Comorbidity Conundrums and Other Brain Teasers

Seize the Opportunity. Psychogenic non-epileptic seizures (PNES) may be a symptom of a variety of processes rather than a specific disorder, thereby requiring personalized treatments instead of a one-size-fits-all intervention. Although PNES are events that appear to be similar to seizures, they are not caused by abnormal electrical brain activity. Instead, they are thought to have an underlying psychological cause. It is important to recognize when seizure-like symptoms are being volitionally produced for the purpose of maintaining a sick role or for secondary gain. The authors shed light on a disorder that is difficult to diagnose and manage, and offer insights on how to develop an appropriate treatment plan. See: Psychogenic Non-Epileptic Seizures: Clinical Issues for Psychiatrists

SIGNIFICANCE FOR THE PRACTICING PSYCHIATRIST: Did you know . . . early-onset (adolescence) PNES has been associated with bullying? Furthermore, late-onset PNES has been associated with health-related trauma. After reading this article, psychiatrists will have greater insight on how to assess patients and diagnose PNES. In addition, the authors shed light on the current challenges of treating such illnesses so clinicians can develop an appropriate treatment plan. For a mobile-friendly view of the monarch notes, click here.

The Catatonia Conundrum. Catatonia, described in 1874 by K. L. Kahlbaum, is a distinct and heterogeneous neuropsychiatric syndrome, with both motoric and behavioral signs. It may be hypokinetic, hyperkinetic, or mixed and includes volitional signs, such as mutism, negativism, and automatic obedience. It was formerly relegated to a schizophrenia subtype, or considered extinct after the advent of modern psychopharmacology. Renewed interest and emerging systematic data have highlighted the frequency and pattern of catatonic presentations in psychiatric and medical settings, including in critical illness. See: Update on Medical Catatonia: Highlight on Delirium

SIGNIFICANCE FOR THE PRACTICING PSYCHIATRIST: Of particular interest and potentially of great clinical significance is the relationship between catatonia and delirium. While atypical antipsychotics with benzodiazepines have been considered for psychiatric catatonia in those without fever or autonomic signs, there is no evidence that these agents are safe or effective for medical catatonia or delirium with catatonia. This article presents examples of other medical conditions associated with catatonia. For a mobile-friendly view of the monarch notes, click here.

Special Considerations. Patients go through an adjustment period for about 4 to 6 weeks after diagnosis of cancer. For many patients, cancer is synonymous with death and debilitating treatments, with images of a prolonged painful dying process. Patients often say they feel overwhelmed trying to assimilate medical information and make treatment decisions Although most cancer centers provide some psychosocial services, increased attention to the psychosocial needs of patients with cancer may result in increased referrals to mental health professionals in other settings. Some basic knowledge about a patient’s cancer and treatment are essential for psychiatric management. See: Depression and Anxiety Disorders in Patients With Cancer

SIGNIFICANCE FOR THE PRACTICING PSYCHIATRIST: Concurrent with advances in cancer treatment, the importance of psychosocial care of individuals with cancer is being increasingly recognized. Psychiatrists are learning more about a patient’s cancer diagnosis, staging, treatments and their adverse effects, and prognosis to appreciate the challenges the patient is coping with throughout treatment as well as survivorship or end-of-life. For a mobile-friendly view of the monarch notes, click here.