Secondary Psychosis Following Neoadjuvant AC-T Chemotherapy for Triple-Negative Breast Cancer: Case Report and Literature Review of Psychosis Postchemotherapy.

Triple-negative breast cancer is a unique subtype among breast cancers. Management includes a neoadjuvant chemotherapy regimen. Psychiatric complications of the regimen have not been reported before. We present a case of acute psychosis after the second cycle of chemotherapy in a 42-year-old woman with triple-negative breast cancer. The patient presented with sudden irritability, agitation, disorganization in speech and behavior, and paranoia involving her coworkers conspiring against her and causing her trouble with the law for 4 days. She was in her usual state of health until after her second cycle of chemotherapy. This was the first presentation of psychotic symptoms in her life. She was conscious and oriented. There were no neurologic deficits. She denied any change in her mood and any features of hallucinations. She was uncooperative, restless, had flight of ideas, and persecutory delusions. The remainder of the examination was normal. An autoimmune process, nervous system infection, or psychosis secondary to the chemotherapy were suspected. Serum electrolytes and other biochemical parameters were normal. Imaging of the brain showed no signs of acute brain insults or intracranial metastasis. Cerebrospinal fluid analysis and culture showed no abnormality or growth. The work-up revealed that neurologic, infectious, or autoimmune causes of her psychotic symptoms were less likely. Thus, a diagnosis of psychosis secondary to chemotherapy was considered. Treatment was with paliperidone, risperidone, clonazepam, and sertraline. Over the course of treatment, she showed substantial improvement and completed all of the chemotherapy sessions without adverse effects. In summary, we report a case of a patient whose initial chemotherapy course was complicated by psychosis. Since the neurotoxic and psychiatric effects of chemotherapeutics are not yet sufficiently elucidated, our case emphasizes that early signs of behavioral changes in patients receiving chemotherapy should trigger comprehensive psychiatric evaluation and monitoring of the patient's mental state.

The quality of telepsychiatry in terms of accessibility, appropriateness, effectiveness, and safety among psychiatric patients in King Abdulaziz Medical City: An observational cross-sectional analytical study.

There has been an increasing demand for psychiatric care in recent decades, and "telepsychiatry" was developed to meet these demands. It is a type of telemedicine in which they provide many medical services virtually, such as therapy, counseling, and medication management. Telepsychiatry has numerous advantages, including lower costs, reduced stigma, and improved continuity of care. To the best of our knowledge, no previous studies in the western region of Saudi Arabia addressed patients satisfaction with telepsychiatry. This cross-sectional study aims to assess patient satisfaction in telepsychiatry in terms of accessibility and timeliness, appropriateness, effectiveness, and safety, and to see whether patient satisfaction affects their decision to use the service again in the future. A cross-sectional study was conducted using a prestructured survey on the basis of the Client Satisfaction Questionnaire-18, which is a validated questionnaire used to assess patients' satisfaction with the services provided to them. From January 2021 to July 2021, all male and female psychiatric patients over the age of 18 years who had psychiatric virtual appointments were included in this study. This study included 182 patients, of whom 106 were female. Patients were generally satisfied with the telepsychiatry services; 56.6%, 81.9%, 86.8%, and 91.2% of the participants were satisfied with the access and timeliness, appropriateness, effectiveness, and safety, respectively, and a total of 58.3% either strongly agree or agree of the overall satisfaction level. Depression and anxiety disorders were the most common psychiatric diseases. The statistical analysis revealed no significant relationships between patients' satisfaction and demographic characteristics. Telepsychiatry has been evaluated to meet the growing demand for psychiatric care; it also has significant advantages. Patients had an overall positive satisfaction level toward telepsychiatry service, and so the results of this study support the continuity of using telepsychiatry in the future. Further research area could include a comparison between patients' and providers' satisfaction levels with telepsychiatry.

Mania as a Rare Adverse Event Secondary to Steroid Eye Drops.

Since glucocorticoids (GCs) were introduced for the treatment of various diseases, they have been linked with the development of psychiatric adverse effects such as mania, depression, and psychosis. These behavioral or psychiatric adverse events usually appear within a few days after commencing GCs and are possibly to reverse with drug withdrawal. We present a rare case of a 75-year-old woman who developed mania during treatment with GC eye drops following cataract surgery. Management consisted of discontinuing prednisolone and administering olanzapine, which resulted in full recovery in a week. Olanzapine was then discontinued, and a diagnosis of steroid-induced mania was concluded for this case.

Accuracy of initial psychiatric diagnoses given by nonpsychiatric physicians: A retrospective chart review.

ABSTRACT: Despite the increased morbidity and mortality associated with psychiatric illnesses, there remains a substantial level of inaccuracy of the initial psychiatric diagnoses given by nonpsychiatric physicians. This study examines the accuracy of initial psychiatric diagnoses by non-psychiatric physicians at the McGill University Health Center (MUHC).We conducted a retrospective chart review for all consultations requested from the consultation-liaison psychiatry service at MUHC. We included all the consultations from January 1, 2018, to December 30, 2018, and excluded patient data with established psychiatric diagnoses. In all requested consults, each diagnosis of a referring physician was compared with the final diagnosis given by the C-L psychiatry team. Conformity between the 2 was validated as accurate.Of the 980 referred inpatients, 875 were enrolled. Patients ranged in age and those older than 70 years constituted the largest group: 54.4% were male. For 467 patients (55.20%), the initial diagnostic impression given by the referring physicians agreed with the final diagnosis made by the C-L psychiatry team, while in 379 patients (44.80%), the initial diagnostic impression was not consistent with the final diagnosis made by the C-L team.Diagnostic impressions of neurocognitive and substance use disorders were highly accurate, but this was not the case when the referring physicians suspected depression or bipolar, personality, or psychotic disorders. This study shows that around half of the referrals were accurately diagnosed, which evinces that nonpsychiatric physicians' knowledge regarding psychiatric conditions is not optimal and that might negatively impact screening and treating these conditions.

Antibiotic Adsorption by Metal-Organic Framework (UiO-66): A Comprehensive Kinetic, Thermodynamic, and Mechanistic Study.

Bacterial antibiotic resistance has been deemed one of the largest modern threats to human health. One of the root causes of antibiotic resistance is the inability of traditional wastewater management techniques, such as filtration and disinfection, to completely eliminate residual antibiotics from domestic and industrial effluents. In this study, we examine the ability of UiO-66; a metal-organic framework (MOF); in removing the antibiotic Doxycycline from aqueous environments. This study's findings suggest that UiO-66 was able to remove nearly 90% of the initial Doxycycline concentration. To correlate the isothermal data, Langmuir and Freundlich models were used. It was determined that the Langmuir model was best suited. Pseudo-first and -second order models were examined for kinetic data, where the pseudo-second order model was best suited-consistent with the maximum theoretical adsorption capacity found by the Langumir model. Thermodynamic analysis was also examined by studying UiO-66 adsorption under different temperatures. Mechanisms of adsorption were also analyzed through measuring adsorption at varying pH levels, thermogravimetric analysis (TGA), Infrared spectroscopy (IR) and Brunauer-Emmet-Teller (BET). This study also explores the possibility of recycling MOFs through exposure to gamma radiation, heat, and heating under low pressure, in order for UiO-66 to be used in multiple, consecutive cycles of Doxycycline removal.