A Misguided Venture: Presidential Fitness and the Duty to Warn

A small but vocal cadre of mental health professionals has questioned President Donald Trump’s fitness for office and claimed that his mental state is dangerous.1,2 These experts have frequently cited a “duty to warn” as the ethical basis for their outspokenness.3 The rallying cry of an obligation to protect the public from a dangerous president has inspired a medical conference at Yale,4 an eponymous online movement,5 and a best-selling...

Commentary on “A Misguided Venture: Presidential Fitness and the Duty to Warn”

For >40 years, the Tarasoff duty to warn of a threat to kill has become an accepted part of medical care. The use of this warning by physician political activists is new. In this response to the editorial by Kels and Kels1 in this issue of the Southern Medical Journal, I first comment on the aim of physician activism to achieve political goals using medical constructs such as the duty to warn. I then focus on the current use of the Tarasoff...

Impact of an Innovative Psychiatric Consultation Liaison Model on Provider Satisfaction with Care of Behaviorally Complex Patients

Objectives: The increasing behavioral acuity and complexity of hospitalized patients overwhelms providers’ capacity to effectively manage their behaviors. Hospitals must train their providers in how to cope with these behaviors to provide high-quality care. In addition to improved patient care, increased capacity to manage these challenging patients may improve resilience and reduce the risk and rates of provider burnout. We created a novel...

Resource Utilization with the Use of Seclusion and Restraint in a Dedicated Emergency Psychiatric Service

Objectives: There is a dearth of data regarding the use of emergency interventions in dedicated emergency psychiatric service settings, and reliable data are needed. This article describes the frequency and duration of the use of seclusion and restraint for imminent or existing agitation, aggression, or violence in a dedicated emergency psychiatric service located within an academic university hospital and staffed by sufficient numbers of...

A Professional Well-Being Continuum: Broadening the Burnout Conversation

Physician burnout is a significant concern that is garnering much-needed attention. Researchers and leaders in health care also have been focusing more on physician wellness. We believe, however, that physician well-being is more nuanced than being either burned out or well (or burned out or not), and the complexities of physician burnout are not fully captured by viewing the problem through this...

Commentary on “A Professional Well-Being Continuum: Broadening the Burnout Conversation”

The concept of physician wellness has attracted significant attention in recent years, as well it should. Statistics suggest that, depending on your specialty, 55% to 72% of physicians are experiencing what is frequently referred to as “burnout.”1 Although some may argue that burnout is common among many individuals in today’s society, physicians appear to be struggling at a rate twice that of the general population (49% vs...

Playing Music for Hospitalized Patients Enhances Mood and Reduces Perceptions of Pain

Objectives: For most people, music serves as a calming influence or as a pleasurable stimulus that lifts their spirits. In an attempt to both distract and cheer up hospitalized patients, we designed a brief intervention that would bring music to their hospital rooms in attempt to enhance their mood and minimize their awareness of pain. Methods: In this prospective study of adult patients on the general medicine ward at Johns Hopkins Hospital,...

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...