Aripiprazole: examining the clinical implications of D2 affinity.

Schizophrenia is a prevalent psychiatric illness, which causes significant financial and social burden on the population overall. The development of second generation antipsychotics, such as Aripiprazole, Risperidone, and Paliperidone, has changed treatment practice for many psychiatrists. Aripiprazole has extremely high binding affinity for the dopamine D2 receptor, which is the receptor thought to be responsible for the antipsychotic effect, although Aripiprazole is not the most potent of the second generation antipsychotics. In theory, Aripiprazole could displace or outcompete other, more potent antipsychotics, prompting decreased antipsychotic effect. We describe a proposed case of this phenomenon, Ms. A. We describe how Aripiprazole may have caused a worsening of psychiatric symptoms by blocking the antipsychotic effects of Paliperidone due to its strong binding affinity for the D2 receptor. Aripiprazole has a high affinity for the D2 receptor, but may have a lesser reduction of psychotic symptoms compared to other antipsychotics. Prescribers should be aware of this potential interaction and carefully consider initiating long-acting injectable forms of Aripiprazole to avoid this phenomenon.

Cancer beliefs and diet self-management among cancer survivors with comorbid diabetes.

PURPOSE: Illness beliefs impact disease self-management; however, little is known about the impact of patients' beliefs about one illness on the management of another illness. We sought to understand how cancer beliefs impact diet self-management for cancer survivors with diabetes and whether a change in beliefs leads to a change in dietary adherence. METHODS: Seventy-eight participants with diabetes and recently diagnosed early-stage breast, prostate, lung, or colon cancer were recruited. Participants were surveyed at enrollment and after 12 months about their cancer and diabetes illness beliefs and dietary adherence. Associations between beliefs about cancer and diabetes to diet adherence at baseline and at 12 months were assessed. Change in diet adherence was examined in relation to beliefs about each illness. RESULTS: The mean age was 62 years, and 23 (32%) identified as black non-Hispanic, 22 (31%) as white non-Hispanic, and 14 (19%) as Hispanic. Participants with more threatening beliefs about both cancer and diabetes at baseline had worse adherence to a diabetes diet than those with less threatening beliefs. However, at 12 months, those with more threatening cancer beliefs had better dietary adherence than participants with less threatening beliefs. Diabetes beliefs were not associated with diet adherence at 12 months. CONCLUSIONS: While threatening illness beliefs may initially result in worse diet adherence, over time these beliefs may result in increased activation for better self-care and improved diet adherence. IMPLICATIONS FOR CANCER SURVIVORS: Understanding how cancer beliefs impact diet self-management for diabetes may provide coping strategies to improve cancer survivors' management of comorbidities.

The Poison Center as a pandemic response: establishment and characteristics of a COVID-19 hotline through the New Jersey Poison Center.

BACKGROUND: Poison Centers are uniquely positioned to respond to an unprecedented public health threat such as the COVID-19 pandemic, as fully operational 24-h hotlines already staffed with healthcare professionals. METHODS: On January 27, 2020 the New Jersey Poison Information and Education System (NJPIES) agreed to operate the New Jersey Coronavirus Hotline. Call patterns, subject matter, and staffing and infrastructure strategies that were implemented to meet the demand are described. In addition, a sample of 1500 individual calls were collected and analyzed in an endeavor to describe call times, call days, area from which the call originated, callers to the hotline, primary language of the caller, and why a call was placed to the hotline. Binomial regression analysis was utilized in an attempt to identify significant patterns. RESULTS: Since the inception of the hotline through October 31, NJPIES responded to 57,579 calls for COVID-19 information. Most calls (68.7%) were regarding testing for COVID-19 and for general questions/symptoms. Call types varied when they were analyzed by time of day with calls for general questions/symptoms and where to get tested for COVID-19 showing a significant association for the early morning hours, how to obtain test results being significantly associated with the afternoon hours, and how to renew or obtain a medical license showing a significant association to the evening hours. We additionally noted that specific call types became significant when analyzed on a week-to-week basis and as specific events, like the enactment of the CARES Act of 2020, occurred. CONCLUSION: Although not the traditional role of a regional Poison Control Center, pandemic response synergizes with the workflow of this hotline because the infrastructure, staffing, and healthcare expertise are already present. Poison centers can rapidly adapt through scaling and process change to meet the needs of the public during times of public health threats.

Physician Knowledge, Attitudes, and Practices Regarding Breast Density.

Background: Many states have enacted breast density laws, requiring that women be informed of their breast density status; however there is currently no consensus for screening guidelines or recommendations for women with dense breasts. The objective of this study is to access physician views about breast density and their practices for breast cancer screening of women with dense breasts in light of breast density laws. Materials and Methods: Setting: Academic medical centers, community and private practices mostly in New York City. Participants: Primary care providers (PCPs), radiologists and gynecologists. Procedure: We conducted the study through anonymous, self-administered surveys about physician knowledge, attitudes, and practices regarding screening of women with dense breasts. Bivariate and multivariate analyses were performed to assess differences between PCPs and specialists. Results: We received 155 responses of which 75% were female, 77% were attending-level physicians, 42% were PCPs, 28% were radiologists, 17% were gynecologists, and 9% other. Almost half of the respondents (48%) were unaware of breast density laws, and two-thirds (67%) felt they needed more education about breast density and supplemental screening. More than half of the respondents (62%) were unaware of the increased risk of breast cancer related to dense breasts. Compared to specialists, PCPs were less aware of their state's breast density laws (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.09-0.50) and of the increased breast cancer risk for women with dense breasts (OR 0.23; 95% CI 0.09-0.60). Conclusion: Breast density laws have not translated into greater knowledge of breast density and recommendations for supplemental screening among PCPs.