Why Psychiatrists Should Read (and Watch) the Lord of the Rings.

Stories have, throughout all of time, given human beings an opportunity to contrast our own experiences and thoughts with a character's. To imagine another's situation, empathize with it, and then learn of their struggles or achievements, is an excellent opportunity for us to grow. It is transformative. These meaningful messages should be examined, rather than simply dismissed. Medicine has learned much from examining animals, nature, and history. Is it outlandish to consider the possibility that examination of Middle Earth, Hobbits and Elves, could be equally useful? When we consider psychiatric illness or distress, we are examining many very complicated processes happening within an individual's mind. Similarly, when we read or watch a well-done novel or film, the impact can be very far from fictitious. We experience the story with the characters, often reciprocating their emotions and deliberating on their decisions. To chalk this experience up as "fake" would be a disservice. After all, the effects of the physical world and a person's imagination can have comparable reverberations throughout the psyche. Stories have considerable impact on our psychological health, and the insight that we extract from them can improve overall emotional wellbeing. The Lord of the Rings is a classic and brilliantly depicted narrative. Despite many characters being of different species, they teach very tangible human lessons. This article will explore some of these lessons, all the while considering their influence and importance in life, whether psychiatrically beneficial or destructive. Specifically, six lessons will be discussed.

Oculogyric Crisis after Initiation of Aripiprazole: A Case Report of an Active Duty Service Member.

Introduction: Oculogyric crisis is an acute dystonic reaction characterized by sustained, bilateral, and upward deviation of the eyes. It is a relatively uncommon extrapyramidal side effect of antipsychotic medications. Aripiprazole is an atypical antipsychotic that is FDA-approved for the treatment of schizophrenia, bipolar disorder, Tourette's disorder, and treatment resistant major depressive disorder. Compared to other antipsychotics, it is thought to have a lower propensity for causing dystonic side effects. Clinical Case. This case report is of a 19-year-old male who was psychiatrically hospitalized for first episode psychosis and initiated on low-dose oral aripiprazole. Three days after initiation of the medication, the patient was found to be markedly anxious and pacing around his room. Exam was notable for intermittent upward eye rolling, sustained upward conjugate gaze, and limited downward gaze. No other facial dyskinetic movements were observed. Treatment. The patient's oral aripiprazole was held, and he was administered 50 mg of oral diphenhydramine with improvement in symptoms within one hour. Ocular symptoms, dizziness, frontal headache, and pacing were resolved the following morning. He declined reinitiation of an antipsychotic medication. Conclusion: Aripiprazole-induced acute dystonia, specifically OGC, is a rare potential adverse effect of aripiprazole. Risk factors include male gender, young age, use of typical antipsychotics, and initiation or uptitration of an antipsychotic. Even though atypical antipsychotics including aripiprazole are associated with lower risk for extrapyramidal symptoms, the possibility of oculogyric dystonia merits close monitoring especially in young, male, and drug naive patients. Anticholinergic agents such as diphenhydramine can treat symptoms of acute dystonia.

Expanding the indications for single-incision laparoscopic cholecystectomy to all patients with biliary disease: is it safe?

PURPOSE: The safety of single-incision laparoscopic cholecystectomy (SILC) has been proven in well-selected patients. The objective of this study was to determine whether SILC can be offered to all patients with any indication for cholecystectomy. METHODS: A total of 173 consecutive SILCs were performed between January 2010 and November 2012 with no exclusion criteria. Demographic data, operative, and postoperative outcomes were prospectively collected and analyzed. RESULTS: Patients with acute cholecystitis and gallstone pancreatitis had longer operative times and a higher conversion to 4-port cholecystectomy than patients with biliary colic. Similar relationships were seen when comparing patients with obesity to nonobese patients. There were no differences in complication rates between the groups. CONCLUSIONS: SILC can be safely offered to patients with a wide spectrum of biliary disease with the understanding that this may result in increased operative times and a higher likelihood of conversion to multiport laparoscopy.

The effect of increasing hydrophobicity on the self-assembly of amphipathic beta-sheet peptides.

Peptide self-assembly processes are central to the etiology of amyloid diseases. Much effort has been devoted to characterizing amyloid structure and the mechanisms of peptide self-assembly leading to amyloid. It has been proposed that aromatic side-chain interactions play a central role in early self-assembly recognition events, but this contention remains somewhat controversial. Recent studies have indicated that in some amyloid peptides, aromatic residues can be exchanged for other hydrophobic residues and these nonaromatic variant peptides still retain competency to form amyloid, although with attenuated kinetics. In an effort to understand the relative contributions of aromatic versus generic hydrophobic interactions, studies to quantify the self-assembly properties of amyloid peptides as a function of increasing hydrophobicity and altered aromatic character have been undertaken. In the present study, the amphipathic (FKFE)(2) peptide has been chosen as a model system. The aromatic phenylalanine residues have been globally replaced with nonaromatic natural residues with lower hydrophobicity (alanine, valine, and leucine) and a nonnatural residue with greater hydrophobicity (cyclohexylalanine). The self-assembly properties of these peptides have been characterized by secondary structure analysis and microscopic analysis of the resulting aggregate structures. These studies confirm that aromatic interactions are not strictly required for amyloid formation and that the nonaromatic, but highly hydrophobic, cyclohexylalanine appears to have unique self-assembly characteristics and enhanced hydrogelation properties. The aromatic phenylalanine-containing peptide displays intriguing solvent- and concentration-dependent polymorphism, suggesting that aromatic interactions, while not essential for self-assembly, may give rise to unique structural features.