Use of a human skin-grafted nude mouse model for the evaluation of topical retinoic acid treatment.

Cultured human keratinocytes and artificial dermal equivalents maintained in vitro do not perfectly mimic the terminal differentiation patterns and response to drugs observed in intact human skin. We have made use of human skin grafted onto nude mice to demonstrate that such grafts maintain the pattern of pharmacologic responsiveness to all-trans retinoic acid previously reported in human subjects. The use of a quantitative polymerase chain reaction method to measure induction of a retinoic acid responsive gene, cytoplasmic retinoic acid binding protein II, has made it possible to generate objective data suitable for investigations of drug efficacy. This method of using grafted human skin has potential broad applicability for investigation of topical drugs in a number of therapeutic fields.

Self-cutting after rape.

The authors present three cases of women who began to cut themselves superficially after they had been raped. To the authors' knowledge, no such findings have been reported in the current literature on short- and long-term effects of rape.

Retrospective study of 2,200 involuntary psychiatric admissions and readmissions.

OBJECTIVE: The authors describe demographic data, the distribution of diagnoses, and comorbid psychoactive substance use in a large sample of patients involuntarily admitted to a psychiatric hospital from multiple crisis centers and explore the relative roles these variables may play in service utilization and admission rates. METHOD: Data on demographic characteristics and comorbid psychoactive substance use in 2,200 consecutive involuntary hospital admissions of 1,755 psychiatric patients were gathered. Pertinent demographic and comorbidity data at first admission for the 1,755 patients, 314 of whom were admitted more than once, were analyzed; then the data for the 1,441 single-admission patients and the data at first admission for the 314 patients who had multiple admissions were compared. Finally, the diagnostic distribution and comorbid psychoactive substance use in all 2,200 admissions were investigated, with attention to a subgroup of 88 high-risk patients (those with three or more admissions) who represented a total of 307 admissions. RESULTS: Specific demographic characteristics were represented in the patient group at a high level of statistical significance. The diagnosis of schizophrenia was significantly overrepresented. Schizophrenia and psychosis not elsewhere classified clustered in the subgroup with a high risk of readmission. CONCLUSIONS: The results suggest a specific profile for the patient with heightened risk of hospital admission: a young, unmarried, African American male who has schizophrenia without comorbid substance abuse. An effect size data analysis identified marital status and a diagnosis of schizophrenia as the variables associated with the greatest likelihood of admission. Unexpectedly, the impact of comorbid psychoactive substance use was relatively modest and showed a uniform distribution among diagnostic groups.

Gender differences among civilly committed schizophrenia subjects.

The authors describe a sample of 815 acutely ill schizophrenia patients hospitalized under a petition for involuntary inpatient treatment and illustrate how this group of patients can be considered as more representative of involuntary commitment status than more traditional "involuntary" patients drawn from State hospitals' wards. Available demographics of the general population from which the sample was drawn are also presented for comparison. The authors then report the gender distribution of several variables--age, marital status, psychoactive substance use, comorbidity, length of stay, and frequency of readmissions--among the study sample and discuss the relevance of these findings.

Reported prevalence of drug abuse comorbidity in a city-wide emergency rooms system.

Frequency and results of urine toxicology screens in a state-guided system of emergency rooms in a large city were compared with frequency and results of the same tests in the same population at a university-run intensive treatment psychiatric unit. Differences both in prevalence and in results were noted, with the emergency rooms testing significantly less patients than the intensive treatment unit and documenting a significantly lower rate of active substance abuse comorbidity to psychiatric disorders. Possible explanations for these differences are discussed, including clinical, attitudinal, and cost containment factors. These findings have a definite impact on treatment decision making, diagnostic precision, and validity of epidemiologic reports.

Comorbid substance abuse and recovery from acute psychiatric relapse.

OBJECTIVE: The study investigated whether chronic mentally ill patients whose psychiatric relapse was complicated by active substance abuse recovered from relapse at a different rate than similar patients with no comorbid substance abuse. METHODS: A total of 401 patients involuntarily hospitalized on a short-term psychiatric treatment unit received a urine toxicology screen on admission; the severity of their psychiatric symptoms was rated on the fifth day of hospitalization using the Brief Psychiatric Rating Scale (BPRS). Differences in scores between patients who had positive screens and those who had negative screens were evaluated for various diagnostic groups. RESULTS: Patients who had a positive screen and a primary discharge diagnosis of psychoactive substance abuse had a BPRS total score indicating less psychopathology than similarly diagnosed patients with negative screens. Patients who had positive screens and a diagnosis of personality disorder had some BPRS subscale scores indicating greater psychopathology than their counterparts with negative screens. No other significant differences in recovery rates between the two groups were found, although comparisons indicated trends toward faster recovery in some areas of functioning by schizophrenic patients with positive screens and affective disorder patients with negative screens. CONCLUSIONS: Results suggest that use of a urine toxicology screen and the BPRS early in treatment may aid in assessing the acute course of several psychiatric disorders and the effect of comorbidity.

A pilot course for residents on sexual feelings and boundary maintenance in treatment.

Surveys indicate that between 6% and 10% of psychiatrists report sexual contact with patients. Surveys also indicate that only a small minority of psychiatrists feel that they have received adequate teaching about this unethical behavior. Educational efforts aimed at reducing sexual exploitation of patients would be of value to trainees, patients, academic programs, and the profession. The authors report their experience with a pilot 6-session course for residents, and a longer model course is outlined. Such education should be mandatory in U.S. residencies. Mandated instruction would be consistent with both the high priority training directors have reported placing on the subject of sexual misconduct in ethics teaching, and with the widespread calls for increased education on this important subject.

Providers and reviewers teach informed managed care.

Two utilization review case studies are summarized, with discussion of both the provider's and the reviewer's perspective. This interface between managed care organizations and behavioral health care professionals offers some instructive guidelines on how to best approach the utilization review process.

Investigating stress levels of residents: a pilot study.

A pilot study of the levels of stress among residents was conducted in three departments in a university hospital prior to initiating a programme in stress management for residents. The Beck Depression Inventory, which is a brief, standardized self-report measure of depression, was given to residents in anaesthesiology, paediatrics and psychiatry. Six additional questions were asked about the functioning of peers and services residents would like to have available. Of the 113 residents surveyed, 16% were experiencing a mild mood disturbance. The researchers feel this is probably under-reported. Residents felt that about 15% of their colleagues were emotionally impaired; 10% may have a drug and/or alcohol problem; 12% were having marital problems. Eighty per cent of all residents studied said that they would attend support groups if they existed. Approximately 60% thought coping skills/stress management seminars would be useful, and 30% of the paediatric and anaesthesiology residents (60% of the psychiatry residents) said they would use confidential individual psychotherapy if it were available.