A 4-month-old male domestic shorthair cat was evaluated for intermittent tremors, ptyalism, and signs of depression. The cat was small, thin, and unthrifty. Clinically important serum biochemical abnormalities included low blood urea nitrogen concentration and high baseline bile acids concentration. Abdominal ultrasonography and jejunal portography identified an intrahepatic portosystemic shunt. The cat was anesthetized, and a transjugular approach was used for percutaneous coil embolization of the shunt. Guidewires, catheters, and coils were inserted under fluoroscopic guidance to locate the shunt and define its anatomy, measure portal vein pressures before and after temporary balloon occlusion, and place thrombogenic coils to completely attenuate the anomalous vessel. The cat recovered without complications and was weaned from medical management. Ten weeks following the procedure, clinical signs had completely resolved, and baseline bile acids concentration was near reference range. Results in this cat illustrate that interventional radiology techniques can be safely used in small animals and may reduce the morbidity and mortality rates associated with traditional surgical procedures.

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Concurrent psychotherapy is used in various settings for patients of different diagnoses and ages. The concurrent group and individual psychotherapy of older adults with depressive disorders in a psychiatric day hospital is described, emphasizing phases of treatment and transference and countertransference themes uniquely relevant to working with depressed elderly patients in a day hospital. Case examples are offered to illustrate these issues. The special technical considerations that need to be utilized when multiple therapists and settings are present are described. The model employs the use of an integrative, interactive group therapy, along with various other group treatments and antidepressant medication, with individual therapy serving a subordinate but organizing role.