Psychiatric explanations of poor oral intake: A clinically focused review.

BACKGROUND: Poor oral intake (POI) among medical-surgical inpatients can cause malnutrition and delay recovery due to medical consequences and the need for more invasive nutritional support. Many psychiatric conditions can cause POI; however, the role that psychiatric conditions play in POI has received limited attention to date. OBJECTIVE: This review aggregates available information on POI due to psychiatric conditions and provides a framework for the clinical approach to these conditions in hospitalized adult patients. METHODS: We searched PubMed and EMBASE for reviews of POI due to psychiatric causes, but no relevant publications were identified. Diagnostic criteria for relevant conditions in the DSM-5-TR and Rome IV were reviewed, as were C-L psychiatry textbooks and relevant society websites. This review was further supplemented by a case conference at the authors' institution. RESULTS: We have divided results into five sections for clinical utility: (1) the need to rule out medical and psychotropic causes of POI; (2) unpleasant somatic experiences causing POI; (3) mood, psychotic, catatonic, and neurocognitive disorders that can present with POI; (4) eating and feeding disorders; and (5) personal and interpersonal explanations of POI. Within each section, we review how to identify and manage each condition, specifically considering effects of treatment on oral intake. CONCLUSIONS: The clinical management of POI varies based on cause. For instance, psychostimulants can cause POI due to inappetence; however, they can treat POI due to abulia by improving motivation. The fact that such a broad range of psychiatric conditions can cause POI calls for a systematic clinical approach that considers the categories of potential causes. We also identified a need for prospective studies focused on the management of POI due to psychiatric conditions, as the literature on this topic is limited to case reports, case series, and retrospective cohort studies.

Osteoclast-like giant cell tumor of the pancreas-an unusual presentation in a patient with large mantle cell lymphoma.

Osteoclast-like giant cell tumor of the pancreas is very rare. We report a 78-year-old male who was previously treated for large mantle cell lymphoma, was found to have an increased uptake in a peri-pancreatic node from his restaging PET scan. Endoscopic ultrasound-directed fine-needle aspiration of the mass and lymph node revealed an undifferentiated carcinoma with osteoclast-like giant cells. Osteoclast-like giant cell tumors of the pancreas are frequently found to be unresectable at diagnosis due to their large size (>5 cm). In our patient, due to its small size (<3 cm) sub-total pancreatectomy was performed. Three years from the surgery, the patient is doing well without recurrence. This case report intends to increase provider awareness that in the setting of new pancreatic lesions in a patient with previous history of lymphoma, a high index of suspicion for a primary pancreatic lesion should be included in the differential diagnosis.

Functional and radiological outcomes of semi-rigid dynamic lumbar stabilization adjacent to single-level fusion after 2 years.

OBJECTIVE: To prospectively evaluate the functional and radiological outcomes of Isobar semi-rigid dynamic posterior stabilization adjacent to single-level fusion up to and including 24 months postoperatively. METHOD: A prospective follow-up for 24 months of 36 patients who underwent posterior Isobar dynamic stabilization due to single-level degenerative lumbar discopathy and instability (DLDI) with mild adjacent level degeneration, with collection of functional [visual analog scale (VAS) and Oswestry Disability Index (ODI)] and radiological data (resting, functional X-rays and MRI). RESULTS: Functional outcomes at 24 months showed significant improvement in mean VAS score by 38.9 points (P < 0.01) and ODI by 22.4 points (P < 0.01). Compared with data preoperatively, disc height at the index and adjacent levels and intervertebral angle (IVA) at the index level showed a slight decreasing trend at each follow-up (P > 0.05), while IVA at the adjacent level showed a slight increasing trend (P > 0.05). Range of motion averaged 2.84° at the index level and remained unchanged at the adjacent level (P > 0.05). The mean Pfirrmann score changed from 2.86 preoperatively to 2.92 at 24 months postoperatively at the index level (P > 0.05), and from 1.92 preoperatively to 1.96 at 24 months postoperatively at the adjacent level (P > 0.05). No reoperation, loosening of screws or infection was recorded. CONCLUSIONS: Patients with single-level DLDI and mild adjacent level degeneration treated with Isobar stabilization show a clinical improvement after 2 years. However, disc degeneration at the index and adjacent levels seems to continue despite using semi-rigid dynamic stabilization.