Violence Associated with Somatic Delusions.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) characterizes delusional disorder (DD) by the presence of delusions for longer than one month, without bizarre behavior or functional impairment. According to Kaplan and Saddock, the lifetime prevalence of DD (all subtypes) is about 0.2%. The persecutory subtype of delusional disorder (DD-PS) is the most common and the somatic subtype (DD-SS) is exceedingly rare. We aim to describe two cases of patients with somatic delusions, both presenting as imminently dangerous and threatening. We also discuss one case that resulted from our extensive literature review where somatic delusions were implicated in elevating a mass shooter's violence risk. Both patients whose cases are presented were involuntarily hospitalized after their doctors called 911 to report that they were being threatened by a weapon. These patients had no established psychiatric diagnoses and were evaluated thoroughly and diagnosed with DD-SS. Both perceived that their physicians were indifferent to their needs and cited their frustration as the trigger for planning attacks on the doctors. Unlike PS, SS is not traditionally described as increasing danger or risk of violence, and thorough risk assessments are not usually performed in DD-SS. We demonstrate that formal psychiatric violence risk assessments remain a useful tool to methodically stratify and effectively address risk, even in patients we do not typically expect to demonstrate premeditated violence.

Medical student attitudes and educational interventions to prevent neurophobia: a longitudinal study.

BACKGROUND: With an aging American population, the burden of neurologic disease is intensifying and the decline in neurology residents and practicing neurologists is leaving these patients helpless and unable to find care. 'Neurophobia', a chronic illness that begins early in medical school, has been identified as a cause for the low number of neurology residents. METHODS: A longitudinal study surveyed medical students at the beginning of their first year (M1) and then again at the beginning of their second year (M2). Three neuroscience educational interventions were studied: team based learning (TBL), case based teaching (CBT), and problem based learning (PBL). Participants provided self-reported neurophobia levels, attitudes about neuroscience, and the effectiveness of educational interventions. RESULTS: A total of 446 students during M1 and 206 students during M2 participated in the survey. A significant change in self-reported neurophobia (p = 0.035) was observed from 19% in M1 to 26% in M2. Neuroscience knowledge and confidence managing a neurologic condition also significantly increased (p < 0.001 and p = 0.038 respectively). Perceived interest, difficulty, and desire to pursue a career in neuroscience did not a change significantly. Majority of students perceived CBT (76%), TBL (56%), and PBL (66%) beneficial. Only CBT demonstrated a statistical difference (p = 0.026) when stratified by self-reported change in neurophobia. CONCLUSION: An increase in neurophobia after completing a neuroscience was observed but the prevalence rate of 26% was lower than previous studies. Knowledge about neuroscience increased significantly and educational interventions were considered beneficial by students. Thus, interventions that increase knowledge and decrease neurophobia can lead to an increase in students pursuing neurology residencies.

Breast Density Legislation: Discussion of Patient Utilization and Subsequent Direct Financial Ramifications for Insurance Providers.

Now that New Jersey has become the 14th state in the United States to enact legislation regarding dense breast screening, its patients are eligible to receive screening breast sonography coverage from their insurance carriers. This law is intended to improve breast cancer detection in patients with dense breasts and create awareness of unique issues that come with dense breast tissue, while reinforcing already present efforts to reduce the incidence of and morbidity related to the diagnosis of breast cancer. The aim of this study was to examine data from months preceding the effective date of this legislation in a community hospital setting and compare these data with data from months immediately after, and 6 months after, its enactment to present patient participation data and estimate the legislation's direct financial ramifications. Detractors of this type of legislation worry about overburdening the health care system with an influx of patients. Although there is a lack of present studies confirming this suspicion in other states with dense breast legislation, this study confirms a large increase in patient utilization after enactment, showing a minimum relative increase of 176.90% and a maximum relative increase of 335.56% in patient utilization of screening breast sonography. The investigators further include an estimation of an increased direct cost for insurers of $4,910,899.18 to $9,848,897.96 for a given month.