Catatonia occurs in a wide range of neuropsychiatric conditions. Among the psychiatric disorders, occurrence of catatonia has rarely been documented in obsessive-complsive disorder. Given the paucity of reports, we report two cases of obsessive compulsive disorder that presented as catatonia.
Introduction Health and social service providers have limited expertise with regard to assessing and treating psychiatric disorders in adults with intellectual and developmental disabilities. The aim of this study was to describe the development and pilot evaluation of a virtual capacity-building program (Project ECHO) focused on supporting the mental health of adults with these disabilities in Ontario, Canada.Method The pilot program consisted of 12 weekly 1.5 hour sessions hosted through a video-conferencing platform, with a combined focus of didactic teaching and case-based learning, led by an interprofessional team of subject matter experts. The program evaluation was informed by Moore's evaluation framework for continuing medical education. Ongoing attendance tracking, weekly surveys, and pre-post questionnaires were used to evaluate participation, satisfaction, learning and self-efficacy, and practice change.Results The program included 62 participants from across Ontario, Canada, from both the health and social service sectors. Seventy-three percent of participants attended six or more sessions, with high participant satisfaction ratings seen with the program. A statistically significant improvement in self-efficacy mean scores of 14.7% was observed pre-post. Seventy-four percent of respondents indicated that they had changed their practice because of participating in this ECHO.Conclusion Good participant retention, satisfaction, and increased confidence suggests this cross-sector virtual medical education program may have value for health and social service providers as they support the mental health of adults with intellectual and developmental disabilities.
The present study explored psychopathological dimensions in psychoses of children and adolescents and the distribution of demographic and clinical variables across different psychopathological domains. This study included 101 consecutive patients aged 6-18 years who had a DSM-IV psychotic disorder (schizophrenia and related disorders or mood disorders). Exclusion criteria included presence of organicity, substance use disorders, and any other childhood disorder. Psychopathology was assessed with Scales for Assessment of Positive and Negative Symptoms. Analysis revealed a four-factor model comprising primary negative, secondary negative, manic and paranoid factors. Patients were regrouped into one of the four factors based on their symptomatology. Patients in these four groups differed in education and age of onset and duration of illness. This study confirmed the existence of a factor structure in psychoses of children and adolescents.
This study aims to evaluate the impact of several organisational initiatives implemented as part of a physician engagement, wellness and excellence strategy at a large mental health hospital. Interventions that were examined include: communities of practice, peer support programme, mentorship programme and leadership and management programme for physicians.A cross-sectional study, guided by the Reach, Effectiveness/Efficacy, Adoption, Implementation and Maintenance evaluation framework, was conducted with physicians at a large academic mental health hospital in Toronto, Canada. Physicians were invited to complete an online survey in April 2021, which composed of questions on the awareness, use and perceived impact of the organisational wellness initiatives and the two-item Maslach Burnout Inventory tool. The survey was analysed using descriptive statistics and a thematic analysis.103 survey responses (40.9% response rate) were gathered from physicians, with 39.8% of respondents reporting experiences of burn-out. Overall, there was variable reach and suboptimal use of the organisational interventions reported by physicians. Themes emerging from open-ended questions included the importance of addressing: workload and resource related factors; leadership and culture related factors; and factors related to the electronic medical record and virtual care.Organisational strategies to address physician burn-out and support physician wellness require repeated evaluation of the impact and relevance of initiatives with physicians, taking into account organisational culture, external variables, emerging barriers to access and participation, and physician needs and interest over time. These findings will be embedded as part of ongoing review of our organisational framework to guide changes to our physician engagement, wellness and excellence strategy.
Anupam Thakur, Karuppiah Jagadheesan, Vinod Kumar Sinha, Department of Child and Adolescent Psychiatry, Central Institute of Psychiatry, Ranchi, India: Lamotrigine, a new anti-epileptic mood stabilizer, with documented therapeutic benefits for refractory bipolar disorder [1], is reported to enhance clinical improvement in bipolar affective disorder when added to valproate therapy in adults [2]. The present report reveals the clinical efficacy and safety of such combination therapy for the treatment of paediatric bipolar affective disorder. A 71/2-year-old boy, RM, presented with DSMIV bipolar affective disorder, mixed affective episode. His physical state and blood investigations were unremarkable, but electroencephalogram (EEG) showed generalized epileptiform (spike-waves) activities. He was commenced on sodium valproate 600 mg/day (20 mg/kg/day) along with olanzapine 2.5 mg/day, the latter being started for aggression. Due to lack of clinical response, at 6 weeks, lamotrigine was added to this regimen at a dose of 12.5 mg/day. The lamotrigine dose was gradually increased with 12.5 mg every 2 weeks and at 8 weeks of treatment, while on a dose of 62.5 mg/day, his symptoms remitted completely with no evidence of any adverse effects. Olanzapine was discontinued after 1 month on follow-up, and he remained symptom-free for the next 6 months. The report shows that lamotrigine add-on to sodium valproate therapy facilitated clinical remission and that this combination was well tolerated. The presence of EEG abnormalities could be considered a potential factor favouring clinical improvement with an anti-epileptic mood stabilizer therapy [3]. However, symptomatic remission in this patient, following combination therapy, suggests that the differential pharmacodynamic properties of valproate (GABA enhancer) and lamotrigine (sodium channel stabilizer) [4] could possibly have had a synergistic effect in facilitating clinical remission.
To investigate the incidence and phenomenology of catatonia in a child and adolescent population.Children and adolescents who had attended a paediatric psychiatric outpatient clinic between April and July 2001 were examined for catatonic signs with a formal catatonia rating scale, and patients who had at least two catatonic signs were included.Eleven patients met the criteria (5.5% of the entire sample and 17.7% of the patients with affective and nonaffective psychotic disorder); of them eight had an affective disorder and three a nonaffective disorder. The mean catatonic scores were significantly high for males and patients with mental retardation.This study shows that catatonia occurs in children and adolescents. Further studies are essential to clarify the distribution of catatonia across various diagnoses and the outcome of paediatric catatonia.
Despite the increasing global population of individuals with intellectual and developmental disabilities (IDD), this population remains especially vulnerable to health disparities through several factors such as a lack of access to sufficient medical care and poor determinants of health. To add, numerous studies have shown that healthcare professionals are still insufficiently prepared to support this population of patients. This review synthesizes the literature on current pre-graduate IDD training programs across healthcare professions with the goal of informing the creation of evidence-based curricula.
Abstract Background Despite the increasing global population of individuals with intellectual and developmental disabilities (IDD), this population remains especially vulnerable to health disparities through several factors such as a lack of access to sufficient medical care and poor determinants of health. To add, numerous studies have shown that healthcare professionals are still insufficiently prepared to support this population of patients. This review synthesizes the literature on current pre-graduate IDD training programs across healthcare professions with the goal of informing the creation of evidence-based curricula. Methods Four major databases were searched for current pre-graduate IDD training interventions for healthcare professionals. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram and the Best Evidence Medical Educations systematic review guide were used to frame our collection and analysis. Results Of the 6236 studies screened, 24 studies were identified, with most studies involving medical students (50%). Of note, 38% of studies were interprofessional. Most interventions utilized multiple pedagogical methods with a majority including clinical experiences (83%) followed by theoretical teaching (50%). Kirkpatrick outcomes showed 13% were level 0, 9% were level 1, 17% were level 2, 33% were level 2B, 25% were level 3, 4% were level 4A, and none were level 4B. Conclusions There is a paucity of formally evaluated studies in pre-graduate health professional IDD education. As well, there are a lack of longitudinal learning opportunities and integration into formal curriculum. Strengths identified were the use of multimodal approaches to teaching, including interprofessional approaches to optimize team competencies.
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