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1.
AIDS Care ; 23(11): 1351-9, 2011 Nov.
Article in English | MEDLINE | ID: mdl-21767117

ABSTRACT

INTRODUCTION: HIV-infected individuals face a tremendous burden of psychiatric comorbidity. This study evaluates a community health care system's effort to screen for psychiatric disorders among patients at an HIV clinic and evaluate adherence to psychiatric service utilization. METHODS: Standardized screening measures were used to identify participants who met diagnostic symptom criteria for post-traumatic stress disorder (PTSD), acute stress disorder (ASD) and depression. All participants who screened positive were referred for psychiatric follow-up. Rates of utilization were measured and barriers to adherence were investigated. RESULTS: Of the 210 participants, 118 patients met screening criteria for PTSD, ASD, and/or depression, and 116 of these had medical records available for review. Of the 116 patients with psychiatric comorbidity, 46.6% saw a psychiatrist and/or were prescribed a psychiatric medication. Thirty-two percent of Latinos, 40.5% of African Americans, and 38.5% of heterosexuals utilized referred psychiatric services, and these rates were significantly less than their counterparts. One hundred patients were seen by a social worker. DISCUSSION: While a large burden of psychiatric comorbidity exists among this population of HIV-positive patients, only half adhered to recommended psychiatric services referrals. Further research is warranted to examine cost-effective interventions to maximize psychiatric screening, referral, and follow-up with mental health services in this vulnerable population.


Subject(s)
Community Mental Health Services/statistics & numerical data , Depressive Disorder/therapy , HIV Infections/psychology , Patient Compliance/statistics & numerical data , Stress Disorders, Post-Traumatic/therapy , Stress Disorders, Traumatic, Acute/therapy , Adult , California , Depressive Disorder/complications , Depressive Disorder/diagnosis , Female , HIV Infections/complications , Humans , Male , Mass Screening , Middle Aged , Poverty , Program Evaluation , Referral and Consultation , Risk Factors , Stress Disorders, Post-Traumatic/complications , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Traumatic, Acute/complications , Stress Disorders, Traumatic, Acute/diagnosis
2.
Glob Adv Health Med ; 9: 2164956120973981, 2020.
Article in English | MEDLINE | ID: mdl-33329941

ABSTRACT

Accounts of frontline health care workers experiencing distress in the midst of the COVID-19 pandemic highlight the need for accessible psychological support for them. Prior to the pandemic, medical residents and physicians often experienced difficulty receiving counseling due to concerns about confidentiality, stigma, cost, time, and reportability to licensure/credentialing bodies. Since 2004, the OHSU Resident and Faculty Wellness Program (RFWP) team has sought to reduce these barriers by providing on-site free, confidential, individual counseling and medication management. Utilization of this program is high with over 500 physicians a year seeking care; 38% of all OHSU residents/fellows and 7% of all faculty eligible for our services participated in 2019-20. In the present essay, we describe how our model of care for trainees and faculty was a key wellness resource during COVID-19. Similar to other accounts of lower help-seeking by health professionals initially during the pandemic, we experienced a slight downturn in utilization rates during the initial weeks of when the pandemic struck our area, but quickly returned to normal and exceeded prior levels. All appointments shifted to telehealth visits and a number of physicians expressed gratitude for the opportunity to talk through concerns and strengthen coping. A number of physicians requested medication consultations to address severe insomnia, anxiety, and depression. We hope that being present in our physicians' lives when they are exposed to COVID-related stress or trauma will keep them safe, help them cope with difficult experiences and losses, and ultimately facilitate both recovery and post-traumatic growth.

3.
Child Adolesc Psychiatr Clin N Am ; 15(2): 477-99, x, 2006 Apr.
Article in English | MEDLINE | ID: mdl-16527667

ABSTRACT

This article first reviews ways to assess children in the justice system who may benefit from psychopharmacologic treatments. Second, it summarizes the emerging understanding of the nature of aggression and violence and the utility of using the schema of reactive ("hot") and proactive ("cold") aggression as a way to consider pharmacologic options. Third, it summarizes the current published studies on the treatment of conduct disorder, which roughly corresponds to the population of children in the juvenile justice system. Finally, it examines the ways that different classes of medications might be considered when approaching juvenile delinquents and the ways that psychopharmacology could be used as part of an overall treatment plan.


Subject(s)
Juvenile Delinquency/psychology , Mental Disorders/drug therapy , Psychopharmacology/methods , Psychotropic Drugs/therapeutic use , Adolescent , Humans
4.
J Health Care Poor Underserved ; 15(4): 538-46, 2004 Nov.
Article in English | MEDLINE | ID: mdl-15531813

ABSTRACT

We conducted a cross-sectional survey of 210 patients who came to a free medical clinic for health care over an 8-month period. We (1) measured their satisfaction with care, (2) determined the frequency of missed opportunities for providing health education and social work consultation, and (3) assessed whether patient-specific factors drive the frequency of these missed opportunities. Of the 210 patients surveyed, a total of 168 (80.0%) completed the entire survey. The mean satisfaction rating was high (4.6 on a scale of 1 to 5). A significant number of missed opportunities occurred, with only 28% of patients receiving patient education material, and 32% of patients visiting the social worker. No particular patient groups emerged as most susceptible to these missed opportunities. This study shows both the high degree of patient satisfaction at this free clinic and the many opportunities for improving patient education and social services. Adding health education and social work consultation to the patient encounter could improve the health of these patients.


Subject(s)
Consultants , Patient Education as Topic/organization & administration , Social Work , California , Cross-Sectional Studies , Data Collection , Female , Humans , Male , Patient Satisfaction
5.
Personal Ment Health ; 8(1): 42-51, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24532554

ABSTRACT

OBJECTIVE: The aims of this study were to examine the prevalence and comorbidities of personality disorders among incarcerated juveniles and to investigate the validity of these results. METHOD: A sample of 790 incarcerated youth (650 boys and 140 girls; mean age = 16.8 years) completed an assessment of Axis II diagnoses (Structured Interview for DSM-IV Personality). Subjects also completed secondary questionnaires assessing anger-irritability (Youth Self-Report (YSR)), aggression (YSR), delinquency (Massachusetts Youth Screening Instrument-2), and distress and restraint (Weinberger Adjustment Inventory). RESULTS: Personality disorders can be found among incarcerated youth at high rates. Many meet the criteria for more than one personality disorder. Those with personality disorders have significant elevations of anger-irritability, aggression, delinquency, and distress and reduced restraint compared with incarcerated youth without a personality disorder. CONCLUSIONS: Results indicate that personality disorders can be found in incarcerated youth at high rates. These findings further our understanding of chronic psychiatric illness and possibly criminal recidivism in this at-risk population. Addition of personality measures in the assessment of delinquents may assist in the development of more effective interventions. Furthermore, the supportive convergent validity of these findings in a population younger than 18 years may indicate a need to reassess the current rationale for the diagnosis of Axis II disorders.


Subject(s)
Personality Disorders/epidemiology , Prisoners/statistics & numerical data , Adolescent , Comorbidity , Female , Humans , Male , Personality Disorders/psychology , Prevalence , Prisoners/psychology , Sex Factors , Surveys and Questionnaires , Young Adult
6.
J Health Care Poor Underserved ; 21(1): 237-50, 2010 Feb.
Article in English | MEDLINE | ID: mdl-20173266

ABSTRACT

Despite high rates of psychiatric morbidity among young offenders, few studies look closely at prevalence rates in terms of race/ethnicity or developmental stage. Seven hundred and ninety (790) incarcerated young people with a mean age of 18+/-1.2 years were examined. The racial/ethnic distribution was White (17%), African American (28%), Hispanic (47%) and Other (8%). White males had greater than average levels of psychosis; African American males showed lower than average alcohol dependence rates but higher levels of marijuana dependence. White females were more likely than Hispanic and African American females to have attention deficit-hyperactivity disorder and substance and stimulant dependence. Race/ethnicity and age differences can be useful when creating culturally-informed and developmentally appropriate interventions for incarcerated young people.


Subject(s)
Black or African American/psychology , Hispanic or Latino/psychology , Mental Disorders/ethnology , Prisoners/psychology , Psychology, Adolescent , White People/psychology , Adolescent , Black or African American/statistics & numerical data , Age Factors , California/epidemiology , Female , Hispanic or Latino/statistics & numerical data , Humans , Juvenile Delinquency , Male , Prevalence , Prisoners/statistics & numerical data , White People/statistics & numerical data
7.
Psychiatr Serv ; 60(6): 838-41, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19487357

ABSTRACT

OBJECTIVE: This study examined prevalence rates of psychiatric disorders among young offenders after they were incarcerated for nine months. METHODS: A total of 790 youths were surveyed, including a significant proportion of females (N=140, 18%), nine months after incarceration. The Structured Clinical Interview for DSM-IV with portions of the Diagnostic Interview for Children and Adolescents and the Structured Interview for DSM-IV Personality were used. RESULTS: Even when conduct disorder and oppositional defiant disorder were excluded, 88% of males and 92% of females had a psychiatric disorder (including substance use disorder); more than 80% of offenders met criteria for some type of substance use disorder. Gender differences were found for anxiety disorders (males 26%, females 55%, p<.01), marijuana dependence (males 32%, females 24%, p=.04), marijuana abuse (males 19%, females 11%, p=.04), and stimulant dependence (males 25%, females 44%, p<.01). CONCLUSIONS: Despite nine months of incarceration, young offenders continued to show high levels of psychiatric and substance use disorders.


Subject(s)
Juvenile Delinquency/psychology , Mental Disorders/epidemiology , Prisoners/psychology , Adolescent , California/epidemiology , Female , Humans , Interview, Psychological , Male , Sex Factors , Young Adult
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