Korean Americans have one of the highest rates of depression of the Asian subgroups in the United States, and they have culture-related factors that affect their mental health. It is important for health care providers to understand the cultural considerations of Korean Americans to better address their mental health. This review article delves into the pertinent cultural practices of Korean Americans for navigating discussions of mental health. We note the cultural views, language barriers, historical traumas, and immigration challenges of Korean Americans, and we consider the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision's discussion of Koreans. We also include a table of Korean mental health terms with cultural significance and a list of online resources tailored for Korean Americans. In addition, we discuss the unique experiences of North Korean refugees that affect their mental health. Overall, this review informs health care providers about cultural considerations for navigating discussions of mental health with Korean Americans.

Charles Bonnet syndrome (CBS) is a clinical condition in which patients with visual impairment experience visual hallucinations (VH) in the presence of clear consciousness. It typically occurs in elderly people and confuses clinicians with multiple differential diagnoses due to VH, which can be present in a variety of clinical conditions ranging from psychosis to neurocognitive disorders (eg, neurocognitive disorder with Lewy bodies). In the latter, the concomitant presence of cognitive decline and parkinsonism aids the diagnosis. Here we report the case of an elderly man with retinitis pigmentosa (and thus significant visual loss), who presented with VH, thus warranting a diagnosis of CBS, but who later also manifested a rapid onset cognitive decline and parkinsonism, which necessitated a new diagnosis of major neurocognitive disorder with Lewy bodies. This case prompted us to consider whether CBS is a harbinger of neurocognitive disorder with Lewy bodies or whether there is a clinical overlap between these 2 clinical constructs. This case report attempts to unravel this clinical conundrum.

Borderline personality disorder (BPD) poses significant challenges for early identification and diagnosis due to its intricate symptomatology that overlaps with other psychiatric illnesses. To address this challenge, the McLean Screening Instrument for BPD (MSI-BPD) was developed to identify individuals displaying potential BPD symptoms. This review aims to consolidate the current limited body of research on the MSI-BPD, delving into its origins, the rigor of its validation process, its practicality in clinical settings, and potential applications. By comprehensively examining these aspects, clinicians and researchers involved in BPD assessment and diagnosis can develop a deeper understanding of the instrument's utility. The MSI-BPD's development involved meticulous consideration of BPD diagnostic criteria, resulting in a tool tailored to effectively capture relevant symptoms. Validation studies have provided supportive evidence for its accuracy in identifying individuals at risk of BPD, thereby underlining its utility as a resource for early screening and intervention in clinical settings. However, it is essential to acknowledge that, while the MSI-BPD demonstrates satisfactory psychometric properties and utility as a screening tool for BPD, its diagnostic accuracy may vary across diverse populations. Consequently, clinicians and academics must judiciously consider sample characteristics and potential limitations when utilizing this instrument in both clinical and research contexts. Recognizing the advantages and potential applications of the MSI-BPD within a comprehensive approach to addressing BPD is important for professionals working in the field of BPD assessment and diagnosis. It is important to emphasize that the MSI-BPD is a screening tool and one data point in understanding patients presenting with complex symptomatology.

Subjective cognitive complaints are common among patients presenting for evaluation of attention-deficit/hyperactivity disorder (ADHD). Despite these complaints, research overwhelmingly suggests that reported cognitive deficits do not align with objective neurocognitive performance. This study explored the relationship between subjective cognitive complaints, objective neuropsychological functioning, and performance and symptom validity testing in adult patients referred for evaluation due to concern about ADHD.

Psychodynamic therapy (PDT), a technical adaptation of psychoanalysis, is one of the most widely practiced forms of psychotherapy, making evaluative research on it essential. Although research on PDT has been ongoing for several decades, theoretical and practical challenges initially hindered the adoption of evidence-based medicine standards in such research, a shift that has largely taken place over the past 20 years. This article reviews the evolution of evaluative research on PDT for mental disorders in adults, with a focus on those with complex conditions. Since the first prospective evaluative studies in the 1950s, an accumulating body of knowledge-including cohort studies, randomized controlled trials, and meta-analyses-has established PDT as an evidence-based treatment for common mental disorders such as depression, anxiety, somatic symptoms and related disorders, and personality disorders, as well as complex mental disorders involving combinations of these conditions. There is also evidence supporting PDT's usefulness in treating anorexia nervosa and opioid dependence, along with some findings suggesting its potential use for schizophrenia spectrum disorders, bulimia nervosa, and posttraumatic stress disorder. Recent studies indicate that PDT can serve as a personalized treatment, promoting deep and lasting psychopathological changes in patients with severe, complex, and chronic mental disorders, involving specific technical features and mechanisms of change. These findings support the inclusion of PDT in mental health care policies and training, while ongoing research continues to explore its optimal treatment parameters.

This article presents a case demonstrating that multiple medication use can begin on the first outpatient visit if the prescriber makes multiple psychiatric diagnoses and then feels the need to treat each diagnosis with a different central nervous system active medication labeled for each indication. This approach poses potential problems. First, a single drug or perhaps 2 drugs, in this case, may have been sufficient as initial and perhaps final treatment. Second, the prescriber cannot tell which drug(s) is/are producing either a beneficial or an adverse effect. This approach may stem from prescribers thinking that if they have made a diagnosis then they need to treat it with a drug labeled for or clinically used to treat that indication rather than taking a more conservative approach. However, such an approach adversely affects the ability to determine cause-and-effect relationships and hence adversely affects the ability to determine the best way to revise the treatment going forward.

To examine trends and predictors of administrative actions against psychiatric clinicians' licenses between 2002 and 2022.

Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune neuromuscular junction disorder characterized by proximal weakness, autonomic dysfunction, and areflexia associated with antibodies against voltage-gated calcium channels (VGCCs). Psychotic symptoms can occur in many autoimmune neurological disorders but they have rarely been observed in myasthenic syndromes. We report the case of a 21-year-old woman with primary autoimmune LEMS due to anti-VGCC antibodies subtype P/Q, who developed psychotic symptoms 3 years after the onset of motor symptoms. These symptoms decreased after every cycle of monthly intravenous immunoglobulin therapy. Different causes of reversible psychosis were excluded, such as autoimmune encephalitis. Due to a worsening of the patient's muscle strength, and the psychotic episodes, the patient received several treatments including an admission to a neurology unit. To our knowledge, this is the first described case of psychotic symptoms associated with LEMS. We speculate that VGCC antibodies could have a role in the development of mental symptoms, although additional hypotheses are also discussed.

Ciprofloxacin is an antibiotic from the fluoroquinolone group that is frequently used in many clinical practices. In addition to its peripheral neuropathic side effects, it is an antibiotic that can pass through the blood-brain barrier due to its lipophilic features and cause rare central nervous system symptoms. Although cases of neuropsychiatric symptoms developing after treatment with ciprofloxacin have been reported in the literature, the number of reports of manic episodes after ciprofloxacin use is limited, and there have been no reports of delirious mania developing after ciprofloxacin use until the case presented in this report. Here we report the case of a 52-year-old woman who developed manic symptoms after receiving ciprofloxacin, which evolved into delirious mania. Clinical factors that may predispose to neurotoxicity are discussed and compared with features of the mania cases in the literature. The underlying neurobiological mechanisms are also reviewed.

Insomnia, characterized by difficulty initiating or maintaining sleep, or poor sleep quality, is highly prevalent among individuals with substance use disorders (SUDs). The relationship between the 2 conditions is often bidirectional. We reviewed the impact of various substances (alcohol, stimulants, opioids, and cannabis) on sleep architecture and their potential to contribute to insomnia. The role of insomnia as a risk factor for different SUDs is also explored. Assessment strategies for co-occurring insomnia and SUDs are discussed, emphasizing the importance of reassessment throughout various phases of substance use treatment. Evidence-based nonpharmacologic and pharmacologic interventions for managing insomnia in SUD patients are presented, highlighting the importance of tailoring treatment approaches to individual needs and substance-specific considerations. Assessment and management of comorbid insomnia and SUDs is crucial but can be difficult; however, studies have shown some benefits using nonpharmacologic and pharmacologic approaches.

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is one of the most commonly used instruments for assessing and quantifying the presence and severity of obsessive-compulsive disorder (OCD) symptoms. Both the interview and self-report (SR) versions of the original Y-BOCS have demonstrated good psychometrics. However, areas for revision were noted regarding the measure's severity ceiling and a "resistance to obsessions" item that did not perform adequately in psychometric testing and was not consistent with theoretical models of OCD. The Y-BOCS-II was thereby created to address these concerns. While the interview has demonstrated strong psychometrics, psychometric evaluation of the self-report version is currently nonexistent. In a sample of 63 adult patients seeking outpatient treatment for OCD (66.7% female, 77.8% white, and 17.5% Hispanic or Latine), we examined the psychometric properties of the Y-BOCS-II-SR, including the level of agreement with the Y-BOCS-II items, subscales, and severity qualifiers, as well as its internal consistency, and its convergent validity with measures of OCD, functional impairment, and quality of life. As expected, the Y-BOCS-II-SR demonstrated strong psychometric properties and expected overlap with responses obtained using the Y-BOCS-II. The findings provide strong initial support for the psychometric properties of the Y-BOCS-II-SR and suggest that it is an efficient and effective option to measure OCD severity.

The Level of Personality Functioning Scale (LPFS) was introduced in DSM-5 to articulate a conceptual foundation for all types of personality psychopathology, and to provide an assessment of the severity of impairment. Constructed using universal human capacities related to self- and interpersonal functioning, the LPFS defines a continuum of 5 levels ranging from optimal functioning to extreme impairments in functioning. While there have been a growing number of empirical studies demonstrating its reliability and validity, the LPFS was designed fundamentally as an informative clinical tool, potentially useful to practitioners working in a variety of roles using diverse interventions. This article addresses the issue of treatment utility from 2 particular perspectives. First, we illustrate how the capacities targeted by the LPFS offer a framework for treatment, applicable to a variety of theoretical or methodological orientations. We illustrate that the different facets of the LPFS may provide general aims for treatment by identifying the pathways through which change is realized in (whatever) psychotherapy. Second, we suggest how the levels of functioning may inform pathways toward change by providing information useful for treatment assignment and planning, such as the therapist's stance, the types of intervention, and specific goals in treatment. Through discussing these issues while using brief clinical vignettes, we hope that this article may stimulate clinicians to use the LPFS and discover its value in clinical practice.

This column addresses the role of dreams in psychoanalysis and psychodynamic therapy. It includes an autobiographical perspective on how a dream led this psychiatrist to become a psychoanalyst and an introduction to social dreaming.

The relationship between the scientific method and clinical practice was discussed in an earlier column. Another column described the application of analog scales to clinical practice. This column will discuss how the combination of these 2 strategies can be used to increase the efficiency and completeness of outpatient psychiatric management.

In this case series, we present several examples from participants (2 patients and 1 healthy control) of a 12-week pilot feasibility study to create a digital phenotype of depression (unipolar or bipolar) through active and passive data collection from a smartphone and a wearable device combined with routine clinical care for mood disorders. The selected cases represent real clinical examples that highlight the intrinsic challenges that should be expected when conducting similar studies, including appropriate health data privacy protection, clinical standardization, and interindividual differences in levels of engagement and acceptability of active and passive data collection (ie, self-reported, behavioral, cognitive, and physiological data), particularly with patient-generated data in mobile apps, digital proficiency habituation, and consistent use of wearable devices. In the context of the rapidly growing use of digital technologies in psychiatry, anticipating challenges for the integration of personal mobile devices and smartphone mental health apps as aides to track specific aspects of depressive disorders is critical for a clinically meaningful digital transformation of mood disorders care.

Prolonged grief disorder (PGD) is a new diagnosis that is often mistaken for other psychopathologies. We report a case of PGD in a patient who screened positive for personality disorder. Both PGD and personality disorder symptoms were much improved after a course of prolonged grief disorder therapy.

Intentional overdose with semaglutide is an infrequently reported phenomenon. We present the case of a 39-year-old transgender male-to-female who attempted suicide by an intentional overdose of semaglutide (Ozempic). Her symptoms after the overdose were mild and self-limiting in nature. This finding reflects positively on the safety profile of the frequently prescribed weight-loss and diabetes medication, Ozempic.

Catatonia is a neuropsychiatric syndrome affecting movement, emotion, speech, and behavior, which commonly occurs secondary to medical or psychiatric disorders and with comorbid illnesses. We report the case of an 18-year-old male with a history of depression, anxiety, attention-deficit/hyperactivity disorder, polysubstance use, and previous suicide attempts who presented to the hospital from a residential eating disorders treatment facility, due to psychomotor slowing. The patient scored 3 or lower on the Bush-Francis Catatonia Rating Scale (BFCRS), but he showed marked improvement following 2 mg of intravenous lorazepam. The patient was referred for ECT, experienced dramatic improvement, and was discharged at his baseline functioning. His discharge diagnosis was catatonic syndrome secondary to severe melancholic depression. Catatonia may present a diagnostic challenge as no single catatonia screener captures all possible phenotypes. The patient consistently scored low on the BFCRS but he had a clear response to standard-of-care catatonia treatment. Psychomotor slowing is common in catatonia but is not designated as a catatonic feature in either the DSM-5 or the BFCRS. This case also presented diagnostic complexity as the patient initially presented with malnutrition and concern about a possible eating disorder. This report highlights that diagnosing catatonia is challenging, particularly in the context of medical complexity, and that there are discrepancies between diagnostic tools. When suspicion of catatonia is high, despite low individual screening scores, clinicians may consider alternative screening instruments or empiric treatment.