Rapid resolution of catatonia secondary to post traumatic stress disorder with secondary psychotic features through scheduled zolpidem tartrate.

Catatonia is a complication of numerous psychiatric and medical conditions. The first-line treatment is typically management of the underlying primary condition as well as scheduled benzodiazepines or electroconvulsive therapy. Electroconvulsive therapy and benzodiazepines are not always tolerated or available when treating patients with catatonia. For this reason, other treatment regimens have been trialed in recent years, including the GABA-modulatory Z drugs such as zolpidem. Some alternative treatment modalities have shown great promise. However, which populaces these are most beneficial for is still unclear. In this article, we examine a case report of a woman who suffered from post-traumatic stress disorder with secondary psychotic features who experienced recurrent akinetic catatonia that was refractory to benzodiazepine therapy. She responded rapidly to scheduled zolpidem with minimal side effects. It is our author's belief that when managing catatonia in patients with post traumatic stress disorder with secondary psychosis, Z drugs may be preferable to benzodiazepines.

Prevalence and Treatment for Alcohol Use Disorders Based on Kentucky Medicaid 2012-2019 Datasets.

Alcohol use is the leading substance use in the United States. Persons with alcohol use disorder (AUD) face enormous health consequences and family problems. Analysis of Medicaid enrollee data is critical to understand different aspects of AUD and the treatment utilization for patients with AUD. Yearly patient-level data were constructed from the Kentucky 2012-2019 Medicaid claims data. ICD-9-CM and ICD-10-CM codes were used to identify patients with AUD and their comorbid conditions, the 11-digit National Drug Codes were used to identify medication treatments, and procedure codes were used to identify psychosocial and behavioral therapies. Logistic regression models were used to examine factors that were associated with AUD prevalence and AUD treatments. The prevalence of AUD trended up over time. Patients living in metro areas, between ages 45-54, having mental disorders, tobacco use, and with a family history of alcoholism had significantly higher rates of AUD. About 60% of patients diagnosed with AUD had major depressive disorder or anxiety. The treatment utilization for AUD also trended up from 2012 to 2019; however, it was still lower than 25% in 2019. Pharmacological treatments were used in only 2.89% of AUD cases in 2012, which increased to 8.13% in 2019. Psychosocial treatments were used in only 1.59% of AUD cases in 2012 that increased to 18.95% in 2019. The prevalence of AUD trended up over years. However, the treatment utilization for AUD was lower than 25%, even as of 2019. There is an urgent need for comprehensive, evidence-based, personalized AUD treatments.

Prevalence and Treatment Utilization of Patients Diagnosed with Depression and Anxiety Disorders Based on Kentucky Medicaid 2012-2019 Datasets.

Objectives: To examine the prevalence and treatment utilization of patients diagnosed with Depression and Anxiety Disorders (DAD) based on Kentucky Medicaid 2012-2019 datasets. Methods: The study was based on Kentucky Medicaid claims data from 2012 through 2019 for patients 14 years and older. We constructed yearly patient-level databases using ICD_9 CM and ICD_10 CM codes to identify the patients with DAD, using the Current Procedure Terminology (CPT) codes to identify individual psychotherapy and group psychotherapy and using the National drug codes to categorize pharmacotherapy. Based on these data, we constructed summary tables that reflected the trends in prevalence of DAD across eight Kentucky Medicaid regions and for different demographic subgroups. Next, we implemented logistic regression on the constructed yearly patient-level data to formally assess the impact of risk factors and treatments on the prevalence of DAD. The potential risk factors included age, gender, race/ethnicity, geographic characteristics, comorbidities such as alcohol use disorder and tobacco use. Results: The prevalence of DAD increased from 30.84% in 2012 to 36.04% in 2019. The prevalence of DAD was significantly higher in patients with the following characteristics: non-Hispanic white, females, aged between 45 and 54 years old, living in rural areas, having alcohol use disorder, and using tobaccos. Other than 2013, the utilization of pharmacotherapy maintained at about 62%. The utilization of psychotherapy increased over years from 24.4% in 2012 to 36.5% in 2019. Overall, the utilization of any treatment slightly increased from 70.9% in 2012 to 73.3% in 2019 except a drastic decline in 2013 due to the reduction of benzodiazepine prescription. Patients being whites, females, and living in rural areas were more likely to use pharmacotherapy, and patients living in rural areas were less likely to use psychotherapy than those residing in urban areas. Conclusion: The prevalence of DAD has increased over time from 2012 to 2019. The utilization of pharmacotherapy maintained at 62% over eight years except 2013, and the utilization of psychotherapy has steadily increased over time.

Protein tyrosine kinase involvement in learning-produced changes in Hermissenda type B photoreceptors.

Learning-correlated changes in the excitability and photoresponses of Hermissenda's ocular type B photoreceptors are mediated by reductions in two distinct K(+) currents, I(A) and I(K-Ca). The suppression of these K(+) currents has been linked to conditioning-produced activation of protein kinase C (PKC). The question of whether PKC accounts completely for the changes in excitability and K(+) currents or whether other kinase(s) are involved has received little attention. In the present experiments, we asked whether protein tyrosine kinases (PTKs) might also contribute to conditioning-produced alterations in B cells. We found that the PTK inhibitors genistein and lavendustin A greatly reduced cumulative depolarization of type B cells, a short-term correlate of associative learning. This disruption occurred even when PKC activation had been either occluded by preexposure of type B cells to a phorbol ester or otherwise prevented by the pseudosubstrate inhibitor peptide PKC[19-31]. PTK inhibitors also increased the amplitude of the transient (I(A)) and delayed (I(Delayed)) components of voltage-dependent K(+) current that have previously been shown to be selectively reduced by conditioning and to contribute to cumulative depolarization. Genistein partially prevented the reduction of I(A) and I(Delayed) due to in vitro conditioning and blocked the changes in their voltage dependencies. Ionophoresis of pervanadate ion, a potent inhibitor of protein tyrosine phosphatases, depolarized type B photoreceptors and occluded conditioning-produced cumulative depolarization. Pervanadate also suppressed I(A) and I(Delayed), reduced their voltage dependence, and altered inactivation kinetics for I(A), mimicking conditioning. Western blot analysis using a phosphotyrosine antibody indicated that conditioning increased the phosphotyrosine content of many proteins within the Hermissenda CNS. Collectively, our results suggest that in addition to PKC, one or more PTKs play an important role in conditioning-produced changes in type B cell excitability. PTKs and PKCs converge to effect reductions in B cell K(+) currents during conditioning, apparently through distinct biophysical mechanisms.

Chemosensory conditioning in molluscs: I. Failure of contextual conditioning in Hermissenda.

Aversive chemosensory conditioning alters Hermissenda's feeding behavior. But opposite behavioral changes have been reported, depending on whether discrete-trial or context-conditioning paradigms were used, raising questions about the roles of associative and nonassociative processes. We attempted to produce chemosensory contextual conditioning but failed to do so across a wide range of conditions. In Experiments 1-3, we observed large, nonspecific bite latency increases to shellfish extracts, regardless of whether they had signaled the presence or absence of shaking. In Experiment 4, we found that mere exposure to shellfish extract produced latency increases; vestibular stimulation was unnecessary. In a final experiment, using Y-maze choice tests, we failed to observe selective reductions in animals' preference for shellfish paired with shaking. Nonassociative processes stemming from prolonged exposure to concentrated shellfish extracts appear to be major factors in our failure to demonstrate associative chemosensory contextual conditioning.

Chemosensory conditioning in molluscs: II. A critical review.

We critically review chemosensory conditioning studies with molluscs and find that, in many studies, the influence of nonassociative processes complicates, obscures, and renders ambiguous the unique contribution of associative learning. These nonassociative processes include sensory adaptation, habituation, sensitization, and changes in feeding motivation. They arise from both the food extracts that have often been used as conditioned stimuli and the aversive stimuli that have been used as unconditioned stimuli.