The development of posttraumatic stress disorder following an unusual life event: a case report.

Posttraumatic stress disorder is the only psychiatric disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, that requires a specific life-threatening event to have occurred prior to diagnosing the illness. The traumatic event is described as an experience of witnessing either the occurrence, or imminent threat, of serious injury or death. This case report describes the development of posttraumatic stress in a middle-aged man, with no prior psychiatric history, after he ingested part of a candy bar he later discovered to be infested with maggots. This case report adds to the literature supporting a broader diagnostic view of posttraumatic stress in the absence of life-threatening stressors.

The social and treatment consequences of a shared delusional disorder in a homeless family.

OBJECTIVE: Delusional disorder is defined as a fixed, false belief that is held by a person despite evidence to the contrary. Shared psychotic disorder, also known as folie a' deux, psychosis by association and induced psychotic disorder, is an uncommon and unique psychiatric disorder. It is even more unusual when it occurs within families (folie a' famille). CASE PRESENTATION: This case report describes the occurrence of a shared delusion within a family consisting of an adults on and two elderly parents. The shared delusion, which was the belief that a large financial settlement was a waiting to be disbursed to the family members by the local law enforcement agency, contributed to their state of homelessness and rejection of all offers of assistance from service providers. CONCLUSION: The impact of this shared psychotic disorder contributed to the family's state of extreme poverty and homelessness, which, as a consequence, greatly impeded the initiation of evidence-based therapeutic interventions.

The use of duloxetine in chronic bulimia nervosa: a case report.

Selective serotonin reuptake inhibitors are routinely prescribed as off-label treatments for bulimia nervosa. There is, however, a paucity of literature addressing the efficacy of the serotonin norepinephrine reuptake inhibitors in the pharmacologic management of this disorder. This article describes a clinical situation in which duloxetine, a serotonin norepinephrine reuptake inhibitor, effectively treated a patient with long-standing bulimia nervosa, purging type, and comorbid generalized anxiety disorder.

Psychiatric street outreach to homeless people: fostering relationship, reconnection, and recovery.

Individuals who suffer from serious and persistent mental illnesses constitute nearly one-third of the homeless population in this country. Perhaps the most vulnerable people in the homeless population are those who are disabled from a mental illness and are also chronically unsheltered. Psychiatric street outreach to this particular segment of the homeless population is commonly justified based upon the need to engage the most severely impaired and most medically underserved individuals in our communities assertively. This brief paper describes the core objectives of fostering relationship, reconnection, and recovery through a transdisciplinary, psychiatric street outreach initiative in Jacksonville, Florida.

Physical and sexual abuse history in women seeking treatment at a psychiatric clinic for the homeless.

The rate of lifetime exposure to physical and/or sexual abuse among homeless women is very high, and the prevalence of depression, anxiety, and substance abuse is greater in this population than in the general population. The relationship between abuse and mental illness in homeless women is incompletely understood. Using multivariable logistic regression, the present study examines this relationship in a retrospective study of women seeking treatment at a psychiatric clinic for the homeless in Jacksonville, Florida. The results of this study indicate a strong association between abuse history and anxiety disorders, especially posttraumatic stress disorder.

Recognizing psychologically masked illnesses: the need for collaborative relationships in mental health care.

BACKGROUND: Both research and clinical experience support the view that unrecognized medical illnesses in mental health, as well as in primary care, treatment settings can directly cause or exacerbate a patient's presenting psychological symptoms. No study has compared medical and nonmedical health care professionals on their respective abilities to identify common medical illnesses that frequently masquerade as psychological disorders. METHOD: In this study, 24 psychiatrists, 20 primary care physicians, 31 psychologists, and 17 social workers, recruited between November 2005 and April 2007, were asked to complete a questionnaire designed to measure the respondents' knowledge of masked medical illness. The questionnaire consisted of 10 different clinical vignettes in which a patient is seeking treatment for psychological problems that are due to a hidden medical illness. Statistical (analysis of covariance) comparisons of questionnaire scores were conducted between the medically trained and nonmedically trained participants. RESULTS: After adjusting for clinical experience, medical mental health care professionals demonstrated significantly greater knowledge of medical illnesses that commonly masquerade as psychological disorders (F = 177.02, df = 1,82, p = .000, partial eta(2) = .68) than did nonmedical providers. In addition, correlational results showed a strong relationship (r = .82, N = 92, p < .001) between the presence of medical training and knowledge of masked medical illness in mental health care. CONCLUSIONS: Study findings suggest that non-medical mental health care providers may be at increased risk of not recognizing masked medical illnesses in their patients. On the basis of these findings, proposed collaborative and educational approaches to minimize this risk and improve patient care are described.