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Alpha-gal syndrome, which is typically acquired by a tick bite, is an IgE-mediated immune response to galactose-alpha-1,3-galactose (alpha-gal), an oligosaccharide in most mammalian tissue. This report describes a 29-year-old Caucasian female with comorbid alpha-gal syndrome who presented to the inpatient psychiatric unit after an intentional overdose. Because of the patient’s alpha-gal syndrome, the treatment team worked with the hospital pharmacy to evaluate treatment options that did not contain mammalian products. After carefully reviewing the ingredients of suitable medications on formulary, the patient was started on a generic sertraline formulation that was free of mammalian derivatives. At the time of discharge, the patient reported significant symptom improvement and was free of symptoms suggesting an alpha-gal allergic reaction. This case illustrates the challenges of starting psychiatric medications in a patient with comorbid alpha-gal syndrome.

Smith-Magenis syndrome (SMS) is a severe neurodevelopmental disorder characterized by intellectual disability, sleep abnormalities, behavioral dyscontrol, and a distinct somatic phenotype. This report describes the case of a 10-year-old female with SMS who presented with aggression, self-injurious behavior, impulsivity, and attention deficits. She had failed trials of several stimulants and clonidine prior to presentation. An evening-dosed, delayed-release/extended-release methylphenidate formulation was added to her regimen, and she demonstrated significant improvement in her presenting symptoms. To our knowledge, this is the first published case of the use of an evening-dosed, delayed-release/extended-release methylphenidate formulation in a patient with SMS. This case highlights the need for further research on the role of these medications in managing behavioral and attentional symptoms associated with SMS.

Background: The use of psychedelic compounds to treat psychiatric disorders has become a very significant topic of research over the past several years. Psilocybin has raised to prominence as one of the most studied amongst these psychedelic compounds and multiple trials have already shown that it can be a safe and efficacious form of treatment for a variety of medical conditions. This study intends to perform a meta-analysis of data reported in clinical trials studying psilocybin’s effect on depression and anxiety. Methods: Articles were searched, screened, and ultimately selected using predetermined inclusion criteria. Data was collected from commonly used psychometric tests that measured mood and anxiety symptoms. Effect sizes were calculated comparing scores in these tests at baseline and control to experimental groups. Sub-group analysis was performed to assess psilocybin’s effect on depression and anxiety during short, medium, and long-term time frames. Results: Statistical significance was achieved in the reduction of depression and anxiety symptoms compared to controls in multiple subgroups. Heterogeneity of the effect sizes was calculated using an I2 value which showed low to moderate values. Multiple tools were used to assess for publication bias and none could be found. Conclusion: Although research on psilocybin is continuing to show promise, the evidence is still at a preliminary phase and more trials need to be conducted with larger patient populations over longer periods of time in order for psilocybin to potentially be approved for use in a community setting.