First 150 years of catatonia:Looking back at its complicated history and forward to the road ahead

Karl Ludwig Kahlbaum(1828-1899)was the first to conceptualize and describe the main clinical features of a novel psychiatric illness,which he termed catatonia in his groundbreaking monograph published 150 years ago.Although Kahlbaum postulated catatonia as a separate disease entity characterized by psychomotor symptoms and a cyclical course,a close examination of his 26 cases reveals that most of them presented with motor symptom complexes or syndromes associated with various psychiatric and medical conditions.In his classification system,Kraepelin categorized catatonic motor symptoms that occur in combination with psychotic symptoms and typically have a poor prognosis within his dementia praecox(schizophrenia)disease entity.Because of the substantial influence of Kraepelin’s classification,catatonia was predominantly perceived as a component of schizophrenia for most of the 20th century.However,with the advent of the psychopharmacotherapy era starting from the early 1950s,interest in catatonia in both clinical practice and research subsided until the early 2000s.The past two decades have witnessed a resurgence of interest in catatonia.The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition,marked a paradigmatic shift by acknowledging that catatonia can occur secondary to various psychiatric and medical conditions.The introduction of an independent diagnostic category termed“Catatonia Not Otherwise Specified”significantly stimulated research in this field.The authors briefly review the history and findings of recent catatonia research and highlight promising directions for future exploration.

Self-Compassion and Empathy: Impact on Burnout and Secondary Traumatic Stress in Medical Training

Objective: To determine how self-compassion and empathy might influence the degree of burnout, secondary traumatic stress and compassion satisfaction among medical students and residents. Methods: Cross-sectional survey of medical students and select residency programs at Henry Ford Hospital in Detroit, Michigan. Respondents completed the Professional Quality of Life Scale (burnout, secondary traumatic stress and compassion satisfaction), Neff’s Self-Compassion Scale, and the empathic concern and personal distress subscales of the Interpersonal Reactivity Index. Results: The response rate was 28.6%. 23.9% and 27.3% of medical trainees reported high levels of burnout and secondary traumatic stress, respectively. Females reported greater empathy but lower self-compassion than males. Greater concern for others and oneself and lower personal distress predicted greater pleasure derived from professional work. Less concern for others and lower concern for oneself predicted greater burnout. Conclusions: Compassion for oneself and for others within their care appears to ameliorate burnout and can increase professional satisfaction. Initiatives to foster empathy and self-compassion may enhance individual well-being.

Lost in the Present: Anterograde Amnesia and Medical Decision Making Capacity

Although there have been a limited number of case reports of human bilateral hippocampal injury, none of these have addressed the impact of such injuries on medical decision making capacity. The authors present a case of an elderly man with discrete bilateral hippocampal injury. As a result of his injury, the patient was hopelessly “lost in the present” and only retained the basic cognitive functions necessary to have decision making capacity for a limited period of time. He was unable to appreciate the nature of his injury, the potential risks involved in his decisions, and the recommended course of treatment longer than a few minutes. The patient’s resultant neurocognitive deficits left him lacking medical decision making capacity, a likely outcome for patients with persistent anterograde amnesia.

Acupuncture in living liver and kidney donors: a feasibility study

Objective: The purpose of this study was to test the feasibility of integrating acupuncture into the routine care of living liver and kidney donors during the process of donation and recovery.Methods: This is a pilot study on the feasibility of a brief acupuncture intervention for living liver and kidney donors. Participants received acupuncture immediately prior to organ donation surgery, every day as inpatients, while recovering from donation, and at a 2-week follow-up. Prior to surgery, questionnaires were completed on acupuncture outcome expectations and the State–Trait Anxiety Inventory. After participating, those who received acupuncture provided feedback. Following the active intervention, a retrospective chart review was conducted, using donors who did not receive acupuncture as a comparison cohort.Results: Forty donor candidates were approached and recruited, 32 consented and ultimately 25 donors participated in the acupuncture intervention(15 of kidney, 10 of liver), 68% female, and 88% Caucasian;only one had prior experience with acupuncture. Participants received an average of 4 sessions while inpatient(range 2–8). Those who expected acupuncture to be more helpful prior to the intervention reported lower inpatient pain scores(P = 0.04). Qualitative feedback from patients was predominantly positive,indicating acupuncture was helpful for relaxation and pain. However, a few patients reported feeling overburdened during postdonation recovery, and that the study was viewed as additional obligation.Conclusion: Preliminary findings suggest it is feasible to integrate acupuncture into inpatient recovery for living organ donation. Tailoring interventions to the specific needs of patients is important to address ongoing concerns. Larger studies are needed to further ascertain benefits of peri-operative acupuncture.