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This study sought to determine COVID-19 vaccination rates for individuals with serious mental illness admitted to a large health system in New York State. Vaccination rates among 12,714 patients admitted to psychiatric units and to medical and surgical units were compared between April 6, 2021, and September 30, 2021. Only 40% (N=416 of 1,029) of patients admitted to psychiatric services had at least one COVID-19 vaccination, whereas 64.4% (7,523 of 11,685) of patients admitted to medical and surgical services had at least one vaccination. After adjustment for differences in key demographic and clinical characteristics, patients admitted to psychiatric services had a significantly lower likelihood of vaccination during the study period (risk ratio=0.78, 95% confidence interval=0.73–0.85, p<0.001). Black psychiatric patients had the lowest vaccination rate (28%). Psychiatric patients with acute illness had low COVID-19 vaccination rates. Targeted outreach for COVID-19 vaccination is necessary to reach this population. [ABSTRACT FROM AUTHOR]

Given the published data linking prucalopride with serotonin syndrome, its anxiolytic and antidepressant effects in animal models, and its effect on blood-brain barrier permeability we suspect that prucalopride - likely in combination with escitalopram - precipitated this patient's first manic episode. We queried a drug-drug interaction database, Lexicomp Drug Interactions, for the four medications patient was taking on admission (escitalopram, dicyclomine, prucalopride, tamsulosin). Despite these medication changes, the patient continued to have symptoms of acute mania, including global insomnia, euphoric mood, and grandiose delusions. [Extracted from the article]

The Patient Self Determination Act (PSDA) of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient's preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity (DMC). In general, patients are presumed to have DMC. A patient's DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders. [ABSTRACT FROM AUTHOR]

The article presents a case study of a woman, with mental depression and psychotic-related symptoms, requesting a termination of pregnancy. The obstetrics service evaluated the patient and gave inpatient psychiatry team a 5-day window to treat the patient and make a final capacity determination regarding an abortion request. The woman elected to continue her planned pregnancy and carry the fetus on full term under obstetrics service and care.

Depression presents a wide canvas for considering some approaches, issues, and problems in the study of major categories of mental illness in the context of current behavioral andmolecular neurobiology. The study of depression encompasses multiple interactions among psychiatry, neurology, and neuroscience, as well as interactions with a host of other disciplines. This paper considers issues from an American perspective and discusses topics including historical aspects of the ways humanity has struggled with depression; the growth of approaches, and the "wars" in psychiatry in the middle of the 20th century between different ideologies; the development of psychiatry as a behavioral science inclusive of many disciplines; current diagnostic systems such as the Diagnostic and Statistical Manual ofMentalDisorders (DSM-5) of theAmericanPsychiatricAssociation, and the ICD-10Classification ofMental andBehavioralDisorders of theWorldHealth Organization; the efforts to delineate subtypes of depression; the search for new neurobiological and behavioral targets in the context of the National Institute of Mental Health's Research DomainCriteria framework; and examples of potential future discoveries and disciplines thatmay ultimately improve treatment. [ABSTRACT FROM AUTHOR]

Objectives Individuals with bipolar disorder have high rates of other medical comorbidity, which is associated with higher mortality rates and worse course of illness. The present study examined common predictors of medical comorbidity. Methods The Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE) enrolled 482 participants with bipolar I or bipolar II disorder in a six-month, randomized comparative effectiveness trial. Baseline assessments included current and lifetime DSM- IV- TR diagnoses, demographic information, psychiatric and medical history, severity of psychiatric symptoms, level of functioning, and a fasting blood draw. Medical comorbidities were categorized into two groups: cardiometabolic (e.g., diabetes, hyperlipidemia, and metabolic syndrome) and non-cardiovascular (e.g., seizures, asthma, and cancer). Additionally, we looked at comorbid substance use (e.g., smoking and drug dependence). Results We found that 96.3% of participants had at least one other medical comorbidity. Older age predicted a greater likelihood of having a cardiometabolic condition. Early age of onset of bipolar symptoms was associated with a lower chance of having a cardiometabolic condition, but a greater chance of having other types of medical comorbidity. Additional predictors of other medical comorbidities in bipolar disorder included more time spent depressed, less time spent manic/hypomanic, and longer duration of illness. Medications associated with weight gain were associated with low high-density lipoprotein and abnormal triglycerides. Conclusions There appears to be a substantial medical burden associated with bipolar disorder, highlighting the need for collaborative care among psychiatric and general medical providers to address both psychiatric and other medical needs concomitantly in this group of patients. [ABSTRACT FROM AUTHOR]

Objective The aim of the present case report is to describe a potential interaction between valproic acid and oxcarbazepine that resulted in hepatic injury. Methods We report the case of a 46-year-old man with schizoaffective disorder who was cross-titrated from valproic acid to oxcarbazepine because of liver injury. Results Initiation of oxcarbazepine four days after stopping valproic acid produced a significant elevation in liver enzymes that normalized with oxcarbazepine discontinuation and did not reappear with its reintroduction five days later. Conclusions Our findings suggest that a longer washout period or another agent should be considered when transitioning from valproic acid to oxcarbazepine. [ABSTRACT FROM AUTHOR]