Legal Considerations in Emergency Psychiatry.

Emergency psychiatry stands at the fulcrum between the general principles of autonomy and liberty balanced against illnesses that both subvert autonomy and amplify risks for violence and suicide. Although all specialties of medicine must operate in adherence with the law, emergency psychiatry is particularly constrained and guided by state and federal laws. Routine matters of emergency psychiatric care-including involuntary assessment, admission and treatment, management of agitation, medical stabilization and transfer, confidentiality, voluntary and involuntary commitment, and duties to third parties-all occur within carefully delimited legal boundaries, rules, and processes. This article provides a basic overview of critical legal principles relevant to the practice of emergency psychiatry.

Substance Use Disorders in People Living with Human Immunodeficiency Virus/AIDS.

Persons living with human immunodeficiency virus (HIV)/AIDS have a substantial burden of co-occurring substance use disorders (SUDs); untreated alcohol and drug use disorders among people living with HIV/AIDS contribute to worse HIV care outcomes. SUDs are associated with key health behaviors and outcomes, including delays in seeking medical care, poor engagement in treatment, reduced adherence to medical treatment and antiretroviral therapy, immunosuppression, increased HIV transmission through risky sexual behaviors, and increased burdens on health care systems. HIV infection comorbid with SUD and a psychiatric disorder is a clinically challenging condition creating a complex set of medical and psychosocial challenges.

Physicians' Perceived Roles, as Well as Barriers, Toward Caring for Women Sex Assault Survivors.

BACKGROUND: Sexual assault (SA) affects about 40% of women in the United States and has many mental and physical health sequelae. Physicians often do not address SA with patients, although SA survivors describe a desire to talk to physicians to obtain additional help. Little information exists on how providers perceive their roles regarding caring for women SA survivors and what barriers they face in providing this care. METHODS: We performed a qualitative study using semistructured one-on-one interviews with 16 faculty physicians from five specialties: obstetrics and gynecology (n = 4), internal medicine (n = 4), family medicine (n = 1), emergency medicine (n = 3), and psychiatry (n = 4). Interviews were conducted between July 2011 and July 2012, transcribed verbatim, and coded using a constant comparative approach. Once a final coding scheme was applied to all transcripts, we identified patterns and themes related to perceived roles and barriers to caring for SA survivors. RESULTS: Physicians described two main categories of roles: clinical tasks (e.g., testing and treating for sexually transmitted infections, managing associated mental health sequelae) and interpersonal roles (e.g., providing support, acting as patient advocate). Physician barriers fell into three main categories: 1) internal barriers (e.g., discomfort with the topic of SA), 2) physician-patient communication, and 3) system obstacles (e.g., competing priorities for time). CONCLUSIONS: Although physicians describe key roles in caring for SA survivors, several barriers hinder their ability to fulfill these roles. Training interventions are needed to reduce the barriers that would ultimately improve clinical care for SA survivors.

Deletion of PIK3C3/Vps34 in sensory neurons causes rapid neurodegeneration by disrupting the endosomal but not the autophagic pathway.

The lipid kinase PIK3C3 (also called Vps34) regulates both the endosomal and autophagic pathways. However, the effect of inactivating PIK3C3 on neuronal endosomal versus autophagic processes in vivo has not been studied. We generated mice in which Pik3c3 was conditionally deleted in differentiated sensory neurons. Within a few days after Pik3c3 deletion, mutant large-diameter myelinated neurons accumulated numerous enlarged vacuoles and ubiquitin-positive aggregates and underwent rapid degeneration. By contrast, Pik3c3-deficient small-diameter unmyelinated neurons accumulated excessive numbers of lysosome-like organelles and degenerated more slowly. These differential degenerative phenotypes are unlikely caused by a disruption in the autophagy pathway, because inhibiting autophagy alone by conditional deletion of Atg7 results in a completely distinct phenotype in all sensory neurons (i.e., formation of very large intracellular inclusion bodies and slow degeneration over a period of several months). More surprisingly, a noncanonical PIK3C3-independent LC3-positive autophagosome formation pathway was activated in Pik3c3-deficient small-diameter neurons. Analyses of Pik3c3/Atg7 double mutant neurons revealed that this unconventional initiation pathway still depends on ATG7. Our studies represent in vivo characterization of PIK3C3 functions in mammals and provide insights into the complexity of neuronal endo-lysosomal and autophagic pathways.