child , Humans , Psychotherapy/methodsABSTRACT
Asthma, the most common chronic disease in children and adolescents in industrialized countries, is typified by airway inflammation and obstruction leading to wheezing, dyspnea, and cough. However, the effect of asthma does not end with pulmonary changes. Research has shown a direct link between asthma and stress and psychiatric illness, which if untreated results in heightened morbidity and effects on society. The link between asthma and psychiatric illness, however, is often underappreciated by many pediatric and child mental health professionals. This article reviews the diagnosis and treatment of asthma as well as the correlation between asthma and psychiatric illness in children in an effort to improve management and treatment strategies for this prevalent disease.
ABSTRACT
Asthma, the most common chronic disease in children and adolescents in industrialized countries, is typified by airway inflammation and obstruction leading to wheezing, dyspnea, and cough. However, the effect of asthma does not end with pulmonary changes. Research has shown a direct link between asthma and stress and psychiatric illness, which if untreated results in heightened morbidity and effects on society. The link between asthma and psychiatric illness, however, is often underappreciated by many pediatric and child mental health professionals. This article reviews the diagnosis and treatment of asthma as well as the correlation between asthma and psychiatric illness in children in an effort to improve management and treatment strategies for this prevalent disease.
Subject(s)
Asthma/psychology , Adolescent , Anti-Inflammatory Agents/therapeutic use , Anxiety Disorders/drug therapy , Anxiety Disorders/etiology , Asthma/drug therapy , Asthma/etiology , Biofeedback, Psychology , Bronchodilator Agents/pharmacokinetics , Bronchodilator Agents/therapeutic use , Child , Child, Preschool , Combined Modality Therapy , Depressive Disorder/etiology , Depressive Disorder/therapy , Drug Overdose , Dyspnea/drug therapy , Dyspnea/etiology , Environmental Exposure/adverse effects , Humans , Peak Expiratory Flow Rate , RelaxationABSTRACT
PURPOSE: To describe a case of Wernicke's encephalopathy in a 15-year-old female patient with anorexia nervosa--restricting type. METHOD: The patient and family were interviewed. Literature relevant to the case was reviewed prior to diagnosis. RESULTS: The patient reported a 30-kg weight loss over a 6-month period, following a strict diet deplete in thiamine without vitamin supplementation. The patient reported a carbohydrate binge for 5 days prior to admission. Her clinical presentation, confusion, ataxia, nystagmus, and magnetic resonance imaging demonstrating bilateral subthalamic hyperdensities were consistent with Wernicke's encephalopathy. Nutritional stabilization and parenteral thiamine replacement resulted in rapid improvement of her ataxia and nystagmus and contributed to her recovery. CONCLUSIONS: Wernicke's encephalopathy should be considered in patients with anorexia nervosa. Thiamine therapy could be considered in cases of anorexia nervosa with significant confusion.
Subject(s)
Anorexia Nervosa/complications , Thiamine Deficiency/complications , Wernicke Encephalopathy/diagnosis , Wernicke Encephalopathy/etiology , Adolescent , Anorexia Nervosa/drug therapy , Female , Humans , Malnutrition/complications , Thiamine/therapeutic use , Thiamine Deficiency/diagnosisABSTRACT
PURPOSE: Flavopiridol is a cyclin-dependent kinase inhibitor currently undergoing human clinical trials. As clinical development is pursued, it becomes important to evaluate resistance mechanisms to flavopiridol. To elucidate the contribution of breast cancer resistance protein (BCRP) to cellular resistance to flavopiridol in acute myeloid leukemia, we studied the relationship between cellular resistance to flavopiridol and mRNA expression of BCRP or P-glycoprotein (P-gp, product of MDR1gene) in blast cells from adult patients with acute leukemia. EXPERIMENTAL DESIGN: Twenty-one blast cell samples from 20 patients were studied. The expression of BCRP, P-gp, or beta-actin mRNA was determined by real-time reverse transcription-PCR, using fluorescent hybridization probes to evaluate codon 482, a known site of mutations in BCRP mRNA. In vitro cell viability and apoptosis were examined after 24 h exposure to flavopiridol. RESULTS: BCRP mRNA expression varied over a 200-fold range. In the blast cell samples with BCRP mRNA expression > 10000 copies/pg beta-actin (n = 9), BCRP mRNA correlated proportionally with cell viability in the presence of 250 nM flavopiridol (r = 0.86, P = 0.003) and with apoptosis induced by flavopiridol (r = 0.71, P = 0.031). In contrast, MDR1mRNA expression did not correlate with either flavopiridol cytotoxicity or induction of apoptosis. Melting point analysis of the hybridization probes determined that all 21 patient samples had arginine at codon 482 of BCRP mRNA, the wild-type form. CONCLUSIONS: These results suggest that unlike P-gp, BCRP may play a role in leukemia cellular resistance to flavopiridol. No mutations at codon 482 were observed in BCRP mRNA in this group of patients.
