What if Depressed and Pregnant?

Depression is the most prevalent mood disorder among pregnant women. Only 50% of women seek intervention during gestation. Untreated during pregnancy, depression can induce obstetric and neonatal complications, most commonly, anhedonia, suboptimal weight gain, suicidal behavior, pre-term birth, and/or spontaneous miscarriage. The babies more often suffer cognitive deficits, low birth weight, and growth delay. The mothers subsequently also experience an increased risk for significant degrees of postpartum depression. Those with relatively milder cases of depression should initially receive psychotherapy. Otherwise, there are many antidepressant medications available for the pharmacotherapy of depression. However, treating pregnant females with depression is a challenge because of potential teratogenic effects caused by many pharmaceuticals. Physicians should know the recommended guidelines for treating depressed women during a time of gestation. It is crucial to identify women suffering from depression during pregnancy, and electing those that warrant pharmacotherapy while picking the best and safest medication is a complex process with paramount significance. Before prescribing an antidepressant drug, explain the advantages and disadvantages of the interventions. Whenever prescribing during these circumstances, more than conventionally close obstetric, emotional, and medication monitoring is to be provided. This would also include an emphasis on diet, exercise, psychotherapy, and avoidance of any non-critical medicinal or other substance exposures.

Munchausen Syndrome.

Munchausen syndrome is a factitious disorder that is difficult to diagnose and treat. This article clarifies points for clinical recognition and management of patients with this condition. Patients with this condition often are dramatic and provide false and/or exaggerated symptoms or information. They solicit attention from physicians, going doctor-to-doctor, having repeated diagnostic tests, procedures, hospitalizations, and evidence little improvement. Adherence to treatment plans is generally suboptimal and the patients frequently leave the hospital against medical advice. A compassionate, multidisciplinary approach to treatment is advised. It often includes conjoint clinical communication between the primary care physician and a psychiatrist. Open, supportive discussion with the patient about his or her condition is important. Long-term psychotherapy and follow-up are recommended.

Anxiety Disorders in Older Patients.

Anxiety complaints are common among older people. Specific phobia is characterized by exaggerated fear to a specific object or situation. Fear of falling is one example and occurs in about 50% of older persons who have fallen recently. Polypharmacy heightens fall risks. Generalized anxiety disorder is characterized by chronic uncontrollable worry that interferes with functioning and is accompanied by restlessness and disturbed sleep. Panic disorder refers to recurrent, unexpected surges of intense fear that evidence physical and cognitive dysfunction. Cognitive behavior therapy has efficacy among psychotherapies for older anxious adults. In treating anxiety, medications that might be anxiogenic are reduced in dosage or discontinued. It is essential to monitor for suicidal ideation and symptom change. The first-selected pharmacotherapy for people with most anxiety disorders is selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. The risk-benefit ratio of benzodiazepine pharmacotherapy in elderly patients is not favorable.

Is Transcranial Magnetic Stimulation Appropriate For Treating Adolescents with Depression?

Children who are inadequately treated for depression often experience greater dysfunction. Problems can include conduct disorders, substance abuse, physical illness, and poor performance at school, work, or in psychosocial contexts. Depression can lead to a greater risk of suicide. Suicide is the third most common cause of death among adolescents, with more than 500,000 attempts made by children each year. Suicide is the third most frequent cause of death among young people ages 10 to 19 years old. Thus, proper treatment is important. Major depressive disorder in adolescents is often followed by frequent recurrences in adulthood. Imaging studies document underactivity in the left dorsolateral prefrontal cortex in subjects suffering from depression. Activation of the brain with high-frequency transcranial magnetic stimulation increases neuronal excitability and induces the growth of new connections. Though larger, randomized, controlled trials with more patients and longer follow-up are needed, the favorable side effect profile and efficacy of TMS seen so far in the literature support the use of TMS as a therapeutic intervention in children and adolescents with depression.

Suicide Among Transgender and Gender-Nonconforming People.

Suicide rates are higher in those who identify as transgender or gender nonconforming (TGNC) compared to the overall population. Suicide risk factors include discrimination, family rejection, internalized transphobia, and being denied appropriate bathroom or housing access. It is important to assess the risk of suicide among transgender and gender-nonconforming patients and discuss past experiences of prejudice or maltreatment to prevent further victimization. This narrative review includes the most pertinent literature from the past 17 years on issues related to suicide among individuals who identify as TGNC. ​.

Is Electroconvulsive Therapy a Treatment for Depression Following Traumatic Brain Injury?

Traumatic brain injury (TBI) can be caused by blunt or penetrating injury to the head. The pathophysiological evolution of TBI involves complex biochemical and genetic changes. Common sequelae of TBI include seizures and psychiatric disorders, particularly depression. In considering pharmacologic interventions for treating post-TBI depression, it is important to remember that TBI patients have a higher risk of seizures; therefore, the benefits of prescribing medications that lower the seizure threshold need to be weighed against the risk of seizures. When post-TBI depression is refractory to pharmacotherapy, electroconvulsive therapy (ECT) could provide an alternative therapeutic strategy. Data remain sparse on using ECT in this seizure-prone population, but three case reports demonstrated good outcomes. Currently, not enough evidence exists to provide clinical recommendations for using ECT for treating post-TBI depression, and more research is needed to generate guidelines on how best to treat depression in TBI patients. However, the preliminary data on using ECT in patients with TBI are promising. If proven safe, ECT could be a powerful tool to treat post-TBI depression.

E-Cigarette Toxicity?

Tobacco smoking is the most preventable cause of morbidity and mortality. In just a few short years, electronic cigarettes (e-cigarettes) have become increasingly popular, especially for younger individuals. Many people believe that e-cigarettes are safe. The inhaled aerosols of e-cigarettes contain numerous potential toxicities, some of which could be dangerous for health with long-term use. The safety of prolonged aerosol exposure is not known. The use of e-cigarettes as a harm-reduction tool at stopping tobacco smoking is not uniformly successful. E-cigarettes may be safer than tobacco products, but repeated prolonged exposure to their aerosols has its own considerable potential risk. The long-term health consequences of their use remain to be established. Physicians should vigorously discourage the use of e-cigarettes and tobacco products, with special emphasis on abstinence for younger people and during pregnancy or lactation.

Lithium Suicide Prevention: A Brief Review and Reminder.

Suicide is a major public health problem throughout the world, occurring in over 800,000 people annually. Mood disorders are a common psychopathology and are a signficiant risk factor for suicidality. Lithium pharmacotherapy has been shown to reduce symptoms of suicidal behavior, especially in long-term patient interventions. Reasons for this remain unclear. Lithium treatment for individuals with affective disorders appears underutilized. Use of lithium is thought to reduce risk for suicidality, even if mood stabilization is not achieved and serum concentration is lower than the conventionally accepted therapeutic blood level ranges. In this article, the authors review the currently available literature on lithium's effect on suicidality and provide discussion on proposed mechanisms of action. This brief report serves as an important reminder to clinicians to include lithium pharmocotherapy in their armamentarium for treatment of affective disorders, especially when symptoms of suicidality are present.

Guns and Suicide: Are They Related?

Shooting oneself with a firearm is the leading method of suicide, accounting for over half of all such deaths. About two-thirds of the annual 33,000 gun-related fatalities in the United States are suicide-nearly 60 every day. Although most suicidal impulses are intense, they usually last for a short time, which makes prompt intervention imperative. Approximately 90% of those who attempt suicide and survive do not later die by suicide. However, attempts with a gun are usually fatal. A clear connection between firearms in the home and an increased risk of suicide exists. People who have access to these weapons are more likely to commit suicide than those who live in a home without a gun; thus, limiting access to guns decreases the opportunity for self-harm. Physicians should recommend that firearm access be removed from individuals with depression, suicidal ideations, drug abuse, impulsivity, or a mental or neurologic illness.

Electroconvulsive Therapy During Pregnancy.

Women often experience worsening mood disorder symptoms during pregnancy. Women with mood disorders have an increased risk for suboptimal prenatal care, inadequate weight gain, and more substance abuse during pregnancy. It is often difficult to balance pharmacotherapy risks to a developing fetus versus not medicinally treating maternal mental health conditions. Electroconvulsive therapy (ECT) is a rapid and effective treatment option that can be an appropriate intervention in some women during pregnancy. This report presents an overview of ECT in pregnancy and the case of a 28-year-old pregnant woman with bipolar mania who responded well to ECT.

Benefits of Dexmedetomidine in Management of Post-ECT Agitation.

Electroconvulsive therapy (ECT) is an intervention for patients with a variety of psychiatric conditions. Occasionally, people exhibit dangerous degrees of agitation after this treatment, and some do not respond well to conventional pharmacotherapies. Dexmedetomidine is a central α-2 agonist that can induce significantly calmative effects in persons with post-ECT agitation. The indication for it is in calming individuals with acute and/or recurrent posttreatment agitation. Dexmedetomidine is safe and effective when infused just before, or postictally, at ECT sessions.

Risk of future offense among probationers with co-occurring substance use and mental health disorders.

The criminal justice system is the primary service delivery system for many adults with drug and alcohol dependence, mental health, and other health service needs. The purpose of this study was to examine the relationship between risk of future offense, mental health status and co-occurring disorders in a large substance abuse diversion probationer population. A purposive sample of 2,077 probationers completed an assessment to screen for mental health disorders, substance use disorders, risk of future crime and violence, and several demographic characteristics. Probationers who screened positive for co-occurring substance use and mental health disorders were significantly more likely to be at higher risk of future crime and violence compared to probationers who screened positive for only substance use, only a mental health disorder, or no substance use or mental health disorder. Implications for substance use and mental health service delivery are discussed, and recommendations are made for further research.