Attention-deficit hyperactivity disorder (ADHD) is frequently comorbid with anxiety disorders with rates as high as 25% to 50% in children and adolescents. Despite various treatment options for ADHD symptoms, limited research addresses treatment in the context of comorbidity. This article seeks to provide a review of the evidence regarding treatment of this comorbid population. Distinct emotional, cognitive, and behavioral symptoms have been observed in this population, suggesting a need for tailored treatment. Despite common concerns about anxiety exacerbation, stimulant medications demonstrate good tolerability and good response in addressing symptoms. Atomoxetine has also demonstrated some benefit and good tolerability for treating this comorbid population. Selective serotonin reuptake inhibitors can be used as adjunctive treatment for anxiety but require careful monitoring of side effects. Cognitive behavioral therapy (CBT) is an important treatment to improve anxiety symptoms in the absence of significant ADHD symptoms. Psychosocial interventions are also essential to improve outcomes.

Insomnia is a common and challenging complaint in older adults (> 65 years) because of age-related alterations in sleep physiology. Cognitive behavioral therapy for insomnia is the gold standard for treatment of insomnia in young as well as older patients. Both clinicians and patients often prefer the simplicity of medication, but risks associated with some hypnotics increase with age. Pharmacologic options for older adults include low-dose doxepin, melatonin, ramelteon, and the dual orexin receptor antagonists. A well-informed clinician can help patients navigate the risks and benefits of both pharmacologic and behavioral options.

The evolving unregulated drug supply in the United States has led to an unprecedented rise in xylazine-adulterated synthetic opioid use-related morbidity and mortality, of which Pennsylvania shoulders a disproportionate burden. People experiencing these xylazine harms who seek acute medical care require complex clinical management, multidisciplinary coordination, and appropriate linkage to outpatient care. We describe our experience leading a hospital-wide multidisciplinary xylazine workgroup from February to June 2024 to collaboratively develop time-sensitive clinical protocols on inpatient management of patients exposed to xylazine. Workgroup participants were organized into three subgroups: (1) toxicology screening and harm reduction; (2) withdrawal management; and (3) inpatient wound care management and linkage to outpatient wound care. We summarize our implementation process and clinical protocol recommendations of each subgroup and highlight important cross-cutting issues related to the changing drug supply, standardized patient and provider educational tools, care coordination, and next steps.

Background: The uneven distribution of psychiatrists across the United States has led to a significant deficiency in psychiatric care, particularly in rural and remote areas. Telepsychiatry has emerged as an effective solution to bridge this gap, providing comparable outcomes to in-person services. Objective: This case series aims to highlight the effectiveness of telepsychiatry in diagnosing and managing catatonia, a complex neuropsychiatric condition whose diagnosis often requires physical examination, through consultation-liaison (CL) psychiatry services. Methods: We describe three cases of catatonia managed via telepsychiatry by the CL psychiatry service at The University of Pittsburgh Medical Center. CL psychiatrists located in the university hospital diagnosed and managed catatonia via telepsychiatry in patients medically hospitalized in non-urban hospitals with assistance from an in-person clinician. Each case was assessed for diagnostic accuracy and treatment outcomes using the Bush Francis Catatonia Rating Scale. Results: The use of telepsychiatry facilitated timely diagnosis and treatment of catatonia. All patients showed significant improvement, demonstrating the viability of CL telepsychiatry in managing complex conditions like catatonia in the medical setting. Conclusion: CL Telepsychiatry is a critical tool in addressing the shortage of psychiatric care in underserved areas. It may be effective in facilitating the diagnosis and treatment of catatonia in medical hospitals, ensuring patients receive timely and appropriate care.