Agenesis of the Corpus Callosum in a Patient With Schizophrenia.

The aim of this study is to report the case of a 25-year-old male with a history of schizophrenia who presented involuntarily to the psychiatric emergency department (ED) due to worsening agitation, paranoia, and disorganized behavior concerning a psychotic episode. During medical clearance to rule out acute organic causes of altered mental status prior to admission, the patient was found to have agenesis of the corpus callosum (ACC) on CT of the brain. ACC is a rare congenital disorder characterized by the partial or complete absence of the commissural pathway that connects the two cerebral hemispheres. This case presents a thought-provoking incidental anatomical finding in a patient with an acute exacerbation of chronic schizophrenia and allows for further discussion about the prevalence of undiagnosed malformations and possible underlying genetic contributions in patients with chronic mental illness.

The Role of Psychiatry in the Management of Sexual Assault: A Case Series.

Victims of childhood sexual abuse are at an increased risk for a multitude of mental health conditions. While many children exhibit concerning behavioral changes following abuse, there is often a delay in identification and implementation of psychiatric services, resulting in worsening mental and physical health outcomes for victims. This case series aims to demonstrate the importance of multidisciplinary victim-centered and trauma-focused treatment including proactive psychiatric care. The review presents three cases of child victims of sexual abuse who received psychiatric care after their initial presentation to the Puerto Rico Health Justice Center (PRHJC). As evidenced by the following cases and extant literature, child victims of sexual abuse have an increased risk of severe mental health disorders. This indicates the importance of recognizing and understanding behavioral warning signs of childhood sexual abuse and the importance of psychiatric care as early as possible following disclosure.

Organic vs Stimulant-Induced Psychosis in the Peripartum Period.

This is the case of a 30-year-old pregnant female who presented to the medical emergency department with signs and symptoms consistent with a psychotic episode. At the time of presentation, the patient was noted to have paranoia and delusions focused on her current pregnancy. On further evaluation in the emergency department, the patient's urine toxicology was found to be positive for methamphetamines. Following medical clearance, the patient was admitted for acute inpatient psychiatric stabilization. During hospitalization, her psychosis rapidly resolved with only the use of two emergency treatment injections containing antipsychotic medication. This case presents an interesting differential diagnosis between a brief psychotic disorder with peripartum onset and a substance-induced psychosis, and allows for further discussion in the differentiation and clinical treatment of these diagnoses.

A Web-Based Pharmacogenomics Search Tool for Precision Medicine in Perioperative Care.

Background: Precision medicine represents an evolving approach to improve treatment efficacy by modifying it to individual patient's gene variation. Pharmacogenetics, an applicable branch of precision medicine, identifies patient's predisposing genotypes that alter the clinical outcome of the drug, hence preventing serious adverse drug reactions. Pharmacogenetics has been extensively applied to various fields of medicine, but in the field of anesthesiology and preoperative medicine, it has been unexploited. Although the US Food and Drug Administration (FDA) has a table of pharmacogenomics biomarkers and pharmacogenetics, this table only includes general side effects of the included drugs. Thus, the existing FDA table offers limited information on genetic variations that may increase drug side effects. Aims: The purpose of this paper is to provide a web-based pharmacogenomics search tool composed of a comprehensive list of medications that have pharmacogenetic relevance to perioperative medicine that might also have application in other fields of medicine. Method: For this investigation, the FDA table of pharmacogenomics biomarkers in drug labeling was utilized as an in-depth of drugs to construct our pharmacogenetics drug table. We performed a literature search for drug-gene interactions using the unique list of drugs in the FDA table. Publications containing the drug-gene interactions were identified and reviewed. Additional drugs and extracted gene-interactions in the identified publications were added to the constructed drug table. Result: Our tool provides a comprehensive pharmacogenetic drug table including 258 drugs with a total of 461 drug-gene interactions and their corresponding gene variations that might cause modifications in drug efficacy, pharmacokinetics, pharmacodynamics and adverse reactions. This tool is freely accessible online and can be applied as a web-based search instrument for drug-gene interactions in different fields of medicine, including perioperative medicine. Conclusion: In this research, we collected drug-gene interactions in a web-based searchable tool that could be used by physicians to expand their field knowledge in pharmacogenetics and facilitate their clinical decision making. This precision medicine tool could further serve in establishing a comprehensive perioperative pharmacogenomics database that also includes different fields of medicine that could influence the outcome of perioperative medicine.

Chemical Colitis Induced by Low-dose Hydrogen Peroxide Enema in a Cocaine User.

Home remedies are usually cheap options to alleviate conditions commonly used prior to patients seeking medical advice for their problems, and are sometimes the only option for some populations that have otherwise no healthcare access. Hydrogen peroxide enemas appear to be an easily accessible solution to constipation, with "how to guides" found ubiquitously on the Internet. To our knowledge there are a few case reports exposing its complications. Our case reports complications in a patient who used a lower than average dose of a hydrogen peroxide enema, albeit compounded by cocaine abuse. Our experience suggests that the risks of concurrent use of cocaine and hydrogen peroxide enemas can lead to dangerous vasoconstriction, decreased blood flood to the bowel mucosa, and might lead to significant complications to otherwise tolerable doses of corrosive agents.

Obstetric patients' perspectives on functional magnetic neuroimaging research in pregnant women.

Magnetic resonance neuroimaging (MRI) studies of healthy pregnant women could identify key mechanisms of spontaneous health behavior changes observed in expectant mothers as novel intervention targets, but are currently unprecedented. As balancing potential benefits of research with unknown risks, including participant perceptions of risk, is foundational to ethical conduct, we surveyed a convenience obstetric sample to understand pregnant women's perspectives on this issue. Respondents were 76 pregnant women (modal age of 30-39 years; 64% multiparous) presenting for obstetric care from April to June 2016 at privately and publicly funded clinics at an urban academic medical center in the Midwestern USA. Following a written description about functional magnetic resonance neuroimaging (fMRI) and its known and unknown risks, women were queried on their willingness to participate in a hypothetical study involving fMRI during pregnancy, and specific concerns about doing so, if hesitant or unwilling. Willingness to participate was "yes" (28.4%, n = 21), "maybe" (28.4%, n = 21), and "no" (43.2%, n = 32). Among those responding "maybe" or "no" (n = 53, 73.6%), 11 women (20.7%) articulated concern about the fetus. Other concerns expressed were time commitment (n = 11, 20.7%) and discomfort being in an MRI machine (n = 4; 7.5%). Pregnant women may be open to participating in research involving MRI provided concerns about fetal health, time, and personal comfort are addressed.