Management of Emotionally Challenging Responses of Hospitalized Patients with Cancer

Cancer is the second leading cause of death in the United States, and the majority of hospital admissions of patients with cancer occur because of uncontrolled, urgent symptoms. In addition to complex physical presentations, these patients often manifest a number of complex emotional and psychological responses resulting in a unique set of healthcare needs and expectations. Inpatient generalists or hospitalists frequently serve as the primary...

Cognitive Behavioral Therapy in the Treatment of Insomnia

Insomnia disorder is present in as much as 30% of the general adult population. Given the significant adverse effects of pharmacotherapy, cognitive behavioral therapy (CBT) has been found to be an effective alternative in individuals with insomnia. CBT for insomnia (CBTi) encompasses sleep hygiene, stimulus control, sleep restriction, cognitive therapy, and relaxation training. In this article we review evidence that establishes CBTi as a useful...

Authors’ Response

To the Editor: The letter to the editor from representatives of the American Association of Physician Assistants (AAPA) in response to our article ‘‘Improving Mental Health Services Through Physician Assistants: Legislation in Several Southern States’’ apparently argues that there are no significant financial risks associated with the utilization of physician assistants (PAs) and that the law changes....

On “Improving Mental Health Services Through Physician Assistants: Legislation in Several Southern States”

To the Editor: The American Academy of Physician Assistants wishes to express concern regarding the article by Buchbinder and colleagues published in the April 2017 issue of the Southern Medical...

Association of White Matter Lesions, Cerebral Atrophy, Intracranial Extravascular Calcifications, and Ventricular-Communicating Hydrocephalus with Delirium Among Veterans

Objectives: The literature regarding the underlying neuropathogenesis of delirium on head computed tomography (CT) is limited. The aim of this research was to investigate, using case–control retrospective chart review, the association of white matter lesions (WML), cerebral atrophy, intracranial extravascular calcifications, and ventricular-communicating hydrocephalus in older adult military veterans with and without delirium hospitalized in a...

Improving Mental Health Services Through Physician Assistants: Legislation in Several Southern States

A national effort to provide more expansive mental health care in the United States has been an increasing priority during the last decade. States have enacted laws that allow for the delegation of psychiatric services to physician assistants in an effort to address the shortage and geographic maldistribution of mental health services and to more efficiently use the skills of psychiatrists. This statutory scheme recognizing physician assistants...

Exploration of the Association Between Physical Health and Suicidal Behavior in Psychiatric Outpatients in Rural America

Objective: Evidence reveals a link between poor physical health and suicide. The physical health of rural, adult psychiatric outpatients with a history of suicide was examined. Methods: The medical records of 192 patients seen at a tertiary-level academic medical center were examined for demographics, psychiatric and medical history, and self-reported measures of depression, anxiety, childhood trauma, and health status. Results: The 48...

Breaking Bad Delirium: Methamphetamine and Boric Acid Toxicity with Hallucinations and Pseudosepsis

Objectives: A 30-year-old patient presented with hallucinations and profound shock. He was initially misdiagnosed as having severe sepsis; once ingestions were considered, he was diagnosed as potentially having arsenic toxicity. Summary: The clinical story reveals many instructional lessons that could aid in the evaluation and management of future patients. This man presented with large amounts of blue crystals around his nose and lips from...

Commentary on “Deep Brain Stimulation for Treatment-Refractory Depression”

Major depressive disorder is a chronic, disabling, and potentially life-threatening disorder that has a lifetime prevalence of 15% to 20%. A 2015 article published in Lancet evaluating the global burden of disease ranked major depressive disorder as the second leading cause of disability in 2013, contributing to 51,784 disability-years.1 Although various treatment modalities, including antidepressants, adjunctive medications, psychotherapy, and...

Deep Brain Stimulation for Treatment-Refractory Depression

: Depression has a high lifetime prevalence and recurrence rate, with more than one-third of affected patients experiencing treatment-refractory depression. These individuals should benefit from additional treatment options such as deep brain stimulation (DBS), a research-grade intervention. DBS is being investigated for its efficacy in treatment-refractory cases. We reviewed the Englishlanguage literature published between the years 2010...

Pharmacogenomics Can Enhance Prescribing of Psychiatric Medications

Many psychiatric patients experience pharmaceutical intolerances, and some of them do not derive optimal efficacy from their pharmacotherapies. Clinical problems such as these may result in prolonged dysfunction, adverse consequences, and repeated changes in medication treatment regimens. Pharmacogenomics is a laboratory method that aids individualized medication selection by predicting drug efficacy and adverse effect profiles. It is a...

Mental Health Impact of Hosting Disaster Refugees: Analyses from a Random Sample Survey Among Haitians Living in Miami

Objectives: Studies on the mental health of families hosting disaster refugees are lacking. This study compares participants in households that hosted 2010 Haitian earthquake disaster refugees with their nonhost counterparts. Methods: A random sample survey was conducted from October 2011 through December 2012 in Miami-Dade County, Florida. Haitian participants were assessed regarding their 2010 earthquake exposure and impact on family and...

Homelessness and Emergency Psychiatric Evaluations

To the Editor: Homelessness is associated with increased illness burden and increased utilization of emergency health services.1,2 Mental illness and substance abuse are both common in the homeless population.2 Major societal distress from events such as Superstorm Sandy has been associated with increased rates of homelessness and emergency department...

Special Series on Mental Health

Featured in this issue of the Southern Medical Journal is a short series of articles on mental health, a clinical care challenge in the United States. The articles address a range of mental health issues, identifying the characteristics of certain disorders and proposing interventions of promise. The purpose of this series is to continue the Journal’s mission to support the dissemination of information relating to mental health across the...

Commentary on “Impact of Nutrition on Neurocognition”

We live in the information age. In this month’s issue of the Southern Medical Journal, Yeh and Kaliebe1 clearly explicate this flood of information and the ease of obtaining data--it is now the song that sticks in our heads. I am dating myself with the introductory quote, but this song comes to mind as I peruse even medical Web sites for information. In fact, the majority of the delivery of such data is now passive: advertisements on...

Commentary on “One-Visit Behavioral Intervention for Older Primary Care Patients with Mild to Moderate Depressive Symptoms”

Everyone wants to feel well. Doctors try to mitigate illness and promote health. Patients and physicians optimally strive to achieve a team approach to a partnership that promotes...

Conversion Disorder in an Appalachian Community

Objectives: Conversion disorder (CD) is believed to be the manifestation of physical and/or neurological symptoms for primary gain without an identifiable organic cause. Although it is believed to be more common in rural areas, the literature examining this claim is sparse. To our knowledge, no study has been published evaluating the prevalence of CD in a rural Appalachian population. The aim of this study was to characterize and determine the...

One-Visit Behavioral Intervention for Older Primary Care Patients with Mild to Moderate Depressive Symptoms

Objectives: We pilot tested a one-visit behavioral intervention with telephone follow-up for older primary care patients with mild to moderate depressive symptoms. Methods: A total of 16 English-speaking primary care patients aged 60 years and older who scored 5 to 14 on the Patient Health Questionnaire-9 (PHQ-9) engaged in the intervention visit. Outcomes were assessed at baseline and 4 weeks: activity goals, readiness to change (University...

Impact of Nutrition on Neurocognition

Today’s media-saturated environment bombards us with a constant stream of information about the latest diet ‘‘do’s and don’ts.’’ The 2015-2020 US Department of Agriculture and Department of Health and Human Services’ Dietary Guidelines for Americans have generated much online attention for both stated and unstated recommendations. Simply described, these guidelines focus on healthful eating patterns, emphasizing a variety of...

Relation Between Physicians’ Work Lives and Happiness

Objectives: Although we know much about work-related physician burnout and the subsequent negative effects, we do not fully understand work-related physician wellness. Likewise, the relation of wellness and burnout to physician happiness is unclear. The purpose of this study was to examine how physician burnout and wellness contribute to happiness. Methods: We sampled 2000 full-time physician members of the American Academy of Family...