Regardless of cultural or religious background, the residents endorsed the curriculum as a worthwhile experience and increased their appreciation of the place of spirituality in the holistic care of patients with psychiatric conditions.

Background: Antipsychotic drug use in children has doubled from 2001 to 2007 with concomitant increase in obesity. Second-generation antipsychotic (SGA) medication use is associated with weight gain, metabolic derangements, and blood sugar and lipid abnormalities in children. The American Psychiatric Association and the American Diabetes Association have recommended metabolic monitoring guidelines for patients using SGA. Study Question: The study objective was to investigate and compare metabolic monitoring for SGA medications in psychiatry (PSY), and pediatrics and family medicine [primary care providers (PCP)] outpatient clinics of a university medical center. Study Design: This is a retrospective study of 149 charts of patients newly prescribed with SGA, ages 5–18 years, from their initial visit in the outpatient clinics. Measures and Outcomes: Compliance with recommended metabolic monitoring was evaluated for initial and subsequent clinic visits. Parameters included body mass index, waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile. Results: Of the 149 charts, 110 patients were in PSY and 39 in PCP. The parameter most regularly monitored was body mass index (baseline: PSY 88.3%, PCP 97.4%; 12 weeks: PSY 86.4%, PCP 85.0%; and 24 weeks: PSY 91.8%, PCP 100%). Fasting plasma glucose (baseline: PSY 18.9%, PCP 25.6% and 12 weeks: PSY 8.6%, PCP 10.0%) and fasting lipid profile (baseline: PSY 12.7%, PCP 25.6% and 12 weeks: PSY 7.0%, PCP 10.0%) had low completions rates. No difference was seen in metabolic monitoring by sex or ethnic group. Conclusions: Metabolic monitoring rate of child and adolescent patients on SGAs was low overall. No statistically significant differences were seen between psychiatry and PCP except a significantly higher rate of fasting plasma glucose level monitoring at baseline among PCP. Limitations to the study include the small sample size obtained for the period investigated and insufficient documentation in some electronic charts. Extending the period studied may increase the statistical significance of the data.

This is a case of a 22-year-old Hispanic male with a history of bipolar disorder and methamphetamine dependence who was admitted after presenting with suicidal ideations by slashing his throat with a machete. The patient had been smoking and inhaling “processed” pyrethroid for about eight weeks as an inexpensive methamphetamine substitute. He reported experiencing a “rush” similar to methamphetamine after using pyrethroid from liquid insecticide that had been heated (electrocuted) or sprayed on hot metal sheets until it crystallized. The patient presented with no significant physical markings or findings but claimed to have his suicidal ideations precipitated by concerns of ill effects of pyrethroid on his health. He also had positive urine drug screen for methamphetamine, which he admitted to using on the day of admission. We conclude that it is important for physicians to maintain a high level of suspicion for alternate and uncommon substances of abuse as well as risks for suicidal tendencies in these patients.

In February 2020, the governing bodies of the United States Medical Licensing Examination (USMLE) announced the decision to change Step 1 score reporting from a three-digit system to pass/fail designation. Previous studies theorized that Step 2 Clinical Knowledge (CK) will become the numerical standard by which residency directors can quickly sort through program applicants. The goal of this study is to review prior research and identify significant factors associated with Step 2 CK outcomes.A systematic literature search on PubMed, Web of Science, Scopus, and ERIC that included articles published between 2005 and 2015 was conducted using the keywords "USMLE," "Step 2 CK," "score," "success," and "predictors."After screening the initial search yield of 3,239 articles, 52 articles were included for this review. Positively correlated factors included Step 1 score, clinical block grades, Comprehensive Clinical Science Self-Assessment (CCSSA), Comprehensive Clinical Science Examination (CCSE), and volunteerism. Factors such as clerkship sequence and pass/fail grading failed to correlate with Step 2 CK. Medical College Admission Test (MCAT) score (p < 0.01) and undergraduate grade point average (GPA) (p = 0.01) positively correlated, while age displayed a negative correlation. Additionally, females typically scored higher on Step 2 CK than their male peers.The study findings suggest that continuous learning and academic success throughout medical school positively influence eventual Step 2 CK scoring. Performance on USMLE practice examinations, Step 1, and clinical evaluations serve as positive predictors for Step 2 CK scores. Interestingly, changing answers and spending more time on each question during the examination were associated with higher scores.