Psychiatric Comorbidities of Incarceration in a Patient With Gender Dysphoria: A Case Report and Literature Review.

ABSTRACT: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition defines gender identity disorder (GID) as a strong and persistent identification with the opposite sex and the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender. The onset of GID commonly begins early in childhood. Gender dysphoria has a higher prevalence of other comorbid psychiatric illnesses, such as mood, anxiety, and adjustment disorders, with increased suicide incidence and self-harming behaviors than the general population. Studies show that some temperamental, environmental, genetic, and psychological factors play a role in developing GID. Approximately 16% of transgender people and 21% of transgender women get incarcerated compared with the general US population. During incarceration, they face many issues, such as victimization, severe verbal harassment, purposeful humiliation, unwanted sexual advances, physical assault, forcible sex, and unwanted strip searches. There is a need for a better understanding of the issues and needs of this population to promote positive outcomes.

Unraveling the Inferno: An Arson Case Series.

Firesetting behaviors present multifaceted challenges that intersect the realms of mental health, law, and societal welfare. While distinct in nature, firesetting, arson, and pyromania collectively embody a spectrum of behaviors that cause harm with profound implications for mental health and legal system. Firesetting is a behavior, arson is a criminal offense, and pyromania is a classified psychiatric diagnosis. Nevertheless, the underlying motivations for these behaviors in the context of psychiatric symptomatoloty remain poorly understood. Arson alone exacts a staggering financial toll in the United States, emphasizing the urgent need to understand the reason behind these acts. Within legal contexts, mental health professionals frequently encounter individuals exhibiting firesetting behaviors while consulting on legal cases. The strong correlation between firesetting behavior and mental disorders shows a dire need for extensive and detailed collaboration between psychiatric experts, legal practitioners, and fire services. Here, we describe a series of firesetting cases and their ties to the mental health and legal systems underscoring the imperative for integrated, multifaceted approaches to address this pressing societal concern.

Examining Risk Factors for Suicidality in Adolescents and Adults Experiencing Their First Episode of Psychosis.

This narrative review aimed to identify the risk factors associated with suicidality in adolescents and adults with first-episode psychosis. The review included studies that examined various factors such as psychiatric, familial, and social factors, as well as previous self-harm, suicidal ideation, and comorbid mental health disorders. A comprehensive literature search was conducted across three publicly available databases (Embase, American Psychological Association PsycINFO, and PubMed) using specific search terms related to first-episode psychosis, suicide, self-harm, and children/adolescents and adults. The inclusion criteria included original articles focusing on prospective and retrospective cohort trials, with substantial data on first-episode psychosis and self-harm, measuring both suicidal intent and outcome. Non-original studies, case reports, case series, non-English-language publications, and studies examining violence and self-harm related to substance-induced psychosis were excluded. After manual screening and removing duplicate articles, 13 articles met the established criteria for inclusion in this review. Included studies adhered to similar inclusion and exclusion criteria, had long-term follow-up, and assessed outcomes at least twice. The findings suggest that depressive symptoms, substance use disorders, previous self-harm or suicidal ideation, and longer duration of untreated psychosis are associated with an increased risk of suicidality. However, insights into psychosis and premorbid intellectual functioning did not show a direct association with suicidality.

Reasons for Antipsychotic Treatment Switch: A Systematic Retrospective Review of Prescription Records and Prescriber Notes.

Objective: Switching of antipsychotic medications, which are used for many psychiatric conditions, is common. However, reasons and clinical documentation of such switches have scarcely been studied.Methods: A systematic, retrospective review of prescription records and prescriber notes was conducted to characterize reasons for and types of antipsychotic switches at one hospital during inpatient or outpatient care, starting August 1, 2017, until 270 antipsychotic switches with type and reasons were collected, as required by power analysis.Results: After removing 7 cases in which quetiapine was switched to a non-antipsychotic agent, 263 antipsychotic switches involving 195 unique subjects (median age = 31 [interquartile range, 24-47] years; schizophrenia = 36.9%, bipolar disorder = 27.7%, schizoaffective disorder = 18.5%) were analyzed. Frequent reasons for antipsychotic switch were intolerability (45.7%) and inefficacy/clinical worsening (17.6%). Reasons did not differ by race (P = .2644), age (P = .0621), or insurance type (P = .2970), but differed heterogeneously regarding different reasons by sex (P = .004). The most common reported switches were from second-generation oral antipsychotics (SGA-OAPs) to other SGA-OAPs (N = 155, 58.9%), mostly due to tolerability or inefficacy; second-generation long-acting injectable antipsychotics (SGA-LAIs) to SGA-OAPs (11%), mostly due to intolerability, patient preference, or insurance coverage problems; and SGA-OAPs to SGA-LAIs (10.7%) due to nonadherence. Reasons for antipsychotic switch were properly documented in 208 (79.1%) of the prescriber notes.Conclusions: In this retrospective chart review, switching varied by sex regarding reasons and occurred almost in half of the cases due to intolerability. Different reasons predominated in switches from SGA-OAP to SGA-OAP, SGA-LAI to SGA-OAP, and SGA-OAP to SGA-LAI. One in 5 switches were not properly documented, requiring attention.