From the Pages of Psychiatric Times: November 2022

In the November issue of Psychiatric Times^TM, we worked with experts from multiple psychiatric areas to bring you thoughtful articles about a wide variety of psychiatric issues, from research on lithium and cardiac adverse effects to advances and challenges in adult ADHD. Here are some highlights from the issue.

Lithium: Cardiac Adverse Effects and When to Get an ECG

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A recent consultation motivated an evaluation of the evidence on when one should monitor electrocardiograms (ECGs) in patients taking lithium. Opinions vary and tend to be vague about when and how often to measure the ECG. Mogens Schou, MD, who was perhaps the world’s foremost expert on lithium and a passionate advocate for its use, observed that lithium occasionally changes the function or electrical activity of the heart, but the presence of heart disease rarely should prevent lithium treatment. 

If heart disease was present, however, he recommended a consultation with a cardiologist and serial ECGs might be considered. Much more recently, The Maudsley Prescribing Guidelines in Psychiatry from the United Kingdom recommended getting an ECG if there are risk factors for, or preexisting, cardiac disease—but offered no further details. Continue Reading

HIPAA vs Ethical Care: Accounting for Privacy With Neuropsychiatric Impairments

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The law presumes that individuals are rational. The reasonable individual, a hypothetical figure whose actions judges and juries weigh against others, will lucidly consider risks versus benefits before acting. Yet, we know that neuropsychiatric impairment can impede the capacity for making these calculated judgments, and in some cases this impairment is associated with a lack of illness awareness (or “insight”) that affects adherence with treatment.

Nevertheless, patients, families, and clinicians must still make critical health care decisions, such as a patient’s determination to engage in or refuse treatment, often with urgency and limited information. The COVID-19 pandemic has compounded the obstacles physicians commonly face in gaining patient acceptance of treatment and psychiatric referral; physicians often encounter exacerbated suspicion, mistrust, and emotional isolation even in individuals who do not suffer from neuropsychiatric impairment. Continue Reading

Affirming Evidence-Based Care for Young Patients Who Are Transgender or Gender Diverse

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The data is clear: We should expect an increasing number of transgender and gender diverse (TGD) youth presenting to our practices over the coming years. We must ask ourselves: Are we prepared to treat these patients and their families with the most affirming, evidence-based treatment available?

Case Example

For discussion purposes, consider a prototypical case of “Bar,” an 11-year-old child who presents to your office accompanied by his parents. Bar was assigned female at birth but recently began identifying with “he/him” pronouns; he is scared to face impending puberty. Bar’s father informs you that he is afraid Bar will be “bullied for being gay.”

Supporting the Patient and Their Family

Recent qualitative studies suggest that the caregivers’ response and adjustment to their TGD child’s identity development is critical to the child’s mental health. An integrative family therapy approach should affirm and support the TGD child in an equal partnership between the caregivers and the child. Addressing attunement and attachment is important for the family system, as there is likely longstanding intergenerational trauma from adoption of rigid, binary gender norms. Continue Reading

Advances and Challenges in Adult ADHD

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Many advances have been made in the past 20 years in the field of adult attention-deficit/hyperactivity disorder (ADHD), explained Theresa Cerulli, MD, and Anthony L. Rostain, MD, MA, during a recent PsychView custom video program.

“The good news is that thanks to our efforts to educate both the public and health professionals about the fact that ADHD exists in adults, it has become more and more recognized by a growing number of people,” said Rostain, founding director of the Adult ADHD Treatment and Research Program and emeritus professor of psychiatry and pediatrics at Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

Nonetheless, Rostain and Cerulli, president and medical director of Cerulli & Associates in North Andover, Massachusetts, and lecturer and clinical supervisor at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, agreed there are still challenges in clinical practice, including biases and incomplete treatment response. Continue Reading

See the full November issue of Psychiatric Times^TM here. And be sure to stay up-to-date by subscribing to the Psychiatric Times^TM 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.