From the Pages of Psychiatric Times: July 2023

In the July issue of Psychiatric Times®, we worked with experts from multiple psychiatric areas to bring you thoughtful articles about a wide variety of psychiatric topics, from early intervention in postpartum psychosis to ethical and legal principles of treatment over objection. Here are some highlights from the issue.

A Year of 988: The First Step in a Long Journey

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A year ago, the National Suicide Prevention Lifeline switched to its new 3-digit number, 988. Since its launch, the Lifeline has received a startling number of contacts: over 5 million, including more than 1.43 million calls, 416,000 chats, and 281,000 texts. But is it effective in saving lives?

“The transition to the 988 Suicide & Crisis Lifeline has sparked a transformational moment in behavioral health care in this country. For the first time in my 26-year career history, every state and territory is talking about improving their behavioral health crisis systems,” said Monica Johnson, MA, director of the 988 & Behavioral Health Crisis Coordinating Office at the Substance Abuse and Mental Health Services Administration (SAMHSA). “While we know that there is still much work to do to achieve a robust response system for mental health and substance use crisis care across the country, we have accomplished a lot in the past year.” Continue Reading

Postpartum Psychosis: Improving the Likelihood of Early Intervention

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“She would never hurt her baby.” These are words commonly uttered by the partners and family members of women presenting to our facilities with postpartum psychosis (PPP) symptoms. In their reluctance to accept the presence of a mental illness and its related risks, and in their desire to get their loved one out of a psychiatric facility and back home with her baby, partners and family members of patients with PPP often minimize the severity of symptoms they have observed and place themselves at odds with the inpatient psychiatric team seeking to hold and treat the patient. Their reasons for doing so are myriad, but often rooted in a lack of understanding of the course of PPP episodes and the potential for devastating outcomes of not providing treatment.

At Connections Health Solutions psychiatric crisis centers in Arizona, where I serve as medical director, we typically have at least 1 patient with PPP. By contrast, many psychiatrists in the community encounter PPP rarely, or not at all. Despite this, it is vital that we are all prepared to recognize the risk factors and early signs of a developing episode, and to provide education and guidance to patients and their supports. Continue Reading

Treatment Over Objection: Ethical and Legal Principles

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Consultation-liaison psychiatrists and trainees are often consulted to assess capacity in medically admitted patients who have a history of psychiatric illness. Subsequent decisions about providing medical and psychiatric treatment over objection (TOO) may involve hospital ethics committees and legal counsel.

We present a case in which the issue of TOO for an incapacitated patient remained incompletely resolved due to a conflict between the most ethically appropriate treatment and the most legally appropriate treatment. This conflict, along with uncertainty about the ethical and legal principles themselves and the role of each team, caused both the medicine and psychiatry teams significant moral distress. Continue Reading

Adolescent Substance Use: Reasons for Optimism and Concern

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There are reasons to be optimistic about adolescent substance use given an overall consistent decline in use for this age group over the past 20 years. However, nicotine and cannabis use have fluctuated, and adolescents have been disproportionately impacted by the development of electronic vaping devices. Likewise, adolescents have been disproportionately affected by the increase in counterfeit pills containing illicitly manufactured fentanyl, and there has recently been a sharp increase in drug overdose deaths.

For these reasons, it is important that child and adolescent behavioral health clinicians remain vigilant regarding early identification of substance use, as youth with mental health conditions who use substances are at increased risk for developing a substance use disorder (SUD). Continue Reading

See the full July issue of Psychiatric Times here. And be sure to stay up-to-date by subscribing to the Psychiatric Times E-newsletter.

Do you have a comment on any of these or other articles? Have a good idea for an article and want to write? Interested in sharing your perspectives? Write to us at PTeditor@mmhgroup.com.