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1.
Pediatr Dermatol ; 2024 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-38500340

RESUMO

BACKGROUND: Isotretinoin treatment for acne can reduce adverse psychiatric outcomes in adults, but there has been little investigation of the incidence of psychiatric outcomes in treated adolescents. METHODS: This retrospective cohort study using the Rochester Epidemiology Project identified 606 patients aged 12-18 prescribed isotretinoin over a 10-year period between January 1, 2008 and December 31, 2017. Medical records were reviewed to identify psychiatric diagnoses before and during isotretinoin therapy, as well as psychiatric symptoms not captured by formal diagnoses and changes to isotretinoin dosing because of psychiatric diagnoses or symptoms. RESULTS: One hundred seventy-seven (29.2%) had a psychiatric diagnosis prior to isotretinoin initiation, but 98 (16.2%) had a new psychiatric diagnosis or psychiatric symptom while taking isotretinoin. Patients with a psychiatric history were no more likely than those without to receive a new psychiatric diagnosis during treatment (4.5% vs. 3.7%; p = .650), but did experience more psychiatric symptoms, primarily low mood and mood swings (23.7% vs. 7.7%; p < .001). Only 25.5% of the 98 with a new psychiatric diagnosis or psychiatric symptom had a subsequent dose change. A dose change was more likely if patients received a new psychiatric diagnosis (41.7% vs. 20.3%; p = .037) or patients did not have a psychosocial explanation for psychiatric symptoms (34.4% vs. 10.8%; p = .009). CONCLUSIONS: A substantial proportion of adolescent patients prescribed isotretinoin had a prior psychiatric diagnosis. This predicts more psychiatric symptoms during isotretinoin treatment. Adolescents with a psychiatric history who have worsening symptoms and those with new-onset psychiatric symptoms would benefit from close monitoring while taking isotretinoin.

2.
Int J Bipolar Disord ; 11(1): 38, 2023 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-38063942

RESUMO

BACKGROUND: Factors associated with suicide attempts during the antecedent illness trajectory of bipolar disorder (BD) and schizophrenia (SZ) are poorly understood. METHODS: Utilizing the Rochester Epidemiology Project, individuals born after 1985 in Olmsted County, MN, presented with first episode mania (FEM) or psychosis (FEP), subsequently diagnosed with BD or SZ were identified. Patient demographics, suicidal ideation with plan, self-harm, suicide attempts, psychiatric hospitalizations, substance use, and childhood adversities were quantified using the electronic health record. Analyses pooled BD and SZ groups with a transdiagnostic approach given the two diseases were not yet differentiated. Factors associated with suicide attempts were examined using bivariate methods and multivariable logistic regression modeling. RESULTS: A total of 205 individuals with FEM or FEP (BD = 74, SZ = 131) were included. Suicide attempts were identified in 39 (19%) patients. Those with suicide attempts during antecedent illness trajectory were more likely to be female, victims of domestic violence or bullying behavior, and have higher rates of psychiatric hospitalizations, suicidal ideation with plan and/or self-harm, as well as alcohol, drug, and nicotine use before FEM/FEP onset. Based on multivariable logistic regression, three factors remained independently associated with suicidal attempts: psychiatric hospitalization (OR = 5.84, 95% CI 2.09-16.33, p < 0.001), self-harm (OR = 3.46, 95% CI 1.29-9.30, p = 0.014), and nicotine use (OR = 3.02, 95% CI 1.17-7.76, p = 0.022). CONCLUSION: Suicidal attempts were prevalent during the antecedents of BD and SZ and were associated with several risk factors before FEM/FEP. Their clinical recognition could contribute to improve early prediction and prevention of suicide during the antecedent illness trajectory of BD and SZ.

3.
Front Psychiatry ; 14: 1241071, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37732076

RESUMO

Background: There is evidence suggesting racial disparities in diagnosis and treatment in bipolar disorder (BD) and schizophrenia (SZ). The purpose of this study is to compare psychiatric diagnoses and psychotropic use preceding a first episode of mania (FEM) or psychosis (FEP) in racially diverse patients. Methods: Using a comprehensive medical records linkage system (Rochester Epidemiology Project, REP), we retrospectively identified individuals diagnosed with BD or SZ and a documented first episode of mania or psychosis. Illness trajectory before FEP/FEM were characterized as the time from first visit for a mental health complaint to incident case. Pathways to care and clinical events preceding FEP/FEM were compared based on subsequent incident case diagnosis (BD or SZ) and self-reported race (White vs. non-White). Results: A total of 205 (FEM = 74; FEP = 131) incident cases were identified in the REP. Duration of psychiatric antecedents was significantly shorter in non-White patients, compared to White patients (2.2 ± 4.3 vs. 7.4 ± 6.6 years; p < 0.001) with an older age at time of first visit for a mental health complaint (15.7 ± 6.3 vs. 11.1 ± 6.0 years; p = 0.005). There were no significant differences by race in FEM pathway to care or age of first seeking mental health. Overall non-White patients had lower rates of psychotropic use. Conclusion: These data are unable to ascertain reasons for shorter duration of psychiatric antecedents and later age of seeking care, and more broadly first age of initial symptom presentation. If symptoms are confirmed to be earlier than first time seeking care in both groups, it would be important to identify barriers that racial minorities face to access timely psychiatric care and optimize early intervention strategies.

4.
J Affect Disord ; 340: 25-32, 2023 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-37506772

RESUMO

OBJECTIVE: We aim to compare the psychiatric antecedents of schizophrenia (SZ) and bipolar disorder (BD). METHODS: Using the Rochester Epidemiology Project, we searched for residents of Olmsted County that had a diagnosis of SZ or BD. We confirmed each case using DSM-5 criteria and obtained the psychiatric antecedents. RESULTS: We identified 205 cases with first episode psychosis or mania (SZ = 131; BD = 74). The mean age at first visit for mental health reasons was 12.3 ± 6.3 years for SZ and 13.9 ± 5.6 years for BD. The duration of the initial prodrome (time from first mental health visit to first episode) was similar for both groups (SZ 8.3 ± 6.2 years vs BD 7.3 ± 5.9 years). We found that SZ and BD have overlapping antecedents, but SZ was more common in males and in foreign born and had more learning deficits before the first episode. BD was more common in white population and had higher rates of depressive and adjustment disorders prior to first episode. BD also had more affective symptoms, nightmares, and panic attacks before the first episode. Both groups had similarly high rates of substance use (SZ 74 % vs BD 74.3 %), prescription of antidepressants (SZ 46.6 % vs BD 55.4 %) and stimulants (SZ 30.5 % vs BD 22.9 %). CONCLUSIONS: The psychiatric antecedents of SZ and BD usually start during adolescence, overlap, and present in unspecific ways. The initial prodromes are more alike than distinct. Further studies are encouraged to continue looking for specific factors that distinguish the antecedents of these two disorders.


Assuntos
Transtorno Bipolar , Transtornos Psicóticos , Esquizofrenia , Masculino , Adolescente , Humanos , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/psicologia , Mania , Estudos Retrospectivos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia
5.
Artigo em Inglês | MEDLINE | ID: mdl-37162659

RESUMO

Transgender youth experience high rates of suicidal ideation and suicide attempts. This systematic review sought to examine interventions for suicide prevention in transgender children and adolescents. Literature related to suicide in the transgender population was systematically collected in accordance with PRISMA criteria. Searches identified studies with at least one suicide prevention method for participants ages 24 years or younger with gender identity and sex clearly defined. Primary outcomes include suicide-related thoughts and behaviors. A total of 1558 citations were identified with 17 articles meeting inclusion criteria. Interventions with potential effectiveness included a gender-affirming crisis hotline, medical care via interdisciplinary gender clinics, online media-based outreach, safety and connectedness in schools, and family system-based interventions. In the included studies, the overall quality of evidence was low and the risk of bias high. Further high-quality studies are needed.

6.
Exp Clin Psychopharmacol ; 31(2): 300-304, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36048112

RESUMO

Hallucinogen persisting perception disorder (HPPD) is characterized by visual disturbances that resemble psychedelic intoxication and linger after use has ceased. The most common substances precipitating HPPD, lysergic acid diethylamide (LSD) and psilocybin, are posited to do so via damage to serotonergic neurons involved in vision. Mr. N is a 37-year-old with a history of alcohol, cannabis, LSD, cocaine, and nicotine use disorders who described visual distortions that resolved when he drank heavily or received benzodiazepines for withdrawal. He did not appear psychotic. Over 20 years after his last LSD use, he continued to experience illusions of halos around objects, moving walls, and figures appearing cartoonish. He understood that his perceptual disturbances were not reality based. During hospitalization for suicidal ideation, laboratory tests, head computed tomography (CT), and electroencephalogram (EEG) studies offered no explanation for his visual disturbances other than HPPD. The visual distortions remitted with scheduled clonazepam treatment, although chemical dependency treatment programs were hesitant to accept him while on a benzodiazepine. This case emphasizes the importance of diagnostic clarification when patients present with perceptual disturbances that do not fit typical psychotic presentations. Our discussion will distinguish misperceptions from hallucinations and review the pathophysiology of HPPD. Last, we will discuss management strategies for patients with co-occurring HPPD and substance use disorders. It is necessary to discern the correct cause of visual disturbances in order to provide proper treatment. The risks and benefits of long-term benzodiazepine use must be weighed when deciding whether to prescribe them for patients with comorbid HPPD and alcohol use disorder. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Assuntos
Alcoolismo , Alucinógenos , Transtornos da Percepção , Humanos , Masculino , Adulto , Alucinógenos/efeitos adversos , Benzodiazepinas/uso terapêutico , Dietilamida do Ácido Lisérgico/efeitos adversos , Transtornos da Percepção/induzido quimicamente , Transtornos da Percepção/diagnóstico , Percepção
11.
J Occup Environ Med ; 64(3): e136-e144, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-34935679

RESUMO

OBJECTIVE: Aggression from patients and families on health care providers (HCP) is common yet understudied. We measured its prevalence and impact on HCPs in inpatient and outpatient settings. METHODS: Four thousand six hundred seven HCPs employed by a community teaching hospital received an anonymous survey with results analyzed. RESULTS: Of 1609 HCPs (35%) completing the survey, 88% of inpatient staff reported experiencing different types of aggression compared to 82% in outpatient setting. Almost half did not report it to their supervisor. Younger staff were more likely to report abuse. Negative impacts on productivity and patient care were reported. A third of all responders' indicated negative effects on mental health. CONCLUSIONS: Despite negative impacts on staff wellbeing and productivity, patient/family aggression toward HCPs is highly prevalent and underreported. Our healthcare system needs measures to address staff security and wellness.


Assuntos
Agressão , Pessoal de Saúde , Atitude do Pessoal de Saúde , Pessoal de Saúde/educação , Humanos , Prevalência , Inquéritos e Questionários
12.
Mayo Clin Proc ; 96(10): 2514-2516, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34531064
13.
J Am Coll Surg ; 233(2): 321-327, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33991651

RESUMO

In response to the challenges faced as diverse students when first encountering the intricacies of scrubbing into the operating room (OR), we have prepared a rudimentary surgical skills guide to supplement the knowledge of students and educators alike. In keeping with the need to adapt standard protocols to accommodate religious and cultural practices, this guide focuses on hijab, natural hair, dastar, protective styles, and beard protocol in the OR. It addresses some of the personal protective equipment needs of Muslims, Orthodox Jews, Sikhs, and groups maintaining beards as a part of cultural or religious practices. We intend this guide to serve as a foundation on which the medical field can update its educational practices in line with the increased diversity of the medical professions, while also continuing to ensure the safety of OR and ICU patients. This guide also highlights COVID-19-specific changes in personal protective equipment and seeks to open up a conversation about the necessity of currently held surgical practices.


Assuntos
COVID-19 , Salas Cirúrgicas , Desinfecção das Mãos , Humanos , Unidades de Terapia Intensiva , SARS-CoV-2
14.
Psychiatr Serv ; 72(7): 758-765, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33887959

RESUMO

OBJECTIVE: Acetaminophen is a common cause of intentional and inadvertent overdoses among children and adolescents worldwide. Little is known about characteristics and clinical outcomes of these youths. The primary goal of this naturalistic study was to describe the psychiatric characteristics, medical management, outcomes, and dispositions of children and adolescents evaluated for excessive acetaminophen exposure. METHODS: The Rochester Epidemiology Project database was searched for all patients ages 0-18 treated for excessive acetaminophen exposure in Olmsted County, Minnesota, during a 7-year period (2004-2010). Demographic factors, overdose intentionality, medical and psychiatric treatment, mental health and addiction history, and disposition from the emergency department (ED) were documented. RESULTS: Of 110 cases of acetaminophen overdose (89 female patients and 21 male patients), 97 (88%) were intentional and 13 (12%) were unintentional. Fifteen patients (14%) were discharged from the ED, and 69 (63%) required admission to a medical unit. Sixty-four (59%) received N-acetylcysteine. Ninety-eight (89%) were evaluated by psychiatry, and 80 (73%) were admitted for psychiatric hospitalization. Most had at least one psychiatric diagnosis, most commonly depression (55%); 22 (20%) had a prior suicide attempt. Substance use was common, notably alcohol dependence (N=16, 15%), alcohol abuse (N=18, 16%), and cannabis abuse (N=18, 16%). All survived and recovered without liver transplant. CONCLUSIONS: Among pediatric patients with acetaminophen overdoses, psychiatric comorbidities and substance use were common. Most received both inpatient medical and psychiatric treatment. Interventions that restrict acetaminophen access are needed for this population, as are suicide risk reduction interventions for delivery in emergency settings.


Assuntos
Acetaminofen , Overdose de Drogas , Adolescente , Criança , Pré-Escolar , Overdose de Drogas/epidemiologia , Overdose de Drogas/terapia , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Masculino , Minnesota/epidemiologia , Estudos Retrospectivos , Tentativa de Suicídio
16.
Acad Med ; 95(12): 1791, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33234824
17.
Mayo Clin Proc ; 95(8): 1766-1774, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32753149

RESUMO

Primary care physicians (PCPs) are often asked to perform disability evaluations for patients with psychiatric disorders, which are now a leading cause of disability worldwide. After acknowledging the limitations of disability assessments for all conditions, this review aims to provide PCPs with practical knowledge to inform their assessments and interventions with a focus on patients with depression. After the disability definitions and programs in the United States are reviewed, a pragmatic approach to assessing function and discussing return to work is offered. Individualized assessment is key, and functional recovery rather than symptom relief should be prioritized. Finally, evidence-based interventions for enhancing the likelihood of return to work are considered. We believe the principles of functional assessment and recovery lend themselves to ready adaptation for use in other psychiatric conditions and chronic somatic syndromes, including chronic pain. The key principles of this approach are as follows: 1) a patient is not categorically disabled, but has specific limitations in specific contexts; 2) graded, work-oriented rehabilitation with tailored problem-solving strategies are essential; 3) involving a multidisciplinary team in coordinated care optimizes functional recovery; 4) return to work is an iterative process aimed at restoring meaningful function in a stepwise fashion; and 5) the relationship between symptoms and function is bidirectional. PCPs can use these principles to plan optimal recovery paths for psychiatrically ill patients presenting with a wide array of biopsychosocial realities.


Assuntos
Avaliação da Deficiência , Transtornos Mentais/diagnóstico , Depressão/diagnóstico , Depressão/terapia , Humanos , Transtornos Mentais/terapia , Recuperação de Função Fisiológica
18.
Acad Med ; 95(3): 357-360, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31567156

RESUMO

Diversity initiatives in U.S. medical education, following the passage of the Civil Rights Act of 1964, were geared toward increasing the representation of African Americans-blacks born in the United States whose ancestors suffered under slavery and Jim Crow laws. Over time, blacks and, subsequently, underrepresented minorities in medicine (URMs), became a proxy for African Americans, Puerto Ricans, Mexican Americans, and Native Americans, thus obscuring efforts to identify and recruit specifically African Americans. Moreover, demographic shifts resulting from the recent immigration of black people from Africa and the Caribbean have both expanded the definition of "African American medical students" and shifted the emphasis from those with a history of suffering under U.S. oppression and poverty to anyone who meets a black phenotype.Increasingly, research indicates that African American patients fare better when their physicians share similar historical and social experiences. While all people of color risk discrimination based on their skin color, not all have the lived experience of U.S.-based, systematic, multigenerational discrimination shared by African Americans. In the high-stakes effort to increase URM representation in medical school classes, admissions committees may fail to look beyond the surface of phenotype, thus missing the original intent of diversity initiatives while simultaneously conflating all people of color, disregarding their divergent historical and social experiences. In this Perspective, the authors contend that medical school admissions committees must show greater discernment in their holistic reviews of black applicants if historical wrongs and continued underrepresentation of African Americans in medicine are to be redressed.


Assuntos
Diversidade Cultural , Educação Médica/organização & administração , Grupos Minoritários/estatística & dados numéricos , Objetivos Organizacionais , Critérios de Admissão Escolar , Faculdades de Medicina/organização & administração , Estudantes de Medicina/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Estados Unidos , Adulto Jovem
19.
J Am Acad Child Adolesc Psychiatry ; 58(9): 919-920, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31445620

RESUMO

Dr. Brent's Master Clinician Review: Saving Holden Caulfield: Suicide Prevention in Children and Adolescents is a timely synthesis of evidence-based approaches to suicide reduction, including prevention strategies and programs, increased access to mental health care, changes in systems of care delivery, and means restriction.1 Although this review appears in what is predominantly a journal for clinicians working in their offices or on hospital units, it is notable that most of the approaches he describes operate at primary or secondary prevention levels. That is, they use population-level strategies to prevent the development of suicide risk (primary prevention), or devise programs to detect and treat individuals before they become dangerously symptomatic (secondary prevention).


Assuntos
Suicídio , Adolescente , Criança , Humanos , Masculino , Prevenção Primária , Prevenção Secundária
20.
Mayo Clin Proc ; 94(10): 1983-1993, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31427140

RESUMO

OBJECTIVE: To compare health care usage between suicide decedents and living controls in the year before suicide in a large representative US population. PATIENTS AND METHODS: Cases (n=1221) and controls (n=3663) belonged to an integrated health care system from January 1, 2009, through December 31, 2014. Cases and controls were matched for age and sex in a 1:3 ratio, with diagnostic and/or billing codes used to enumerate and classify health care visits in the year before the index suicide. Matched analysis via conditional logistic regression related odds of suicide to visit type. A generalized estimating equation model was used to compare timing and frequency of visits between cases and controls. RESULTS: In the year before death, cases had an increased odds of both inpatient hospitalizations and emergency department nonmental health visits (odds ratio [OR], 1.55; 95% CI, 1.27-1.88; P<.001 and OR, 1.42; 95% CI, 1.26-1.60; P<.001) but not outpatient nonmental health visits (OR, 1.00; 95% CI, 0.99-1.01; P=.63). Decedents increased health care utilization closer to suicide death and had significantly more health care visits than did controls 3 months before suicide (6 vs 2; P=.01) but not 9 to 12 months before suicide (4 vs 2; P=.07). At all time points, cases used more mental health care services than did controls. CONCLUSION: Compared with controls, suicide decedents had emergency department visits and more inpatient hospitalizations, both mental health and nonmental health related. As death approached, cases' frequency of health care usage increased. The only category in which cases and controls did not differ was in the frequency of outpatient nonmental health visits.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
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