From neurological abnormalities in first-episode psychosis to psychiatric boarding in emergency departments, here are highlights from the week in Psychiatric Times.
This week, Psychiatric Times® discussed a wide variety of psychiatric issues and industry updates, from neurological abnormalities in first-episode psychosis to psychiatric boarding in emergency departments. Here are some highlights from the week.
Positive Data for First and Only Treatment Approved for Agitation in Alzheimer Dementia
Recently released positive phase 3 trial data of brexpiprazole (Rexulti)—the first and only treatment approved to treat agitation associated with dementia due to Alzheimer disease—showed it reduced agitation in Alzheimer dementia significantly in 3 agitation symptoms categories: aggressive behaviors, physically nonaggressive behaviors, and verbally agitated behaviors.
“Treatment of agitation is essential to increase the comfort, quality of life, and safety of patients with Alzheimer dementia; to ease the burden on their caregivers; and to allow patients to live at home longer,” wrote the authors. Continue Reading
Prevalence of Neuroradiological Abnormalities in First-Episode Psychosis
There is no present consensus regarding the role of magnetic resonance imaging (MRI) scanning in the clinical assessment of patients presenting with FEP. Some guidelines recommend scanning all patients, whereas others recommend restricting to cases in which a secondary cause of psychosis is suspected.
Although most radiological abnormalities in patients with FEP are incidental, a minority of abnormalities require a change in clinical care. Estimates of clinically relevant radiological abnormalities in FEP range from 0% to 10%. It is important to note that in otherwise healthy individuals, white matter hyperintensities are associated with incident cognitive decline, cerebrovascular risk, and mortality. Continue Reading
Restorative Justice vs Hate Speech
Individuals who are denied agency have all the more need to exercise it. Psychiatric clinicians can help empower patients to exercise their agency, including by resorting to legal remedies. Moreover, clinicians who advise public and private institutions on risk management can provide guidance for preventing retraumatization of vulnerable individuals, as well as enabling such individuals to seek redress.
Restorative justice offers those who have been disenfranchised, marginalized, and disempowered a means of recovering agency. The need to respond to the harms that hate speech creates in vulnerable populations is imperative as humanity increasingly spreads messages via social media. New research on survivors of traumatic incidents and those who live with the day-to-day trauma of ambient prejudice demonstrates a need to empower victims of hate speech against its perpetrators. Continue Reading
Psychiatric Boarding in Emergency Departments
“If you are having an emergency, please call 911 or go to your nearest emergency department.” This is a common statement heard after hours for those seeking care from their outpatient mental health providers. The statement may have been modified recently, directing patients to call 988, but the latter phrase continues to exist. But what does it mean to receive crisis care in the typical emergency department?
Unfortunately, care in the average emergency department (ED) tends not to be trauma informed or person centered. EDs are very good at addressing life-threatening emergencies but fall short when treating patients in crisis, and the setting itself may lead to iatrogenic agitation. Busy EDs are loud, brightly lit, and have policies that lead many to feel dehumanized (possessions taken away, forced into scrubs/gowns, placed in a room that may look like a prison cell). Continue Reading
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