What if Depressed and Pregnant?

Depression is the most prevalent mood disorder among pregnant women. Only 50% of women seek intervention during gestation. Untreated during pregnancy, depression can induce obstetric and neonatal complications, most commonly, anhedonia, suboptimal weight gain, suicidal behavior, pre-term birth, and/or spontaneous miscarriage. The babies more often suffer cognitive deficits, low birth weight, and growth delay. The mothers subsequently also experience an increased risk for significant degrees of postpartum depression. Those with relatively milder cases of depression should initially receive psychotherapy. Otherwise, there are many antidepressant medications available for the pharmacotherapy of depression. However, treating pregnant females with depression is a challenge because of potential teratogenic effects caused by many pharmaceuticals. Physicians should know the recommended guidelines for treating depressed women during a time of gestation. It is crucial to identify women suffering from depression during pregnancy, and electing those that warrant pharmacotherapy while picking the best and safest medication is a complex process with paramount significance. Before prescribing an antidepressant drug, explain the advantages and disadvantages of the interventions. Whenever prescribing during these circumstances, more than conventionally close obstetric, emotional, and medication monitoring is to be provided. This would also include an emphasis on diet, exercise, psychotherapy, and avoidance of any non-critical medicinal or other substance exposures.

Anxiety Disorders in Older Patients.

Anxiety complaints are common among older people. Specific phobia is characterized by exaggerated fear to a specific object or situation. Fear of falling is one example and occurs in about 50% of older persons who have fallen recently. Polypharmacy heightens fall risks. Generalized anxiety disorder is characterized by chronic uncontrollable worry that interferes with functioning and is accompanied by restlessness and disturbed sleep. Panic disorder refers to recurrent, unexpected surges of intense fear that evidence physical and cognitive dysfunction. Cognitive behavior therapy has efficacy among psychotherapies for older anxious adults. In treating anxiety, medications that might be anxiogenic are reduced in dosage or discontinued. It is essential to monitor for suicidal ideation and symptom change. The first-selected pharmacotherapy for people with most anxiety disorders is selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. The risk-benefit ratio of benzodiazepine pharmacotherapy in elderly patients is not favorable.

Suicide Among Transgender and Gender-Nonconforming People.

Suicide rates are higher in those who identify as transgender or gender nonconforming (TGNC) compared to the overall population. Suicide risk factors include discrimination, family rejection, internalized transphobia, and being denied appropriate bathroom or housing access. It is important to assess the risk of suicide among transgender and gender-nonconforming patients and discuss past experiences of prejudice or maltreatment to prevent further victimization. This narrative review includes the most pertinent literature from the past 17 years on issues related to suicide among individuals who identify as TGNC. ​.

E-Cigarette Toxicity?

Tobacco smoking is the most preventable cause of morbidity and mortality. In just a few short years, electronic cigarettes (e-cigarettes) have become increasingly popular, especially for younger individuals. Many people believe that e-cigarettes are safe. The inhaled aerosols of e-cigarettes contain numerous potential toxicities, some of which could be dangerous for health with long-term use. The safety of prolonged aerosol exposure is not known. The use of e-cigarettes as a harm-reduction tool at stopping tobacco smoking is not uniformly successful. E-cigarettes may be safer than tobacco products, but repeated prolonged exposure to their aerosols has its own considerable potential risk. The long-term health consequences of their use remain to be established. Physicians should vigorously discourage the use of e-cigarettes and tobacco products, with special emphasis on abstinence for younger people and during pregnancy or lactation.

Lithium Suicide Prevention: A Brief Review and Reminder.

Suicide is a major public health problem throughout the world, occurring in over 800,000 people annually. Mood disorders are a common psychopathology and are a signficiant risk factor for suicidality. Lithium pharmacotherapy has been shown to reduce symptoms of suicidal behavior, especially in long-term patient interventions. Reasons for this remain unclear. Lithium treatment for individuals with affective disorders appears underutilized. Use of lithium is thought to reduce risk for suicidality, even if mood stabilization is not achieved and serum concentration is lower than the conventionally accepted therapeutic blood level ranges. In this article, the authors review the currently available literature on lithium's effect on suicidality and provide discussion on proposed mechanisms of action. This brief report serves as an important reminder to clinicians to include lithium pharmocotherapy in their armamentarium for treatment of affective disorders, especially when symptoms of suicidality are present.

Guns and Suicide: Are They Related?

Shooting oneself with a firearm is the leading method of suicide, accounting for over half of all such deaths. About two-thirds of the annual 33,000 gun-related fatalities in the United States are suicide-nearly 60 every day. Although most suicidal impulses are intense, they usually last for a short time, which makes prompt intervention imperative. Approximately 90% of those who attempt suicide and survive do not later die by suicide. However, attempts with a gun are usually fatal. A clear connection between firearms in the home and an increased risk of suicide exists. People who have access to these weapons are more likely to commit suicide than those who live in a home without a gun; thus, limiting access to guns decreases the opportunity for self-harm. Physicians should recommend that firearm access be removed from individuals with depression, suicidal ideations, drug abuse, impulsivity, or a mental or neurologic illness.

Benefits of Dexmedetomidine in Management of Post-ECT Agitation.

Electroconvulsive therapy (ECT) is an intervention for patients with a variety of psychiatric conditions. Occasionally, people exhibit dangerous degrees of agitation after this treatment, and some do not respond well to conventional pharmacotherapies. Dexmedetomidine is a central α-2 agonist that can induce significantly calmative effects in persons with post-ECT agitation. The indication for it is in calming individuals with acute and/or recurrent posttreatment agitation. Dexmedetomidine is safe and effective when infused just before, or postictally, at ECT sessions.

Risk of future offense among probationers with co-occurring substance use and mental health disorders.

The criminal justice system is the primary service delivery system for many adults with drug and alcohol dependence, mental health, and other health service needs. The purpose of this study was to examine the relationship between risk of future offense, mental health status and co-occurring disorders in a large substance abuse diversion probationer population. A purposive sample of 2,077 probationers completed an assessment to screen for mental health disorders, substance use disorders, risk of future crime and violence, and several demographic characteristics. Probationers who screened positive for co-occurring substance use and mental health disorders were significantly more likely to be at higher risk of future crime and violence compared to probationers who screened positive for only substance use, only a mental health disorder, or no substance use or mental health disorder. Implications for substance use and mental health service delivery are discussed, and recommendations are made for further research.