Neuropsychiatric considerations in treating anorexia nervosa patients with osteopathic manipulative medicine: a narrative review.

Osteopathic manipulative medicine (OMM) has a growing recognition in serving as an effective treatment to promote adaptation and homeostasis of the body by addressing musculoskeletal, neural, vascular, and lymphatic structures to promote self-healing and regulation. OMM can treat the musculoskeletal tension and sympathetic hyperactivity resulting from the increased cortisol response and hypersensitivity found in varying psychiatric illnesses, including anorexia nervosa (AN). This paper addresses the considerations necessary for treating AN patients with OMM, emphasizing the need to evaluate their abnormal high-level neuronal processing of sensory information, including differences in touch perception compared to the general population. Current literature was gathered utilizing a combination of the following keywords: anorexia nervosa, perception of touch, and osteopathic manipulative medicine/treatment. No literature was found addressing the effects of OMM on treating AN patients. Eight studies addressed the change in perception of touch found in AN patients. Results of the literature review reveal that the perceptions of touch in AN patients are distorted and can lead to reduced perceived pleasantness encountered in social interactions and touch. Specific changes have been found in C-tactile (CT) afferents responsible for the positive effects of touch, thus influencing emotional regulation. The significance of addressing this topic is to provide insight into the pathophysiological processes of AN and to inform physicians of unconventional stimuli that may exacerbate AN symptoms and behaviors. Further study is required to elucidate the role and mechanism of OMM in patients with AN and whether manual therapy could worsen pathological behavior and thinking patterns seen in AN patients. Such studies could include, but are not limited to, examining biological factors such as cortisol levels in AN patients receiving OMM and collecting data about AN patients' thinking patterns and behavior during OMM treatment.

A systematic review of manual therapy modalities and anxiety.

CONTEXT: Anxiety disorders have a far-reaching impact on society, with profound implications on both mental and physical health. In response, there is growing interest in manual therapy modalities, with emerging research suggesting their potential to alleviate related symptoms. OBJECTIVES: To establish a consensus regarding manual therapy modalities for addressing anxiety symptoms, a systematic review of current literature was conducted. METHODS: A literature search was conducted between May and August 2023, utilizing a systematic search on both PubMed and Google Scholar, adhering to the defined inclusion criteria. In addition, information was gathered utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Both authors (KLW and TH) conducted the literature review. The inclusion criteria include articles written in English, peer-reviewed, anxiety conditions documented, and manual therapy delivered by a respectfully qualified professional. Manual therapy modalities include massage therapy, osteopathic manipulative treatment (OMT), foot reflexology, acupressure, manual therapy, healing touch, therapeutic touch, and gentle touch. After initial data collection, both researchers independently screened articles utilizing two metrics: a level of evidence (LOE) table and a screening criterion incorporating unique elements from the search process. The quality of the included articles was assessed utilizing Strength of Recommendation Taxonomy (SORT). When reviewer discrepancies arose, authors reread full-text studies and discussed the inclusion and exclusion criteria to achieve consensus. RESULTS: The data searches identified 8,979 articles, with 239 articles remaining after duplicates and nonapplicable articles were removed. A total of 42 articles met the inclusion criteria, with only 40 articles able to be obtained for full-article review. After full review and the exclusion of articles with invalid author conclusions, meta-analysis, or systematic reviews, 34 articles were included in the review. All articles received an LOE rating of 2 or better and aligned with our specific screening criteria. Based on SORT, each modality was assigned a "B" rating. Among the included articles, n=27 demonstrated statistical significance in favor of manual therapy modalities as an anxiety treatment. The positive results for the aforementioned manual therapies on anxiety symptom improvement are shown: 15/18 (83 %) massage therapy, 2/6 (33 %) OMT, 5/5 (100 %) foot reflexology, 1/1 (100 %) acupressure, 1/1 (100 %) manual therapy, 0/2 (0 %) healing touch, 1/1 (100 %) therapeutic touch, and 1/1 (100 %) gentle touch. CONCLUSIONS: A pattern emerged, wherein individuals receiving manual therapy interventions displayed a statistically significant reduction in anxiety intensity. Considering the positive results, manual therapy should be considered an effective strategy for anxiety management.

Examination of medical student and physician attitudes towards suicide reveals need for required training.

The attitudes of healthcare providers towards suicidal patients are known to influence their motivation to treat patients during a suicidal crisis. Patients who attempted suicide are more likely to have recently visited a primary care provider who is not necessarily sufficiently trained in managing a suicidal patient rather than a mental health provider who is trained to do so. For those reasons, documenting medical students and physicians' attitudes towards suicide can help in the development of effective intervention training to prepare them to manage these types of patients. In this mini review, attitudes towards suicidal patients, the effectiveness of training on changing their attitudes are discussed. In summary, primary care providers are recognized as a top area where improvements can prevent suicides; providing proper suicide prevention training can effectively improve attitudes and quality of care for suicidal patients.

Teaching psychiatry to family practice residents.

OBJECTIVE: This article outlines a psychiatry curriculum developed for family practice residents by family practice-psychiatry residents. METHODS: A literature review, needs assessment, planning, implementation, and initial assessment were conducted. CONCLUSION: Early results demonstrated improved general psychiatric knowledge and a high level of satisfaction.