No abstract

No abstract

Introduction: Routine screening of adolescents for depression and suicide risk is now considered best clinical practice. However, due to a lack of training, many physicians do not engage in screening. The goal of this curriculum is to improve learner knowledge of and comfort in adolescent depression and suicide risk assessment and management. Methods: The didactic session typically takes 60-90 minutes to complete. In addition to a teaching PowerPoint that provides instruction in both the assessment and management of adolescent depression and suicide risk, the curriculum also includes a suicide assessment and management protocol. This protocol outlines an algorithm that assists in distinguishing between individuals at high and low risk of suicide. The algorithm enables clinicians to determine the most appropriate management plan based on the assessed level of suicide risk. Results: Outcome measures indicate that the majority of residents improved their self-perceived knowledge and comfort in assessing and managing depression and suicide risk, with an average of 61.7% of residents moving from the novice to the proficient group at the conclusion of the rotation. These results reflect learners obtaining 4 weeks of supervised clinical experience after the didactic session. Discussion: This curriculum was designed for use with pediatric and internal medicine-pediatric residents during their adolescent medicine rotation but could easily be adapted for use with other learners in different settings.

Stimulant laxatives are the class of laxatives most often abused by patients with eating disorders. The abrupt cessation of high‐dose stimulant laxatives is known to cause edema. We present the case of a patient with anorexia nervosa with binge‐purge subtype who was taking ∼100 stimulant laxatives per day. Upon discontinuation of stimulant laxatives, she experienced severe peripheral edema with rapid gain of 11.6 kg over 1 week. Unique features of this case include the high quantity of stimulant laxatives consumed per day, the amount of weight gained due to edema, and the 3 month duration of edema after laxative cessation. This case report details the time course of development of edema after abrupt laxative cessation. It also details the dosing and duration of furosemide used for diuresis in order to provide a precedent to inform future care. This case calls into question the best treatment approach for patients with severe edema after laxative cessation who do not meet criteria for Pseudo Bartter syndrome.

No abstract