Catatonia is a frequently missed diagnosis on medical wards, delaying effective treatment or permitting accidental use of neuroleptics that can exacerbate the condition. Thyroid storm has rarely been associated with catatonia in case reports, with no prior reviews synthesizing this research. We present a case of catatonia during thyroid storm following administration of low-dose haloperidol followed by a review of previously published cases.

Delirium commonly occurs in older adults following surgery; although its pathophysiology is not fully understood, underlying neurodegeneration is a risk factor.

Major depressive disorder is often associated with subclinical hypothyroidism (SCH), but the clinical and biochemical characteristics in young, first-episode, drug-naive patients remain unclear. This study aims to examine the prevalence and clinical correlates of SCH in this population to enhance screening and management strategies.

Despite rapid shifts in consultation-liaison psychiatry (CLP) training in residency, including increasing general residency training requirements from the Accreditation Council for Graduate Medical Education, greater utilization of advanced practice providers, and effects of the coronavirus-2019 pandemic, the Academy of Consultation-Liaison Psychiatry has not updated recommendations for residency training in CLP since 2014. A national survey of residency program directors in 2021 suggested many changes to the structure of CLP rotations at individual programs over the past decade.

Catatonia is a psychomotor syndrome associated with neurotransmitter disturbances, common in both psychiatric and medical settings. Hypoactivity of the GABA receptor is one of the predominant theories behind the pathophysiology of catatonia, affecting both motor functioning and emotional regulation. Benzodiazepines such as lorazepam are considered the first-line treatment for catatonia. However, up to 27% of catatonia cases fail to respond to benzodiazepines alone. Zolpidem, which can be used as a challenge, monotherapy, or augmentation agent, serves as a promising pharmacological agent for catatonia due to its unique pharmacodynamic and pharmacokinetic profile.

Mild behavioral impairment (MBI) has been associated with global brain atrophy, but the regional neural correlates of MBI symptoms are less clear, particularly among community-dwelling older individuals without dementia. Our objective was to examine the associations of MBI domains with gray matter (GM) volumes in a large population-based sample of older adults without dementia.

The End of Life Option Act (EOLOA) legalized medical aid in dying (MAID) in California in 2015. University of California, San Francisco (UCSF) Health initially implemented a policy requiring a mandatory mental health assessment of all patients seeking MAID, though this was not required by the EOLOA. State-level statistics on EOLOA are available, but less is known about outcomes at individual institutions and how institutional policy affects outcomes for patients seeking MAID.

In 2021, suicide was the second leading cause of death in early adolescent Americans ages 10-14. Research into suicidal behavior in this age group is limited. We report on prior psychiatric care, attempt method, and attempt outcomes in a cohort of 164 early adolescents accrued by first suicide attempt coming to medical attention.

Breastfeeding shares a complex, occasionally contradictory relationship with maternal mental health. Both positive and negative mood impacts have been noted in relation to breastfeeding initiation as well as cessation. Though popular magazines and online forums discuss the onset of psychiatric symptoms following weaning, there is limited medical literature detailing this relationship.

We present the fictional case of a 29-year-old man with sickle cell disease referred to psychiatry for evaluation of depression during an acute pain episode. Consultation-liaison psychiatrists with expertise in sickle cell disease provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching points include the high prevalence of mood and cognitive disorders in this population, as well as pertinent issues related to chronic pain, opioids, and stigma.

Medical psychiatry units (MPUs), also known as complexity intervention units, represent an important innovation for integrating medical and behavioral health care in the hospital setting, thereby reducing the need for sequential medical and psychiatric hospitalization. As US hospitals face an increased demand for mental health services, interest in the MPU model is gaining momentum. However, there is no shared definition for what constitutes an MPU, and significant variation exists among units across the United States that have been designated as an MPU. The lack of a unified definition for MPUs results in significant variability and poses challenges for creating new MPUs and studying existing MPUs. To address this gap, the Medical-Psychiatry Unit Consortium recruited a panel of MPU experts to conduct a consensus study. The consortium used a survey to assess the relative importance of various characteristics of MPUs within the following categories: structural organization, environment and design, spectrum of care, staffing, and culture of care. After two rounds of a modified Delphi process, consensus was achieved with regard to which characteristics are necessary or preferred vs. not necessary or harmful. The necessary or preferred characteristics include those that would be expected on a general medical unit, such as having cardiac telemetry monitoring capabilities, as well as characteristics typical of a psychiatric unit, such as locked unit doors, locked cabinets for patient belongings, and common area or milieu. Overall, this suggests that an ideal MPU combines the ability to provide acute medical care with acute psychiatric care. Notably, staffing and culture of care emerged as categories with the highest ranking of necessary characteristics, outweighing environment, design, or the breadth of services offered. These findings suggest that MPU experts feel teamwork and having a shared mission are critical components of effective MPUs and highlight the importance of staff recruitment and training.

Nonprescribed substance use (NPSU) is a recognized phenomenon exhibited by patients with substance use disorders while admitted to inpatient hospitals. What factors distinguish patients who engage in NPSU, or how their hospitalizations and outcomes differ, remains to be understood in full.

We present a case of a patient who presented for endocarditis and subsequently had a prolonged and challenging hospital course, with much of it spent in the intensive care unit (ICU). Throughout their hospitalization, personality factors, combined with impaired communication and pain in severe medical illness, led to challenging behaviors of disengagement, impulsivity, splitting, agitation, and suicidal statements. Experts in critical care psychiatry review the case and its key elements, including principles of critical care psychiatry and pharmacologic management of ICU patients; communication problems in ICU patients and associated psychiatric distress; the benefits of proactive consultation for challenging patients; and the construct of post-intensive care syndrome. Patients with personality disorders often struggle to cope with severe medical illness, leading to challenging, self-defeating behaviors. Such acts are even more difficult to manage in intensive care, where a patient's tenuous medical status depends on smooth interactions between them and the medical team. We address how these challenges may be mitigated in collaboration with a psychiatric consult team.

Pediatric catatonia is associated with a high degree of morbidity and mortality in children. However, pediatric catatonia is highly responsive to treatment if rapidly identified and appropriate interventions are administered. To our knowledge, there are no current publications which propose a systematic approach for the management of pediatric catatonia.

There is limited characterization of neuropsychiatric symptoms (NPS) in patients with idiopathic intracranial hypertension (IIH). Along with commonly presenting symptoms of IIH, including headache and papilledema, NPS may have a significant impact on IIH outcomes.

Consultation-liaison (CL) psychiatrists are frequently asked to consult on various abnormal movements (1). CL psychiatrists can be instrumental in aiding the primary teams to identify and manage these movement disorders. In this manuscript, we provide an illustrative case of a patient presenting with myoclonus and offer a review on this important topic. Myoclonus accompanied by delirium represents a rare post-transplant complication and can be associated with heightened morbidity and mortality. The incidence of this complication in solid organ transplant recipients is scarcely documented, and its pathophysiology remains inadequately understood. Potential etiologies in the intensive care unit are numerous and likely multifactorial. The literature lacks detailed descriptions of the correlation and association between myoclonus and uremia. Management of this condition requires a multimodal approach, focusing on resolving underlying metabolic disturbances and providing symptomatic treatment.

The benefits of a proactive consultation-liaison psychiatry service have been well documented in the adult population, including decreased length of stay (LOS), increased satisfaction among physicians, and enhanced collaborative care. However, there is no available research on the effectiveness of this model in pediatric hospitals.

As more and more American states legalize medical aid in dying (MAID), Consultation-Liaison Psychiatrists will increasingly be asked to assist medical and surgical colleagues in differentiating this end-of-life practice from suicide. Where suicide is traditionally understood as an act clouded by depression, desperation, or both, MAID represents a terminally medically ill patient's effort to take control of their dying process when death is imminent, likely to occur within 6 months, and inevitable. Rendering opinions on patient suicidality in the setting of a complex co-occurring medical illness is a Consultation-Liaison Psychiatrist's bread and butter. This paper seeks to elucidate 4 points that distinguish MAID from suicide: (1) Hastening death when the end of natural life is approaching is not synonymous with suicide in the vernacular American usage of the term. (2) Unlike suicide, MAID is a highly collaborative process in which dying, mentally capable adults involve their doctors and loved ones in legally recognized decisions to hasten death. (3) The clinical presentation of patients requesting MAID differs from that of individuals whose suicidality is driven by psychopathology. (4) Certain behavioral traits differentiate such MAID patients from suicidal ones. Understanding and applying these distinctions in the consultation-liaison arena will help remove the stigma of suicide from end-of-life care deliberations where it does not belong while ensuring appropriate end-of-life care for dying individuals for whom MAID is the culmination of a carefully considered process of self-determination rather than suicide.

Poor oral intake (POI) among medical-surgical inpatients can cause malnutrition and delay recovery due to medical consequences and the need for more invasive nutritional support. Many psychiatric conditions can cause POI; however, the role that psychiatric conditions play in POI has received limited attention to date.

The HOME Study is the largest and among the most important trials in the history of consultation-liaison psychiatry, and its study team is to be commended for this landmark study. In this article, we provide context for the HOME Study and consider several aspects of the study critical to understanding the nature of the intervention and interpreting its results. First, we compare the model of proactive integrated consultation-liaison psychiatry as implemented in the HOME Study with versions of proactive consultation-liaison psychiatry as commonly practiced in the US. Key distinctions of proactive integrated consultation-liaison psychiatry include a direct assessment of all study arm participants by a consultation-liaison psychiatrist rather than the use of initial screening for acute psychiatric issues, the unique inclusion of an occupational therapist as a member of the proactive integrated consultation-liaison psychiatry team, and patient-level randomization as opposed to unit-based approaches as commonly practiced in the US. Next, we consider several characteristics of the HOME Study sample relevant to its generalizability. These include an average age of 82 years, limited ethnic and racial diversity, and a high prevalence of both cognitive and functional impairment. Third, we review how study methodology informs study interpretation. These include early trial termination due to COVID, which limits power to detect a 1-day reduction in hospital, a mean 3.5-day delay from hospital admission to study enrollment, and the exclusion of patients who had already received a psychiatric consultation, which likely reduced the acuity of mental health issues addressed in this study. Despite these considerations, the HOME Study is a truly remarkable contribution to the literature, and its results will be discussed for years to come. In view of the aging global population, the HOME Study set about to tackle an especially ambitious and forward-looking question by focusing exclusively on older hospitalized adults. Like all good studies, this trial raises many important questions. As the first randomized trial of proactive consultation-liaison psychiatry of any form, the HOME Study is an encouragement to the field to consider the range of potential benefits of providing proactive, integrated mental health care to medical and surgical inpatients with mental health needs.