Abstract

Introduction

Patients who abruptly stop the consumption of alcohol are at risk of alcohol withdrawal syndrome (AWS). Guidelines recommend the use of a validated clinical withdrawal scoring tool to assess the severity of a patient’s withdrawal. The modified Minnesota Detoxification Scale (mMINDS) provides detailed definitions to help guide nurses in objectively scoring patients’ withdrawal symptoms. Although mMINDS has been validated in a medical intensive care unit, it has not yet been validated in a psychiatric facility.

Methods

The primary objective was to determine if using mMINDS was preferred by nurses and increased confidence in assessing AWS compared with the current standard of care in an adult inpatient psychiatric hospital. After 3 months of using mMINDS, nurses were asked to complete a survey to assess their preference and confidence with mMINDS. A retrospective review was also conducted on all patients, 18 years and older, who were monitored for AWS both pre- and post-implementation of mMINDS.

Results

Overall, 60% (n = 12) of nurses selected mMINDS as the scoring tool they felt most confident with assessing AWS. Patients in the mMINDS group also received lower cumulative doses of benzodiazepines, although this finding did not reach statistical significance (0.75 mg post-implementation vs. 1.75 mg pre-implementation [P = 0.101]).

Discussion

The use of mMINDS was preferred by nurses for monitoring AWS in patients hospitalized at an inpatient psychiatric hospital. These results suggest that mMINDS may be an effective tool for monitoring AWS in an inpatient psychiatric setting.

Abstract

Introduction

Alice in Wonderland Syndrome (AIWS) is an uncommon condition manifesting visual and somatosensory disturbances in which patients may perceive objects, including their own bodies, as larger or smaller than they are. In adults, AIWS typically is associated with migraine and epilepsy but has been reported as an adverse effect of topiramate, which is used to treat both illnesses, making it difficult to ascertain whether illness or medication causes altered perceptions. Reported is a case of topiramate-associated AIWS, which adds to the limited reports published on this unique phenomenon.

Case Report

A 40-year-old woman admitted to a 3-week pain rehabilitation program to treat chronic migraine reported macrosomatognosia that she retrospectively recalled beginning during titration of topiramate. The symptoms of AIWS resolved after the topiramate was discontinued. An assessment with the Naranjo ADR Probability Scale indicated a possible association between topiramate and macrosomatognosia.

Discussion

In this patient with migraine, the onset of AIWS coincided with titration of topiramate, providing a clue that its emergence may have been an adverse drug reaction rather than the underlying illness. Consistent with previous reports, AIWS resolved shortly after topiramate was discontinued, lending credence to this conclusion. However, the mechanism of AIWS is unknown and may be multifactorial, leaving the possibility that migraine predisposed the patient to develop AIWS from topiramate.

Conclusion

The long association of AIWS with migraine and epilepsy makes it possible that cases caused by medications used to treat these illnesses, like topiramate, are underreported. Awareness of the temporal relationships between the course of illness and the timing of drug therapy can help guide the recognition of AIWS as a potential adverse event.

Abstract

Refeeding syndrome (RFS) occurs when previously malnourished patients are reintroduced to nutritional support, triggering a metabolic response that often results in electrolyte abnormalities, vitamin deficiencies, and potential end organ disturbance. Whereas RFS has been well documented in patients with eating disorders, its presentation in those with severe mental illness (SMI), such as schizophrenia, is less commonly reported. This report highlights a case of schizophrenia-induced starvation and the potential development of RFS during an inpatient psychiatric hospitalization. RFS may not always be identified in patients, especially when its presentation deviates from classic signs and symptoms. Increased awareness of the signs, symptoms, and at-risk populations, including individuals with SMI, may aid in the prevention and management of RFS.

Dear Editor,

We commend Pamela Hernandez Bustamante et al on their scoping review, “Pharmacist Administration of Long-Acting Injectable Medications for Substance Use Disorders” (Ment Health Clin. 2025;15(1):17-24). This critical work highlights the potential for pharmacists to enhance access to long-acting injectable buprenorphine (LAIB) for substance use disorders. The authors note a gap in research on pharmacist-administered LAIB and recommend standardizing training, developing operating procedures, and addressing billing and reimbursement issues to support widespread implementation.

In North Carolina, pharmacists gained the authority to administer long-acting injectable (LAI) medications in October 2021 with North Carolina Medicaid reimbursing them for injection administration at

A potential case of refeeding syndrome in a patient with severe mental illness

Amber R. DouglassPharmD, BCPS, BCPP, FAAPP,

Eliana SpeyBS, and

Kimberly A. EhrhardPharmD, BCPP

Use of psychostimulants in the management of treatment-resistant major depressive disorder

Introduction

Implementation of mMINDS monitoring for alcohol withdrawal at an inpatient academic psychiatric facility

Abstract

Introduction

Methods

Results

Discussion

A case of Alice in Wonderland Syndrome associated with topiramate in a patient with vestibular migraine

Abstract

Introduction

Case Report

Discussion

Conclusion

A potential case of refeeding syndrome in a patient with severe mental illness

Abstract

Memantine leading to physical aggression in the treatment of chronic catatonia secondary to schizophrenia: A case report

Abstract

Introduction

Case

Conclusions

A primary care psychiatric pharmacist clinic for addressing hypertension and mental health disparities in black patients

Abstract

Re: Hernandez Bustamante et al. “Pharmacist administration of long-acting injectable medications for substance use disorders”

A potential case of refeeding syndrome in a patient with severe mental illness

Use of psychostimulants in the management of treatment-resistant major depressive disorder

Implementation of mMINDS monitoring for alcohol withdrawal at an inpatient academic psychiatric facility

A case of Alice in Wonderland Syndrome associated with topiramate in a patient with vestibular migraine

Memantine leading to physical aggression in the treatment of chronic catatonia secondary to schizophrenia: A case report

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