Vision-Related Quality of Life and Seasonal Affective Disorder in Patients with Glaucoma and Macular Degeneration.

Seasonal affective disorder (SAD) is characterized by depressive episodes related to changes in the seasons. Patients with severe vision loss are at an increased risk of SAD. This study seeks to determine the extent to which patients with moderate vision loss report symptoms of SAD. In this cross-sectional, comparative case series, the Seasonal Pattern Assessment Questionnaire (SPAQ) and the National Eye Institute Visual Function Questionnaire (VFQ-39) were used to screen 111 patients with age-related macular degeneration (AMD) and/or primary open-angle glaucoma (POAG). A multiple regression analysis was performed to create a predictive model for SAD based on the Global Seasonality Score (GSS) using the VFQ-39. Subjects who reported symptoms of SAD (GSS > 8) had lower vision-related quality of life (composite score: 57.2 versus 73.2, p < 0.001). Exploratory factor analysis revealed that the items on the VFQ-39 split into two distinct dimensions that together accounted for 63.2% of the total variance in the GSS. One group of questions addressed vision-related problems; the other group comprised questions related to the quality of life. Whereas this model successfully identified patients with vision loss at risk of SAD, a model restricted to the questions available on the shorter, widely used VFQ-25 instrument did not reliably identify patients at risk of SAD.

Physical Examination for the Academic Psychiatrist: Primer and Common Clinical Scenarios.

As clinical psychiatry has evolved to mirror the patient care model followed in other medical specialties, psychiatrists are called upon increasingly to utilize general medical skills in routine practice. Psychiatrists who practice in academic settings are often required to generate broad differential diagnoses that include medical and neurologic conditions and, as a result, benefit from incorporating physical examination into their psychiatric assessments. Physical examination allows psychiatrists to follow and to teach patient-informed clinical practices and comprehensive treatment approaches. In this commentary, the authors encourage routine use of a targeted physical examination and outline common scenarios in which physical examination would be useful for the academic psychiatrist: delirium, toxidromes, and unexplained medical conditions (e.g., somatic symptom disorders).

Special Considerations in Trauma Patients.

The emergent management of a traumatic injury can be an extremely intense situation. These assessments can be even more difficult when patients have an underlying psychiatric condition. After a protocoled evaluation of the traumatic injuries, the psychological manifestation of diseases can be addressed. The appropriate use of physical or chemical restraints to facilitate the work-up is paramount in the ability of the provider to protect patients and staff from agitated and traumatized patients. The emergency medicine provider should have a low threshold for including psychiatry in the treatment plans, as the long-term sequelae of these entities require specialized treatment.

Psychosomatic medicine training as a bridge to practice: training and professional practice patterns of early career psychosomatic medicine specialists.

BACKGROUND: The number of interested candidates for psychosomatic medicine (PM) training programs has not matched the growing need for psychiatrists trained to care for complex medically ill patients. The reasons for this lack of growth may be found in the experience of new entrants into the subspecialty. OBJECTIVE: To investigate this issue, we conducted a survey of early career psychiatrists (ECPs) practicing PM to identify the personal and professional characteristics of ECP PM specialists and to examine the relevance of PM training to professional practice. METHODS: ECPs who attended the 2012 Academy of Psychosomatic Medicine annual meeting or who were registered members of the Academy of Psychosomatic Medicine completed a survey on training and work experiences. Decisional factors associated with pursuit of subspecialty fellowship education and professional practice patterns were identified using descriptive statistics and chi-square tests. RESULTS: A total of 102 ECPs completed the survey. Of the respondents, 67 (67%) had completed a PM fellowship. Motivating factors for pursuing fellowship training included (1) obtaining additional clinical training, (2) developing a special interest in PM training, and (3) improving job candidacy. Overall, 80% of ECPs desired inpatient consultation-liaison positions at the time of fellowship graduation. Overall, 22% reported difficulty in obtaining employment in PM after training. Chi-square tests between subjects who pursued a PM fellowship and those who did not proved nonsignificant. CONCLUSIONS: PM fellowship training remains relevant and important to ECPs in this sample. The survey results can be used to shape institutional and professional supports to better meet early career transition needs for PM psychiatrists.

The 2009 schizophrenia PORT psychopharmacological treatment recommendations and summary statements.

In light of the large number of studies published since the 2004 update of Schizophrenia Patient Outcomes Research Team psychopharmacological treatment recommendations, we conducted an extensive literature review to determine whether the current psychopharmacological treatment recommendations required revision and whether there was sufficient evidence to warrant new treatment recommendations for prespecified outcomes of interest. We reviewed over 400 articles, which resulted in 16 treatment recommendations: the revision of 11 previous treatment recommendations and 5 new treatment recommendations. Three previous treatment recommendations were eliminated. There were 13 interventions and/or outcomes for which there was insufficient evidence for a treatment recommendation, and a statement was written to summarize the current level of evidence and identify important gaps in our knowledge that need to be addressed. In general, there was considerable consensus among the Psychopharmacology Evidence Review Group and the expert consultants. Two major areas of contention concerned whether there was sufficient evidence to recommend specific dosage ranges for the acute and maintenance treatment of first-episode and multi-episode schizophrenia and to endorse the practice of switching antipsychotics for the treatment of antipsychotic-related weight gain. Finally, there continue to be major gaps in our knowledge, including limited information on (1) the use of adjunctive pharmacological agents for the treatment of persistent positive symptoms or other symptom domains of psychopathology, including anxiety, cognitive impairments, depressive symptoms, and persistent negative symptoms and (2) the treatment of co-occurring substance or medical disorders that occur frequently in individuals with schizophrenia.