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AJP CME: July 2017 - Psychiatric Complications of Primary Hyperparathyroidism and Mild Hypercalcemia

Activity Type:

  • Journal CME

Release Date: 7/1/2017

Expiration Date: 6/30/2019

  • AMA PRA Category 1 Physician: 1
  • Participation: 1

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Abstract: The incidence of primary hyperparathyroidism (PHPT) is about 21 cases per 100,000 person-years, and the disorder is usually caused by a solitary parathyroid adenoma. PHPT has traditionally been recognized by its characteristic symptoms, including urolithiasis (“stones”); osteopenia and osteoporosis (“bones”); abdominal cramping, nausea, and peptic ulceration (“moans”); and depression, anxiety, cognitive dysfunction, insomnia, confusion, and personality changes (“psychiatric overtones”). Although the pathogenesis of psychiatric symptoms in PHPT remains unclear, calcium is thought to figure prominently in determining changes in monoamine metabolism in the CNS, thereby modifying neurotransmission and resulting in alterations in mood and cognition. Generally, the psychopathology emerges after a prolonged period of subclinical hypercalcemia, but the correlation between symptom severity and degree of hypercalcemia is poor. Of note to the psychiatrist, lithium use has an absolute risk of 10% for PHPT, compared with a 0.1% risk in the general population. This is because lithium increases the calcium set point at which suppression of parathyroid hormone release occurs, thus causing an increase in parathyroid gland volume and hormone secretion.


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Educational Objective

The participant will outline the prevalence of neuropsychiatric symptoms in patients with primary hyperparathyroidism and explain how to manage symptomatic patients with mild hypercalcemia.

Target Audience

This program is designed for all psychiatrists in clinical practice, residents in Graduate Medical Education programs, medical students interested in psychiatry, and other physicians who wish to advance their current knowledge of clinical medicine.

Estimated Time to Complete

Duration: 1 hour
Begin Date: July 1, 2017
End Date: June 30, 2019

How to Earn Credit

In order to earn CME credit, subscribers should read through the material presented in the article. After reading the article, complete the quiz and submit your evaluation and study hours (up to 1 AMA PRA Category 1 Credit™).  A score of 60% or higher is required to receive credit.


The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The APA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty and Planner Disclosures

Title: Psychiatric Complications of Primary Hyperparathyroidism and Mild Hypercalcemia

Authors: Kristin A. Parks, D.O., Clayton G. Parks, M.D., Obiora E. Onwuameze, M.D., Ph.D., Santosh Shrestha, M.D.

Affiliations: From the Division of Medicine/Psychiatry, Department of Internal Medicine,

and the Department of Psychiatry, Southern Illinois University School of Medicine, Springfield (K.A.P., C.G.P., O.E.O., S.S.).

Disclosures: The authors report no financial relationships with commercial interests.

Discussion of unapproved or investigational use of products*: No.

*APA policy requires disclosure by CME authors of unapproved or investigational use of products discussed in CME programs. Off-label use of medications by individual physicians is permitted and common. Decisions about off-label use can be guided by scientific literature and clinical experience.

Program Planners

Robert Freedman, M.D. (Editor-in-Chief, AJP); Susan K. Schultz, M.D. (Deputy Editor, AJP); Michael D. Roy (Editorial Director, AJP); Michael A. Pogachar (Online Content Manager, Journals).

Dr. Schultz has received research support from the Alzheimer’s Disease Cooperative Study for projects conducted in partnership with Toyama Chemical Company and in partnership with Eli Lilly and Company. Dr. Freedman, Mr. Roy, and Mr. Pogachar report no financial relationships with commercial interests.

Hardware/Software Requirements

This internet-based CME activity is best experienced using Internet Explorer 8+, Mozilla Firefox 3+, Safari 4+. This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat, Microsoft PowerPoint, and Windows Media Player.
Optimal System Configuration:
  • Flash Player: Adobe Flash Player 10.1+ 
  • Browser: Firefox 3+, Internet Explorer 8.0+, Safari 4.0+, or Google Chrome 7.0+ 
  • Operating System: Windows XP+ or Mac OS X 10.4+ 
  • Internet Connection: 1 Mbps or higher
  • Screen Resolution: 1024 x 768 pixels.

Minimum Requirements:

  • Windows PC:500-MHz Pentium II; Windows XP or higher; 128 MB RAM; Video Card at least 64MB of video memory; Sound Card at least 16-bit; Macromedia Flash Player 10 or higher, audio playback with speakers for programs with video content; Firefox 1.1+, Internet Explorer 7.0+, Safari 1.0+, Google Chrome, or Opera
  • Macintosh: Mac OS X 10.3 or higher with latest updates installed; 1.83MHz Intel Core Duo or faster; RAM: 128MB or more; Video Card: at least 64MB of video memory; Sound Card: at least 16-bit

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