Clinical Approach to Personality Change Due to Another Medical Condition.

BACKGROUND: Medical personality change (MPC) is a codable diagnosis (i.e., F07.0) that deserves consideration when a patient is inexplicably no longer "acting like him/herself." Its presentation ranges from subtle to severe and is often characterized by bafflingly poor judgment and impairment in several aspects of a person's life. Despite the global impact that MPC can have on a patient's functioning, occupation, and relationships, this condition receives far less clinical consideration than better known syndromes such as depression or anxiety and is often likely incorrectly formulated as such. OBJECTIVE/METHODS: This article provides a clinically focused review of MPC. We review its clinical assessment followed by a review of its subtypes, which we have categorized to reflect the behavioral correlates of known frontotemporal-subcortical circuits. These include the apathetic type (ventromedial prefrontal cortex), the labile and disinhibited types (orbitofrontal cortex), and the aggressive and paranoid types (medial temporal lobes). RESULTS: For each of these 3 categories, we describe the clinical presentation and review management strategies. For each category, we focus on 3 common causes for MPC-traumatic brain injury, Huntington disease, and brain tumors-which we have selected because clinical features of MPC due to these conditions generalize to many other etiologies of MPC. CONCLUSIONS: MPC warrants clinical attention for the range of dysfunction and distress it can cause. It also deserves further scientific study to better characterize its phenotypes, to tailor instruments for its clinical assessment, and to identify effective treatments.

Simple Schizophrenia Remains a Complicated Diagnosis: Case Report and Literature Review.

The diagnosis of simple schizophrenia has been challenged and criticized since it was first described by Otto Diem in 1903. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), released by the American Psychiatric Association in May 2013, classified it as a condition for further study with the name "attenuated psychosis syndrome." This clinical condition has undergone several revisions with each edition of the DSM. It is characterized by oddities in conduct, inability to meet the demands of society, and decline in total performance in the absence of obvious psychotic symptoms. We discuss the case of a 35-year-old man who presented with symptoms fitting the criteria for simple schizophrenia and review the various definitions and case reports published over the years that defend the diagnosis of simple schizophrenia.

Initiating buprenorphine treatment for hospitalized patients with opioid dependence: A case series.

BACKGROUND AND OBJECTIVES: Opioid dependent patients are hospitalized frequently. We aimed to determine if initiation of buprenorphine treatment during hospitalization facilitates entry into treatment following discharge. METHODS: Retrospective case series (n = 47). RESULTS: Twenty-two (46.8%) patients successfully initiated buprenorphine treatment within 2 months of discharge. Those patients obtaining a referral to a specific program were more successful in continuing treatment, but this difference did not reach statistical significance (59.1% vs 39.1%, p = 0.18). DISCUSSION AND CONCLUSIONS: Hospitalization may be an important opportunity to engage opioid dependent patients to initiate buprenorphine treatment. SCIENTIFIC SIGNIFICANCE: This study provides provisional support for utilizing buprenorphine for hospitalized patients.

Enhancing management of agitation after traumatic brain injury: Psychiatric perspectives and quantitative assessments.

BACKGROUND: Post-traumatic agitation is a common and problematic complication after traumatic brain injury. It may present with features consistent with psychiatric disorders, which may provide clues as to management. OBJECTIVE: This is a narrative review of pertinent literature and a description of a collaborative clinical approach utilizing psychiatric and brain injury rehabilitation strategies to optimize outcomes in the management of post-traumatic agitation. METHODS: Describe and provide evidence for a transdisciplinary clinical approach supported by existing literature and clinical experience. RESULTS: Given the heterogeneity of the problem and limitations in the current literature there is no standardized approach to manage post-traumatic agitation; nevertheless, a strategy is proposed that clinicians may utilize to guide treatment and assess efficacy of the chosen intervention(s). CONCLUSION: A clinical approach that uses quantitative assessment of targeted behavior to objectively evaluate pharmacological interventions that are generated by a collaborative approach may yield improved outcomes for managing post-traumatic agitation.

Clinical Approach to Personality Change Due to Another Medical Condition.

BACKGROUND: Medical personality change (MPC) is a codable diagnosis (i.e., F07.0) that deserves consideration when a patient is inexplicably no longer "acting like him/herself." Its presentation ranges from subtle to severe and is often characterized by bafflingly poor judgment and impairment in several aspects of a person's life. Despite the global impact that MPC can have on a patient's functioning, occupation, and relationships, this condition receives far less clinical consideration than better known syndromes such as depression or anxiety and is often likely incorrectly formulated as such. OBJECTIVE/METHODS: This article provides a clinically focused review of MPC. We review its clinical assessment followed by a review of its subtypes, which we have categorized to reflect the behavioral correlates of known frontotemporal-subcortical circuits. These include the apathetic type (ventromedial prefrontal cortex), the labile and disinhibited types (orbitofrontal cortex), and the aggressive and paranoid types (medial temporal lobes). RESULTS: For each of these 3 categories, we describe the clinical presentation and review management strategies. For each category, we focus on 3 common causes for MPC-traumatic brain injury, Huntington disease, and brain tumors-which we have selected because clinical features of MPC due to these conditions generalize to many other etiologies of MPC. CONCLUSIONS: MPC warrants clinical attention for the range of dysfunction and distress it can cause. It also deserves further scientific study to better characterize its phenotypes, to tailor instruments for its clinical assessment, and to identify effective treatments.