Table of Contents - Academy of Psychosomatic Medicine

in March 2009 as her symptoms had gotten worse. Additionally,
she was noted to have weekly episode of sudden rage
and anger with paranoia where she would start screaming
and accusing her husband of poisoning her and refusing all
cares.
Management: Risperdal was initiated which made her more
agitated, paranoid and she also developed suicidal ideations.
At this point she was admitted to inpatient psychiatric unit.
Medical workup was unremarkable except for mild UTI which
was treated. EEG showed diffuse background slowing, but
no seizure activity. CT head showed bilateral frontal encephalomalacia
left more than right. Risperdal was discontinued
and Seroquel was initiated. She responded well to Seroquel
during her 12 day stay in the hospital, her delusions and
paranoia had subsided. Two weeks post hospital follow up
she was not seeing the doubles of her husband and had no
episodes of paranoid rage.
Conclusions: This case illustrates patients with traumatic
brain injury can develop Capgras delusions anytime. Her history
of SAH and specifically frontal encephalomalacia puts
her at a high risk for developing Capgras delusion, as it is
postulated in the literature that frontal region involvement is
common in Capgras delusions. Also, Seroquel could potentially
be used for treatment of Capgras Delusion
70. Patients’ Medical Decision-Making
Capacity and Educating Primary Care
Physicians: A Pilot Study
Presenting Author: Abhishek Jain, MD
Co-Authors: Nolan Hughes, MD, Kevin Patterson, MD, Kurt
Ackerman, MD, PhD
Background: Medical decision-making capacity (DMC) continues
to be a prevalent, complicated, and oftentimes misunderstood
topic among primary care physicians (Appelbaum
2007). The purpose of this research study is to determine
whether a lecture and discussion on patients’ DMC will be
beneficial to primary care clinicians in improving objective
knowledge and subjective comfort with this topic.
Methods: Family practice residents and attendings were administered
a pre-test, with 5 questions on subjective comfort
and 15 questions on objective knowledge, related to medical
DMC. Then, a 45-minute lecture and discussion on DMC,
including key components, common misconceptions, and
case examples, was presented. The same pre-test, along
with a feedback form for the presentation, was then readministered.
Results: Twenty-two participants attended the 45-minute
lecture and discussion and completed the pre and posttests.
Complete statistical analyses are ongoing. Preliminary
data indicates a mean pre-test objective score of 7/15(47%)
and a mean post-test objective score of 11/15(73%), with
all 22 participants’ scores improving. Preliminary data from
the subjective questions indicate improved comfort in all
participants.
Conclusions: This pilot suggests that a 45-minute didactic
session on patient’s medical DMC for primary care
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physicians improves both subjective comfort and objective
knowledge. Assessing long-term retention of this knowledge
and the effect on clinical outcomes will be examined in future
studies.
References: Applebaum P. Assessment of Patients’ Competence
to Consent to Treatment. NEJM 2007; 357; 1834-40.
71. The Role of the Forensic Psychiatrist in
the General Hospital
Presenting Author: Elizabeth A. Davis, MD
Co-Authors: Fabian M. Saleh, MD, Rebecca W. Brendel,
MD, JD, FAPM
This poster illustrates the multiple services a practicing forensic
psychiatrist can provide in a general hospital setting.
The forensic psychiatrist can fulfill functions that are beyond
the scope of consultation liaison psychiatrists, ethicists, and
risk management. The role is primarily to educate staff regarding
legal issues concerning hospitalized patients and to
minimize risk on behalf of both patients and the institution.
A forensic psychiatrist can help staff navigate a complicated
legal system that, on the one hand, serves to protect patient
autonomy, and on the other, interferes with the expedient
delivery of clinical care. These conflicting needs and multiple
pressures necessitate such as role. Frequently the forensic
psychiatrist consults around matters of discharge planning
involving dangerous and/or incompetent patients, limits
of confidentiality, malpractice, treatment refusal, substitute
decision-making, and informed consent. Functions also include
petitioning for guardianships on behalf of patients who
lack capacity, as well as risk management around transfers
between medical and surgical departments and psychiatric
units.
72. Neutropenia Associated with Mirtazepine
use in a Liver Transplant Recipient
Presenting Author: Marie Tobin, MD
Co-Authors: Helen Te, MD, Giuliano Testa, MD
Background: Mirtazepine, like other tetracyclic antidepressants
is known to cause neutropenia/agranulocytosis. (1)
Despite this mirtazepine is particularly useful in Consult-
Liaison psychiatry because of beneficial effects on sleep
and appetite. Immunocompromised patients are at risk of
blood dyscrasias either as the result of disease process or
immunosuppressive agents, including post-transplantation
patients.
Purpose: We here describe a case of neutropenia associated
with mirtazepaine use in a liver transplant recipient.
Results: Five months after living donor liver transplantation
this patient presented with depression and anxiety which responded
to sertraline 100mg daily. Sertraline was discontinued
because of persistent diarrhea and the patient was started
on mirtazepine 15 mg daily. Four days later the patient
had was noted to have a WBC of 1.4 K/uL (3.5-11) and an
absolute neutrophil count (ANC) of 0.78 (1.12-6.72). At that
time, her immunosuppressive regime was mycophenolate