Faculty Bibliography

OBJECTIVE:To assess whether object relations theory (ORT) formulations generated by large language models (LLMs) enhance resident education in psychodynamic psychiatry. METHODS:This institutional review board (IRB)-approved observational study was conducted at a single academic program from January to March 2025. Eleven postgraduate year (PGY) 3 and 4 residents submitted de-identified psychotherapy case narratives to a GPT-4 model using a standardized ORT prompt. Residents evaluated accuracy, clarity, and educational value using a 10-item, 5-point Likert scale and provided free-text feedback. Descriptive statistics were calculated. Thematic analysis was used to identify key perceptions. RESULTS:Ten residents completed the rating process. Mean scores ranged from 3.5 to 4.2 across all items, with the highest ratings for identification of objects, affective tone, and educational value. Qualitative analysis identified five themes: (1) improved clarity and structure, (2) stronger conceptual anchoring to ORT, (3) risk of overgeneralization, (4) maternal emphasis bias, and (5) importance of faculty oversight. Residents characterized the outputs as concise and clinically applicable, although they noted occasional factual inaccuracies and misalignments with specific case details. CONCLUSIONS:With appropriate supervision, AI-generated ORT formulations may serve as a valuable adjunct to psychodynamic education by standardizing terminology and supporting conceptual development. Future controlled studies are needed to evaluate effects on Milestone-aligned assessment and applicability to additional psychotherapy models.

We present the case of a physician who engages with a peer response team and discloses suicidal ideation-while himself seeing patients in the hospital. Top experts in consultation-liaison (C-L) psychiatry provide guidance for this clinical case based on their experience and a review of the available literature. Key teaching topics include a general approach to suicide risk assessment; peer response programs for healthcare workers; and ethical and clinical considerations in treating colleagues. C-L psychiatrists should be familiar with suicide risk management, take a pro-active approach to addressing modifiable risk factors, and keep in mind unique challenges of treating colleagues referred for care.

Premenstrual exacerbation of an existing psychiatric disorder refers to the worsening of symptoms inherent to the condition during the premenstrual phase. Research consistently indicates that hormonal fluctuations during the menstrual cycle present a unique period of vulnerability for the onset or exacerbation of psychiatric symptoms, impacting diagnosis, risk assessment, and treatment. This review sought to elucidate the phenomenon of premenstrual exacerbation and its impact across a spectrum of psychiatric illnesses, including mood, anxiety, psychotic, obsessive-compulsive, personality, and trauma-related disorders. Despite the expanded research in recent years on premenstrual dysphoric disorder and premenstrual syndrome, premenstrual exacerbation remains underexplored and poorly defined. This review offers significant contributions to the diagnosis and management of psychiatric conditions, advocating for heightened awareness and novel treatment approaches in the context of premenstrual exacerbation.

BACKGROUND:As the science of consultation-liaison psychiatry advances, the Academy of Consultation-Liaison Psychiatry's Guidelines and Evidence-based Medicine Subcommittee reviews articles of interest to help Academy members remain familiar with the latest in evidence-based practice. OBJECTIVE:We identify the 10 most important manuscripts for clinical practice in consultation-liaison psychiatry from 2020 using the new Importance and Quality (IQ) instrument for assessing scientific literature. METHODS:The Subcommittee published annotated abstracts for 97 articles on the Academy website in 2020. Reviewers then rated all articles on clinical importance to practice and quality of scholarship using the IQ instrument. We describe the 10 articles with the highest aggregate scores and analyze the reliability of IQ instrument. RESULTS:Twenty-four raters identified the top 10 scoring articles of 2020. These papers provide practical guidance on key areas of consultation-liaison psychiatry including management of COVID-19, lithium treatment for complex patients, medical risks among patients with severe mental illness, and substance use disorders in medical settings. The assessment instrument demonstrated good to excellent interrater reliability. CONCLUSION/CONCLUSIONS:These articles offer valuable guidance for consultation-liaison psychiatrists regardless of their practice area. Collaborative literature reviews with standardized assessments help clinicians deliver evidence-based care and foster a high standard of practice across the specialty.

OBJECTIVE:Medical events such as myocardial infarction and cancer diagnosis can induce symptoms of posttraumatic stress disorder (PTSD). The optimal treatment of PTSD symptoms in this context is unknown. METHODS:A literature search of 6 biomedical electronic databases was conducted from database inception to November 2018. Studies were eligible if they used a randomized design and evaluated the effect of treatments on medical event-induced PTSD symptoms in adults. A random effects model was used to pool data when two or more comparable studies were available. RESULTS:Six trials met full inclusion criteria. Studies ranged in size from 21 to 81 patients, and included patients with PTSD induced by cardiac events, cancer, HIV, multiple sclerosis, and stem cell transplantation. All trials assessed psychological interventions. Two trials comparing a form of exposure-based cognitive behavioral therapy (CBT) with assessment-only control found that CBT resulted in lower PTSD symptoms [Hedges's g = -0.47, (95% CI -0.82 - -0.12), p = .009]. A third trial compared imaginal exposure (another form of exposure-based CBT) with an attention control and found a trend toward reduced PTSD symptoms. Three trials compared eye movement desensitization and reprocessing (EMDR) with active psychological treatments (imaginal exposure, conventional CBT, and relaxation therapy), and found that EMDR was more effective. CONCLUSION/CONCLUSIONS:CBT and EMDR may be promising approaches to reducing PTSD symptoms due to medical events. However, additional trials are needed in this patient population.

Post-traumatic stress disorder (PTSD) induced by life-threatening medical events has been associated with adverse physical and mental health outcomes, but it is unclear whether early interventions to prevent the onset of PTSD after these events are efficacious. We conducted a systematic review to address this need. We searched six biomedical electronic databases from database inception to October 2018. Eligible studies used randomized designs, evaluated interventions initiated within 3 months of potentially traumatic medical events, included adult participants, and did not have high risk of bias. The 21 included studies (N = 4,486) assessed a heterogeneous set of interventions after critical illness (9), cancer diagnosis (8), heart disease (2), and cardiopulmonary surgery (2). Fourteen psychological, 2 pharmacological, and 5 other-type interventions were assessed. Four of the psychological interventions emphasizing cognitive behavioral therapy or meaning-making, 1 other-type palliative care intervention, and 1 pharmacological-only intervention (hydrocortisone administration) were efficacious at reducing PTSD symptoms relative to control. One early, in-hospital counseling intervention was less efficacious at lowering PTSD symptoms than an active control. Clinical and methodological heterogeneity prevented quantitative pooling of data. While several promising interventions were identified, strong evidence of efficacy for any specific early PTSD intervention after medical events is currently lacking.