Browsing by Subject "Mental Disorders"
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Item Open Access Accuracy of proactive case finding for mental disorders by community informants in Nepal.(Br J Psychiatry, 2015-12) Jordans, Mark JD; Kohrt, Brandon A; Luitel, Nagendra P; Komproe, Ivan H; Lund, CrickBACKGROUND: Accurate detection of persons in need of mental healthcare is crucial to reduce the treatment gap between psychiatric burden and service use in low- and middle-income (LAMI) countries. AIMS: To evaluate the accuracy of a community-based proactive case-finding strategy (Community Informant Detection Tool, CIDT), involving pictorial vignettes, designed to initiate pathways for mental health treatment in primary care settings. METHOD: Community informants using the CIDT identified screen positive (n = 110) and negative persons (n = 85). Participants were then administered the Composite International Diagnostic Interview (CIDI). RESULTS: The CIDT has a positive predictive value of 0.64 (0.68 for adults only) and a negative predictive value of 0.93 (0.91 for adults only). CONCLUSIONS: The CIDT has promising detection properties for psychiatric caseness. Further research should investigate its potential to increase demand for, and access to, mental health services.Item Open Access Beyond the looking glass: recent advances in understanding the impact of environmental exposures on neuropsychiatric disease.(Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 2020-06) Hollander, Jonathan A; Cory-Slechta, Deborah A; Jacka, Felice N; Szabo, Steven T; Guilarte, Tomás R; Bilbo, Staci D; Mattingly, Carolyn J; Moy, Sheryl S; Haroon, Ebrahim; Hornig, Mady; Levin, Edward D; Pletnikov, Mikhail V; Zehr, Julia L; McAllister, Kimberly A; Dzierlenga, Anika L; Garton, Amanda E; Lawler, Cindy P; Ladd-Acosta, ChristineThe etiologic pathways leading to neuropsychiatric diseases remain poorly defined. As genomic technologies have advanced over the past several decades, considerable progress has been made linking neuropsychiatric disorders to genetic underpinnings. Interest and consideration of nongenetic risk factors (e.g., lead exposure and schizophrenia) have, in contrast, lagged behind heritable frameworks of explanation. Thus, the association of neuropsychiatric illness to environmental chemical exposure, and their potential interactions with genetic susceptibility, are largely unexplored. In this review, we describe emerging approaches for considering the impact of chemical risk factors acting alone and in concert with genetic risk, and point to the potential role of epigenetics in mediating exposure effects on transcription of genes implicated in mental disorders. We highlight recent examples of research in nongenetic risk factors in psychiatric disorders that point to potential shared biological mechanisms-synaptic dysfunction, immune alterations, and gut-brain interactions. We outline new tools and resources that can be harnessed for the study of environmental factors in psychiatric disorders. These tools, combined with emerging experimental evidence, suggest that there is a need to broadly incorporate environmental exposures in psychiatric research, with the ultimate goal of identifying modifiable risk factors and informing new treatment strategies for neuropsychiatric disease.Item Open Access Characteristics of antipsychotic medication prescribing on inpatient obstetric floors.(Archives of women's mental health, 2016-08) Johnson, Kim; Muzyk, Andrew; Wald, MarlaItem Open Access Comorbid substance use disorders with other Axis I and II mental disorders among treatment-seeking Asian Americans, Native Hawaiians/Pacific Islanders, and mixed-race people.(Journal of psychiatric research, 2013-12) Wu, Li-Tzy; Blazer, Dan G; Gersing, Kenneth R; Burchett, Bruce; Swartz, Marvin S; Mannelli, Paolo; NIDA AAPI WorkgroupLittle is known about behavioral healthcare needs of Asian Americans (AAs), Native Hawaiians/Pacific Islanders (NHs/PIs), and mixed-race people (MRs)-the fastest growing segments of the U.S. population. We examined substance use disorder (SUD) prevalences and comorbidities among AAs, NHs/PIs, and MRs (N = 4572) in a behavioral health electronic health record database. DSM-IV diagnoses among patients aged 1-90 years who accessed behavioral healthcare from 11 sites were systematically captured: SUD, anxiety, mood, personality, adjustment, childhood-onset, cognitive/dementia, dissociative, eating, factitious, impulse-control, psychotic/schizophrenic, sleep, and somatoform diagnoses. Of all patients, 15.0% had a SUD. Mood (60%), anxiety (31.2%), adjustment (30.9%), and disruptive (attention deficit-hyperactivity, conduct, oppositional defiant, disruptive behavior diagnosis, 22.7%) diagnoses were more common than others (psychotic 14.2%, personality 13.3%, other childhood-onset 11.4%, impulse-control 6.6%, cognitive 2.8%, eating 2.2%, somatoform 2.1%). Less than 1% of children aged <12 years had SUD. Cannabis diagnosis was the primary SUD affecting adolescents aged 12-17. MRs aged 35-49 years had the highest prevalence of cocaine diagnosis. Controlling for age at first visit, sex, treatment setting, length of treatment, and number of comorbid diagnoses, NHs/PIs and MRs were about two times more likely than AAs to have ≥ 2 SUDs. Regardless of race/ethnicity, personality diagnosis was comorbid with SUD. NHs/PIs with a mood diagnosis had elevated odds of having SUD. Findings present the most comprehensive patterns of mental diagnoses available for treatment-seeking AAs, NHs/PIs, and MRs in the real-world medical setting. In-depth research is needed to elucidate intraracial and interracial differences in treatment needs.Item Open Access Cues to deception.(Psychol Bull, 2003-01) DePaulo, Bella M; Lindsay, James J; Malone, Brian E; Muhlenbruck, Laura; Charlton, Kelly; Cooper, HarrisDo people behave differently when they are lying compared with when they are telling the truth? The combined results of 1,338 estimates of 158 cues to deception are reported. Results show that in some ways, liars are less forthcoming than truth tellers, and they tell less compelling tales. They also make a more negative impression and are more tense. Their stories include fewer ordinary imperfections and unusual contents. However, many behaviors showed no discernible links, or only weak links, to deceit. Cues to deception were more pronounced when people were motivated to succeed, especially when the motivations were identity relevant rather than monetary or material. Cues to deception were also stronger when lies were about transgressions.Item Open Access Depressive symptoms among informal caregivers of older adults: insights from the Singapore Survey on Informal Caregiving.(International psychogeriatrics, 2012-08) Malhotra, Chetna; Malhotra, Rahul; Østbye, Truls; Matchar, David; Chan, AngeliqueThis paper determines care recipient and caregiver characteristics and caregiving dimensions - associated with depression among caregivers of older adults, using path analysis and assesses whether the identified path model differs between spousal and adult child caregivers.Data from 1,190 dyads comprising care recipients (community-dwelling adults aged ≥ 75 years with at least one activity of daily living (ADL) limitation) and caregivers (family member/friend most involved in providing care/ensuring provision of care to care recipient), who were interviewed through the Singapore Survey on Informal Caregiving (2010-2011), were used. Using path analysis, we assessed the direct and indirect associations between primary stressors (care recipient's ADL and instrumental ADL status, and memory and behavior problems), caregiver health status, receipt of assistance from a foreign domestic worker/maid, amount of caregiving, negative reaction to caregiving, caregiver's self-esteem, perceived emotional support, and caregiver depressive symptoms.Our analysis showed that primary stressors, receipt of assistance from a foreign domestic worker/maid, perceived emotional support, and caregiver health status were directly or indirectly associated with caregiver depressive symptoms, and this association was mediated by negative reaction to caregiving. Caregiver self-esteem mediated the relationship between perceived emotional support and negative reaction to caregiving only among adult child caregivers.The results provide insights into factors associated with depressive symptoms among spousal and adult child caregivers, and help identify targeted interventions for improving caregiver mood.Item Open Access Homeopathic treatments in psychiatry: a systematic review of randomized placebo-controlled studies.(J Clin Psychiatry, 2011-06) Davidson, Jonathan RT; Crawford, Cindy; Ives, John A; Jonas, Wayne BOBJECTIVE: To systematically review placebo-controlled randomized trials of homeopathy for psychiatric conditions. DATA SOURCES: Eligible studies were identified using the following databases from database inception to April 2010: PubMed, CINAHL, PsycINFO, Hom-Inform, Cochrane CENTRAL, National Center for Complementary and Alternative Medicine grantee publications database, and ClinicalTrials.gov. Gray literature was also searched using Google, Google Scholar, the European Committee for Homeopathy, inquiries with homeopathic experts and manufacturers, and the bibliographic lists of included published studies and reviews. Search terms were as follows: (homeopath* or homoeopath*) and (placebo or sham) and (anxiety or panic or phobia or post-traumatic stress or PTSD or obsessive-compulsive disorder or fear or depress* or dysthym* or attention deficit hyperactivity or premenstrual syndrome or premenstrual disorder or premenstrual dysphoric disorder or traumatic brain injury or fibromyalgia or chronic fatigue syndrome or myalgic encephalitis or insomnia or sleep disturbance). Searches included only English-language literature that reported randomized controlled trials in humans. STUDY SELECTION: Trials were included if they met 7 criteria and were assessed for possible bias using the Scottish Intercollegiate Guidelines Network (SIGN) 50 guidelines. Overall assessments were made using the Grading of Recommendations Assessment, Development and Evaluation procedure. Identified studies were grouped into anxiety or stress, sleep or circadian rhythm complaints, premenstrual problems, attention-deficit/hyperactivity disorder, mild traumatic brain injury, and functional somatic syndromes. RESULTS: Twenty-five eligible studies were identified from an initial pool of 1,431. Study quality according to SIGN 50 criteria varied, with 6 assessed as good, 9 as fair, and 10 as poor. Outcome was unrelated to SIGN quality. Effect size could be calculated in 16 studies, and number needed to treat, in 10 studies. Efficacy was found for the functional somatic syndromes group (fibromyalgia and chronic fatigue syndrome), but not for anxiety or stress. For other disorders, homeopathy produced mixed effects. No placebo-controlled studies of depression were identified. Meaningful safety data were lacking in the reports, but the superficial findings suggested good tolerability of homeopathy. A funnel plot in 13 studies did not support publication bias (χ(2)(1) = 1.923, P = .166). CONCLUSIONS: The database on studies of homeopathy and placebo in psychiatry is very limited, but results do not preclude the possibility of some benefit.Item Open Access How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment.(Psychol Med, 2010-06) Moffitt, TE; Caspi, A; Taylor, A; Kokaua, J; Milne, BJ; Polanczyk, G; Poulton, RBACKGROUND: Most information about the lifetime prevalence of mental disorders comes from retrospective surveys, but how much these surveys have undercounted due to recall failure is unknown. We compared results from a prospective study with those from retrospective studies. METHOD: The representative 1972-1973 Dunedin New Zealand birth cohort (n=1037) was followed to age 32 years with 96% retention, and compared to the national New Zealand Mental Health Survey (NZMHS) and two US National Comorbidity Surveys (NCS and NCS-R). Measures were research diagnoses of anxiety, depression, alcohol dependence and cannabis dependence from ages 18 to 32 years. RESULTS: The prevalence of lifetime disorder to age 32 was approximately doubled in prospective as compared to retrospective data for all four disorder types. Moreover, across disorders, prospective measurement yielded a mean past-year-to-lifetime ratio of 38% whereas retrospective measurement yielded higher mean past-year-to-lifetime ratios of 57% (NZMHS, NCS-R) and 65% (NCS). CONCLUSIONS: Prospective longitudinal studies complement retrospective surveys by providing unique information about lifetime prevalence. The experience of at least one episode of DSM-defined disorder during a lifetime may be far more common in the population than previously thought. Research should ask what this means for etiological theory, construct validity of the DSM approach, public perception of stigma, estimates of the burden of disease and public health policy.Item Open Access How do prescription opioid users differ from users of heroin or other drugs in psychopathology: results from the National Epidemiologic Survey on Alcohol and Related Conditions.(Journal of addiction medicine, 2011-03) Wu, Li-Tzy; Woody, George E; Yang, Chongming; Blazer, Dan GTo study substance use and psychiatric disorders among prescription opioid users, heroin users, and non-opioid drug users in a national sample of adults.Analyses of data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093).Four groups were identified among 9140 illicit or non-prescribed drug users: heroin-other opioid users (1.0%; used heroin and other opioids), other opioid-only users (19.8%; used other opioids but never heroin), heroin-only users (0.5%; used heroin but never other opioids), and non-opioid drug users (78.7%; used drugs but never heroin or other opioids). After adjusting for variations in socioeconomic characteristics, history of substance abuse treatment, and familial substance abuse, heroin-other opioid users had greater odds of several substance use disorders (cocaine, hallucinogen, sedative, amphetamine, and tranquilizer) as compared with the other groups; heroin-only users had reduced odds of sedative and tranquilizer use disorders as compared with other opioid-only users. Non-opioid drug users had reduced odds of all substance use disorders and other mental disorders (mood, anxiety, pathological gambling, and personality) as compared with other opioid-only users. Past-year other opioid-only users also reported slightly lower scores on quality of life than past-year non-opioid drug users.All opioid use groups had higher rates of substance use disorders than non-opioid drug users, and these rates were particularly elevated among heroin-other opioid users. Findings suggest the need to distinguish between these four groups in research and treatment as they may have different natural histories and treatment needs.Item Open Access Identifying core curricular components for behavioral health training in internal medicine residency: Qualitative interviews with residents, faculty, and behavioral health clinicians.(International journal of psychiatry in medicine, 2019-05) Hemming, Patrick; Revels, Jessica A; Tran, Anh N; Greenblatt, Lawrence H; Steinhauser, Karen EObjective
Behavioral health services frequently delivered by primary care providers include care for mental health and substance abuse disorders and assistance with behavioral risk factor reduction. Internal medicine residencies in the United States lack formal expectations regarding training in behavioral health for residents. This qualitative study aimed to determine learners' and teachers' perceptions about appropriate behavioral health curricular components for internal medicine residents.Method
Focus groups and interviews were conducted with the following individuals from the Duke Outpatient Clinic: residents with continuity practice (n = 27), advanced practice providers (n = 2), internal medicine attending physicians (n = 4), internal medicine/psychiatry attending physicians (n = 2), and behavioral health clinicians (n = 4). A focus group leader asked regarding residents' successes and challenges in managing behavioral health issues and about specific learning components considered necessary to understand and manage these behavioral health conditions. Transcripts were coded using an editing analysis style to identify central themes and concordance/discordance between groups.Results
Regarding mental health management (Theme 1), residents emphasized a need for better care coordination with specialty mental health, while attendings and behavioral health clinicians gave priority to residents' skills in primary management of mental health. Residents, attendings, and behavioral health clinicians all emphasized advanced interviewing skills (Theme 2) with subthemes: eliciting the patient's perspective, managing time in encounters, improving patients' understanding, and patient counseling.Conclusions
Internal medicine residents, attendings, and behavioral health clinicians may differ significantly in their perceptions of primary care's role in mental health care. Future internal medicine behavioral health curricula should specifically address these attitudinal differences. Curricula should also emphasize interview skills training as an essential component of behavioral health learning.Item Open Access Improving The Measurement Of Structural Racism To Achieve Antiracist Health Policy.(Health affairs (Project Hope), 2022-02) Hardeman, Rachel R; Homan, Patricia A; Chantarat, Tongtan; Davis, Brigette A; Brown, Tyson HAntiracist health policy research requires methodological innovation that creates equity-centered and antiracist solutions to health inequities by centering the complexities and insidiousness of structural racism. The development of effective health policy and health equity interventions requires sound empirical characterization of the nature of structural racism and its impact on public health. However, there is a disconnect between the conceptualization and measurement of structural racism in the public health literature. Given that structural racism is a system of interconnected institutions that operates with a set of racialized rules that maintain White supremacy, how can anyone accurately measure its insidiousness? This article highlights methodological approaches that will move the field forward in its ability to validly measure structural racism for the purposes of achieving health equity. We identify three key areas that require scholarly attention to advance antiracist health policy research: historical context, geographical context, and theory-based novel quantitative and qualitative methods that capture the multifaceted and systemic properties of structural racism as well as other systems of oppression.Item Open Access Influence of comorbid alcohol and psychiatric disorders on utilization of mental health services in the National Comorbidity Survey.(The American journal of psychiatry, 1999-08) Wu, LT; Kouzis, AC; Leaf, PJOBJECTIVE: This study sought to determine how comorbidity of psychiatric and substance abuse disorders affects the likelihood of using mental health services. METHOD: The analysis was based on data on adults aged 18-54 years in the National Comorbidity Survey (N = 5,393). Users and nonusers of mental health and substance abuse services were compared in terms of their demographic characteristics, recent stressful life events, social support, parental history of psychopathology, self-medication, and symptoms of alcohol abuse/dependence. RESULTS: The prevalence of service utilization varied by diagnostic configurations. Comorbid psychiatric or alcohol disorders were stronger predictors of service utilization than a pure psychiatric or alcohol disorder. Factors predicting utilization of services differed for each disorder. CONCLUSIONS: Since comorbidity increases the use of mental health and substance abuse services, research on the relationship of psychiatric and alcohol-related disorders to service utilization needs to consider the coexistence of mental disorders. Attempts to reduce barriers to help seeking for those in need of treatment should be increased.Item Open Access Life Program: Pilot Testing a Palliative Psychology Group Intervention.(Journal of palliative medicine, 2018-11) Ramos, Katherine; Hastings, S Nicole; Bosworth, Hayden B; Fulton, Jessica JBackground
Psychosocial interventions for palliative care populations, individuals with life-limiting illness, improve distress; however, less is known about these interventions among military Veterans.Objectives
This quality improvement project evaluated a palliative psychology group intervention to reduce depression, anxiety, and stress among Veterans with advanced life-limiting illness.Methods
Veterans receiving palliative care at a mid-Atlantic VA healthcare system were referred by a mental health provider. The group intervention was delivered face-to-face in six to eight weekly sessions, with groups of four to eight participants. The intervention (Life Program), was a hybrid of cognitive-behavioral therapy and acceptance and commitment therapy that targeted: personal values, mindfulness, and psychological flexibility. A single-arm pre-post-test design was used to assess depression, anxiety, and stress, and satisfaction with the intervention.Results
Seventy-five percent (39/52) of all Veterans who were contacted expressed interest and agreed to participate. Seventeen of 39 enrolled Veterans completed all sessions. The mean age of participants who completed the program was 63.06 (standard deviation = 8.47). Most participants were male (88%), Caucasian (58%), and had a cancer diagnosis (65%). Mean pre-post reductions in depression (18.82 vs. 13.20), anxiety (16.59 vs. 14.59), stress (19.18 vs. 13.88), and psychological inflexibility were observed. Mean differences in symptom severity were clinically meaningful. Barriers to feasibility included transportation issues and illness burden.Conclusions
Veterans who completed all sessions of a palliative psychology group intervention had reductions in depression, anxiety, and stress. Estimates of the treatment effects may be inflated using completer data alone. Further research is needed to inform ways to improve program engagement and adherence and examine efficacy in Veterans with advanced life-limiting illness.Item Open Access Mental Health and Substance Use Among Patients in a North Carolina HIV Clinic.(N C Med J, 2015-07) Sikkema, KJBACKGROUND: The HIV/AIDS epidemic is a significant public health concern in North Carolina, and previous research has pointed to elevated mental health distress and substance use among HIV-infected populations, which may impact patients' adherence to medications. The aims of this study were to describe the prevalence of mental health and substance use issues among patients of a North Carolina HIV clinic, to examine differences by demographic characteristics, and to examine factors associated with suboptimal adherence to HIV medications. METHODS: This study was a secondary analysis of clinical data routinely collected through a health behavior questionnaire at a large HIV clinic in North Carolina. We analyzed data collected from February 2011 to August 2012. RESULTS: The sample included 1,398 patients. Overall, 12.2% of patients endorsed current symptomology indicative of moderate or severe levels of depression, and 38.6% reported receiving a psychiatric diagnosis at some point in their life. Additionally, 19.1% had indications of current problematic drinking, and 8.2% reported problematic drug use. Nearly one-quarter (22.1%) reported suboptimal adherence to HIV medications. Factors associated with poor adherence included racial/ethnic minority, age less than 35 years, and indications of moderate or severe depression. LIMITATIONS: The questionnaire was not completed systematically in the clinic, which may limit generalizability, and self-reported measures may have introduced social desirability bias. CONCLUSION: Patients were willing to disclose mental health distress, substance use, and suboptimal medication adherence to providers, which highlights the importance of routinely assessing these behaviors during clinic visits. Our findings suggest that treating depression may be an effective strategy to improve adherence to HIV medications.Item Open Access Multifactorial determinants of the neurocognitive effects of electroconvulsive therapy.(J ECT, 2014-06) McClintock, Shawn M; Choi, Jimmy; Deng, Zhi-De; Appelbaum, Lawrence G; Krystal, Andrew D; Lisanby, Sarah HFor many patients with neuropsychiatric illnesses, standard psychiatric treatments with mono or combination pharmacotherapy, psychotherapy, and transcranial magnetic stimulation are ineffective. For these patients with treatment-resistant neuropsychiatric illnesses, a main therapeutic option is electroconvulsive therapy (ECT). Decades of research have found ECT to be highly effective; however, it can also result in adverse neurocognitive effects. Specifically, ECT results in disorientation after each session, anterograde amnesia for recently learned information, and retrograde amnesia for previously learned information. Unfortunately, the neurocognitive effects and underlying mechanisms of action of ECT remain poorly understood. The purpose of this paper was to synthesize the multiple moderating and mediating factors that are thought to underlie the neurocognitive effects of ECT into a coherent model. Such factors include demographic and neuropsychological characteristics, neuropsychiatric symptoms, ECT technical parameters, and ECT-associated neurophysiological changes. Future research is warranted to evaluate and test this model, so that these findings may support the development of more refined clinical seizure therapy delivery approaches and efficacious cognitive remediation strategies to improve the use of this important and widely used intervention tool for neuropsychiatric diseases.Item Open Access Prevention in the Era of COVID-19 and the Role of Behavioral Health Care Teams.(Psychiatric services (Washington, D.C.), 2021-04) Balasuriya, Lilanthi; Jorgensen, Shea; Swartz, Marvin SItem Open Access Psychiatric correlates of snuff and chewing tobacco use.(PLoS One, 2014) Fu, Qiang; Vaughn, Michael G; Wu, Li-Tzy; Heath, Andrew CCompared to the association between cigarette smoking and psychiatric disorders, relatively little is known about the relationship between smokeless tobacco use and psychiatric disorders. To identify the psychiatric correlates of smokeless tobacco use, the analysis used a national representative sample from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) wave 1. Smokeless tobacco use was classified as exclusive snuff use, exclusive chewing tobacco, and dual use of both snuff and chewing tobacco at some time in the smokeless tobacco user's life. Lifetime psychiatric disorders were obtained via structured diagnostic interviews. The results show that the prevalence of lifetime exclusive snuff use, exclusive chewing tobacco, and dual use of both snuff and chewing tobacco was 2.16%, 2.52%, and 2.79%, respectively. After controlling for sociodemographic variables and cigarette smoking, the odds of exclusive chewing tobacco in persons with panic disorder and specific phobia were 1.53 and 1.41 times the odds in persons without those disorders, respectively. The odds of exclusive snuff use, exclusive chewing tobacco, and dual use of both products for individuals with alcohol use disorder were 1.97, 2.01, and 2.99 times the odds for those without alcohol use disorder, respectively. Respondents with cannabis use disorder were 1.44 times more likely to use snuff exclusively than those without cannabis use disorder. Respondents with inhalant/solvent use disorder were associated with 3.33 times the odds of exclusive chewing tobacco. In conclusion, this study highlights the specific links of anxiety disorder, alcohol, cannabis, and inhalant/solvent use disorders with different types of smokeless tobacco use.Item Open Access Psychiatric symptoms and substance use disorders in a nationally representative sample of American adolescents involved with foster care.(The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2006-04) Pilowsky, Daniel J; Wu, Li-TzyTo ascertain the prevalence of psychiatric symptoms and substance use disorders among adolescents with a lifetime history of foster care placement, using data from a nationally representative sample of U.S. adolescents.We studied adolescents aged 12-17 years in the public use file of the 2000 National Household on Drug Abuse (n = 19,430, including 464 adolescents with history of foster care placement). Psychiatric symptoms and substance use disorders were ascertained through direct interviewing of adolescents. Logistic regression analyses were used to estimate the odds of past-year psychiatric symptoms and substance use disorders among adolescents involved with foster care, as compared to those without a lifetime history of foster care placement (comparison group).Adolescents involved with foster care had more past-year psychiatric symptoms, and especially more conduct symptoms, and past-year substance use disorders than those never placed in foster care. Adolescents involved with foster care were about four times more likely to have attempted suicide in the preceding 12 months (adjusted odds ratio [AOR] 3.95; 95% confidence interval [CI] 2.78, 5.61), and about five times more likely to receive a drug dependence diagnosis in the same period (AOR 4.81; 95% CI 3.22, 7.18).Adolescents involved with foster care have a higher prevalence of psychiatric symptoms and drug use disorders than those never placed in foster care. Additionally, the results of this study suggest that they may be at elevated risk for suicide attempts.Item Open Access Ralph Albert Blakelock (1847-1919): Psychiatric hospitalization and the abduction of an American landscape artist.(Journal of medical biography, 2017-02) Davidson, Jonathan RtRalph Blakelock was a leading American landscape painter. Much of his life was lived in obscurity and destitution. He developed late onset paranoid schizophrenia, resulting in prolonged hospitalization. During his time in hospital, demand for Blakelock's works grew, but he was unable to enjoy any of this success. Instead, the artist fell prey to unscrupulous and unlikely exploitation by a self-appointed guardian, aided and abetted by Blakelock's psychiatrists, which broke his spirit and may well have hastened his demise.Item Open Access Rapid Triage of Mental Health Risk in Emergency Medical Workers: Findings From Typhoon Haiyan.(Disaster medicine and public health preparedness, 2018-02) Sylwanowicz, Lauren; Schreiber, Merritt; Anderson, Craig; Gundran, Carlos Primero D; Santamaria, Emelie; Lopez, Jaifred Christian F; Lam, H; Tuazon, ACObjective
To determine the ability of a novel responder mental health self-triage system to predict post-traumatic stress disorder (PTSD) in emergency medical responders after a disaster.Methods
Participants in this study responded to Typhoon Haiyan, which struck the Philippines in November 2013. They completed the Psychological Simple Triage and Rapid Treatment (PsySTART) responder triage tool, the PTSD Checklist (PCL-5) and the Patient Health Questionnaire-8 (PHQ-8) shortly after responding to this disaster. The relationships between these 3 tools were compared to determine the association between different risk exposures while providing disaster medical care and subsequent levels of PTSD or depression.Results
The total number of PsySTART responder risk factors was closely related to PCL-5 scores ≥38, the threshold for clinical PTSD. Several of the PsySTART risk factors were predictive of clinical levels of PTSD as measured by the PCL-5 in this sample of deployed emergency medical responders.Conclusions
The presence of a critical number and type of PsySTART responder self-triage risk factors predicted clinical levels of PTSD and subclinical depression in this sample of emergency medical workers. The ability to identify these disorders early can help categorize an at-risk subset for further timely "stepped care" interventions with the goals of both mitigating the long-term consequences and maximizing the return to resilience. (Disaster Med Public Health Preparedness. 2018;12:19-22).