Collaboration Between Child and Adolescent Psychiatrists and Mental Health Pharmacists to Improve Treatment Outcomes.

Access to mental health care is a long-standing challenge. The high, rising prevalence of mental health disorders and a shortage of mental health professionals has further strained an already fragile system. The clinical pharmacy is underutilized within the mental health space. Interdisciplinary collaboration between child psychiatrists and mental health pharmacists gives the psychiatrist more time for patient evaluation and treatment, while the psychiatric pharmacist provides drug monitoring, medication coordination, and education for providers. This collaborative approach improves outcomes, prevents adverse drug events, reduces hospital stays, lessens emergency department visits, and improves engagement and adherence.

Psychological and physical impact of anabolic-androgenic steroid dependence.

STUDY OBJECTIVE: To contrast the characteristics of two groups of anabolic-androgenic steroid (AAS) users-those with versus those without AAS dependence. DESIGN: Subanalysis of data from the Anabolic 500, a cross-sectional survey. PARTICIPANTS: One hundred twelve male AAS-dependent users and 367 AAS-nondependent users who completed an online survey between February 19 and June 30, 2009. MEASUREMENTS AND MAIN RESULTS: Respondents were recruited from the Internet discussion boards of 38 fitness, bodybuilding, weightlifting, and steroid Web sites. The respondents provided online informed consent and completed the Anabolic 500, a 99-item Web-based survey. Self-reported data included demographics, exercise patterns, use of AAS and other performance-enhancing agents, adverse effects of AAS use, behavior consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for AAS dependence, history of illicit drug and alcohol use, history of sexual or physical abuse, and psychiatric conditions diagnosed according to the DSM-IV-TR. Behavior consistent with AAS dependence was identified in 23.4% of the survey participants. These AAS-dependent users were more excessive in their AAS use (e.g., higher doses, higher quantity of agents, longer duration of use), more likely to report a history of illicit heroin use in the last 12 months (5.4% vs 1.9%, p=0.049), and more likely to report a diagnosis of an anxiety disorder (16.1 vs 8.4%, p=0.020) or major depressive disorder (15.2% vs 7.4%, p=0.012) than AAS-nondependent users. CONCLUSION: Data from the Anabolic 500 survey showed that almost one quarter of AAS users were dependent on these drugs. These AAS-dependent users had a higher rate of heroin use as well as anxiety and major depressive disorders compared with AAS-nondependent users. These findings can help clinicians and researchers better understand and address the potential illicit drug use and psychiatric comorbidities that may be present among AAS-dependent users.

Diffusion tensor imaging reveals regional differences in the cervical spinal cord in amyotrophic lateral sclerosis.

Therapeutic development in amyotrophic lateral sclerosis (ALS) is hampered by the lack of suitable biomarkers that might be sensitive to spatial and temporal patterns of neurodegeneration. Diffusion tensor imaging is a useful non-invasive tool that permits detection of microstructural tissue changes due, for example, to neurodegeneration. Even though the spinal cord bears the brunt of the disease process, diffusion tensor imaging has mainly been used to study white matter changes in the brain. The aim of this study was to examine the diffusion tensor imaging parameters of the cervical spinal cord (C1 through C6 segments) and brainstem (corticospinal tracts in the pyramids and pons) among ALS patients, to compare these to findings in age-matched healthy controls, and to correlate these differences with clinical measures of disease severity. Fractional anisotropy in the white matter of the cervical cord was 12% lower (p<0.01) in ALS patients (n=14) compared to age-matched healthy control subjects (n=15), and showed significant positive correlation with the average finger and foot tapping speed (r=0.61, p<0.05) in ALS patients. Radial diffusivity in the cervical cord was 15% higher (p<0.05) in ALS patients compared to healthy control subjects. Radial diffusivity in the white matter of the cervical cord was significantly correlated with clinical measures of disease severity such as forced vital capacity (FVC % predicted, r=-0.69, p<0.01), average finger and foot tapping speed from all four limbs (r=-0.59, p<0.05), and ALSFRS-R (r=-0.55, p<0.05) in ALS patients. There were no significant differences in mean diffusivity or axial diffusivity in the cervical spinal cord, or in any diffusion tensor imaging parameters measured in the brainstem. Analysis of diffusion tensor imaging parameters from individual cervical segments as well as profile plots along the length of the cervical cord showed larger differences in fractional anisotropy and radial diffusivity at more distal cervical segments, providing evidence that supports the "dying-back" hypothesis of neurodegeneration in ALS.