Antibody-mediated encephalopathies associated with serum or cerebrospinal fluid antibodies directed against neuronal structures may present with a multitude of neuropsychiatric syndromes. Although some of the antibody-driven conditions are now well recognized in adults (eg, N-methyl-D-aspartate receptor antibody encephalitis), the spectrum of neuropsychiatric manifestations in the pediatric population is less clear. Psychosis, confusion, catatonia, and additional behavioral changes, along with seizures, encephalopathy, and movement disorders, may be initial manifestations or concurrent features in all age groups. Psychosis, when present, is often part of a broader spectrum of neurological and neuropsychiatric symptoms for which the diagnosis of autoimmune encephalitis is considered. The authors present the case of an adolescent with an acute and isolated psychotic presentation of voltage-gated potassium channel antibody encephalitis, further expanding the phenotypic spectrum of this specific antibody-mediated disease and raising the possibility that specific immune-mediated processes may define a biological subgroup of psychoses.

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Family meetings are a critically important component of managing acutely psychiatrically ill patients, and learning how to conduct such a meeting is critically important in the training of psychiatrists. Because we found no published comprehensive tools that dealt with the biopsychosocial content areas to be covered in family meetings in acute psychiatric settings, we developed and present such a comprehensive tool that is based in part on a review of existing tools utilized by other disciplines. This article describes the specific steps involved in premeeting planning, the formal topic areas that might be canvassed during the meeting, and postmeeting documentation and debriefing. The general content areas for discussion during the meeting include the setting of goals and expectations, relevant history-gathering, assessment of the family's understanding of the issues at stake, formal psychoeducation, and review of specific treatment strategies and clinical progress. The meeting may also include a discussion of resources available to the patient and family members and a review of issues related to the safety of the patient and others, management of early warning signs, and sensitive topics such as trauma, abuse, or violence that may play a role in the presentation or treatment of the patient to best translate established goals into a longer term plan of care. Implementation of this comprehensive and necessarily structured model should enhance the patient's and family's understanding of the issues at stake and should improve satisfaction, promote trust and an effective working alliance, and enhance the quality of the biopsychosocial care plan.

Newer noninsulin agents to treat Type 2 diabetes offer more options for treatment intensification.Recent guidelines continue to emphasize a stepwise approach after metformin monotherapy is exhausted.When efficacy is essentially equivalent between agents, the 'collateral' effects of noninsulin agents can help clinicians craft diabetic treatments to suit patients' needs and comorbid conditions. Concerns about possible detrimental cardiovascular effects from sulfonylureas and thiazolidiones make incretin-based therapies (DPP-4 inhibitors and GLP-1 mimetics) more attractive in patients with risk factors.Thiazolidinediones increase fluid retention, which may promote decompensated congestive heart failure and diabetic macular edema in at-risk patients.In women with polycystic ovarian syndrome, metformin improves ovulation rates, hyperandrogenemia and hirsutism, but is generally less efficacious in achieving pregnancy compared with ovarian stimulation with clomiphene.Long-term use of pioglitazone has been linked to increased risk of bladder cancer in epidemiological studies; however, the mechanism remains unknown. Pancreatic cancer, meanwhile, has not been definitively linked with the use of exenatide or sitagliptin. Finally, thyroid C-cell hyperplasia and metaplasia have been observed in rodents treated with liraglutide; however, increased rates of medullary thyroid cancer have not been detected in patients treated with GLP-1 mimetics. SUMMARYThe increasing availability of non-insulin-based pharmacological therapy for Type 2 diabetes permits clinicians greater flexibility to design treatment regimens that suit individual patients' needs. Often, patients with Type 2 diabetes carry multiple comorbidities related to insulin resistance and inadequate diabetic control, which predispose to the