Withdrawal catastrophizing scale: initial psychometric properties and implications for the study of opioid use disorder and hyperkatifeia.

Background: Discovery of modifiable factors influencing subjective withdrawal experience might advance opioid use disorder (OUD) research and precision treatment. This study explores one factor - withdrawal catastrophizing - a negative cognitive and emotional orientation toward withdrawal characterized by excessive fear, worry or inability to divert attention from withdrawal symptoms.Objectives: We define a novel concept - withdrawal catastrophizing - and present an initial evaluation of the Withdrawal Catastrophizing Scale (WCS).Methods: Prospective observational study (n = 122, 48.7% women). Factor structure (exploratory factor analysis) and internal consistency (Cronbach's α) were assessed. Predictive validity was tested via correlation between WCS and next-day subjective opiate withdrawal scale (SOWS) severity. The clinical salience of WCS was evaluated by correlation between WCS and withdrawal-motivated behaviors including risk taking, OUD maintenance, OUD treatment delay, history of leaving the hospital against medical advice and buprenorphine-precipitated withdrawal.Results: WCS was found to have a two-factor structure (distortion and despair), strong internal consistency (α = .901), and predictive validity - Greater withdrawal catastrophizing was associated with next-day SOWS (rs (99) = 0.237, p = .017). Withdrawal catastrophizing was also correlated with risk-taking behavior to relieve withdrawal (rs (119) = 0.357, p < .001); withdrawal-motivated OUD treatment avoidance (rs (119) = 0.421, p < .001), history of leaving the hospital against medical advice (rs (119) = 0.373, p < .001) and buprenorphine-precipitated withdrawal (rs (119) = 0.369, p < .001).Conclusion: This study provides first evidence of withdrawal catastrophizing as a clinically important phenomenon with implications for the future study and treatment of OUD.

Central sensitization in alcohol use disorder: correlates of pain, addiction and health-related quality of life.

BACKGROUND: Central sensitization is an important mechanism underlying many chronic pain conditions. Chronic pain and alcohol use disorder (AUD) are highly comorbid. Despite great scientific interest in brain mechanisms linking chronic pain and AUD, progress has been impeded by difficulty assessing central sensitization in AUD. OBJECTIVE: The present study is the first to employ a validated surrogate measure to describe central sensitization in a clinical sample with AUD. METHODS: Participants with AUD (n = 99) were recruited from an academic addiction treatment center. A well-established surrogate measure of central sensitization, The American College of Rheumatology Fibromyalgia Survey Criteria (ACRFMS) was administered. Participants also responded to questions about quality of life (RAND-36), and AUD. Descriptive analyses and Spearman's rho correlations were performed. RESULTS: Chronic pain and evidence of central sensitization were prevalent. Greater central sensitization was associated with worse health-related quality of life. Participants higher in central sensitization expressed greater endorsement of pain as a reason for AUD onset, maintenance, escalation, treatment delay, and relapse. CONCLUSION: The present study bolsters prior assertions that AUD and chronic pain might compound one another via progressive sensitization of shared brain circuitry. These results may inform future mechanistic research and precision AUD treatment.

Perceptions of Residents and Their Training Directors Regarding Wellness Education, Program Support, and Access to Depression Treatment: the DEPRESS-Ohio Study.

OBJECTIVE: This study determines the extent to which residents and their program directors have discordant perceptions regarding wellness, support, and treatment opportunities for trainees. In addition, the authors examined whether psychiatry residents differed in their perceptions compared with residents in other specialties. METHODS: Residents and their program directors from each of 10 specialties were electronically surveyed after IRB approval and giving informed consent. RESULTS: Of 42 program directors responding, over 92% indicated they provided wellness education and programming; however, a significantly lower percentage of 822 trainees were aware of this (81.2% and 74.9%, respectively). A similar disparity existed between program directors (PDs) who knew where to refer depressed residents for help (92.9%) and residents who knew where to seek help (71%). Moreover, 83.3% of program directors believed they could comfortably discuss depression with a depressed resident, but a lower percentage of their trainees (69.1%) felt their training directors would be supportive. A significantly greater percentage of program directors (40.5%) believed seeking treatment for depression might compromise medical licensure than did residents (13.0%). Psychiatry residents were significantly more aware of wellness, support, and access than were residents from other specialties. CONCLUSIONS: The availability of wellness education, programming, program director accessibility, and knowing where to ask for help if depressed does not seem to be adequately communicated to many residents. Moreover, program directors disproportionately see depression treatment as a risk to medical licensure compared with their residents. Psychiatry residents seem to be more aware of program director support and access to care than their colleagues.

Projected Workforce of Psychiatrists in the United States: A Population Analysis.

OBJECTIVE: This analysis quantified and assessed the projected workforce of psychiatrists in the United States through 2050 on the basis of population data. METHODS: With use of data from the Association of American Medical Colleges (2000-2015), American Board of Psychiatry and Neurology (2000-2015), and U.S. Census Bureau (2000-2050), the psychiatrist workforce was projected through 2050. Two established psychiatrist-to-population ratios were used to determine the estimated demand for psychiatrists and potential shortages. RESULTS: The psychiatrist workforce will contract through 2024 to a projected low of 38,821, which is equal to a shortage of between 14,280 and 31,091 psychiatrists, depending on the psychiatrist-to-population ratio used. A slow expansion will begin in 2025. By 2050, the workforce of psychiatrists will range from a shortage of 17,705 psychiatrists to a surplus of 3,428. CONCLUSIONS: Because of steady population growth and the retirement of more than half the current workforce, the psychiatrist workforce will continue to contract through 2024 if no interventions are implemented, leading to a significant shortage of psychiatrists. Despite an expected workforce expansion beginning in 2025, it is unclear whether the shortage will completely resolve by 2050. Future research should focus on developing strategies to address this quantified shortage in an effort to curb the worsening shortage through 2024 and over the coming decades.

Maintaining Personal Safety: Understanding and Addressing Aggression and Violence in the Health Care Setting.

Introduction: A 2-hour introductory lecture-discussion curriculum was developed to provide medical students and residents with education about personal safety in the health care setting. The course focused on providing learners with proactive and practical advice for understanding, recognizing, and responding to difficult patients or others who may pose risks of violence. It was designed for participants to gain knowledge about initial management of often unfamiliar situations before untoward behaviors escalate to violence. Methods: Eight hundred thirty-eight medical students participated in this required element of the third-year psychiatry clerkship experience. Sixty first-year through fourth-year psychiatry residents participated as part of departmental orientation. Instructors provided the same seminar for both learner groups throughout the project's duration. In addition to a PowerPoint presentation, learners participated in discussion about personal safety threats in the health care setting. Evaluations were obtained, and more recent cohorts also completed a postcourse assessment of knowledge. Results: Results suggested that learners from both groups viewed the session favorably, indicating the personal safety curriculum was beneficial and practical and helped increase their knowledge about this important topic. The session received a high number of positive comments from learners, reinforcing its valuable take-home message. Discussion: Given the growing magnitude and understanding of risk of aggression and violence in health care settings, we incorporated a required personal safety session into our psychiatry residency and medical school curricula. The session's emphasis was on preventative and proactive strategies to employ with patients before and during escalation of potentially violent situations.

Understanding Patient Experience: A Course for Residents.

INTRODUCTION: A 4-hour curriculum was developed to provide residents with information about the concepts of patient satisfaction and experience. The course focuses on the competencies of professionalism and interpersonal and communication skills. It is designed to allow participants to reflect on current knowledge of the patient experience and service principles and to develop a greater appreciation of these concepts' utility and importance to everyday work. METHODS: Thirty-two residents in 2015 and nine incoming residents in 2016 participated in weekly hour-long sessions over 4 weeks. The curriculum also included an optional fifth component, in which patient satisfaction data were provided to the residents. Residents participated in pre- and postcurriculum survey assessments regarding their awareness of concepts involving patient experience. RESULTS: Preliminary results suggested that residents found the curriculum beneficial and that it helped to increase their understanding of the relevance of patient satisfaction and experience education to their practice. Quarterly feedback from patient surveys was provided to residents, identifying strengths and opportunities for improvement. DISCUSSION: Given the growing importance and utilization of patient satisfaction surveys, residents participated in this educational intervention to determine if a novel curriculum and proactive approach to resident understanding and utilization of satisfaction data could result in increased patient satisfaction with resident interactions. The study is ongoing and longitudinal, with initial results encouraging.

Effect of curriculum change on exam performance in a 4-week psychiatry clerkship.

OBJECTIVE: The authors investigated whether curriculum change could produce improved performance, despite a reduction in clerkship length from 8 to 4 weeks. METHODS: The exam performance of medical students completing a 4-week clerkship in psychiatry was compared to national data from the National Board of Medical Examiners' Psychiatry Subject Examination and the United States Medical Licensure Examination Step 2 CK psychiatry and mental disorders subtests. RESULTS: Curriculum change and restructuring to a 4-week psychiatry clerkship resulted in above-average and sustained improvement on nationally standardized assessment measures. CONCLUSION: Examination performance can be optimized despite a 50% reduction in the duration of a psychiatry clerkship.

The junior medical student psychiatry clerkship: curriculum, attitudes, and test performance.

OBJECTIVE: The third-year clerkship provides fundamental psychiatric training experience for medical students at Ohio State University. The authors aimed to assess students' attitudes toward this clerkship, as well as its quality and its relationship to standardized measures of performance. METHODS: Pre- and post-surveys using Likert-type scales were conducted. RESULTS: The majority of students appeared to have favorable attitudes at the beginning of the clerkship, and students with initial neutral attitudes seemed to develop more favorable attitudes at the conclusion of the rotation. Students demonstrated definitive attitudes toward various curriculum components that were currently in place. CONCLUSION: These findings reaffirm that timing of the rotation is a critical factor in standardized test performance. Data from this baseline study were utilized to modify the existing clerkship experience. Further research is underway to determine its impact.