The Week in Review: February 24-28

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This week, Psychiatric Times discussed a variety of psychiatric issues and industry news, including making the case for developmental trauma disorder to be included in the DSM and considering celiac disease when diagnosing adolescent patients.

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Why Developmental Trauma Disorder Should Be Included in the DSM: A Case Study

The case study of “Victor” offers insight into the impact early childhood adversity has on neurodevelopment and psychiatric health. Victor's experiences, having been adopted at 30 months old from a southeastern European orphanage and going on to be diagnosed with generalized anxiety disorder, encephalopathy (static)/fetal alcohol syndrome, and attention-deficit/hyperactivity disorder (ADHD), exemplify how adverse childhood experiences can lead to complex trauma responses not adequately captured by existing DSM diagnoses. This has led to the proposal of developmental trauma disorder (DTD) as a DSM subcategory specifically addressing the unique manifestations of complex childhood trauma. DTD emphasizes the necessity for comprehensive treatment strategies encompassing psychological, medical, and social support to effectively address the multifaceted needs of affected individuals. Recognizing and including DTD in the DSM would facilitate more accurate diagnoses and tailored interventions, ultimately improving outcomes for those impacted by early developmental trauma. Read more.

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Cannabis Use in Senior Patients

The use of cannabis among older adults has increased, with many seeking relief from pain, insomnia, anxiety, and depression. While its cultural acceptance has grown, the medical community has largely overlooked the impact of cannabis use in senior patients. Many older individuals turn to cannabis as an alternative when traditional treatments for anxiety or sleep disorders, such as benzodiazepines, are avoided due to fears of cognitive decline or safety. However, cannabis use is not risk-free. A study from Harvard Health Publishing showed an increase in emergency care visits in California with cannabis use in older adults, from 366 in 2005 to 12,169 in 2019. More research into the efficacy of sleep and anxiety medications vs different forms of cannabis can provide better insight for clinicians. Read more.

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Celiac Disease: An Overlooked Cause of Mental Illness in Children

Mental health assessment and treatment are often focused largely on the patient’s symptoms, leading to a DSM-5 diagnosis and treatment with medication. But what if other physiological and biochemical disruptions are contributing to a patient’s symptoms? Celiac disease is commonly linked to gastrointestinal issues but often overlooked as a cause of mental health problems in children. Many individuals with celiac disease experience neurological and psychiatric symptoms, such as anxiety, depression, ADHD, and eating disorders, often due to nutritional deficiencies, autoimmune antibodies, or gluten’s neurotoxicity. Importantly, these symptoms can occur even without the traditional gastrointestinal issues, leading to misdiagnosis. Research shows more than 80% of patients with celiac disease go undiagnosed, further complicating treatment. Screening for celiac disease and a trial of a gluten-free diet should be taken into consideration when treating a child or adolescent with psychiatric symptoms, as early diagnosis and dietary intervention can potentially alleviate them. Read more.

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Diagnosis and Management of Catatonia via Telepsychiatry: Case Series and Guide for Clinical Practice

Catatonia is often underdiagnosed in general hospitals, with consultation-liaison psychiatry playing a crucial role in improving detection. Many rural hospitals face significant challenges due to a lack of psychiatrists, leaving patients without timely diagnosis or treatment. Telepsychiatry offers a promising solution, allowing remote psychiatric consultations to bridge this gap. A case series highlights 3 patients successfully diagnosed and treated for catatonia through telemedicine, demonstrating its effectiveness. In these cases, on-site clinicians trained in using the Bush Francis Catatonia Rating Scale and conducting physical exams worked alongside telepsychiatrists to ensure accurate assessments. This collaborative approach enabled proper treatment and showed that with appropriate training and coordination, telepsychiatry can be a reliable method for managing catatonia, particularly in areas where in-person care is limited. Read more.

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What Works for Adults With ADHD?

A recent meta-analysis evaluated various treatments for adult ADHD, comparing pharmacological, psychological, and neurostimulatory interventions. Findings indicate that both stimulant medications and atomoxetine are significantly more effective than placebo in reducing core ADHD symptoms over 12 weeks, as assessed by clinicians and patients. Conversely, relaxation therapy was found to be less effective than placebo based on self-reported measures. Psychological interventions—including cognitive behavioral therapy, cognitive remediation, mindfulness, and psychoeducation—and neurostimulatory approaches like transcranial direct current stimulation showed superiority over placebo in clinician ratings, but did not achieve significant improvement in patient self-reports. These results underscore the importance of personalized treatment plans, and individual responses to therapies can vary. Clinicians should consider both medication and psychological strategies, tailoring approaches to each patient’s unique needs to optimize outcomes in ADHD management. Read more.