RESUMO
BACKGROUND/OBJECTIVES: Racial and ethnic disparities in depression incidence, prevalence, treatment, and outcomes still persist. The hypothesis of this study was that use of collaborative care management (CCM) in treating depressed primary care patients would decrease racial disparities in 6-month clinical outcomes compared with those patients treated with usual primary care (UC). RESEARCH DESIGN/SUBJECTS: In a retrospective chart review analysis, 3588 (51.2%) patients received UC and 3422 (48.8%) patients were enrolled in CCM. Logistic regression analyses were used to examine disparities in 6-month outcomes. RESULTS: Minority patients enrolled in CCM were more likely to be participating in depression care at 6 months than minority patients in UC (61.8% vs. 14.4%; P≤0.001). After adjustment for demographic and clinical covariates, this difference remained statistically significant (odds ratio=9.929; 95% CI, 6.539-15.077, P≤0.001).The 568 minority UC patients with 6-month follow-up PHQ-9 data demonstrated a much lower odds ratio of a PHQ-9 score of <5 (0.220; 95% CI, 0.085-0.570; P=0.002) and a much higher odds ratio of PHQ-9 score of ≥10 (3.068; 95% CI, 1.622-5.804; P<0.001) when compared with the white, non-Hispanic patients. In contrast, the 2329 patients treated with CCM, the odds ratio for a PHQ-9 score of <5 or ≥10 after 6 months, demonstrated no significance of minority status. CONCLUSIONS: Utilization of CCM for depression was associated with a significant reduction of the disparities for outcomes of compliance, remission, or persistence of depressive symptoms for minority patients with depression versus those treated with UC.
Assuntos
Depressão/terapia , Transtorno Depressivo/terapia , Disparidades em Assistência à Saúde/etnologia , Grupos Minoritários/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Competência Cultural , Etnicidade/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Grupos Raciais/estatística & dados numéricos , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: Allowing psychiatric patients access to their electronic medical record (EMR) may cause difficulty related to the sensitivity of the note content. The authors investigated whether notes written by psychiatry trainees were ready for release to patients. METHODS: Authors conducted a review of 128 PGY-3 to PGY-5 outpatient notes not explicitly marked as "highly confidential." One psychiatrist and one non-psychiatrist read each note from the patient's perspective. Reviewers assigned a score of 0-2 (0: No Concern; 1: Some Concern; 2: Major Concern) for each note. RESULTS: Eighty-nine notes (70%) were assessed as "No Concern" by both reviewers; 30 (23%) were of "Some Concern;" and 9 (7%) were of "Major Concern;" 92 (72%) were deemed of "No Concern" by a psychiatrist, as compared with 120 (94%) by the non-psychiatrist. CONCLUSIONS: Trainee EMR outpatient notes are not likely to cause major concerns for patients who read them. Psychiatrist-reviewers identified more concerns than non-psychiatrist-reviewers.
Assuntos
Confidencialidade/ética , Registros Eletrônicos de Saúde/normas , Psiquiatria/normas , Adulto , Registros Eletrônicos de Saúde/ética , Humanos , Psiquiatria/ética , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The aims of this study were to test the psychometric properties of the Kessler 10 (K10) in a clinical setting and to investigate the utility of the K10 as a means for identifying suicidality. METHODS: One hundred forty-nine inpatients at an inpatient psychiatric hospital completed a battery of assessments during their inpatient hospital stay. Factor analysis provided information suggesting multiple factor loadings present within the K10. A series of t tests examined differences of group means between suicidal participants and a control group, whereas multiple regression models examined the correlation between the K10 and several suicide-specific assessments. MAIN RESULTS: The K10 seems to be composed of 2 primary factors (depression and anxiety) and differentiated suicidal and nonsuicidal inpatients and was associated with several measures related to suicidality. CONCLUSIONS: The observed results indicate that the K10 may be an effective screener to measure occult suicidality in a clinical setting.
Assuntos
Ideação Suicida , Suicídio/psicologia , Adolescente , Adulto , Idoso , Ansiedade/psicologia , Estudos Transversais , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PsicometriaRESUMO
OBJECTIVE: The aim of this study was to determine the validity of assigning suicidal individuals into differing typologies of suicidality based on their reported wish to live and wish to die. METHODS: One hundred five inpatients who reported suicidal ideation in the previous 48 hours completed a battery of assessments during inpatient psychiatric hospitalization. An algorithm was used to assign participants into 1 of 3 typologies of suicide: wish to live, ambivalent, or wish to die. Discriminant function analysis and group classification were used to predict group membership, followed by multiple analysis of variance and follow-up contrasts to measure between-group differences. MAIN RESULTS: Group classification resulted in 76% accuracy for predicting typology of suicidality based on scores from suicide-specific measures. Self-perceived risk of suicide and hopelessness were the strongest variables at differentiating between the 3 groups. Patients in the wish to die typology were less likely to report having never made a suicide attempt. CONCLUSIONS: Creating typologies of suicidality may prove useful to clinicians seeking to better differentiate among suicidal patients within a limited period of assessment.
Assuntos
Atitude Frente a Morte , Prevenção do Suicídio , Suicídio/classificação , Adulto , Estudos Transversais , Análise Discriminante , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Testes Psicológicos , Medição de Risco , Ideação Suicida , Estados UnidosRESUMO
OBJECTIVE: The aim of the study was to define the extent of current and lifetime smoking by diagnostic groups and suicide risk as reason for admission in a geographically defined psychiatric inpatient cohort. DESIGN: The study used a population-based retrospective chart review. METHODS: Smoking status and discharge diagnoses for Olmsted County, Minnesota, inpatients aged 18 to 65 admitted for psychiatric hospitalization in 2004 and 2005 were abstracted from the electronic medical record. Diagnostic groups were compared to each other using chi(2) tests and Fisher exact test to analyze smoking status within the inpatient sample with significance defined as P Assuntos
Transtornos Mentais/psicologia
, Fumar/epidemiologia
, Suicídio/psicologia
, Adolescente
, Adulto
, Idoso
, Transtornos de Ansiedade/psicologia
, Distribuição de Qui-Quadrado
, Feminino
, Humanos
, Pacientes Internados/psicologia
, Masculino
, Pessoa de Meia-Idade
, Minnesota/epidemiologia
, Transtornos do Humor/psicologia
, Transtornos da Personalidade/psicologia
, Prevalência
, Transtornos Psicóticos/psicologia
, Estudos Retrospectivos
, Fatores de Risco
, Abandono do Hábito de Fumar/psicologia
, Abandono do Hábito de Fumar/estatística & dados numéricos
, Transtornos Relacionados ao Uso de Substâncias/psicologia
, Adulto Jovem
RESUMO
We investigated the psychometric validity and reliability of the Suicide Status Form-II (SSF-II) developed by Jobes, Jacoby, Cimbolic, and Hustead (1997). Participants were 149 psychiatric inpatients (108 suicidal; 41 nonsuicidal) at the Mayo Clinic. Each participant completed assessment measures within 24 hours of admission and 48-72 hours later. Factor analyses of the SSF core assessment produced a robust two-factor solution reflecting chronic and acute response styles. The SSF core assessment had good to excellent convergent and criterion validity; pre-post SSF ratings also demonstrated moderate test-retest reliability. The results replicated previous research and show that the SSF-II is psychometrically sound with a high-risk suicidal inpatient sample.
Assuntos
Transtornos Mentais/psicologia , Admissão do Paciente , Inventário de Personalidade/estatística & dados numéricos , Tentativa de Suicídio/psicologia , Suicídio/psicologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/estatística & dados numéricos , Reprodutibilidade dos Testes , Medição de Risco , Tentativa de Suicídio/prevenção & controle , Adulto Jovem , Prevenção do SuicídioRESUMO
Suicide is a public health problem that claims the lives of approximately 1 million people around the world each year. This article describes suicide rates in the United States and Minnesota and discusses potential effects of the economy on the rate, concerns regarding suicides in the Army, and what clinicians can do to make a difference in the lives of patients who may be at risk.
Assuntos
Campanha Afegã de 2001- , Economia , Guerra do Iraque 2003-2011 , Suicídio/tendências , Adolescente , Adulto , Fatores Etários , Idoso , Causas de Morte , Estudos Transversais , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Militares/estatística & dados numéricos , Minnesota , Fatores de Risco , Fatores Sexuais , Suicídio/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Estados Unidos , Adulto Jovem , Prevenção do SuicídioRESUMO
INTRODUCTION: Increased mortality in people with schizophrenia, compared to the general population, has been consistently reported worldwide. This mortality has been attributed predominantly to "unnatural" deaths-suicide, accidents, and homicide. Recent studies have shown an increase in natural causes of death. Our objective is to compare the mortality of schizophrenic and schizoaffective subjects to the general US population. METHODS: 319 Olmsted County residents meeting DSM-IV-TR criteria for schizophrenia or schizoaffective disorder seen at the Mayo Clinic between 1950 and 1980 were followed until February 2005 for a median of 23.5 years. RESULTS: At the end of follow-up, 44% of patients were deceased. Mortality was significantly (p<0.001) increased compared to the Caucasian population in the US for persons of like age, gender, and calendar year of birth. The median survival following diagnosis was 36.2 years. Death certificate cited cause of death was cardiac (29%), cancer--including lung (19%), and pulmonary disease (17%). Concerningly, there was no association with the year of diagnosis to survival. CONCLUSIONS: Tsuang and colleagues showed in 1975 that mortality in schizophrenics and later, those with schizoaffective disorder was significantly increased compared to the US general population. Thirty years later, with a demographically similar population, we have found the same pattern of increased mortality. In light of continued improvements in the general population's lifespan, the survival gap in schizophrenia/schizoaffective disorder appears to be increasing.
Assuntos
Transtornos Psicóticos/mortalidade , Esquizofrenia/mortalidade , Adolescente , Adulto , Idoso , Causas de Morte/tendências , Criança , Estudos de Coortes , Atestado de Óbito , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Cardiopatias/mortalidade , Humanos , Pneumopatias/mortalidade , Masculino , Pessoa de Meia-Idade , Minnesota , Neoplasias/mortalidade , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Transtornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Taxa de Sobrevida , Estados UnidosAssuntos
Benzazepinas/uso terapêutico , Transtorno Bipolar/fisiopatologia , Agonistas Nicotínicos/uso terapêutico , Quinoxalinas/uso terapêutico , Abandono do Hábito de Fumar/métodos , Adulto , Depressão/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , VareniclinaRESUMO
OBJECTIVE: Patients with schizophrenia sometimes receive substandard medical care. This study explored such disparities among lung cancer patients with underlying schizophrenia. METHODS: This retrospective study focused on patients with pre-existing schizophrenia (or in some instances schizoaffective disorder) and a lung cancer diagnosis made between 1980 and 2004. 'Disparity' was defined as a patient's having been prescribed less aggressive therapy for a potentially curable cancer based on state-of-the-art treatment standards for the time and for the cancer stage. Qualitative methods were used to assess healthcare providers' decision-making. RESULTS: 29 patients were included. The median age was 59 years; 38% were men. Twenty-three had non-small cell lung cancer and 6 small cell lung cancer; 17 had potentially curable cancers. Five of 17 had a 'disparity' in cancer care: (1) no cancer therapy was prescribed because of chronic obstructive pulmonary disease; (2) no cancer therapy was prescribed because of infection; (3) no chemotherapy was prescribed because the patient declined it; radiation was provided; (4) no chemotherapy was prescribed because of the patient's schizophrenia symptoms; radiation was administered; and (5) no surgery was performed because of disorientation from a lobotomy; radiation was prescribed. Comments from healthcare providers suggest reflection and ethical adjudication in decision-making. CONCLUSION: Schizophrenia was never the sole reason for no cancer treatment in patients with potentially curable lung cancer. This study provides the impetus for others to begin to assess the effect of schizophrenia on lung cancer management in other healthcare settings.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/psicologia , Carcinoma Pulmonar de Células não Pequenas/terapia , Carcinoma de Células Pequenas/psicologia , Carcinoma de Células Pequenas/terapia , Disparidades em Assistência à Saúde/ética , Neoplasias Pulmonares/psicologia , Neoplasias Pulmonares/terapia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Esquizofrenia/diagnóstico , Psicologia do Esquizofrênico , Adulto , Idoso , Atitude do Pessoal de Saúde , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma de Células Pequenas/diagnóstico , Carcinoma de Células Pequenas/epidemiologia , Comorbidade , Ética Médica , Medicina Baseada em Evidências , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Preconceito , Prognóstico , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/epidemiologia , Estudos Retrospectivos , Esquizofrenia/epidemiologiaRESUMO
BACKGROUND: A new clinical entity, Acute Suicidal Affective Disturbance (ASAD), was recently proposed to characterize rapid-onset, acute suicidality including the cardinal symptom of behavioral intent. This study examines the proposed ASAD criteria factor-analytically and in relation to correlates of suicidal behavior and existing psychiatric disorders in samples of psychiatric outpatients and inpatients. METHODS: Two samples of psychiatric outpatients (N=343, aged 18-71 years, 60.6% female, 74.9% White) and inpatients (N=7,698, aged 15-99 years, 57.2% female, 87.8% White) completed measures of their ASAD symptoms and psychological functioning. RESULTS: Across both samples, results of a confirmatory factor analysis supported the unidimensional nature of the ASAD construct. Additionally, results provided evidence for the convergent and discriminant validity of ASAD, demonstrating its relation to, yet distinction from, other psychiatric disorders and correlates of suicide in expected ways. Importantly, ASAD symptoms differentiated multiple attempters, single attempters, and non-attempters, as well as attempters, ideators, and non-suicidal patients, and was an indicator of past suicide attempts above and beyond symptoms of depression and other psychiatric disorders. LIMITATIONS: This study utilized cross-sectional data and did not use a standardized measure of ASAD. CONCLUSIONS: ASAD criteria formed a unidimensional construct that was associated with suicide-related variables and other psychiatric disorders in expected ways. If supported by future research, ASAD may fill a gap in the current diagnostic classification system (DSM-5) by characterizing and predicting acute suicide risk.
Assuntos
Transtorno Depressivo/psicologia , Pacientes Internados/psicologia , Pacientes Ambulatoriais/psicologia , Comportamento Autodestrutivo/psicologia , Tentativa de Suicídio/psicologia , Adulto , Idoso , Estudos Transversais , Transtorno Depressivo/complicações , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Comportamento Autodestrutivo/complicações , Ideação Suicida , Suicídio/psicologia , Adulto JovemRESUMO
Previously restricted primarily to Hawaii and California, methamphetamine abuse has reached epidemic proportions throughout the United States during the past decade, specifically in rural and semirural areas. Particular characteristics of methamphetamine production and use create conditions for a "perfect storm" of medical and social complications. Unlike imported recreational drugs such as heroin and cocaine, methamphetamine can be manufactured locally from commonly available household ingredients according to simple recipes readily available on the Internet. Methamphetamine users and producers are frequently one and the same, resulting in both physical and environmental consequences. Users experience emergent, acute, subacute, and chronic injuries to neurologic, cardiac, pulmonary, dental, and other systems. Producers can sustain life-threatening injuries in the frequent fires and explosions that result when volatile chemicals are combined. Partners and children of producers, as well as unsuspecting first responders to a crisis, are exposed to toxic by-products of methamphetamine manufacture that contaminate the places that serve simultaneously as "lab" and home. From the vantage point of a local emergency department, this article reviews the range of medical and social consequences that radiate from a single hypothetical methamphetamine-associated incident.
Assuntos
Estimulantes do Sistema Nervoso Central/intoxicação , Infecções por HIV/etiologia , HIV , Metanfetamina/intoxicação , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Criança , Feminino , Infecções por HIV/epidemiologia , Humanos , Incidência , Masculino , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
Linezolid, a novel antimicrobial with activity against gram-positive bacteria including pathogens resistant to traditional antimicrobials, also inhibits monoamine oxidase. This latter property can cause potentially lethal adverse interactions with antidepressant medications. Long known to psychiatrists, monoamine oxidase inhibitors (MAOIs) and complications of their use may be unfamiliar to medical and surgical practitioners who may thus unwittingly precipitate a hypertensive crisis or serotonin syndrome. We review the pharmacology of MAOis and describe 3 clinical situations In which linezolid-selective serotonin inhibitor (SSRI) interactions, actual or potential, figured prominently.
Assuntos
Acetamidas/farmacologia , Interações Medicamentosas , Inibidores da Monoaminoxidase/farmacologia , Oxazolidinonas/farmacologia , Inibidores Seletivos de Recaptação de Serotonina/farmacologia , Síndrome da Serotonina/induzido quimicamente , Sertralina/farmacologia , Idoso , Feminino , Humanos , Linezolida , Masculino , Pessoa de Meia-Idade , Síndrome da Serotonina/diagnóstico , Síndrome da Serotonina/prevenção & controleRESUMO
Despite their high prevalence, little is known about the effects of substance use disorders and active substance use on the suicide risk or length-of-stay of psychiatric inpatients. This study examines the relationship between active substance use at the time of psychiatric hospitalization and changes in suicide risk measures and length-of-stay. Admission and discharge ratings on the Suicide Status Form-II-R, diagnoses, and toxicology data from 2,333 unique psychiatric inpatients were examined. Data for patients using alcohol, tetrahydrocannabinol, methamphetamines, cocaine, benzodiazepines, opiates, barbiturates, phencyclidine, and multiple substances on admission were compared with data from 1,426 admissions without substance use. Patients with substance use by toxicology on admission had a 0.9 day shorter length-of-stay compared to toxicology-negative patients. During initial nurse evaluation on the inpatient unit, these patients reported lower suicide measures (i.e., suicidal ideation frequency, overall suicide risk, and wish-to-die). No significant between-group differences were seen at discharge. Patients admitted with a substance use disorder diagnosis had a 1.0 day shorter length-of-stay than those without, while those with a substance use disorder diagnosis and positive toxicology reported the lowest measures of suicidality on admission. These results remained independent of psychiatric diagnosis. For acute psychiatric inpatients, suicide risk is higher and length-of-stay is longer in patients with substance use disorders who are NOT acutely intoxicated compared with patients without a substance use disorder. Toxicology-positive patients are less suicidal on admission and improve faster than their toxicology-negative counterparts. This study gives support to the clinical observation that acutely intoxicated patients may stabilize quickly with regard to suicidal urges and need for inpatient care.
Assuntos
Hospitalização/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Overdose de Drogas/epidemiologia , Overdose de Drogas/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Suicídio/psicologia , Adulto JovemRESUMO
BACKGROUND: Collaborative care management (CCM) has been shown to have superior outcomes to usual care (UC) for depressed patients with a fixed end point. This study was a survival analysis over time comparing CCM with UC using remission (9-item Patient Health Questionnaire [PHQ-9] score <5) and persistent depressive symptoms (PDSs; PHQ-9 score ≥10) as end points. METHODS: A retrospective cohort study of 7340 patients with depression cared for at 4 outpatient primary care clinics was conducted from March 2008 through June 2013. All adult patients diagnosed with depression (International Classification of Diseases, 9th Revision [ICD-9], codes 296.2-3) or dysthymia (ICD-9 code 300.4) with an initial PHQ-9 score ≥10 were included. CCM was implemented at all clinics between 2008 and 2010. Kaplan-Meyer survival curves for time to remission and PDSs were plotted. A Cox proportional hazards model was used to adjust for expected differences between patients choosing CCM versus UC. RESULTS: Median time to remission was 86 days (95% confidence interval [CI], 81-91 days) for the CCM group versus 614 days (95% CI, 565-692 days) for the UC group. Likewise, median duration of PDSs was 31 days (95% CI, 30-33 days) for the CCM group versus 154 days (95% CI, 138-182 days) for the UC group. In the Cox proportional hazards model, which controlled for covariates such as age, sex, race, diagnosis, and initial PHQ-9 score, CCM was associated with faster remission (hazard ratio of the CCM group [HRCCM], 2.48; 95% CI, 2.31-2.65). CONCLUSIONS: This study demonstrated that patients enrolled in CCM have a faster rate of remission and a shorter duration of PDSs than patients choosing UC.
Assuntos
Transtorno Depressivo/terapia , Equipe de Assistência ao Paciente/organização & administração , Assistência Centrada no Paciente/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Estudos de Coortes , Transtorno Depressivo/diagnóstico , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Equipe de Assistência ao Paciente/normas , Assistência Centrada no Paciente/normas , Modelos de Riscos Proporcionais , Indução de Remissão , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Recursos Humanos , Adulto JovemRESUMO
BACKGROUND: Adolescent use of alcohol and illicit substances is quite common among pediatric psychiatry inpatients; however, little data exist on substance use screening instruments that can be used to augment thorough psychiatric diagnostic interviews. CRAFFT is a screening tool for adolescent substance use that has been validated in outpatient general medical settings. This is the first study to examine its use in adolescent psychiatric inpatients. METHODS: We performed a chart review of records from adolescents admitted to our inpatient psychiatric unit who completed a CRAFFT screen on admission. We compared CRAFFT scores with other measures of substance use, including urine drug screens and the diagnosis of a substance use disorder at discharge. We also examined measures of depression and suicidality in individuals with elevated CRAFFT scores (≥2 positive answers out of 6) and compared them with measures in those with normal CRAFFT scores. RESULTS: Elevated CRAFFT scores were correlated with other measures of alcohol and substance use, including the diagnosis of a substance use disorder at discharge (P<0.0001), and laboratory screening for alcohol (P=0.0048) and marijuana (P<0.0001) on admission. Previous suicide attempts (P=0.005) and "psychiatric trauma" (P=0.0027) were also positively associated with elevated CRAFFT scores. CONCLUSIONS: CRAFFT scores in adolescent inpatients were correlated with other measures of substance use, supporting its efficacy as a screening tool in this population. CRAFFT scores were also positively correlated with a history of psychiatric trauma and past suicide attempts, which is consistent with the results of previous studies associating pediatric substance use and traumatic life events with an increased risk of suicide.
Assuntos
Alcoolismo , Pacientes Internados , Medição de Risco/métodos , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias , Tentativa de Suicídio , Adolescente , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Estudos Transversais , Depressão/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Drogas Ilícitas/análise , Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Masculino , Trauma Psicológico/epidemiologia , Projetos de Pesquisa , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Ideação Suicida , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia , Estados Unidos/epidemiologiaRESUMO
In the United States, psychoactive prescription medications rank second only to marijuana as drugs of abuse (if tobacco and alcohol are discounted). Physician shopping--visiting multiple physicians simply to procure prescriptions--has been a traditional method for acquiring drugs illicitly. As community-based efforts to curtail physician shopping have expanded, drug abusers have turned increasingly to the Internet. Illegal Internet pharmacies, increasing rapidly in number during the past decade and requiring neither prescription nor physician oversight, offer minimal interference to obtaining drugs. With no physician involved, patients cease to be patients. Instead, they become consumers able to buy prescription medications, even controlled substances, from anonymous providers offering no ongoing treatment relationship and taking no responsibility for the drugs dispensed. When complications occur, these consumers become patients, turning back to the traditional medical system to manage overdoses, addictions, and drug adverse effects and interactions. We present a case series illustrating some of the medical problems that resulted from drugs bought on-line illegally.
Assuntos
Prescrições de Medicamentos , Internet/estatística & dados numéricos , Sistemas On-Line/estatística & dados numéricos , Assistência Farmacêutica/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias , Adulto , Interações Medicamentosas , Revisão de Uso de Medicamentos/organização & administração , Controle de Medicamentos e Entorpecentes/organização & administração , Feminino , Humanos , Masculino , Anamnese , Papel do Médico , Gestão da Segurança/organização & administração , Transtornos Relacionados ao Uso de Substâncias/etiologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Estados UnidosRESUMO
OBJECTIVE: To determine if the relationship of agitation with suicide ideation and suicide attempts differed between men and women. METHOD: Self-reported severity of agitation and other suicide risk factors was obtained from 7698 consecutive patients during admission for inpatient psychiatric treatment during a 5-year period. RESULTS: Agitation was highest among men with a history of suicide attempts. Agitation was significantly associated with frequency of suicide ideation and history of suicide attempt, but the gender-by-suicide interaction was only significant as a predictor of suicide attempt history. For men, agitation was associated with significantly increased risk for suicide attempt, but for women, agitation was not associated with risk for suicide attempt history. Results were unchanged when analyses were repeated among the subgroup of patients with suicide ideation. CONCLUSIONS: Agitation is associated with history of suicide attempt among male but not female psychiatric inpatients. Agitation differentiates between those men who have only thought about suicide and those who have made suicide attempts.
Assuntos
Ansiedade/epidemiologia , Transtornos Mentais/epidemiologia , Agitação Psicomotora/epidemiologia , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Unidade Hospitalar de Psiquiatria , Fatores Sexuais , Adulto JovemRESUMO
BACKGROUND: Suicide is the third leading cause of death in the United States for youth 12-17 years or age. Acute psychiatric hospitalization represents a clear worst point clinically and acute suicide risk is the most common reason for psychiatric admission. We sought to determine factors associated with differences in individual suicide risk assessment for children and adolescents during acute psychiatric admission. METHODS: Study participants were 1153 youth consecutively admitted to an inpatient psychiatry unit who completed a self-administered Suicide Status Form (SSF) within 24h of admission. Additional information on suicide risk factors was obtained through medical chart abstraction. RESULTS: Females reported significantly greater psychological pain, stress, hopelessness, and self-hate on the SSF and were significantly more likely to have made a suicide attempt just prior to the index hospital admission (OR=1.59, SE=0.29; CI=1.12-2.26), report a family history of suicide (OR=2.02, SE=0.33; CI=1.47-2.78), and had experienced a greater number of inpatient psychiatry admissions related to suicidal ideation (RR=1.33, SE=0.13; CI=1.10-1.61). High school aged youth and those with a primary diagnosis of depression displayed consistently elevated SSF scores and risk factors for suicide compared to comparison groups. LIMITATIONS: Diagnosis was determined through chart abstraction. Responses to access to firearm question had missing data for 46% of the total sample. CONCLUSIONS: Systematic administration of a suicide-specific measure at admission may help clinicians improve identification of suicide risk factors in youth in inpatient psychiatry settings.
Assuntos
Adolescente Hospitalizado/psicologia , Criança Hospitalizada/psicologia , Suicídio/psicologia , Adolescente , Criança , Feminino , Indicadores Básicos de Saúde , Hospitalização , Humanos , Masculino , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Estresse Psicológico , Estados UnidosRESUMO
BACKGROUND: Single infusions of ketamine have been used successfully to achieve improvement in depressed patients. Side effects during the infusions have been common. It is not known whether serial infusions or lower infusion rates result in greater efficacy. METHODS: Ten depressed patients were treated with twice weekly ketamine infusions of ketamine 0.5 mg/kg administered over 100 min until either remission was achieved or four infusions were given. Side effects were assessed with the Young Mania Rating Scale (YMRS) and the Brief Psychiatric Rating Scale (BPRS). Patients were followed naturalistically at weekly intervals for four weeks after completion of the infusions. RESULTS: Five of 10 patients achieved remission status. There were no significant increases on the BPRS or YMRS. Two of the remitting patients sustained their improvement throughout the four week follow-up period. CONCLUSIONS: Ketamine infusions at a lower rate than previously reported have demonstrated similar efficacy and excellent tolerability and may be more practically available for routine clinical care. Serial ketamine infusions appear to be more effective than a single infusion. Further research to test relapse prevention strategies with continuation ketamine infusions is indicated.