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Update on Psychiatry Residency Training in Personality Disorders: Becoming a Good Psychiatrist Through Becoming Good Enough at Treating Borderline and Narcissistic Personality Disorders
No full textPURPOSE OF REVIEW: We review recent clinical developments in borderline personality disorder and personality disorders more broadly, as well as changes in national psychiatry residency training guidelines in an effort to establish a roadmap for psychiatry residency training directors to create curricula to prepare residents to manage these disorders. RECENT FINDINGS: Though no randomized controlled trials exist, small studies demonstrating positive effects of teaching specialized treatment models to residents in programs with resources in these areas. The ACGME\u27s Milestones 2.0 and their relevance for personality disorder curriculum are discussed. Narcissistic Personality Disorder (NPD), its increasing importance in public and clinical consciousness, and recent developments in diagnosis, theory, and manualized treatments are noted, including a recent model of group psychoeducation. The current state of dimensional models for personality including the DSM 5 Section III (the Alternative Model for Personality Disorders) and ICD-11\u27s version introduced in 2022 are reviewed. Given BPD\u27s widespread prevalence, especially in the clinical setting, and the combination of the disorder\u27s complexity, comorbidity, and treatment challenges, we argue that devoting curricular resources to teaching about BPD makes good educational sense. We present a model curriculum based on the generalist approach of Good Psychiatric Management (GPM). This, we argue, can allow programs without specialist faculty to provide good enough preparation of residents for treating BPD, while also allowing more resource rich programs to add specialized Evidence Based Treatment (EBT) training for interested residents. We also offer GPM\u27s adapted approach to NPD as the basis for residency curricula for this important disorder. Finally, we propose ways to teach the use of the Alternative Model for Personality Disorders in the classroom setting, and in working with NPD patients
The role of social relationships in recovery court programs
No full textBACKGROUND: Recovery courts offer an empirically supported alternative to incarceration for legally involved individuals struggling with addiction. While studies suggest that graduation from recovery courts leads to a lower likelihood of recidivism as compared to incarceration, attrition rates among recovery court participants are high. Relatively little is known about how court participants\u27 social and family interactions affect progression through recovery court programs - information that could facilitate development of interventions to decrease court program attrition. METHODS: We used in-depth, semi-structured qualitative interviews with recovery court participants (N = 68) across nine recovery courts in one northeastern state to explore the role of social relationships on recovery court program progress. RESULTS: We found the following relationships can serve as barriers or facilitators through the recovery court program: relationship with one\u27s self, minor children, other family, twelve-step peer support group members, court program peers, sober living home residents, and court staff. Participants described how recovery courts favored increased focus on one\u27s self, which was not practical for those with family roles, and study participants felt recovery courts hindered relationships with minor children. Although other family relationships could be motivational, participants also faced misunderstanding and stigma from family members. Furthermore, overreliance on family members and friends for logistical needs (e.g., housing, transportation) could stress fragile relationships and lead to missed court requirements. Court programming facilitated supportive relationships with peers in recovery through required twelve-step peer support group involvement and interaction with court peers. However, ongoing substance use among these peer groups could be distressing for participants, especially in residential facilities. Recovery court staff were further sources of new relationships that were validating of participant progress. CONCLUSION: Our findings indicate that the impact of social relationships on recovery court participants is complex and could influence court program progress. We suggest that recovery courts serving legally involved populations consider borrowing approaches from the family treatment court model to strengthen pre-existing relationships and support navigation of parenting roles. Connection to wrap-around services could further alleviate stress on family dynamics. Additional incorporation of previous program graduates or those with substance use histories into recovery court programming could also be explored
The Impact of Glucagon-Like Peptide-1 Receptor Agonists on Pharmacokinetics and Toxicokinetics: Is a New Diagnostic and Therapeutic Framework Needed?
No full textA Staphylococcus aureus Virulence Inhibitor Identified by SaeRS Refactoring and Screening in Bacillus subtilis
No full textBacteria utilize two-component system (TCS) signal transduction pathways to sense environmental and physiological stimuli and mount appropriate responses. In opportunistic pathogens such as Staphylococcus aureus, TCSs activate virulence programs in response to host defense systems. Due to their critical role in pathogenesis, TCSs are important targets for antivirulence drug discovery campaigns. However, challenges associated with screening TCSs in pathogens and in vitro have limited the output of such efforts to a small number of characterized drug candidates. Here, we functionally express the S. aureus virulence-regulating TCS SaeRS from synthetic gene regulatory elements in the model bacterium Bacillus subtilis to reliably screen this system against a small molecule library under simple culturing conditions. Our approach reveals the compound NSC97920 as a strong inhibitor of SaeRS signaling. We combine in situ, in vivo, in silico, and in vitro characterization to demonstrate that NSC97920 suppresses the critical step of autophosphorylation in the SaeS histidine kinase, resulting in strong antivirulence activity. Our work shows that heterologous expression and screening of TCSs in model bacteria could accelerate the development of therapeutics against antibiotic-resistant pathogens
Alpha-Gal Syndrome in New England – A Case Report
Get PDFIntroduction: Alpha-gal syndrome (AGS) is an increasingly common allergy to mammalian meats and other mammalian products that is caused by a tick bite from the Lone Star tick. Climate change is likely contributing to expansion of the tick’s range into parts of southern New England.
Clinical Findings: The patient was 68 years old at the time of his sensitization. He developed gastrointestinal symptoms, including cramps and diarrhea, approximately 4 to 5 hours after eating a hamburger that he cooked on his home grill. After a second episode a few weeks later, he remembered reading about an allergy to beef and pork caused by tick bites, and he decided to avoid these products.
Clinical Course: Avoiding beef and pork products allowed the patient to have no further severe episodes of symptoms. After discussion with a tick researcher and infectious disease specialist, the patient had a serum immunoglobulin E test for alpha-gal, which was positive at 2.5 kUA/L. Over time, the patient learned about other sources of alpha-gal and has been able to continue avoiding symptoms of AGS.
Conclusions: Maine clinicians may see cases of AGS as climate change facilitates range expansion of the Lone Star Tick further north along the coast. Clinicians should be alert to new symptoms of meat allergy in adults who were previously able to eat meat. They can use the serum immunoglobulin E level to alpha-gal to confirm suspected cases, and they can recommend avoidance and symptomatic treatment to patients to help with this syndrome
An Opt Out Tobacco Cessation Referral Process for a Cancer Care Network
Get PDFOpt out tobacco cessation referrals should be standard of care.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1005/thumbnail.jp
Pharmacist-Led Statin Initiation in Adults with Diabetes at an Adult Internal Medicine Clinic
Get PDFPurpose: Implement and evaluate a pharmacist-led program addressing the current underutilization of statins among these high-risk patients with diabeteshttps://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1004/thumbnail.jp
Rigid Sternal Fixation Alone Does Not Result in a Reduction in Postoperative Opiod Administration Following Cardiac Surgery
Get PDFBackground: Persistent postoperative pain, infection, and sternal dehiscence are devastating complications after cardiac surgery that affect patient quality of life and increase healthcare system burden. Chronic sternal pain lasting more than 1 year affects 25 to 33% of cardiac surgery patients, and wound complications such as infection and sternal nonunion represent significant peri-operative risk factors1,2. Wire cerclage (WC) is the most widely accepted sternal closure technique among cardiac surgeons because of its perceived lower rates of sternal dehiscence, wound infection, and cost.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1001/thumbnail.jp
Factors Influencing No Show Rates in Adult Urology Patients
Get PDFOur study highlights a strong association between insurance status and no-show rates. Patients with Medicaid or no insurance were significantly more likely to miss appointments (OR 3.25 and 5.99).https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1009/thumbnail.jp
Laying the Groundwork: Implementing the 2021 AAP Well Appearing Febrile Infant Clinical Practice Guideline Across a Rural Health System
Get PDFThe American Academy of Pediatrics (AAP) published their first-ever Clinical Practice Guideline (CPG) on the management of well-appearing febrile infants aged 8-60 days in 2021. A system specific CPG and order set for the management of well-appearing febrile infants has been published across MaineHealth (MH) to align with the AAP.https://knowledgeconnection.mainehealth.org/lambrew-retreat-2025/1008/thumbnail.jp