The Week in Review: February 19-23

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This week, Psychiatric Times® discussed a wide variety of psychiatric issues and industry updates, from connections between bipolar disorder and cardiometabolic issues to management of agitation in emergency departments.

Bipolar Disorder and Risk of Cardiometabolic Disease, Heart Failure, and Mortality

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Bipolar disorder is associated with increased cardiovascular disease comorbidity and mortality and a shorter life expectancy. Most previous studies were conducted in Europe and North America, with more limited evidence in Asian populations.

In patients with bipolar disorder, heart failure may be a major cause of excessive sudden cardiac death in patients aged >50 years. Another small study found evidence of unfavorable cardiac structural measures in patients with bipolar disorder. Continue Reading

“What Is Happening to My Wife?”

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In this installment of Tales From the Clinic: The Art of Psychiatry, we discuss agitation and how it can mimic various psychiatric illnesses. Agitation, possibly leading to aggression, is a major issue in emergency centers. The role of psychiatry in acute settings, such as emergency departments (EDs) and consultation-liaison services, often entails managing agitation and diagnosing then managing underlying mental illness when applicable.

This topic was chosen because of the pervasiveness of the issue, the severity of the impact of agitation (believed to cause burnout and turnover in staff and physicians), and the possibility of misdiagnosing an agitated patient with mental illness when the etiology, as in this case, is in fact medical. Continue Reading

Future Proofing Lithium Pharmacokinetic Research

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If I asked you to meet me at a restaurant, but never mentioned a time for us to meet, it would be a pretty useless invitation. A place without a time, (or a time without a place), is incomplete information. Space and time are inherently linked.

So, consider this extract from Nolen et al: “For maintenance treatment of BD several reviews recommend differing minimum effective lithium serum levels ranging from 0.40 mmol/L and 0.50 mmol/L or 0.60 mmol/L…to as high as 0.80 mmol/L.” The author has given the equivalent of a place (a lithium serum concentration range) without a time. How can we accurately interpret these values without knowing when they were taken, how long it has been since the last dose of lithium, and what the dosing schedule is? Continue Reading

The Power of Plain Old Psychiatry

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Psychiatry is regularly criticized for offering ineffective or unproven treatments. This criticism is demonstrably false. Medications, psychotherapy, and a host of other interventions constitute well-validated medical treatments for specific mental illnesses. But there is another more general aspect of psychiatric treatment which both critics and advocates of psychiatry regularly forget: the simple power of seeing a psychiatrist.

A psychologist colleague of mine once wrote a fine book with the subtitle, “Treating Trauma with Plain Old Therapy.” Here, I will borrow his idea to discuss plain old psychiatry, the generic and implicit interventions that patients receive simply by virtue of seeing a competent psychiatrist for treatment. Continue Reading

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