Food Refusal Secondary to Psychosis: A Case Series and Literature Review.

The aim of this article is to emphasize that starvation is an important potential consequence of psychosis and to provide recommendations for management of this condition. A review of the literature on food refusal and starvation in patients with psychotic illnesses was performed. Our search strategy returned 54 articles with one article meeting inclusion criteria. Additional independent research returned an additional four cases of patients with psychosis engaging in self-starvation. The cases of several patients from our institution who engaged in self-starvation behaviors as a result of psychosis are also presented. The management and outcomes of each of these 10 patients are discussed. Starvation secondary to psychosis is an important but underappreciated consequence of psychosis that can lead to serious adverse outcomes in these patients. Few cases have been reported in the literature. More study is warranted to develop evidence-based management guidelines.

The Use of Electroconvulsive Therapy in Eating Disorders: A Systematic Literature Review and Case Report.

OBJECTIVE: The aim of this study was to determine the potential for safe and effective use of electroconvulsive therapy (ECT) in treating eating disorders (EDs) in patients with and without comorbid psychiatric disorders. METHODS: A review of the literature pertaining to the use of ECT in patients with EDs was performed through PubMed, PsycINFO, and MEDLINE. Search terms included "Electroconvulsive Therapy," "ECT," and "Electroshock" each combined with "Anorexia Nervosa," "Bulimia Nervosa," "Binge Eating Disorder," "Eating Disorder," "EDNOS," and "OSFED." Additionally, a case in which ECT was used in treating a patient with anorexia nervosa is presented. RESULTS: Eighty-nine articles were reviewed, and 11 were selected for inclusion. These articles detailed 14 patients with active EDs who received ECT during their course of treatment. Of these patients, 13 were noted to have shown improvement in disordered eating after receiving ECT, and no adverse medical outcomes were reported. Our case detailed an additional patient who benefitted from ECT. CONCLUSIONS: There are limited data supporting the use of ECT in treating EDs; however, there is evidence to support that ECT is safe in this population and has been effective in cases of patients with AN with and without psychiatric comorbidities as well as binge eating disorder. More research is needed for treatment guidelines.

Trainees Unprepared for Advances in Psychedelic Medicine: A Survey Study.

This study aimed to characterize attitudes and identify gaps in trainee knowledge and education that may impact the field's readiness for the reemergence of psychedelic use in psychiatry. A two-part survey was sent out targeting medical and allied professional trainees who may interact with patients using or planning to use psychedelics therapeutically. Collected data for part one characterized demographics, sources of information, attitudes, experiences, and amount and type of education available about psychedelics in training programs. Part two was an assessment of psychedelic literacy, and predictors of trainee knowledge were analyzed. A total of 473 responses were obtained, 221 of which were unique, complete, thought to be authentic, and therefore included. Results indicated trainees had learned about psychedelics and related therapies from a wide variety of sources, most notably social media and word-of-mouth, which did not correlate with increased knowledge. There is limited structured education available, and although overall knowledge is low, participation in programming at home institutions did predict greater psychedelic literacy. As psychedelics are becoming increasingly available and research into their use in medicine advances, inclusion of relevant material in academic training programs will be essential to prepare future professionals to effectively educate and counsel patients.

Safe Ketamine Use and Pregnancy: A Nationwide Survey and Retrospective Review of Informed Consent, Counseling, and Testing Practices.

Objective: Ketamine is contraindicated in pregnancy given the lack of knowledge about potential effects on a developing fetus. This study aimed to characterize current clinical practices specific to pregnancy and reproduction related to the use of ketamine for the treatment of psychiatric illness.Methods: Online surveys were sent to outpatient ketamine clinics across the United States inquiring about practices related to pregnancy. Responses were collected between September and November 2023. Additionally, a retrospective medical record review was conducted to ascertain the frequency of pregnancy testing and contraception use with ketamine treatments administered at a large academic health system. Online, publicly available informed consent documents were also reviewed for language related to pregnancy.Results: Fewer than half of survey respondents (n = 126) discuss specific risks related to pregnancy and fetal ketamine exposure during the informed consent process. Twenty percent of clinics require pregnancy tests prior to treatment, and 10.5% require subsequent testing during treatment; however, 22.9% of clinics do not have a standard process for testing. Only 13.7% of clinics specifically recommend or require use of contraception. Retrospective record review revealed that all patients who received intravenous ketamine for psychiatric indications in an academic medical center were pregnancy tested weekly, but only half were using contraception during treatment.Conclusion: Many women with the potential to become pregnant are treated with ketamine for psychiatric illness. Results of the present study reveal that risks of fetal ketamine exposure are often overlooked, indicating a need for increased awareness about reproductive concerns when prescribing ketamine for the treatment of psychiatric disorders.