Tuesday, January 5, 2010

When to admit an adolescent to a psychiatric inpatient facility

Michael T. Sorter, MD, Associate professor of psychiatry and pediatrics, Department of psychiatry, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Admitting an adolescent to a psychiatric inpatient facility may be necessary to address a crisis. Interdependent links among the patient, family, and support network complicate the determination of whether an adolescent requires inpatient care. To make the best decision, a psychiatrist needs to understand the youth’s difficulties within family, school, and community.

The decision to admit an adolescent rests on:

  • the clinician’s ability to evaluate the risk of harm and functional status

  • how much support the family and/or caregivers can provide

  • the clinician’s knowledge of treatment resources available to the adolescent and family.

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Borderline, bipolar, or both?

Jess G. Fiedorowicz, MD, Assistant professor, Department of psychiatry, University of Iowa, Carver College of Medicine, Iowa City, IA

Donald W. Black, MD, Professor, Department of psychiatry, University of Iowa, Carver College of Medicine, Iowa City, IA

Borderline personality disorder (BPD) and bipolar disorder are frequently confused with each other, in part because of their considerable symptomatic overlap. This redundancy occurs despite the different ways these disorders are conceptualized: BPD as a personality disorder and bipolar disorder as a brain disease among Axis I clinical disorders.

BPD and bipolar disorder—especially bipolar II—often co-occur and are frequently misidentified, as shown by clinical and epidemiologic studies. Misdiagnosis creates problems for clinicians and patients. When diagnosed with BPD, patients with bipolar disorder may be deprived of potentially effective pharmacologic treatments. Conversely, the stigma that BPD carries—particularly in the mental health community—may lead clinicians to:

  • not even disclose the BPD diagnosis to patients

  • lean in the direction of diagnosing BPD as bipolar disorder, potentially resulting in treatments that have little relevance or failure to refer for more appropriate psychosocial treatments.

To help you avoid confusion and the pitfalls of misdiagnosis, this article clarifies the distinctions between bipolar disorder and BPD. We discuss symptom overlap, highlight key differences between the constructs, outline diagnostic differences, and provide useful suggestions to discern the differential diagnosis.

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Listen to Dr. Fiedorowicz explains why a thorough and rigorous psychiatric history is essential to distinguish BPD from bipolar disorder

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New Year’s resolutions to help our patients

Henry A. Nasrallah, MD


Most New Year’s resolutions have a self-oriented, narcissistic flavor: “I will ___ (lose weight to look better; exercise to become healthier; stop smoking to live longer; travel to an exotic location; make more money than last year so I can buy that sports car I’ve always wanted; etc.).”

As psychiatrists, we are particularly attuned to the human condition around us, so perhaps we can transcend our personal desires and resolve to do something to help seriously mentally ill patients. Our stressful lives as toiling psychiatrists pale when compared with the lifelong anguish, stigma, disability, loneliness, and poverty faced by many of our chronically ill patients. Beyond providing them with good evidence-based care, I can think of several meaningful resolutions to improve mentally ill persons’ quality of life.