Management of overdose is similar to that of patients presenting with opioid abuse, although kratom may potentially pose a higher risk for drug toxicity and organ injury compared to opioids due to intrinsic properties and adulteration. There is no clinical evidence for its safety and efficacy. The US Food and DEA do not recognize any legitimate medical use of kratom.
 
  Kratom is an emerging public health concern and is abused as an alternative to opioids. Stringent policies and public awareness campaigns are required to curb the perception of its safe use, which needs to be substantiated with well-designed clinical trials.
 Kratom is an emerging public health concern and is abused as an alternative to opioids. Stringent policies and public awareness campaigns are required to curb the perception of its safe use, which needs to be substantiated with well-designed clinical trials.
  Medicine relies on education of trainees for growth of the field. Medical education has benefitted from a rapid pace of innovation, but due to the coronavirus disease 2019 (COVID-19) pandemic, many paradigms underpinning the medical education of trainees shifted-rendering numerous teaching modalities unusable. The COVID-19 pandemic, however, accelerated the development of novel teaching methodologies, which our trainees are now adapting to. We sought to examine emerging teaching methodologies to understand the opportunities available for medical education to innovate our teaching practices for learners in the midst of the COVID-19 pandemic.
 
  In this narrative review, we drew upon the experiences of the authors as both life-long learners and educators. We then reviewed literature pertaining to novel teaching methodologies developed in medical education since the start of the COVID-19 pandemic.
 
  Several medical specialties have employed novel teaching methodologies including use of telemedicine, remote teaching, online curricula, virtual rotations, virtual conferences, simulations, and learning consortia to continue engaging trainees during the COVID-19 pandemic. There is a paucity of literature that addresses efficacy of novel teaching methodologies compared to more traditional teaching methodologies.
 
  The COVID-19 pandemic presents an opportunity for medical education to combine new and innovative teaching methodologies to create novel, accessible, and engaging learning opportunities for our trainees.
 The COVID-19 pandemic presents an opportunity for medical education to combine new and innovative teaching methodologies to create novel, accessible, and engaging learning opportunities for our trainees.Pramipexole is a dopaminergic pharmacologic agent with reported adverse effects that include hypersexuality, shift in sexual interests, pathological gambling, compulsive shopping, and binge eating. Pramipexole is indicated in the treatment of Parkinson's disease and restless leg syndrome and has been used as adjunctive or add-on treatment in major depressive disorder. This report describes the successful treatment of a series of 4 adult men who presented with concerns about problematic sexual interests and behaviors that began after treatment with pramipexole related to Parkinson's disease or restless leg syndrome.The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.
  Vaginismus is one of the most frequently occurring genito-pelvic pain disorders in women. Sexual dysfunction commonly presents with comorbid psychiatric disorders, and many patients suffering from the former exhibit the latter. The objective of this study was to investigate the affective temperaments of women with vaginismus compared to healthy controls.
 
  Forty-eight women with vaginismus and 42 age-matched healthy women were recruited and compared in terms of their scores on the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire and a sociodemographic instrument.
 
  Except for the scores for hyperthymic temperament, those for depressive, cyclothymic, irritable, and anxious temperaments were significantly higher in the vaginismus group than in the healthy controls (P<.05). The analysis of covariance indicated that the anxious temperament was significantly associated with covariants.
 
  On the basis of the preliminary results, women with vaginismus may be candidates for bipolar disorder. This population should therefore be screened more carefully in terms of the development of the disorder. Bipolar disorder should also be considered when treatments for comorbid psychiatric disorders are needed.
 On the basis of the preliminary results, women with vaginismus may be candidates for bipolar disorder. This population should therefore be screened more carefully in terms of the development of the disorder. Bipolar disorder should also be considered when treatments for comorbid psychiatric disorders are needed.Supportive therapy is a practical, flexible, and patient-centered psychosocial intervention that can help improve outcomes for patients struggling with a wide variety of medical illnesses. Due to its highly adaptable nature, brief supportive therapy can be practiced in busy clinical settings by consultation and liaison psychiatrists and primary care providers. In supportive therapy, the patient and provider work collaboratively to reduce distress and enhance functioning. The available evidence supports the use of supportive therapy techniques in managing the mental health consequences of medical conditions. This narrative review helps primary care providers learn and implement the basic goals and interventions of supportive therapy.
  Attention-deficit/hyperactivity disorder (ADHD) in adulthood presents unique challenges for primary care providers, and many lack confidence addressing it.  https://www.selleckchem.com/products/jh-re-06.html  To support them, a workgroup of volunteer primary care and mental health providers created an Adult ADHD Toolkit containing information about the disorder and treatment advice. The objective of this study was to establish the impact of implementing the toolkit in primary care.
 
  Providers completed a survey immediately before and 5 months after the toolkit was implemented. Participation was voluntary and anonymous. Also, prescriptions for stimulant and nonstimulant adult ADHD medications were tracked 6 months before and 6 months after the toolkit was introduced.
 
  The response rate was 77.4% (n=24) at baseline and 64.5% (n=20) at follow-up. At follow-up compared to baseline, participants reported significantly higher comfort for assessment of adult ADHD (P=.039). Participants also reported higher comfort for nonmedication management (P=.10). There was no difference for comfort with medication management or prescribing practices pre versus post toolkit rollout, although participants were more comfortable with and prescribed a greater number of stimulants than nonstimulants.