Voltage-gated Potassium Channel Antibody Autoimmune Encephalopathy Presenting With Isolated Psychosis in an Adolescent.

Antibody-mediated encephalopathies associated with serum or cerebrospinal fluid antibodies directed against neuronal structures may present with a multitude of neuropsychiatric syndromes. Although some of the antibody-driven conditions are now well recognized in adults (eg, N-methyl-D-aspartate receptor antibody encephalitis), the spectrum of neuropsychiatric manifestations in the pediatric population is less clear. Psychosis, confusion, catatonia, and additional behavioral changes, along with seizures, encephalopathy, and movement disorders, may be initial manifestations or concurrent features in all age groups. Psychosis, when present, is often part of a broader spectrum of neurological and neuropsychiatric symptoms for which the diagnosis of autoimmune encephalitis is considered. The authors present the case of an adolescent with an acute and isolated psychotic presentation of voltage-gated potassium channel antibody encephalitis, further expanding the phenotypic spectrum of this specific antibody-mediated disease and raising the possibility that specific immune-mediated processes may define a biological subgroup of psychoses.

Content-Area Framework for Conducting Family Meetings for Acutely Ill Psychiatric Patients.

Family meetings are a critically important component of managing acutely psychiatrically ill patients, and learning how to conduct such a meeting is critically important in the training of psychiatrists. Because we found no published comprehensive tools that dealt with the biopsychosocial content areas to be covered in family meetings in acute psychiatric settings, we developed and present such a comprehensive tool that is based in part on a review of existing tools utilized by other disciplines. This article describes the specific steps involved in premeeting planning, the formal topic areas that might be canvassed during the meeting, and postmeeting documentation and debriefing. The general content areas for discussion during the meeting include the setting of goals and expectations, relevant history-gathering, assessment of the family's understanding of the issues at stake, formal psychoeducation, and review of specific treatment strategies and clinical progress. The meeting may also include a discussion of resources available to the patient and family members and a review of issues related to the safety of the patient and others, management of early warning signs, and sensitive topics such as trauma, abuse, or violence that may play a role in the presentation or treatment of the patient to best translate established goals into a longer term plan of care. Implementation of this comprehensive and necessarily structured model should enhance the patient's and family's understanding of the issues at stake and should improve satisfaction, promote trust and an effective working alliance, and enhance the quality of the biopsychosocial care plan.

Special Considerations in Pediatric Psychiatric Populations.

Proper treatment of the pediatric psychiatric population can be challenging. Emergency department (ED) boarding, availability of child and adolescent psychiatrists, lack of parental understanding, and inexperience working with children with special needs are just some of the obstacles the ED physician will encounter. We discuss the risk stratification and interventions necessary when dealing with children and adolescents presenting with suicidal ideation and violent behavior. In addition, we discuss the unique approaches to patients with autism spectrum disorders and attention deficit hyperactivity disorder.