Comprehensive Textbook of Psychiatry.

Rethinking Psychiatry: From Cultural Category to Personal Experience

/pdf/catatonia-a-critical-review-and-therapeutic-recommendations-fwbbpwurh2.pdf

Catatonia: a critical review and therapeutic recommendations

Neuroleptic malignant syndrome (NMS) can be caused by various drugs. We report a case of a 60-year-old woman who presented with high-grade fever, muscular rigidity, tachycardia, tachypnoea and altered sensorium along with seizures. She had been taking olanzapine for the past 2 years for psychosis. For the last month valproate was added to her treatment. Her blood investigations revealed hyponatraemia and raised serum ammonia and creatinine phosphokinase (CPK) levels. In view of hyperthermia, muscular rigidity, autonomic disturbances, altered mental status and raised CPK, a diagnosis of NMS was made. Valproate could have probably precipitated NMS; although the patient was taking antipsychotics for a long time, it was only with the addition of valproate that she developed these symptoms. Raised serum ammonia levels also indicated the presence of valproate toxicity. Seizures were probably due to electrolyte disturbances. Offending drugs were withdrawn. The patient improved with treatment by dopamine agonist and other supportive treatments.

/pdf/an-atypical-case-of-neuroleptic-malignant-syndrome-25prqktbro.pdf

An atypical case of neuroleptic malignant syndrome precipitated by valproate

I agree with Natarajan and Ravikumar that overseas doctors have been treated very shabbily.1 One of the surprising features of the whole affair has been the lack of outcry from UK and EU doctors in protest. The British Medical Association's response has been muted to say the least. But is this so surprising? In medicine, as in life, there are winners as well as losers and the simple truth is that UK and EU doctors are the winners here. Their jobs will be protected. They will not have to prove that they are better than overseas doctors to get a job; they will merely have to be available and be able to do the job.2

But UK and EU doctors should not become too smug. It is likely that, over the coming years, the large increase in the number of UK medical graduates will make medical unemployment a reality in this country.3 What will they do then? They could go abroad; but in light of the UK's treatment of overseas doctors they should not count on too warm a welcome. Who will speak up for them? We would do well to remember the words of Martin Niemoller, a German pastor: ‘First they came for the Jews and I did not speak out—because I was not a Jew. Then they came for the communists and I did not speak out—because I was not a communist. Then they came for the trade unionists and I did not speak out—because I was not a trade unionist. Then they came for me—and there was no one left to speak out for me’.

/pdf/international-medical-graduates-2avvr55k38.pdf

International medical graduates.

Extreme elevation of creatinine phosphokinase levels in neuroleptic malignant syndrome associated with atypical antipsychotics.

Objective: Latin American-trained international medical graduates (IMGs) in psychiatry residency face multiple challenges that go beyond their medical training. These challenges call for innovative problem-solving. Although the professional development of IMGs has been discussed in the professional literature, little is written about their experiences. In this report, a group of IMGs reflect on their experiences and describe how they solved challenges. Method: Using cogenerative ethnography, four IMGs trained in Colombia, the Dominican Republic, and Mexico provided insights on their challenges and solutions while adapting to psychiatric residency training. Individual interviews, focused discussion, and written reports were analyzed using data reduction, data display, and conclusion-drawing techniques. Results: We illustrate the challenges of IMG training in psychiatry using their reflections and stories. We categorize these challenges into three domains: immigration and acculturation, social adjustment, a...

/pdf/challenges-and-solutions-for-latin-american-trained-1aekfye3ce.pdf

Challenges and Solutions for Latin American-Trained International Medical Graduates in Psychiatry Residency

Mutism, or the absence of speech, is known to have a wide range of etiologies in medicine, neurology and psychiatry. More narrowly defined as “organic or functional absence of the faculty of speech” (1), mutism has been described as a presenting symptom in psychiatric disorders such as Major Depressive Disorder, catatonic states, Conversion Disorder, Anxiety disorders, Acute Adjustment disorders, and some personality disorders (1,2). We present a case in which mutism was a complicating factor in the assessment and treatment of a patient with psychosis, for whom the assessment of dangerousness was especially important but difficult to complete with confidence.

https://print.ispub.com/api/0/ispub-article/5405

David Hauser

Papers

Extreme elevation of creatinine phosphokinase levels in neuroleptic malignant syndrome associated with atypical antipsychotics.

Challenges and Solutions for Latin American-Trained International Medical Graduates in Psychiatry Residency

Assessment Of Dangerousness Complicated By Mutism Associated With Psychosis