Using the Project ECHO Model to Increase Pediatric Primary Care Provider Confidence to Independently Treat Adolescent Depression.

Objective: The model for the Extension for Community Healthcare Outcomes (Project ECHO®) was used to extend specialist support to the pediatric medical home for the treatment of adolescent depression by taking a comprehensive, disease-specific approach.

Methods: Child and adolescent psychiatrists constructed a course to train community pediatric primary care providers (PCPs) to screen patients for depression, initiate evidence-based interventions, and provide ongoing management. Participants were assessed for changes in clinical knowledge and self-efficacy.

The State of Forensic Literature on Persons with Intellectual Disability Who Sexually Offend.

Persons with intellectual disability charged with sexual crimes (PWID/SC) pose a unique challenge for the forensic psychiatrist. They represent a heterogeneous group whose motivations and pathology range from a simple lack of adaptive functioning to more complex comorbid paraphilic disorders. Although there is a growing body of literature on the risk assessment and treatment of PWID/SC, there is a relative lack of guidance and research on the evaluation of these individuals throughout the legal processes that follow being charged with a sexual crime.

An Unusual Delayed Complication of Urogynecologic Surgical Mesh: Perirectal Abscess 10 Years After Initial Placement Treated by Endoscopic Removal.

Surgical mesh is commonly used for the management of pelvic organ prolapse and stress urinary incontinence with overall beneficial effects. However, the Food and Drug Administration has issued safety notifications about potentially serious complications assisted with the use of synthetic mesh in pelvic organ prolapse procedures. In this report, we describe a perirectal abscess in a patient which developed 10 years after initial mesh placement.

Transrectal Endoscopic Ultrasound-Guided Drainage of a Tubo-Ovarian Abscess Via a Lumen-Apposing Metal Stent.

Tubo-ovarian abscess (TOA) is a potentially lethal condition, often requiring a combination of medical and surgical interventions. Endoscopic ultrasound (EUS)-guided drainage is a known modality for safe and effective management of pelvic fluid collections, but its role for the treatment of TOA is not well documented. We report the first known case of successful treatment of a large TOA with EUS-guided transrectal drainage using a lumen-apposing metal stent.

Misconceptions About Working in Correctional Psychiatry.

Incarcerated individuals have high rates of mental disorders and substance use disorders compared with the general population, yet correctional facilities in the United States have difficulty recruiting mental health professionals. This has led to shortages in the availability of clinicians who can provide psychiatric care in these settings. During training and in practice, mental health professionals may develop misconceptions about correctional psychiatry that deter them from the field.

Reducing Phlebotomy Utilization With Education and Changes to Computerized Provider Order Entry.

Introduction: Daily phlebotomy is often a standard procedure in hospitalized patients. Recently, this practice has begun receiving attention as a potential target for efforts focused on eliminating overuse. Several organizations have published their efforts in this arena.

Bi-lobar liver biopsy via EUS enhances the assessment of disease severity in patients with non-alcoholic steatohepatitis.

Background: In patients with non-alcoholic fatty liver disease (NAFLD), all-cause mortality increases with fibrosis stage. Liver biopsy (LB), performed predominantly in the right lobe, assesses fibrosis, however, right lobe LB may not be sufficient due to histological variation in different lobes. Endoscopic ultrasound (EUS) allows for biopsy of right and left liver lobes in the same setting.

No Stone Left Unturned: Using Choledocholithiasis to Open a Papillary Stenosis via a Choledochodudenal Fistula.

In a patient found to have cholelithiasis and choledocholithiasis, a choledochoduodenal fistula was used to gain access to the bile duct. Due to severe stenosis and atrophy of the major papilla, cannulation was not possible. Stones were purposely impacted in the native ampulla to cause bulging and stretching of the stenosis.

Obtaining an Adequate Specimen for the Diagnosis of Pigmented Lesions.

Melanoma is a common, potentially deadly disease but is curable if caught early. A specimen of a pigmented lesion must capture the entire width and depth of the lesion to evaluate the lesion's size, symmetry, and circumscription. Saucerization shaving, punching, and excision biopsy are 3 techniques that can be used to achieve a satisfactory specimen.

Ice-pack dermatosis: a cold-induced dermatitis with similarities to cold panniculitis and perniosis that histopathologically resembles lupus.

Importance: Cold panniculitis is a self-limited condition, manifesting as erythematous plaques or nodules after cold exposure, that typically affects infants and children. Recently, a variant involving the lateral thighs of equestrians has been described. Since the original report of this variant, some confusion has arisen in the literature in which the terms equestrian cold panniculitis and equestrian perniosis are both used.

Tanning themselves to death: a new teen fad.

Incidence rates of melanoma continue to rise, especially in young women, despite the enormous body of evidence that identifies ultraviolet radiation as a skin carcinogen. It is time for a change in societal norms, an increase in counseling of young adults about the risks of indoor tanning facilities, and to prevent young adults from tanning by introducing new legislation.

Staphylococcus aureus infections in kidney transplantation: a matched case controlled study.

Background: Data are lacking on the risk factors and outcomes of Staphylococcus aureus infections in kidney transplant recipients.

Methods: Kidney recipients with S. aureus infections (n = 20) were retrospectively identified and compared to age- and transplant-type-matched (1:2) non-S.

Women accused of sex offenses: a gender-based comparison.

Sexual offenses committed by women are likely underestimated and under-reported. This exploratory study compares and contrasts women accused of sexual offenses and their male counterparts. Data were retrospectively compiled on all alleged female and age-matched male sex offenders who were referred for psychiatric evaluation to a large Midwestern city's court psychiatric clinic over a six-year period.

Reel forensic experts: Forensic psychiatrists as portrayed on screen.

The lay public is much more likely to have encountered a forensic psychiatrist on television or in the movies than to have encountered a real one. Thus, by way of popular culture, the jury's perceptions and expectations of forensic expert witnesses may have been formed long before they take the stand. We describe a typology of five categories of forensic experts portrayed in fiction: Dr.

Violence against mental health professionals: when the treater becomes the victim.

Violence toward mental health staff has been receiving national attention in the face of diminishing resources to treat what appears to be an increasingly violent patient population. Assaults by psychiatric patients against mental health care providers are both a reality and a concern, as the effects of violence can be devastating to the victim. Some staff rationalize that violence is an occupational hazard and believe that they are equipped to cope with it.

Civil commitment in the United States.

This article reviews the academic literature on the psychiatric practice of civil commitment. It provides an overview of the history of involuntary psychiatric hospitalization in the United States-from the creation of the first asylum and the era of institutionalization to the movement of deinstitutionalization. The ethical conflict that the practice of involuntary hospitalization presents for providers, namely the conflict between the ethical duties of beneficence and respect for patient autonomy, is presented.

The perceived functions of alternative primary care options among adults in eastern Canada.

The authors assessed age-group differences in the use, satisfaction and perceptions of 3 acute-care options: after-hours clinics (AHCs), telecare, and hospital emergency departments (EDs). In all, 165 self-administered community surveys were returned. Younger adults used AHCs and telecare more often than did other age groups.

These Boots are Made for Stalking: Characteristics of Female Stalkers.

When one is asked to picture a stalker, images of men with dark sunglasses, trench coats, and surreptitious behavior may come to mind. Contrary to popular belief, it is premature for mental health professionals to discount the actions of female stalkers. This article reviews how stalking is defined and classified in a broad sense and why it is important for mental health professionals to be aware of stalking behavior.

Fathers who kill their children: an analysis of the literature.

Roughly half of filicidal acts are committed by fathers, though the majority of the literature focuses on maternal filicide. This paper reviews the existing literature on paternal filicide with the goal of identifying characteristics common among these fathers. Fathers who killed their children were, on average, in their mid thirties.

An overview of filicide.

Filicide, or the murder of one's own child, is an unfathomable crime. With Andrea Yates's return to trial in the summer of 2006, filicide once again came to the forefront of psychiatric issues in the media. One positive outcome that may be derived from this tragedy is practitioners' heightened awareness that parents may, for a variety of reasons, be compelled to kill their children.

GABAergic modulation of the activity of globus pallidus neurons in primates: in vivo analysis of the functions of GABA receptors and GABA transporters.

Neurons in the external and internal segment of the globus pallidus (GPe and GPi, respectively) receive substantial GABAergic inputs from the striatum and through axon collaterals of neighboring pallidal neurons. The effects of GABA on pallidal activity depend on the synaptic localization of GABA receptors and the distribution and activity of GABA transporters (GATs). To explore the contribution of GABA receptors and transporters to pallidal function, we recorded the activity of single neurons in GPe or GPi before, during, and after local microinjections of GABAergic compounds in awake rhesus monkeys.