Prior incarceration, restrictive housing, and posttraumatic stress disorder symptoms in a community sample of persons who use drugs.

BACKGROUND: Criminalization of drugs in the United States (US) has extensive consequences for people who use drugs (PWUD). Incarceration and substance use overlap with 65% of the US prison population meeting substance use disorder (SUD) criteria. Exposure to the criminal-legal system negatively impacts the health of PWUD. PTSD is commonly comorbid with SUDs, and exposure to restrictive housing (RH) during incarceration may worsen mental health. Because PWUD are disproportionately incarcerated, experiences occurring during incarceration, such as RH, may contribute to the development or exacerbation of PTSD and SUDs. This study of PWUD investigated prior criminal-legal system exposure and its association with PTSD symptoms in community-dwelling PWUD. METHODS: This cross-sectional study recruited PWUD from syringe service programs (SSP). Inclusion criteria were: age 18+, current or past opioid use disorder, and SSP enrollment. Data collected included: sociodemographics; incarceration, substance use, SUD treatment history, and PTSD assessments (Life Events Checklist for DSM-5 and the PTSD Checklist for DSM-5). Bivariate testing and multivariate logistic regression analyses, with probable PTSD as the dependent variable and a three-level variable for criminal legal history as the independent variable, were conducted to determine whether incarceration and RH were associated with probable PTSD. RESULTS: Of 139 participants, 78% had an incarceration history with 57% of these having a history of RH. 57% of participants screened positive for probable PTSD, and physical assault was the most common traumatic exposure. Any history of incarceration was not associated with probable PTSD diagnosis; however, in multivariate testing, adjusting for age, sex, and substance use, a history of RH (adjusted odds ratio [aOR]: 3.76, 95% CI 1.27-11.11) was significantly associated with probable PTSD. CONCLUSIONS: RH and PTSD were both exceptionally common in a sample of SSP participants. RH can be detrimental to physical and mental health. Clinicians and policy makers may not consider incarceration as a traumatic experience for PWUD; however, our data suggest that among highly marginalized PWUD, prior exposure to incarceration and RH may add an additional burden to their daily struggles, namely PTSD.

Anti-NMDA receptor encephalitis presenting as a progression of disease in a patient with underlying congenital leukodystrophy: Case report.

Anti-NMDA Receptor (NMDAR) Encephalitis (NMDARE) is an autoimmune disorder that is often debilitating and difficult to diagnose. Patients, especially those with underlying neuropsychiatric disorders, may experience delayed or misdiagnosis of NMDARE. Here, we report on a patient with known congenital leukodystrophy (CLD) and epilepsy with a challenging diagnosis of NMDARE. The patient first presented with progressive behavior changes and seizure-like episodes. Initial workup, including video EEG and brain MRI, were mostly unremarkable, and the patient's symptoms were resistant to treatment with multiple anti-epileptic drugs. Given the patient's complicated clinical history, his presentation was initially thought of as progression or exacerbation of his chronic disease. With continued lack of improvement, autoimmune encephalitis was considered. The patient was started on immunotherapy and autoimmune encephalitis panels were sent, which came back positive. He continued to improve over the next weeks and months. Despite a growing body of literature, our knowledge on confirmed risk factors for NMDAR remains limited outside of young age, ovarian teratomas, and herpes encephalitis. We know that maintenance of the blood brain barrier is key to preventing autoimmune disorders of the central nervous system (CNS), and multiple congenital leukodystrophies exhibit pathology in the neurovascular unit. This is the first described case of anti-NMDA receptor encephalitis in a patient with an underlying congenital leukodystrophy, which may reflect an underreported NMDAR encephalitis risk factor. With limited known risk factors and time to diagnosis and treatment so important, this case may reflect an important and underreported risk factor for NMDAR.

Oncologic Services Through Project Access and Other Safety Net Care Coordination Programs.

PURPOSE: Little is known about the provision of oncologic services by Project Access safety net care coordination programs. MATERIALS AND METHODS: Information on safety net care coordination program locations, health services, and patient eligibility was obtained via program Web sites and calls. For programs not offering oncologic care, program directors were interviewed to identify oncologic care barriers. RESULTS: Web sites of 29 safety net care coordination programs in 22 states were identified; 62% (n = 18) offered oncologic services. Programs were in 65% (n = 11) of states that did not expand Medicaid. Of those offering oncologic services, 83% (n = 15) offered free chemotherapy, and 93% (n = 27) of all programs offered oncologic imaging. Program director interviews revealed costs, longitudinal care, and multiple-physician buy-in as barriers limiting oncologic care. CONCLUSION: Third-party care coordination centers provide a novel and potentially unrecognized approach to increasing oncology service access. Further research should identify strategies to overcome the relative lack of oncologic care offerings.