In the past 10-15 years, we’ve seen a significant increase in the number of incarcerated individuals receiving mental health treatment.

The recent devastating fires in Los Angeles underscore how disasters—whether fires, hurricanes, floods, or other climate events—can take a serious toll on mental health. 

Correctional facilities are not just places of confinement; they are also intense environments where mental health crises can erupt unexpectedly. 

Dr. Poyurovsky offers practical guidance for identifying and treating akathisia, a movement disorder marked by inner restlessness. He highlights the importance of psychoeducation, gradual dose adjustments, and the use of propranolol or low-dose mirtazapine for relief. He underscores the importance of distinguishing akathisia from other conditions, like psychotic agitation, to avoid unnecessary increases in antipsychotic doses.

Factitious disorder occurs when people intentionally produce or fake symptoms without clear external incentives, like financial gain or avoiding legal trouble. The goal is to adopt the “sick role” to gain attention or sympathy. It’s a tricky condition to diagnose since patients’ symptoms mimic real medical conditions. Take a nonjudgmental approach, practice supportive confrontation, and coordinate with your multidisciplinary team to ensure the patient receives appropriate care, though treatment adherence and outcomes are often poor.

Dr. Gabriela Gilmour offers practical insights into diagnosing and managing functional neurologic disorder (FND) and recommends retiring the term "conversion disorder." She emphasizes that FND is no longer a diagnosis of exclusion, thanks to improved diagnostic tools, and stresses that accurate identification is essential to avoid unnecessary treatments.