A description of antipsychotic prescribing patterns based on race in the inpatient behavioral health setting.

BACKGROUND AND AIMS: A growing body of research shows that race contributes to disparities in mental health services utilization and influences the clinical diagnostic process. To our knowledge, no studies on current practice in the Unites States have documented whether these disparities impact the prescription of antipsychotic medications across individual patients based on race. Consequently, this study aims to describe the prescribing patterns of antipsychotic medications in the inpatient setting based on patients' race, and to explore appropriateness of therapy based on Food and Drug Administration labeling and avoidance of inappropriate polypharmacy. METHODS: Single-centered, retrospective, chart review of 398 psychiatric patients in the inpatient setting and who had a psychiatric diagnosis that warranted a prescription for an antipsychotic medication at the time of discharge. Frequencies were computed to describe differences in demographic variables (race, health insurance type, age, and gender), medical conditions (diagnosis, commodities, hospitalization status, antipsychotic medications, etc.), and screening tests (lipid panel, hemoglobin, urine and illicit drug use). Logistic regression, analysis of variance, and hypothesis tests were used to analyze the data. RESULTS: Significant differences were not found in total chlorpromazine equivalent dose equivalencies by race or insurance. However, patients of involuntary admission status, past medication trials, a diagnosis of schizophrenia or bipolar disorder, and who lacked family support had higher total daily doses of antipsychotics upon discharge. Inappropriate therapy was significantly related to differences in increasing age and a diagnosis of insomnia. CONCLUSION: This single-centered study described patterns of antipsychotic prescribing based on race in an inpatient psychiatry facility. Future studies, using larger and more diverse sample populations, are recommended to elucidate the role that patients' race, admission status, and family support play in the dose and appropriateness of antipsychotics prescribed for mental health care.

Fostering healthcare providers' post-traumatic growth in disaster areas: proposed additional core competencies in trauma-impact management.

Disaster planning has traditionally focused on the concrete needs of the impacted population. This article looks at the impact of direct and indirect trauma exposure as it affects healthcare providers responding to a region-wide natural disaster and discusses trauma management via the incorporation of self-care techniques. It also explores post-traumatic growth as a potential benefit arising from trauma exposure. We propose that preventative and post-traumatic interventions be added to disaster planning. We further propose that the governing bodies that oversee the training of healthcare providers add training in post-traumatic interventions, including training in and support of self-care interventions to prevent and/or mitigate the effects of secondary traumatic stress. We suggest that they also provide training in Mind-Body Medicine Skills, a promising intervention that addresses symptoms of secondary traumatic stress and promotes post-traumatic growth.

The long road home: rebuilding public inpatient psychiatric services in post-Katrina New Orleans.

In August 2006, a year after Hurricane Katrina, the first acute inpatient public psychiatric unit for adults was opened in New Orleans to serve patients referred from local emergency departments. This article describes the clinical and administrative experiences of providing inpatient care in post-Katrina New Orleans, including the increased demand for programs to treat patients with co-occurring disorders, the expanded scope of practice for psychiatrists to include primary care, and ongoing staff shortages in a traumatized and displaced workforce. Lessons learned in regard to disaster planning and recovery are also discussed.