Evolving Roles and Needs of Psychiatry Chief Residents During the COVID-19 Pandemic and Beyond.

Psychiatry chief residents have diverse leadership roles within psychiatry residency programs. Chief residents have historically been viewed as "middle managers", and other leadership roles include administrative work, teaching, and advocacy for residents. Chief residents also help in managing the logistics of complex healthcare systems and mediating between many groups with conflicting needs and perspectives. The COVID-19 pandemic has changed the functioning of psychiatry residency programs, and this has also led to the evolution of the roles of the chief residents in psychiatry. During the COVID-19 pandemic, the chief residents had to help with adapting to the changes in teaching and clinical work with residents and faculty. They had to liaison with various healthcare providers in making decisions related to COVID-19 in residency programs. Along with these changes, chief residents also had to advocate for the wellbeing and needs of their fellow residents. This perspective article is written by authors who have served during or after the transition to the COVID-19 pandemic. We discuss our experiences as chief residents as well as evolving roles and wellness needs of chief residents in psychiatry. Based on the administrative, advocacy, academic and middle management roles of chief residents in psychiatry and their wellbeing, we also make recommendations for support and interventions needed for chief residents in the context of the COVID-19 pandemic and beyond.

A case report of over-the-counter codeine dependence as consequence of self-medication for premature ejaculation.

Over-the-counter (OTC) opioid abuse, including codeine, has been a growing problem around the world. Although the majority of the abusers use it for recreational purposes, many become dependent on it after having used it a medication for pain or cough. We present a case of codeine dependence where the initial prescribed use had been as a cough medication, but the subsequent abuse of it occurred the following self-medication for premature ejaculation. There is growing need for awareness among doctors and pharmacists of OTC abuse of opioids and for preventive interventions such as restricting supply, audit of pharmacies, training pharmacists, and counter staff and dispensing knowledge about proper use of opioid-containing medications to patients.

A case report of rapid-onset hyponatremia induced by low-dose olanzapine.

Hyponatremia has been reported with the use of psychotropic drugs. Olanzapine does not find much mention as a cause of hyponatremia in literature; however, it has been found to be the second most frequently reported atypical antipsychotic to cause it. We report a case of hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion which occurred at a rapid onset following the administration of low-dose olanzapine during inpatient treatment of a patient with bipolar disorder. We would like to highlight our case for the need to be vigil about such fatal side complications apart from metabolic side effects of atypical antipsychotics.

Psychosis in Secondary Empty Sella Syndrome following a Russell's Viper Bite.

Hypopituitarism can present with psychiatric symptoms. We report a unique case of psychosis in clear consciousness in a case of hypopituitarism due to the secondary empty sella syndrome following a Russell's viper bite which was untreated and presented with psychotic symptoms for past 13 years following the snake bite. After the diagnosis of psychosis due to hypopituitarism was made, the patient was treated with levothyroxine and prednisolone supplements and his psychotic symptoms subsided without any psychotropic drugs. Vasculotoxic snake bites can cause hypopituitarism and can present with psychosis. Further research will be needed into the prevalence of this phenomenon.