Frozen conflict in the midst of a global pandemic: potential impact on mental health in Armenian border communities.

Armenia has been in a conflict with its neighbor, Azerbaijan, since 1988. Civilians in Tavush Province are regularly affected by ceasefire violations along the armed border with recent escalations further threatening the population's safety. In the midst of the COVID-19 pandemic, concerns regarding the mental health of border village residents in Armenia are prevalent. We present context-related factors of psychiatric illness, the prevalence of mental health disorders, and the state of mental health services in Armenia. We recommend directing greater attention towards the mental health status of civilians residing in conflict zones during the ongoing COVID-19 pandemic.

Community Violence, PTSD, Hopelessness, Substance Use, and Perpetuation of Violence in an Urban Environment.

We investigated the relationships among chronic violence exposure, post-traumatic stress disorder (PTSD) symptom severity, hopelessness, substance use, and perpetuation of violence to facilitate the development of trauma-related interventions for residents of Newark, NJ. A convenience sample of Newark residents (N = 153) was recruited from community centers during various events in 2016-2017. Anonymous, self-report survey measures included a PTSD screen (PCL-C), Beck's Hopelessness Scale, the CAGE questionnaire, and a CDC Health Behavior Scale. Descriptive statistics, Pearson's correlations, Chi square analyses, logistic, and linear regressions were used for analysis. Thirty percent (95% CI [22.7, 37.4]) of our sample screened positive for PTSD. Drug and alcohol use, fighting, and hopelessness were related to severity of PTSD symptoms (p < 0.05). Female gender, CAGE scores, and hopelessness predicted the severity of PTSD symptoms (R2 = 0.354, p < 0.05). Our data has informed the development of a resilience support group currently in the pilot stage for community members.

Mood disorders of childhood and adolescence in a low-income, urban community: A retrospective chart review.

BACKGROUND: Our goal was to determine the risk factors that most correlated with mood disorder diagnoses in children in a low-income, urban community. METHODS: We conducted a retrospective chart review of 174 patients age 6 to 18 who were seen between November 2016 and July 2017 at the University Hospital Psychiatric Pediatric Emergency Services in Newark, New Jersey, United States. RESULTS: Bivariate and multivariate analyses revealed that increasing age, female sex, exposure to trauma, and family history of psychiatric illness were significantly associated with mood disorders in our sample. CONCLUSIONS: The correlation of mood disorders with trauma and family psychiatric history is of particular significance in our sample. In low-income cities with high crime rates and a lack of positive influences, children often have difficulty obtaining the skills to cope with trauma in a healthy manner. Also, the paucity of resources in these communities prevents family members from getting the mental health treatment that they need, further inhibiting children in these families from developing healthy habits. Mental health treatment must be targeted towards entire families and not just in children with mood disorders in order to most effectively improve the mental health outcomes of those who grow up in these communities.

Dextromethorphan-induced near-fatal suicide attempt in a slow metabolizer at cytochrome P450 2D6.

BACKGROUND: Dextromethorphan (DXM) is a common ingredient in several prescriptions and over-the-counter cough preparations. Its metabolism in humans includes hepatic O- and N-demethylation to form dextrorphan and 3-methoxymorphinan, respectively, followed by conjugation. The active metabolite dextrorphan is a noncompetitive N-methyl-D-aspartate receptor antagonist that has been linked with psychosis, especially in rapid metabolizers at cytochrome P450 (CYP) 2D6. CASE SUMMARY: The patient was a 66-year-old married, retired Portuguese American male, with no prior psychiatric history. He presented to the emergency department following a brief psychotic episode leading to a near-fatal suicide attempt after ingesting an excessive quantity of DXM. The patient had started by ingesting 3 tablespoons (45 mL) of cough syrup per day (total, 1575 mg/d) instead of the prescribed 3 teaspoons (15 mL). In the days preceding the admission, his frequency of use had increased substantially (up to 6 times per day). During the treatment of this episode, he was initially started on sertraline 50 mg/d, which was discontinued within 48 hours, given the lack of depressive symptoms, and risperidone was initiated at 1 mg BID. The medication was discontinued after several months, and the patient completely recovered. Possible medical and psychiatric etiologies related to this brief psychotic episode in a geriatric patient are also discussed. CONCLUSIONS: Caution should be exercised in prescribing DXM to geriatric patients, as they may be more susceptible to the drug's adverse effects because of increased clearance time. It appears that dose may play a greater role in causing psychosis, rather than the rate of metabolism, as evident in our patient who, contrary to the more often described scenario, was a slow metabolizer at CYP2D6.

A Course on Terror Medicine: Content and Evaluations.

INTRODUCTION: The development of medical school courses on medical responses for disaster victims has been deemed largely inadequate. To address this gap, a 2-week elective course on Terror Medicine (a field related to Disaster and Emergency Medicine) has been designed for fourth year students at Rutgers New Jersey Medical School in Newark, New Jersey (USA). This elective is part of an overall curricular plan to broaden exposure to topics related to Terror Medicine throughout the undergraduate medical education. RATIONALE: A course on Terror Medicine necessarily includes key aspects of Disaster and Emergency Medicine, though the converse is not the case. Courses on Disaster Medicine may not address features distinctively associated with a terror attack. Thus, a terror-related focus not only assures attention to this important subject but to accidental or naturally occurring incidents as well. METHODS: The course, implemented in 2014, uses a variety of teaching modalities including lectures, videos, and tabletop and hands-on simulation exercises. The subject matter includes biological and chemical terrorism, disaster management, mechanisms of injury, and psychiatry. This report outlines the elective's goals and objectives, describes the course syllabus, and presents outcomes based on student evaluations of the initial iterations of the elective offering. RESULTS: All students rated the course as "excellent" or "very good." Evaluations included enthusiastic comments about the content, methods of instruction, and especially the value of the simulation exercises. Students also reported finding the course novel and engaging. CONCLUSION: An elective course on Terror Medicine, as described, is shown to be feasible and successful. The student participants found the content relevant to their education and the manner of instruction effective. This course may serve as a model for other medical schools contemplating the expansion or inclusion of Terror Medicine-related topics in their curriculum.