Primary psychiatric prevention in children and adolescents.

BACKGROUND: Approximately 21% of US children age 9 to 17 have a diagnosable mental illness with some degree of impairment. As early-onset mental illness may persist throughout the life span, effective primary mental health prevention programs are of paramount importance. METHODS: We conducted a literature review of various preventive programs targeting childhood-onset psychopathology. We attempted to select those programs that present the strongest data on efficacy and those that are most commonly cited. RESULTS: Modifiable and nonmodifiable risk factors and different primary prevention strategies with positive outcomes have been identified for anxiety disorders, eating disorders, substance abuse, disruptive behavior disorders, and suicide in children. The reported results for attention-deficit/hyperactivity disorder (ADHD) and early-onset schizophrenia are neither uniform nor encouraging. CONCLUSIONS: Based on our review, there is ample evidence to conclude that primary preventive intervention has the potential to be effective for some mental health disorders, promoting positive development, particularly in children of all ages in high-risk environments. Additional research is needed to further investigate the validity and reliability of various preventive strategies.

Scaling the great wall: The impact of communication barriers on quality of psychiatric care in Chinese patients.

BACKGROUND: Racial and ethnic minorities (such as Chinese-speaking (CS)) are known to have less equitable access to mental health services than Caucasians. These disparities have a powerful influence on minority groups that already endure a greater burden from mental health needs. AIM: The aim was to identify perceived provider barriers to care for CS patients. METHODS: The study involved an 11-item web-based survey to multidisciplinary health professionals in the department of psychiatry at a 75-bed teaching community mental health center. RESULTS: More than half the respondents agreed that there are disparities in the management of CS versus non-CS patients primarily due to the language barrier (46%). However, older participants and participants who worked fewer hours per week in patient care were less likely to agree (rho = -.27, p = .05 and rho = .33, p = .015, respectively) that these perceived difficulties prevented them from caring for these patients. CONCLUSION: The study revealed that certain modifiable factors like the limited availability of interpreters and culturally appropriate services, rendering psychoeducation and forming therapeutic alliances with CS patients, posed the greatest challenges on inpatient units. In light of these findings, we aim to make recommendations to remediate concerns of limited provider availability by proposing ways to efficiently utilize current resources and advocate for better staffing to improve the overall well-being of this challenging patient subset.

Persistent Psychosis due to Single Dose of Ecstasy.

Ecstasy, a popular drug among the younger generation, the primary psychoactive component of which is 3,4-Methylenedioxymethamphetamine (MDMA), is rarely known to have acute psychiatric effects and when it does, it is usually short term. We describe a patient who presented to the emergency room in a psychotic state after using ecstasy recreationally. Given his aggressive behavior in the community and risk for self-harm, he was emergently hospitalized to ensure safety. He developed persistent psychotic symptoms (delusions) after one dose of recreational MDMA and the team had the opportunity to observe, monitor, and treat his psychosis. This case along with few other documented cases highlights the gaps in research about the chronic, persistent effects and long-term consequences of MDMA. It also suggests that neuropsychiatric symptoms may not be readily reversible after cessation of use. There is an emphasis on the need for physicians to inquire about MDMA use and include it in toxicology screenings and as a potential differential diagnosis.

Paliperidone use in the elderly.

Paliperidone, the active metabolite of risperidone is a relatively recent introduction for the treatment of schizophrenia. There is paucity of data regarding the use of paliperidone in elderly patients. We have attempted to highlight the prominent aspects of the use of paliperidone in the geriatric population. The limited data indicate that paliperidone may be effective and safe in the treatment of schizophrenia in the elderly.