Facebook is the leading social networking website, with over 500 million users. Prior studies have shown an increasing number of housestaff accessing the site. While Facebook can be used to foster camaraderie, it can also create difficulties in the doctor-patient relationship, especially when boundaries are crossed. This study explored the prevalence of such boundary crossings and offers recommendations for training. An anonymous voluntary survey regarding Facebook use was distributed to current psychiatry residents through the American Psychiatric Association (APA) listserv. Of the 182 respondents, 95.7% had current Facebook profiles, and 9.7% had received friend requests from patients. In addition, 18.7% admitted to viewing patient profiles on Facebook. There is a substantial utilization of Facebook among psychiatric residents as compared with prior studies. Specific guidance regarding social media websites and the potential for ethical difficulties should be offered to trainees.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a hypersensitivity syndrome most commonly associated with antiepileptic agents, allopurinol, and sulfonamides. It is a severe adverse reaction associated with fever, rash, eosinophilia, lymphadenopathy, and internal organ involvement. We present the case of a 17-year-old Caucasian female with bipolar disorder type II and posttraumatic stress disorder treated with lamotrigine for a non-Food and Drug Administration-approved indication that developed DRESS syndrome at an initial dose higher than that recommended. Her symptoms were atypical in that she developed a rash with influenza-like symptoms that resolved after discontinuation of lamotrigine and returned 8 days later. She was hospitalized because of elevated liver enzymes and treated with corticosteroids. In patients presenting with rash and systemic symptoms, DRESS syndrome should be considered and treated appropriately to reduce mortality, which can be as high as 10%. Treatment includes withdrawal of the offending agent and corticosteroids.