State of complementary and alternative medicine education in psychiatry residency programsBackground: The incorporation of integrative medicine as a holistic approach increased in medical education. However, complementary and alternative medicine (CAM) formal teaching in psychiatry residency programs is limited. Aim: To assess the incorporation of CAM education in different Chilean psychiatry programs and to determine the knowledge and attitudes toward this issue. Material and Methods: An online survey was sent to 80 academic staff from five psychiatry programs. Forty-nine participants answered the survey (61%). Some of the questionnaire topics were the inclusion of CAM content in the program, types of CAM included, and motivation and strategies for the CAM content incorporation in their training curriculum. Results: Most respondents answered that there is no formal CAM content in their program's curriculum. The main topics to incorporate CAM in a psychiatry residency are sleep hygiene, stress management, and motivational interviewing. The lack of knowledge, time constraints, and the limited resources are major barriers to include CAM in their curriculums. Conclusions: Our results suggest that many academic staff of Chilean psychiatry training programs are aware of the importance of having CAM content in their curriculum. However, some barriers hinder their incorporation and implementation.
Introduction: Catatonia is a serious syndrome characterized by motor abnormalities associated with mental state alteration, with affection and mood imbalances. Frequent symptoms include mutism, radical negativism, weird posturing, echolalia and echopraxia. Hospital prevalence has been estimated up to 1%, being usually underdiagnosed.Case Presentation: A 49 year old male with a record of refractory frontal lobe epilepsy, borderline personality disorder, C6-C7 spinal trauma related tetraparesia. He presented with a two-month history of behavioral derangement, hallucinations and persecutory delusion. He was then started on risperidone 4.5 mg and venlafaxine 75 mg. Two weeks before admission he started presenting oral intake rejection. Later he was taken to the emergency department, after presenting a convulsive episode (featuring guttural sounds, ascending gaze and upper extremity jerks, without loss of consciousness. Electroencephalography (EEG) showed generalized interictal epileptiform activity. Acute crisis was controlled with 6 mg of lorazepam, following restart of previous medication. Brain CT showed diffuse atrophy and signs of left frontal cortical gliosis. On the third day of stay he was evaluated by psychiatry consultants, impressing oppositional behavior. A possible catatonic syndrome is postulated, scoring 11 points on Bush-Francis score with normal EEG. A 4 mg lorazepam trial results positive, attaining spontaneous speech, cooperation on interview and proper oral intake. Discussion: Catatonia is rather usual in general hospital practice. High suspicion must be kept from clinical presentation -particularly in patients with psychiatric comorbidities -given its potentially deleterious consequences. It should be regarded as a psychiatric emergency.
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