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Background Deep transcranial magnetic stimulation (dTMS) with the H7-coil was FDA cleared for obsessive-compulsive disorder (OCD) in August 2018 based on multicenter sham-controlled studies. Here we look at the efficacy of dTMS for OCD in real world practices. Methods All dTMS clinics were asked to supply their data on treatment details and outcome measures. The primary outcome measure was response, defined by at least a 30% reduction in the Yale Brown Obsessive Compulsive Scale (YBOCS) score from baseline to endpoint. Secondary outcome measures included first response, defined as the first time the YBOCS score has met response criteria, and at least one-month sustained response. Analyses included response rate at the endpoint (after 29 dTMS sessions), number of sessions and days required to reach first response and sustained response. Results Twenty-two clinical sites with H7-coils provided data on details of treatment and outcome (YBOCS) measures from a total of 219 patients. One-hundred-sixty-seven patients who had at least one post-baseline YBOCS measure were included in the main analyses. Overall first and sustained response rates were 72.6% and 52.4%, respectively. The response rate was 57.9% in patients who had YBOCS scores after 29 dTMS sessions. First response was achieved in average after 18.5 sessions (SD = 9.4) or 31.6 days (SD = 25.2). Onset of sustained one-month response was achieved in average after 20 sessions (SD = 9.8) or 32.1 days (SD = 20.5). Average YBOCS scores demonstrated continuous reduction with increasing numbers of dTMS sessions. Conclusions In real-world clinical practice, the majority of OCD patients benefitted from dTMS, and the onset of improvement usually occurs within 20 sessions. Extending the treatment course beyond 29 sessions results in continued reduction of OCD symptoms, raising the prospect of value for extended treatment protocols in non-responders.

Mentalization-based treatment offers a framework for treating youth with chronic suicidality or NSSI. This chapter explores how this approach can be used with young people who are actively suicidal or NSSI; young people after a suicide or NSSI act; to engage in effective supervision during a crisis; and to process the aftermath of a completed suicide. Case studies are presented to illustrate the technique in action. The overarching idea is that most crisis situations are actually a perfect fit for the mentalizing stance.

Mentalization-based therapy for adolescents is an evidenced-based treatment for adolescents with suicidal and self-injurious behaviours. This chapter focuses on the important elements of the mentalizing framework needed to effectively utilize mentalizing theory and skills in psychotherapy with adolescents and their families. These elements include the mentalizing assessment—the development of a mentalizing formulation that is co-constructed with the adolescent, the family and mental health team and co-construction of a mentalizing safety plan. Finally, a review of the overall structure and anticipated time-frame necessary to decrease the symptoms of suicidal and self-injurious thoughts and behaviours through the improving mentalizing in the adolescent and their family is provided thereby increasing social cohesion, competence and connection.

Mentalizing is a crucial aspect of all psychotherapeutic treatments. In addition to all the tools a family therapist carries into the therapy space, mentalizing provides a way of connecting to families with the secure base of therapy/therapist to allow for more curious and open discussions that can feel threatening to all family members. Uncovering hidden, sometimes long-held, mental states within families, is key in supporting secure attachment in the context of the family system. Family mentalizing therapy can assist young people struggling to find their voice such that the entire family system can develop improved ways of connecting while decreasing risk of injury to themselves.

Most patients with borderline personality disorder (BPD) experience symptoms beginning in childhood, with onset of self-injury most often before the teenage years. Understanding BPD in adolescents should therefore be considered a core competency in child and adolescent mental health care. Accurate recognition and disclosure of the diagnosis is crucial to the treatment of BPD in adolescence. This should be followed by thorough psychoeducation for patients, families, and other involved mental health and medical professionals to counter erroneous and stigmatized conceptualizations of the disorder. Psychoeducation should be grounded in a developmental context distinguishing clear signs of BPD from normative adolescent behavior. It is important to highlight the transactional nature of factors in the home that can perpetuate or exacerbate BPD’s course so that parents can seek effective coaching and support as well.

Background Clozapine is widely prescribed for treatment refractory patients with schizophrenia, but its use is limited by potentially life threatening adverse effects. Rechallenge after these complications has been occasionally attempted in patients with severe psychotic symptoms. Objective To review the outcome of clozapine rechallenge after potentially life threatening adverse effects. Methods Electronic, all-language, literature search (1972–2011) followed by demographic and clinical data extraction. The outcome of rechallenge was considered favorable when the lower bound of the 95% confidence interval (CI) of the proportion of patients who could continue clozapine was > 50%. Results Altogether, 138 patients (mean age: 36.3 years, 65.7% male, 57.6% Caucasian, virtually all with schizophrenia spectrum diagnosis) underwent clozapine rechallenge after developing neutropenia (n = 112), agranulocytosis (n = 15), neuroleptic malignant syndrome (NMS) (n = 5), myocarditis (n = 4), pericarditis (n = 1) and lupus erythematosus (n = 1). Rechallenge strategies were heterogeneous and not systematically evaluated. Clozapine rechallenge was successful in 78/112 patients (69.6%, CI: 60.6–77.4) after neutropenia, 3/15 (20%, CI: 7.1–45.2) after agranulocytosis, 5/5 (100%, CI: 56–100) after NMS, 3/4 (75%, CI: 30–95) after myocarditis, 1/1 after pericarditis, and 0/1 after clozapine-induced lupus. Successfully rechallenged patients were followed for 16–96 weeks. None of the rechallenged patients died. Conclusions Although controlled studies are clearly needed, using a priori, confidence interval-based criteria, case reports/series suggest that in refractory patients who benefited from clozapine, careful rechallenge can be considered after neutropenia and NMS, but not after agranulocytosis and myocarditis.

We live in a digital age where information can be found instantaneously via the Internet. Studies have shown that consumers search for much of their medical information on the Internet, particularly utilizing blogs and social media platforms. As the mental health field is riddled with misinformation and stigma, this offers a unique opportunity for psychiatrists and mental health professionals to reach a broad audience for mental health education and advocacy. In this review, we discuss the various methods and techniques for blogging and social media. We then review the current recommendations for ethics and professionalism as well as make recommendations to strengthen our guidance in this new and evolving field.