Comparison of Endoscopic Ultrasound and Transabdominal Ultrasound in the Detection of Gallbladder and Common Bile Duct Microlithiasis.

OBJECTIVE: Endoscopic ultrasonography (EUS) is an emerging method with a wide range of potential uses in gastroenterology, including the detection of bile duct stones and the identification of early ductal alterations in suspected patients. This study was designed to compare the diagnostic yield of EUS and transabdominal ultrasound (TUS) in the detection of gallbladder and common bile duct (CBD) microlithiasis. METHOD: Patients with biliary colic with normal initial TUS were the subjects of this prospective study. EUS scan was performed on all recruited patients and linear endoscopes were used for the EUS examination. Cholecystectomy and histological analysis were done in patients within two weeks after EUS revealing cholelithiasis whereas the cases of CBD stone/microlithiasis were confirmed by endoscopic retrograde cholangiopancreatography (ERCP). The mean values of all hematological characteristics were independently determined for males and females and then compared using Student's t-test. For statistical significance, a p-value of 0.05 or below was used. RESULTS: A total of 131 patients, including 77 females and 54 males, with a mean age of 38.41 ± 14.78 years were examined. All 78 (59.5%) individuals who had cholecystectomy were found to have gallstones or microlithiasis as successfully diagnosed by EUS. The sensitivity and specificity of EUS were 92.9% and 100%, respectively, for CBD stones and 98.8% and 100%, respectively, for the detection of gallbladder microlithiasis. The agreement between EUS and TUS was fair for CBD stones (κ = 0.214) and very weak for microlithiasis (κ = -0.093). CONCLUSION: EUS demonstrates a superior yield over TUS in detecting gallbladder stones and CBD microlithiasis, offering a more reliable diagnostic modality. LIMITATION: This was a single-center study.

National Network of Depression Centers' Recommendations on Harmonizing Clinical Documentation of Electroconvulsive Therapy.

ABSTRACT: Electroconvulsive therapy (ECT) is a highly therapeutic and cost-effective treatment for severe and/or treatment-resistant major depression. However, because of the varied clinical practices, there is a great deal of heterogeneity in how ECT is delivered and documented. This represents both an opportunity to study how differences in implementation influence clinical outcomes and a challenge for carrying out coordinated quality improvement and research efforts across multiple ECT centers. The National Network of Depression Centers, a consortium of 26+ US academic medical centers of excellence providing care for patients with mood disorders, formed a task group with the goals of promoting best clinical practices for the delivery of ECT and to facilitate large-scale, multisite quality improvement and research to advance more effective and safe use of this treatment modality. The National Network of Depression Centers Task Group on ECT set out to define best practices for harmonizing the clinical documentation of ECT across treatment centers to promote clinical interoperability and facilitate a nationwide collaboration that would enable multisite quality improvement and longitudinal research in real-world settings. This article reports on the work of this effort. It focuses on the use of ECT for major depressive disorder, which accounts for the majority of ECT referrals in most countries. However, most of the recommendations on clinical documentation proposed herein will be applicable to the use of ECT for any of its indications.

High frequency repetitive transcranial magnetic stimulation of supplementary motor cortex for obsessive compulsive disorder.

Obsessive compulsive disorder (OCD) is a common psychiatric disorder that can lead to significant dysfunction. It is treated with medications and or cognitive behavior therapy. Many patients with OCD do not respond to above mentioned conventional treatments. OCD is also a disorder with well delineated neuropathology in brain areas that form cortico-striato-thalamocortical loop. Transcranial magnetic stimulation (TMS) can not only offer a noninvasive treatment modality for many of these patients but can also specifically and beneficially affect involved neuronal areas. TMS stimulation of various brain areas including supplementary motor cortex, dorsolateral prefrontal cortex, orbitofrontal cortex and anterior cingulate cortex has been found to be beneficial in alleviating OCD symptoms in various studies. Low frequency and less often high frequency TMS of these areas has been found to be effective. High frequency deep TMS, as opposed to conventional TMS, of medial prefrontal cortex and anterior cingulate cortex was found to be effective and is approved as an adjunctive treatment option for severe OCD. There is no consensus as to the target stimulation site and optimal TMS stimulation protocol that can achieve maximum improvement in OCD symptoms. We hypothesize that high frequency r-TMS of supplementary motor cortex will alleviate OCD symptoms.

Comorbid Insomnia and Psychiatric Disorders: An Update.

Insomnia is a clinical problem of significant public health importance. Insomnia can be a symptom or harbinger of other psychiatric disorders. Insomnia can also be comorbid with other psychiatric disorders, thereby adding to the medical burden and increasing the risk of psychiatric relapse. Insomnia can also be associated with medical and neurological disorders. Some medications can also cause insomnia. Treatment of insomnia can lead to positive outcomes, not only by alleviating symptoms and moderating these comorbid disorders, but by preventing new episodes. Therefore, it is vital to be aware of the relationship between insomnia and psychiatric illness. This article reviews this relationship and provides recommendations for management.

Dopaminergic Neurogenetics of Sleep Disorders in Reward Deficiency Syndrome (RDS).

It is well-known that sleep has a vital function especially as it relates to prevention of substance-related disorders as discussed in the DSM-V. We are cognizant that certain dopaminergic gene polymorphisms have been associated with various sleep disorders. The importance of "normal dopamine homeostasis" is tantamount for quality of life especially for the recovering addict. Since it is now know that sleep per se has been linked with metabolic clearance of neurotoxins in the brain, it is parsonomiuos to encourage continued research in sleep science, which should ultimately result in attenuation of sleep deprivation especially associated with substance related disorders.

Delayed sleep phase disorder and attention deficit and hyperactivity symptoms in a teenager.

JR is an 18-year-old male with five-year history of going to bed late and waking up late. He gives history of poor frustration tolerance, inattention and fidgetiness in school for which he has been unsuccessfully been treated with stimulant medications for last 3 years. There is history of similar sleep problems in his father who works nights as a mechanic. JR's sleep log shows him going to bed early morning and waking up late morning/afternoon. He shows no sleep maintenance problems and sleeps an average of 8 h per night. He shows no symptoms of depression, anxiety, inattention or hyperactivity during his hospital stay. He does not show any learning, cognitive, attention or intellectual deficits. He is currently not taking any medications. He is discharged home after 3-day hospital stay and is reportedly doing well working in a video rental store at night.

Residency programs and psychotherapy competencies: a survey of chief residents.

OBJECTIVE: To survey chief residents' opinion about various aspects of psychotherapy competency determination. METHODS: Chief residents of various psychiatry residency programs were surveyed. RESULTS: One hundred two chief residents were surveyed. Seventy two (70.58%) completed the survey. Eighty four percent of the respondents reported that they were aware of the competencies. The number of patients required for competency determination in five areas of psychotherapy varied widely among the programs. Global assessment by psychotherapy supervisors was the most commonly used method of competency determination (61%). Nineteen (26%) chief residents opined that not all the faculty members involved in teaching and assessing competencies are qualified to do so. Only 23 (31%) of respondents reported that competency criteria were well integrated into the residency curriculum. CONCLUSION: The little consistency in psychotherapy competency determination across various programs, the differential preparedness of programs for competencies and the lack of consistent integration of competencies into residency curricula call for development and implementation of more uniform assessment methods. This variability also calls into question the decision to establish a standard in five areas of psychotherapy competency.

Psychological sequelae of failed scalp replantation.

Published reports of avulsed scalp replant attempts have been promising. Numerous case reports and published series have demonstrated a greater than 90 percent replantation success rate. However, there exists a paucity of articles on the management of patients following failed scalp replantation attempts. The authors recognize numerous stressors that affect these patients, including the inciting traumatic event, hospitalizations, multiple surgical interventions, postsurgical therapies, and disfigurement caused by non-hair-bearing scalp. Thus, as part of the medical management for scalp replant patients, one must address the psychological factors surrounding the medical management. Over the past 25 years, the authors have experienced four cases of scalp replant failures, each posing an opportunity to examine the postoperative course of these patients. Symptoms ranging from mild anxiety to depressive symptoms have been observed in all of these patients. In fact, patient symptoms often satisfied the criteria for major depressive disorder or posttraumatic stress disorder. The authors recognize the importance of informing patients and their families of the immediate and potential long-term complications following an unsuccessful scalp replant attempt. The authors advise that all patients be provided immediate psychiatric evaluation and, if necessary, counseling and medication therapy, regardless of scalp replantation outcome.