Health-related conditions and depression in elderly mexican american and non-Hispanic white residents of a United States-Mexico border county: moderating effects of educational attainment.

We investigated the prevalence of "high" levels of depressive symptomatology and 13 health-related medical conditions in elderly Mexican American (MA) and non-Hispanic white (NHW) residents of El Paso County, Texas. We analyzed the extent to which depressive symptoms in this population are associated with these conditions. Elderly MA residents possessed a higher prevalence of current depression, a relatively unique health-related condition profile, and were more likely to experience a set of conditions that impede participation in daily life-conditions that we found to be strongly associated with high depressive symptomatology in the elderly. After adjusting for educational attainment, using multiple regression analyses, depression was not associated with ethnicity and only six of the health related conditions showed significant differences between MA and NHW subjects. We believe these results provide an important insight into the mechanism of health-related conditions and depressive symptomatology in a large sample of elderly MAs; and how conditions typically attributed to MA ethnicity may in actuality be an artifact of socioeconomic status variables such as educational-attainment.

The health care matrix formulation: a tool for competency assessment in psychiatry residency training.

OBJECTIVE: To assert the importance of the use of the healthcare matrix formulation for competency assessment in psychiatry residency training. METHODS: We present a case from our inpatient psychiatric facility and format it in the form of the healthcare matrix, which was developed at Vanderbilt University incorporating the Institute of Medicine 'aims' and the Accreditation Council for Graduate Medical Education 'core competencies'. We also analyze the healthcare matrix and elucidate its use in clinical practice. RESULTS: The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care, like the one in our psychiatric setting, and allows us to learn from the shortcomings in order to improve. CONCLUSION: The optimal utilization of this tool in the competency assessment of psychiatry residents has an enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format.

Disability from "soft" neuropsychiatric sequelae due to frontal lobe injury.

Each year about 1.5 million people suffer from a traumatic brain injury. Many of these are seen in primary care settings and most recover completely. Traumatic brain injury can show many signs and symptoms, some of which are readily identified and treated. Often the neurobehavioral sequelae appear months to years later and can cause long-term disability and impairment in neurobehavioral functioning. The rehabilitation of these patients is a long and difficult process requiring early identification and proper management. This article reviews the importance of recognizing the neurobehavioral consequences of frontal lobe injury.

Risperidone-induced polydipsia and polyphagia associated with galactorrhea, abdominal pain, and rapid weight gain in an adolescent Hispanic female.

A 15-year-old Hispanic female was started on risperidone for new-onset psychosis. The patient responded well to the gradual dose increase but developed rapid weight gain secondary to polydipsia and polyphagia. She also began complaining of nipple discharge and griping abdominal pain on the left lower quadrant by the third week of treatment. Her prolactin level escalated to three times normal with a weight gain of 12 pounds in 16 days. Risperidone was switched to another antipsychotic. Her prolactin level then dropped to a normal level within 7 days and she lost 7 pounds in the next 2 weeks. Her abdominal pain, galactorrhea, polydipsia, and polyphagia subsided within the first few days of the cessation of risperdione.

Mexican-American ethnicity and cognitive function: findings from an elderly southwestern sample.

Relatively little is known about late-life patterns of cognitive function among Hispanics of Mexican heritage who reside in the United States. The authors designed a study to assess the association between Mexican-American ethnicity (defined in terms of childhood and adolescent developmental history) and cognitive function among elderly Mexican-American and non-Hispanic white residents of El Paso County, Texas. Our findings indicate significant associations between the degree of Mexican-American ethnicity and cognitive impairment on all three measures of cognitive function. These statistically significant findings remain after effects of education, age, and gender have been removed from the multiple regression equation. The authors conclude that a dependable and clinically meaningful negative association exists between Mexican-American ethnicity and late-life cognitive function in this region that is mediated by as yet unmeasured variables.

Risk factors and prevention in adolescent substance abuse: a biopsychosocial approach.

This article provides an overview of existing evidence regarding risk and prevention factors in adolescent substance abuse from a biopsychosocial viewpoint. It is believed that this approach offers a practical model for the integration of inherently complex factors into the clinical setting. These factors cannot be isolated from the influences of the greater society, such as the school system or homelessness. Prevention and treatment issues must approach the impaired adolescent with a multifactorial and comprehensive plan that integrates multidisciplinary involvement.

Assessing residents' competence in psychotherapy.

OBJECTIVE: This article describes the development of a method for assessing resident competence in the five forms of psychotherapy specified in the program requirements for residency training in psychiatry. METHOD: Concomitant with the rise of evidence-based medicine. There has been a movement toward evidence-based training from the Accreditation Council for Graduate Medical Education (ACGME). In the year 2000, the Residency Review Committee (RRC) for psychiatry issued specific requirements for the assessment of residency competence in five forms of psychotherapy. This article describes how a system of assessment was developed using "brainstorming" and the Delphi method to meet these requirements and gives examples of the assessment tools that were utilized. CONCLUSION: A simple system that does not overly tax limited faculty resources can be developed to meet the new RRC requirements.