New-Onset Seizures in an Adolescent Following Use of LSD while on Low-Dose Lithium Therapy: A Case Study.

This case report presents an occurrence of three generalized seizures within 30 minutes of ingestion of lysergic acid diethylamide (LSD) in a 15-year-old female patient with treatment-resistant depressive disorder recently started on low-dose lithium therapy. She had no personal or family history of seizure, brain injury or other neurological disorder. The patient had a history of monthly LSD use on several occasions in the setting of ongoing fluoxetine and longacting bupropion (Wellbutrin XL) treatment, with seizures occurring only after initiation of lithium. Although the definitive causal link cannot be established, this case report suggests an increased seizure risk with combination of LSD and lithium, even at subtherapeutic serum lithium levels. This case emphasizes the need for further research, careful clinical practice, and patient education regarding the potential dangers of using psychedelic substances with psychopharmacological treatment.

Depressive Disorders in Children and Adolescents: Evaluation and Management.

Depressive disorders among children and adolescents impact the practice of many providers, in many specialties. These disorders contribute to illness and disability throughout the world, and they are a significant risk factor for suicide. Depression in these age groups can differ from those in adults, and early recognition along with proper treatment can lead to improved outcomes. It is important for clinicians to differentiate depression from other possible diagnoses such as anxiety disorders, attention deficit hyperactivity disorder (ADHD), and other mood disorders. Once the diagnosis of depression is established, the severity should be assessed to determine the most appropriate level of treatment. Outpatient treatment often starts with therapy, and if medications are indicated, the use of selectiveserotonin reuptake inhibitors (SSRIs) tend to be first-line.

Evaluation and Management of Attention-Deficit/ Hyperactivity Disorder (ADHD) in Children and Adolescents.

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood. Children and adolescents with ADHD are at increased risk for behavioral issues, academic issues, substance abuse issues, and legal problems. Approximately 50% of cases of childhood ADHD will persist into adulthood where it can impact employment, organizational skills, and frustration tolerance. Use of amphetamine and methylphenidate stimulant medications have shown to have the best outcomes, and are considered first line treatments. It is important to monitor stimulant use closely in individuals with substance abuse concerns, however, studies in adolescents with both substance abuse histories and ADHD tend to support their use and benefits. It is important to identify other co-morbid conditions that a patient with ADHD may be struggling with and treat those accordingly. Providers should re-evaluate the symptoms and clinical presentation of patients that show minimal or no improvement with treatment to ensure a proper diagnosis has been made.

Empirically Validated Screening Tools for Adolescent Substance Use Disorders.

Substance use is a major cause of morbidity and mortality in the U.S., and data from treatment centers shows that 75 percent of patients initiated their use prior to the age of 17 years. Substance use in the adolescent years affects brain development and leads to poor physical and psychiatric health, decreased academic performance, and forensic outcomes. Screening at both primary care and specialty visits allows for early intervention and treatment. This article reviews the available screening tools for substance use disorders in children and adolescents for use in a variety of clinical settings.

Assessing Adolescent Suicide Risk.

Suicide currently ranks as the second leading cause of death in the U.S. in youth ages 10-24, and in young adults ages 25-34. It is also the third leading cause of death in youth and young adults worldwide. Although there are multiple factors that increase one's risk for suicide, a history of a previous suicide attempt is likely one of the strongest predictors of a future completed suicide. Alcohol use, substance use, bullying, a history of mental illness, a family history of suicide, hopelessness, and many other risk factors exist that may increase one's risk for attempting suicide. Implementation of screening questionnaires such as the PHQ-A, PHQ-9, or the Columbia-Suicide Severity Rating Scale may help clinicians identify those patients who may be struggling with depression or who may be at risk for suicide. Research has shown that approximately 45 percent of patients who die by way of suicide visited their primary care provider within a month before completing suicide, so it is important that clinicians become comfortable with evaluating and talking with their patients about suicide.

Substance Abuse Treatment for Adolescents in South Dakota.

In the state of South Dakota, there are 39 accredited substance abuse providers who service over 11,000 individuals each year. Knowledge of which substance abuse providers are accredited is important for families looking to find financially affordable substance abuse treatment/care for their loved ones. In order to begin the process of entry into a substance abuse treatment program, an adolescent must first complete a needs assessment with one of the accredited providers. The needs assessment will help to identify the severity of the substance use disorder as well as identify the appropriate level of treatment/care for the individual.

Medicinal and recreational marijuana: what are the risks?

With the recent legalization of recreational marijuana in Colorado, Washington, Alaska, the District of Columbia and legislation pending for both medical and recreational marijuana in several other states, it is important for the facts regarding its potential for serious mental health consequences to be known. Little has been said about the psychiatric risks of this substance, particularly in youth. Several studies have shown increased rates of depression, anxiety and schizophrenia among those who use marijuana on a regular basis. In addition, permanent loss of IQ and structural changes in the brain have been demonstrated with habitual use. Legalization of marijuana for recreational use can influence an adolescent's perception of this substance as "safe." In states that have legalized marijuana for medical purposes, there is the very real problem of "diversion." As many as 34 percent of 12th-graders who use marijuana in states with legalized marijuana had obtained it from a person who had received it through a prescription.

Rivastigmine-induced dystonia.

PURPOSE: A case of acute dystonia related to rivastigmine use is reported. SUMMARY: A 61-year-old Caucasian woman who had suffered from bipolar II disorder with rapid cycling for over 30 years was admitted to an inpatient psychiatry unit. In addition to bipolar II disorder, the patient had been previously diagnosed with early-stage Alzheimer's disease, posttraumatic stress disorder, and various anxiety disorders. During the current hospitalization, she was taking clonazepam, dextroamphetamine, lamotrigine, lansoprazole, levothyroxine, memantine, quetiapine, risperidone, rivastigmine, tranylcypromine, trazodone, and zolpidem. Soon after hospital admission, she began to complain of a tightening in her chest. A review of her records revealed similar complaints during previous hospitalizations. Rivastigmine was discontinued due to concerns of interactions with her antipsychotic regimen. Although these symptoms were previously attributed to anxiety, they appeared worse during this hospitalization. During these events she would be witnessed lying in bed in a supine position with her head canted posteriorly. Benztropine was given to help determine if she was having a dystonic reaction. Within 30 minutes, her chest discomfort began to resolve, and her symptoms resolved completely over the next 48 hours. Three days later, rivastigmine was restarted by the attending psychiatrist because of concerns about the patient's memory, and the dystonia-like symptoms returned within 2 hours of her morning dose. Rivastigmine was discontinued, and benztropine was given and then discontinued, with no return of symptoms for the remainder of her two-week hospitalization. CONCLUSION: A patient with bipolar II disorder and mild-to-moderate Alzheimer's disease developed dystonia, possibly caused by rivastigmine. However, the patient was taking various other medications that could have lowered the threshold for extrapyramidal syndromes.