Evaluation of a Dialectical Behavior Therapy Psychiatry Residency Training Program.

OBJECTIVE: Dialectical behavior therapy (DBT) is a widely disseminated evidence-based treatment for patients with borderline personality disorder (BPD). This evaluation of a community psychiatry residency rotation compared a DBT training program to a standard care training program to determine the levels of confidence in treating patients with BPD, willingness to treat patients with BPD, and attitudes towards this patient population. METHODS: Participants were 57 psychiatry residents who completed a 3-month community psychiatry rotation in a DBT clinic (N = 33), or standard care clinic (N = 24) based in a partial hospitalization program in a community mental health center. A mixed method design was used to collect qualitative and quantitative data on participants' experiences working with BPD and patients at high-risk for suicide. Participants were asked several open-ended questions to determine what aspect of their community psychiatry rotation influenced their level of confidence in treating, and willingness to treat BPD, non-suicidal self-injurious behaviors, and suicidal behaviors. RESULTS: Compared to training in the standard care condition, the DBT condition demonstrated significantly higher rates of willingness to treat, and confidence in treating patients with BPD, and confidence in treating non-suicidal self-injury. There were no significant differences between the two conditions in the level of confidence in treating suicidal patients. Four themes emerged from a qualitative content analysis examining the benefits of the training program, including (1) exposure to high-risk patients, (2) team-based treatment structure, (3) formal didactic training, and (4) individual or group supervision. CONCLUSION: Participants receiving DBT training had more willingness to treat and confidence in treating patients with BPD compared to participants receiving training in the standard care clinic. Team-based structure of DBT and exposure to high-risk patients were two themes from the training that impacted these variables across both study arms, according to participant self-report. Internal validity of the study was limited by the lack of randomization and pre-post design. External validity of the study was strengthened due to the setting of a community mental health clinic and resident training program.

Toxicities associated with NBOMe ingestion-a novel class of potent hallucinogens: a review of the literature.

BACKGROUND: A new class of synthetic hallucinogens called NBOMe has emerged as drugs of abuse. OBJECTIVE: Our aim was to conduct a systematic review of published reports of toxicities associated with NBOMe ingestion. METHODS: We searched PubMed for relevant English-language citations that described adverse effects from analytically confirmed human NBOMe ingestion. Demographic and clinical data were extracted. RESULTS: A total of 10 citations met the criteria for inclusion, representing 20 individual patients. 25I-NBOMe was the most common analogue identified, followed by 25B-NBOMe and 25C-NBOMe. Fatalities were reported in 3 (15%) cases. Of all the patients, 7 (35%) were discharged after a period of observation, whereas 8 (40.0%) required admission to an intensive care unit. The most common adverse effects were agitation (85.0%), tachycardia (85.0%), and hypertension (65.0%). Seizures were reported in 8 (40.0%) patients. The most common abnormalities reported on laboratory tests were elevated level of creatinine kinase (45.0%), leukocytosis (25.0%), and hyperglycemia (20.0%). CONCLUSION: NBOMe ingestion is associated with severe adverse effects. Clinicians need to have a high index of suspicion for NBOMe ingestion in patients reporting the recent use of hallucinogens.

Intentional Intra-arterial Injection of Heroin: A Case Report.

Intravenous injection of drugs is associated with a host of medical complications, notably soft-tissue infections. On the contrary, intra-arterial injections of drugs have also been reported, largely restricted to inadvertent injections. Here we describe a patient who engaged in repeated intra-arterial injections of heroin when she exhausted most of her venous access, and presented acutely with a radial artery occlusion requiring thrombolytic therapy. Clinicians should have a high index of suspicion for intra-arterial injection in injection drug users who present with limb pain, ischemia, and motor/sensory deficits. Given the reluctance patients may have in discussing their injection practices, clinicians should proactively discuss and counsel patients about safe injection practices and the dangers of intra-arterial injections.