Psychiatry

A 65-year-old woman was admitted with depression, recurrent falls, and difficulty caring for herself. She reported weakness on the left side and had a monoplegic gait, but results of strength testing were normal. She was treated for functional neurologic disorder but then had progressive neurologic decline. A diagnostic...

When an obstetrician with a personal history of maternal struggle cares for a patient facing a repeated painful tragedy, she realizes she can help by responding not as a physician, but as a mother.

ECT is effective for several disorders, particularly severe or treatment-resistant depression, with a rapid response, but stigma has impeded its use. The mechanism is not known, but a seizure is required for efficacy. Effects on memory are prominent though usually transient.

Patients who have taken opioids for years for chronic pain must be treated differently from those who have not because such therapies cause profound physiological and neurologic changes. Reflexive approaches to tapering or discontinuing opioids should be avoided.

When a physician finds herself in pain and in need of health care, she discovers both the frustrations of telehealth and some moments of humanity and grace with physicians and patients alike. How do we reconcile these healing moments with our broken system of care?

After her grandmother attempts suicide, a physician finds that the medical team’s avoidance of honest conversation about her grandmother’s reality and desires creates a chasm between the clinicians and the family that is counterproductive and painful.

A 67-year-old man with progressive motor neuron disease was evaluated in the sleep clinic because of dream enactment, daytime sleepiness, and apnea detected on a sleep study. Four months earlier, he had fallen asleep while washing dishes; this resulted in a fall and unstable C1 spinal fracture. A...

In this evaluation of injured drivers treated in British Columbia trauma centers before and after cannabis legalization, the percentage who tested positive for tetrahydrocannabinol was substantially higher after legalization (17.9%) than before legalization (9.2%). There was little change in the percentage who tested positive for alcohol.

Though the current conditions of the physician-burnout crisis are unique, medical professionals have struggled in the past, and remedies have been tried. History may help explain why physicians are under such strain and reveal why so many proposed solutions have fallen short.

This year’s Nobel Prize in Chemistry was awarded to Benjamin List and David MacMillan in recognition of their contributions to the efficient synthesis of enantiomers. Their discoveries have affected pharmacology and alleviated environmental pollution.

E-cigarettes that claim to contain “tobacco-free” synthetic nicotine — nicotine that isn’t derived from tobacco — are proliferating. Such products may threaten ongoing public health efforts to reduce e-cigarette use among adolescents and young adults.

A 76-year-old woman presented with abdominal pain, anorexia, memory impairment, and suicidal ideation. CT of the abdomen and pelvis revealed multiple dilated, fluid-filled loops of small bowel measuring up to 4 cm in diameter, with air–fluid levels and a transition point in the right lower quadrant. The urinary...

This year’s Nobel Prize in Physiology or Medicine was awarded to David Julius and Ardem Patapoutian for identifying molecules that relay sensation of capsaicin pepper, temperature, and physical force. They thus provided the first insights into how animals sense hot and cold temperatures, mechanical force, and the pungent...

Policy has been critical to achieving major public health advances, including in tobacco control, maternal and child health, and injury prevention. The opioid crisis illustrates five steps essential for using policy to produce substantial gains in population health.

In this Graphic Perspective, a physician traveler responding to a medical crisis on the train he’s taking is moved and inspired by the conductor whose quick action, dedication, and compassion save the day.

The latest Child Abuse Prevention and Treatment Act reauthorization bill would change the way families of substance-exposed infants are treated. The Biden administration could also leverage prevention and public health systems to achieve the policy’s objectives.

Intranasal oxytocin therapy has been used to improve various aspects of autism spectrum disorder on the basis of tenuous results from small studies. In a randomized trial involving 290 participants 3 to 17 years of age with autism spectrum disorder, daily use of oxytocin did not improve measures...

Autism spectrum disorder, a common neurodevelopmental disorder with onset in infancy, is characterized by deficits in social functioning and by repetitive–restrictive behaviors, such as repeated body movements, circumscribed interests, or resistance to change in routines. Pharmacologic interventions are limited to the treatment of symptoms, which does not target social...

In a trial in the United Kingdom, patients with depression who were being treated in primary care practices and who felt well enough to discontinue antidepressant therapy were randomly assigned to maintain their current antidepressant therapy or to discontinue such therapy. By 1 year, relapse had occurred in...