Manifestation of anxiety and depression among pediatric patients with psoriasis: A review.

Psoriasis is a chronic, inflammatory skin disorder with manifestations extending beyond visual presentation to encompass psychological burden. Though the association between psoriasis and mental health disorders in adults is widely accepted, there is inadequate research to generalize these findings to pediatric populations. In this review of the literature, we discuss the prevalence of anxiety and depression among pediatric patients with psoriasis in hopes of raising awareness of these associations and advocating for psychological screening and intervention in dermatology practice.

Veteran treatment courts: A promising solution.

The high prevalence of substance use, traumatic brain injury, post-traumatic stress disorder, and other mental illness in the veteran population presents unique public health and social justice challenges. Veteran involvement in the justice system has been identified as a national concern. Criminal justice involvement compounds pre-existing socioeconomic stressors and further strains support systems. The point of contact with the criminal justice system, however, presents an opportunity to establish mental health treatment. This is consistent with the concept of the sequential intercept model that seeks to divert offenders with mental illness from the criminal justice system into treatment. In recent years, many jurisdictions have established veterans treatment courts (VTCs), a type of problem-solving court serving this diversion function for military veterans. This article presents an overview of the problem, the ethical basis for their development, a brief history of the courts, and their potential for success. The Harris County Veterans Court is presented as an example.

Forensic Psychiatry Milestones: Experience After 1 Year.

OBJECTIVE: In 1999, the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties identified six core competencies for medical practice. In 2013, the milestones were introduced to demonstrate these educational outcomes across each specialty. This study represents the first examination of the sub-specialty Forensic Psychiatry Milestones. METHODS: Members of the Association of Directors of Forensic Psychiatry Fellowships were surveyed. Areas of inquiry included whether milestones assisted in identifying areas of deficiency in fellows or programs, whether the graduation milestones matched the goals of training, and what changes were planned, or had been made, based on their implementation. RESULTS: Twenty-six of 35 programs responded, for a response rate of 74%. The majority found the milestones somewhat or very useful, half found the graduation-level milestones matched the program's graduation goals, and a significant majority reported that the milestones assisted in identifying improvements, change, or intended change. In choosing terms to describe the milestones, however respondents chose a variety of negative or neutral terms, rather than positive ones. CONCLUSIONS: The milestones provided a standard mechanism for identifying areas for improvement and a common language to standardize practice. However, due to the variability across fellowship programs and the limitations of educational resources and time, implementation of the new ACGME requirement was characterized in largely negative terms. Recommendations for improvement included modification of the milestones themselves, flexibility in their implementation, and evidentiary support for their use.

Predictors of Incarceration of Veterans Participating in U.S. Veterans' Courts.

OBJECTIVE: Significant variability exists regarding the criteria and procedures used by different veterans' courts (VCs) across the country. Limited guidance is available regarding which VC model has the most successful outcomes. The purpose of this study was to examine factors associated with incarceration during VC participation. METHODS: This study used data for 1,224 veterans collected from the HOMES (Homeless Operations Management and Evaluation System) database of the Department of Veterans Affairs, as well as data from a national phone survey inventory of all U.S. VCs. To identify variables associated with incarceration during VC participation, four backward conditional logistic regressions were performed. RESULTS: The following variables were associated with higher rates of incarceration because of a veteran's noncompletion of the VC program: charges of probation or parole violations, longer stays in the VC program, end of VC participation because of incarceration for a new arrest or case transfer by the legal system, and requiring mental health follow-up but not undergoing treatment. The following variables were associated with lower rates of incarceration: stable housing and participating in a VC program that referred veterans for substance abuse treatment. CONCLUSIONS: This study offers VCs a thorough review of an extensive set of recidivism data. Further investigation is necessary to understand the impact of VCs.

US Veterans' Court Programs: An Inventory and Analysis of National Survey Data.

This study used data from a phone survey inventory of US veterans' courts to provide descriptive information on the current status of their various elements. To identify which items were most predictive of a court's percentage of subjects terminated from their program, a linear regression was performed. The following were associated with higher rates of termination from the veterans' court (VC) program: (a) programs that offered phase progression based on measurable goals, (b) programs that conduct frequent drug and alcohol testing, and (c) programs for which sanctions are more severe for failing immediate goals (sobriety) versus long-term ones (completion of training). The following were associated with lower rates of termination from the VC program: (a) programs in which later phases permit less stringent testing, (b) programs utilizing behavioral contracts, (c) programs utilizing brief incarcerations. This inventory provides nationwide empirical data that may be used in the development of veterans' courts.

Ethical Issues in Emergency Psychiatry.

The care of patients with a psychiatric emergency is fraught with ethical challenges. Applying ethical reasoning to clinical challenges may help to improve care. Emergency providers should assess decision-making capacity using 4 criteria: communication, understanding, appreciation, and reasoning. Maintaining patient confidentiality is a strong imperative for emergency physicians and should be protected unless compelling additional concerns take precedence. The goal of involuntary treatment should be to protect patients from harm that they would not be exposed to were they capable of autonomous decision making, not dangerous, or not impaired by their psychiatric illness using the least restrictive means possible.

An Analysis of Sanctions and Respective Psychiatric Diagnoses in Veterans' Court.

This descriptive analysis is an examination of the extent to which a veteran's mental health diagnosis or the initial criminal charge committed before program enrollment relate to a greater propensity for sanctions, harsher sanctions, higher rates of relapse on substances, or overall program compliance. This is a retrospective descriptive analysis that focuses on those participants in the Harris County (Texas) Veterans' Court Program from June 2010 through April 2012 for whom the court had issued sanctions. The most clinically relevant association (p = .014) was found between veterans with substance use relapse and subsequent discharge from the program. Furthermore, the following four infractions were associated with a subsequent jail sanction: unexcused absence (p = .014), failure to complete a task (p = .010), substance use relapse (p = .001), and missing a hearing (p = .012). Given these findings, veterans with relapses in substance use during the course of the program are at greatest risk of noncompletion of the program and may represent a subpopulation of veterans who require greater or different types of assistance.

An analysis of successful outcomes and associated contributing factors in veterans' court.

This study aims to examine the extent to which a veteran's propensity for arrest following separation from veterans' court is associated with that veteran's length of stay within the program, type of discharge, or number of judicial sanctions issued. This is a retrospective chart review that focuses on the first 100 participants in the Harris County Veterans' Court Program. After controlling for a number of demographic factors, both arrests during enrollment in the veterans' court program (p = .031) and Factor Score 1 (unsuccessful discharge, fewer months in the veterans' court program, and more months of follow up) (p = .042) were predictive of arrest following separation from the veterans' court program. In addition, a prior diagnosis of opiate misuse was also predictive of arrest following separation (p < .001). Given these findings, veterans' court judges and program administrators might examine ways of continuing enrollment for veterans at highest risk for recidivism.