6 results
Can COVID-19 Cause Acute Psychosis in Pediatric Patients? A Case Report
- Sultana Jahan, Ellen O’Neill, Jordan Richardson
-
- Journal:
- CNS Spectrums / Volume 28 / Issue 2 / April 2023
- Published online by Cambridge University Press:
- 14 April 2023, p. 261
-
- Article
-
- You have access Access
- Export citation
-
Objectives
To demonstrate that COVID-19-associated acute psychosis, though rare, can happen in the pediatric patient population. Patients with new-onset psychosis should be tested for COVID-19 infection, and other organic causes of psychosis should also be considered (e.g., delirium, medication-induced psychosis, and catatonia).
MethodPatient X, a 14-year-old female with no known past psychiatric history, presented to the local emergency room following odd behavior for 3 days and having tested positive for COVID-19 2 weeks prior. The patient’s mother reported odd behaviors, including the patient claiming her fish was calling her name and her name was being repeated on TV. She had been moving slowly with occasional staring. The patient’s mother reported episodes in which the patient was repeating phrases over and over and where she would require redirection to a task. When the patient planned to have a bath, her mother noted that she was naked in her room while looking for something and then needed redirection to go take a bath. She did not have any episodes of agitation. A thorough psychiatric evaluation indicated she was experiencing visual hallucinations. Her vitals were within normal ranges, except for a mildly elevated heart rate. The patient was admitted for further testing, assessment, and management. She was started on chlorpromazine 10 mg daily as needed for psychosis.
ResultA complete blood count with differential (CBC), complete metabolic panel (CMP), and thyroid function results were all within the normal range. Urine drug screening was negative. EKG, CSF analysis, chest X-ray, and brain MRI showed no significant abnormalities. Mild background slowing was noted on EEG, with no interictal/epileptiform discharges or any delta brushes. Therefore, a tentative diagnosis of COVID-19-associated psychosis was made. Treated with chlorpromazine 10 mg daily, the patient gradually improved with no hallucinations or bizarre behavior. She was discharged after 5 days and was not prescribed any medication at discharge. Nine days after discharge, the patient was seen by a pediatric neurologist. She did not report any hallucinations or delusions, but her mother reported that the patient moved slowly and had difficulty identifying common objects. An autoimmune panel, physical exam, and repeat EEG were all unremarkable. The neurologist concluded that her psychosis was most likely post-viral sequelae. The patient continued to improve and returned to school over the span of 2 months.
ConclusionAcute psychosis after COVID-19 infection is a new and emerging diagnosis with no consensus on management strategies for pediatric or adult patient populations. This case highlights the need for clinicians to be vigilant of subtle, fluid psychotic symptoms, in addition to patients’ general mental well-being. We do not have research regarding the long-term consequences of acute psychosis episodes. Further studies are needed to investigate the neuropsychiatric etiology of post-COVID-19 psychosis and the optimum treatment for this group of patients.
FundingNo Funding
A Survey of Bullying Experiences in a Child and Adolescent Psychiatric Clinic Population
- Sultana Jahan, Ellen O’Neill, Jordan Richardson
-
- Journal:
- CNS Spectrums / Volume 28 / Issue 2 / April 2023
- Published online by Cambridge University Press:
- 14 April 2023, p. 262
-
- Article
-
- You have access Access
- Export citation
-
Objectives
The study hypothesis is that regardless of "zero-tolerance policies," bullying is still occurring in schools. The study objective is to assess the prevalence of bullying in a child and adolescent psychiatric clinic patient population and gather information from students about their experiences with bullying, the response of school staff, and results of corrective actions taken.
MethodsA proposal was approved by the University of Missouri Internal Review Board to conduct this study. 101 randomly selected patients who are students in the mid-Missouri area were interviewed at the University of Missouri Child and Adolescent Psychiatry Clinic. All school districts in the surveyed area currently endorse a zero-tolerance bullying policy. After obtaining a guardian’s consent, each participant was asked a standard series of questions inquiring whether they had been bullied ever or in the past 12 months, bullied someone else, or witnessed bullying. Details including category, location, and action taken were also collected.
ResultsOf the 101 study participants, 80% reported having been bullied at some point in their lifetime and 49% in the past year. The most common form of bullying was emotional/verbal, which was reported by 77 participants. 43 participants reported they had been victims of physical bullying. 25 participants reported cyber bullying and 11 reported sexual bullying. Of the 81 patients who reported experiencing bullying, 52% were male and 48% were female. The study population was 75% Caucasian, 11% African American, 7% biracial, and 7% other. The bullied population was 80% Caucasian, 11% African American, 4% biracial, and 5% other. When asked where at school bullying occurs the most, responses were as follows: 23% playground, 21% classroom, 20% hallway, 13% lunchroom, 11% restroom, and 13% somewhere else. 66.3% of participants reported never having bullied someone and 74% of participants responded that they would intervene if they saw someone getting bullied. 67 participants reported that they had previously acted against bullying, and 37% of these stated nothing happened as a result of their action. 22% of participants got the bully to stop and 13% got them to stop temporarily. 16% reported that their bully got in trouble, but 9% reported they themselves got in trouble after taking action.
ConclusionsDespite zero-tolerance policies in place, a significant portion of bullied students reported that no action was taken even after reporting their bully. The threat of suspension or expulsion for the child accused may prevent school staff from taking these reports more seriously. Evidence-based methods, such as Positive Behavioral Interventions and Supports, are recommended to prevent bullying victimization. Many of these methods focus on creating a safe, inclusive environment by positively reinforcing expected behavior. There is also substantial evidence that educational programs can be successful in bullying reduction. As demonstrated by the results of this study, zero-tolerance policies alone are not sufficient bullying prevention. Revision to current policy is necessary to protect students in schools.
FundingNo Funding
Profound Anemia Induced by Lamotrigine in a 16-Year-Old Female with Sickle Cell Trait and Mood Disorder: A Case Report and One-Year Follow-Up
- Sultana Jahan, Ellen O’Neill
-
- Journal:
- CNS Spectrums / Volume 27 / Issue 2 / April 2022
- Published online by Cambridge University Press:
- 28 April 2022, p. 253
-
- Article
-
- You have access Access
- Export citation
-
Introduction
Lamotrigine is an antiepileptic drug of the phenyltriazine class with inhibitory effects on voltage-sensitive sodium channels, leading to an inhibition in the release of glutamate and resulting in a general inhibitory effect on cortical neuronal function. Lamotrigine is also a weak dihydrofolate reductase inhibitor. The drug is approved by the U.S. Food and Drug Administration for maintenance treatment of bipolar type I disorder in adults. There have been reports of hematologic adverse effects with lamotrigine therapy. This case report describes a 16-year-old female who developed profound anemia while on lamotrigine therapy.
MethodMs. X was a 16-year-old African-American female with sickle cell trait and mood disorder referred by the Division of Youth Services (DYS). Her medication regimen included lamotrigine 200 mg in the morning, aripiprazole 5 mg in the morning, and mixed amphetamine salts extended-release 30 mg in the morning. While at DYS, she developed fatigue and headaches with exertion. Her blood work detected a very low hemoglobin level of 3.1 g/dL and a very low hematocrit of 10.9%. Her MCV, MCH, and MCHC were within the normal range. The remainder of her blood count and other labs were within normal limits. The patient’s blood pressure was 105/70 mm Hg and her pulse was 109. The patient was sent to the local emergency room immediately; upon hospital admission, she received 4 units of packed red blood cells via transfusion.
ResultsAfter a blood transfusion, the patient’s hemoglobin level improved to 9.7 g/dL. The patient’s symptoms had improved significantly; her headaches and fatigue with exertion were gone. It was suspected that her profound anemia was induced by lamotrigine. She was discharged from the hospital with instructions to stop lamotrigine and visit a hematology specialist. Several weeks later, she underwent a hematologic evaluation, including a bone marrow biopsy and genetic testing, which were unremarkable. Her hemoglobin level remained stable.
ConclusionThe patient’s anemia resolved after the discontinuation of lamotrigine. The patient was followed for 1 year with blood work performed every few months. Her hemoglobin level did not drop further and in fact slowly increased to 13.9 g/dL spontaneously over the next year. In the literature, there have been reports of blood dyscrasias that may or may not be associated with hypersensitivity syndrome in patients who take lamotrigine. Considering hematologic adverse effects, it may be prudent to consider a baseline blood count before starting lamotrigine and repeat this test 3 to 6 months after initiation. It remains unclear whether lamotrigine use with a background of sickle cell trait in this patient put her at an increased risk of profound anemia. Further studies are required to explore the effects of this commonly used medicine.
FundingNo funding
Telepsychiatry and In-Person Care for Pediatric Patients During COVID-19: Patients Perspectives
- Sultana Jahan, Ellen O’Neill
-
- Journal:
- CNS Spectrums / Volume 27 / Issue 2 / April 2022
- Published online by Cambridge University Press:
- 28 April 2022, pp. 252-253
-
- Article
-
- You have access Access
- Export citation
-
Background
The COVID-19 pandemic has greatly affected how physicians, including child and adolescent psychiatrists, practice. A major shift came in the form of telehealth, in which patients attend clinic appointments online.
ObjectivesThe objective of this study was to identify the advantages and disadvantages of the telepsychiatry care delivery system and to devise future strategies to resolve drawbacks to improve patient and caregiver satisfaction.
MethodsA proposal was approved by the University of Missouri-Columbia Internal Review Board to conduct this study. One hundred patients were randomly selected for the study questionnaires. To understand patient satisfaction with telehealth and work toward improvements, this study conducted comparative survey research with 50 patients seen virtually and 50 patients seen in-person. Identical survey questions were filled out by patients and their respective guardians. The survey’s first question asked which setting was preferred during the COVID-19 crisis and was followed by free-response questions prompting responses about what they liked and disliked about telehealth and in-person visits.
ResultsOf the 50 patients seen virtually, 72% indicated a preference for telehealth, 14% preferred in-person, and 14% had no preference. These patients stated they preferred telehealth because it was convenient, required no travel and required fewer absences from school or work. A total of 28% of patients listed safety from exposure to COVID-19 as a reason they liked telehealth. Over half of these patients reported no complaints with telehealth, the most common issue according to patients seen virtually was internet connectivity and technology problems. A total of 64% of in-person patients reported a preference for in-person visits during the COVID-19 crisis. Similar to virtual patients, convenience was the most popular advantage of telehealth and personal connection was the most common disadvantage. The second most common complaint regarding telehealth and the highest reported advantage of in-person visits is the element of personal connection. A total of 16% of patients seen virtually and 24% of patients seen in-person reported more accurate assessment advantage of in-person care. These patients listed concerns about body language, vital signs, and other physical symptoms.
ConclusionWith telehealth as a seemingly permanent aspect of medicine, the field of psychiatry must adapt. Expansion of broadband and increasing affordability of high-speed internet connection are practical solutions to technological issues with telehealth. For patients preferring to be seen virtually, a recommendation can be made to have at least the first visit in-person to establish a personal relationship. Vital signs can be checked at home with proper training. Telepsychiatry is likely to continue to be a part of our care delivery system. To that end, we must be vigilant and develop better strategies to improve the quality of patient care and patient satisfaction.
FundingNo funding
The baby and the bathwater: On the need for substantive–methodological synergy in organizational research
- Joeri Hofmans, Alexandre J. S. Morin, Heiko Breitsohl, Eva Ceulemans, Léandre Alexis Chénard-Poirier, Charles C. Driver, Claude Fernet, Marylène Gagné, Nicolas Gillet, Vicente González-Romá, Kevin J. Grimm, Ellen L. Hamaker, Kit-Tai Hau, Simon A. Houle, Joshua L. Howard, Rex B. Kline, Evy Kuijpers, Theresa Leyens, David Litalien, Anne Mäkikangas, Herbert W. Marsh, Matthew J. W. McLarnon, John P. Meyer, Jose Navarro, Elizabeth Olivier, Thomas A. O’Neill, Reinhard Pekrun, Katariina Salmela-Aro, Omar N. Solinger, Sabine Sonnentag, Louis Tay, István Tóth-Király, Robert J. Vallerand, Christian Vandenberghe, Yvonne G. T. van Rossenberg, Tim Vantilborgh, Jasmine Vergauwe, Jesse T. Vullinghs, Mo Wang, Zhonglin Wen, Bart Wille
-
- Journal:
- Industrial and Organizational Psychology / Volume 14 / Issue 4 / December 2021
- Published online by Cambridge University Press:
- 14 December 2021, pp. 497-504
-
- Article
- Export citation
Contributors
-
- By Núria Duran Adroher, Sergio Aguilar-Gaxiola, Jordi Alonso, Ali Obaid Al-Hamzawi, Laura Helena Andrade, Matthias C. Angermeyer, James Anthony, Corina Benjet, Guilherme Borges, Joshua Breslau, Evelyn J. Bromet, Ronny Bruffaerts, Brendan Bunting, Huibert Burger, José Miguel Caldas de Almeida, Graça Cardoso, Somnath Chatterji, Wai Tat Chiu, Giovanni de Girolamo, Ron de Graaf, Peter de Jonge, Koen Demyttenaere, John Fayyad, Alize J. Ferrari, Silvia Florescu, Anne M. Gadermann, Meyer Glantz, Jen Green, Michael J. Gruber, Oye Gureje, Josep Maria Haro, Yanling He, Steven G. Heeringa, Hristo Hinkov, Chiyi Hu, Yueqin Huang, Irving Hwang, Robert Jin, Elie G. Karam, Norito Kawakami, Ronald C. Kessler, Lola Kola, Viviane Kovess-Masféty, Michael C. Lane, Carmen Lara, William LeBlanc, Sing Lee, Jean-Pierre Lépine, Daphna Levinson, Zhaorui Liu, Gustavo Loera, Herbert Marschinger, Katie A. McLaughlin, Maria Elena Medina-Mora, Elizabeth Miller, Samuel D. Murphy, Aimee Nasser Karam, Matthew K. Nock, Mark A. Oakley Browne, Siobhan O’Neill, Johan Ormel, Beth-Ellen Pennell, Maria V. Petukhova, José Posada-Villa, Rajesh Sagar, Mohammad Salih Khalaf, Nancy A. Sampson, Kathleen Saunders, Michael Schoenbaum, Kate M. Scott, Soraya Seedat, Victoria Shahly, Dan J. Stein, Hisateru Tachimori, Nezar Ismet Taib, Adley Tsang, T. Bedirhan Üstün, Maria Carmen Viana, Gemma Vilagut, Michael R. Von Korff, J. Elisabeth Wells, Harvey A. Whiteford, David R. Williams, Ben Wu, Miguel Xavier, Alan M. Zaslavsky
- Edited by Jordi Alonso, Universitat Pompeu Fabra, Barcelona, Somnath Chatterji, World Health Organization, Geneva, Yanling He
-
- Book:
- The Burdens of Mental Disorders
- Print publication:
- 09 May 2013, pp ix-xii
-
- Chapter
- Export citation