Reflecting on Tales From the Clinic in 2025

Breaking the Cycle: Jail Diversion as an Alternative to Incarceration for Individuals With Co-Occurring Disorders

Authors discuss jail diversion programs and how they can be beneficial compared with traditional incarceration. Jail diversion programs can lead to lower rates of reoffending, better cost efficiency, improved health and social stability, decreased reliance on emergency services, and more. Read the full discussion here.

Suicide: Can Emergency Departments Assist in its Prevention?

Examine a case of trauma with undetected suicidality from the emergency department. Authors note that patients with trauma are at a higher risk of suicide, and survivors of suicide attempts are also at an elevated risk of lethal behaviors. Suicidal risk factors can be complex, and this piece dives into development of interventions and prevention. Read more here.

When Silence Speaks: A Case of Hypoactive Postoperative Delirium in an Older Patient

Postoperative delirium may go unrecognized, especially in cases with older patients, potentially leading to cognitive decline and longer hospital stay. Pathophysiology of this condition can involve inflammation, oxidative stress, and decreased acetylcholine with increased dopamine. Cognitive assessments are the standard for detecting delirium. See the full case here.

Huntington Disease: Recognizing Neuropsychiatric Symptoms

Diagnosing Huntington disease can be challenging, and some neuropsychiatric symptoms are not well understood. Treatments for the disease lack systematic trials, and Huntington disease lacks disease-modifying therapies. Interdisciplinary collaboration is crucial, authors note. Find the full case discussion here.

Burnout and Subfertility in Female Physicians: Examining the Bidirectional Relationship and Emphasizing the Need for Change

Female physicians face unique struggles in dealing with burnout and fertility issues. Stress and delayed childbearing due to medical education may be factors in reproductive challenges. Burnout and subfertility must be addressed, with strategies including psychotherapy, lifestyle changes, and institutional reforms. See more here.

Walking the Line: Navigating Student Mistreatment by Patients

Mistreatment of students by patients, including microaggressions, can lead to increased hopelessness, isolation, and career regret among medical trainees. The ERASE framework provides a structured approach to address patient mistreatment, focusing on preparation, recognition, real-time intervention, support, and institutional culture. Read the discussion here.

The Slow Road to Psychosis

Prodromal symptoms of schizophrenia include cognitive deficits, mood changes, and subthreshold psychotic symptoms, often preceding full psychosis by weeks to years. Assessment tools are crucial for identifying individuals at high risk of developing psychosis, aiding early intervention efforts. Read more here.

Difficulties With Insurance and Patient Care: “Why Is the System So Complicated?”

This case illustrates the challenges of managing psychiatric care within insurance constraints, highlighting the impact of fragmented care and limited access to expertise. Insurance-driven care decisions often complicate patient management, emphasizing the need for improved communication and collaboration among healthcare providers, patients, and families. See further discussion here.

Mental Illness Is an Equal Opportunity Employer

Affluence can be a double-edged sword with mental health outcomes, authors note. Affluence may lead to stress and anxiety, lessened sense of purpose, or deviation from standard of care. Treating affluent patients presents a unique situation that clinicians may need to actively adjust to. See the full article here.