The nation’s leading causes of death are related to alcohol and drug use, tobacco smoke exposure, and behavioral addictions. In addition, the comorbidity of addictions and psychiatric illnesses (ie, dual diagnosis) is… Read More
There is strong evidence to support the hypothesis that cannabis consumption is a risk factor for the development of psychotic symptoms and schizophrenia. . . . Read More
A national survey done by the American Psychiatric Association (APA) showed that workers are hesitant to seek treatment for mental health issues. Reasons cited included concerns about confidentiality or fears of loss of status in the workplace. More »
Limiting benefits and requiring higher out-of-pocket costs for patients with mental health or substance use disorders is a practice that group health insurance plans must abandon, according to new rules issued by the US government. More »
Sporotrichosis is a fungal infection that typically results in cutaneous or lymphocutaneous disease, although other, more severe, life-threatening manifestations do occur. This article reviews updated treatment guidelines, which state that itraconazole has become the preferred therapy for most forms... More »
In early November, the FDA announced the launch of the Safe Use Initiative, a program to protect patients from injury and death caused by improper use of over-the-counter and prescription medications. More »
The medications currently approved for the treatment of insomnia include 9 benzodiazepine receptor agonist (BZRA) hypnotics and the selective melatonin receptor agonist ramelteon. More »
Under new FDA rules going into effect this month, more patients will be able to access experimental drugs without taking part in clinical trials. The new rules are meant to clarify a formal process in place since 1987 More »
Why do people get addicted? Of the countless books that have been published on this topic, this is the first that focuses on the self-medication hypothesis (SMH). Understanding Addiction as Self Medication is largely based on the experiences of the authors and other clinicians with individuals who... More »
Self-administration of drugs of abuse often causes changes in the brain that potentiate the development or intensification of addiction. However, an addictive disorder does not develop in every person who uses alcohol or abuses an illicit drug. Whether exposure to a substance of abuse leads to... More »
Physicians generally display better health and have lower rates of all-cause mortality than the general population.1 However, their education, nutrition, and lifestyle do not offer similar protection from substance abuse and dependence. Prevalence rates of alcohol abuse and dependence among... More »
Cigarette smoking is pervasive among persons who are being treated for substance use disorders. The prevalence is 3- to 4-fold higher than in the general population. Whereas approximately 20% of adults in the United States currently smoke, between 75% and 95% of persons in treatment programs for... More »
Previous studies have suggested that the effect of naltrexone in patients with alcohol dependence may be moderated by genetic factors. In particular, the possession of the G allele of the A118G polymorphism of the -opioid receptor gene (OPRM1) has been associated with a better response to naltrexone, although controversial results have been reported. The aim of this paper is to combine previous findings by means of a systematic review and a meta-analysis. We retrieved studies on the relationship between A118G polymorphism in OPRM1 gene and response to treatment with naltrexone in patients with alcohol dependence by means of electronic database search. A meta-analysis was conducted using a random-effects model. Calculations of odds ratio (OR) and their confidence intervals (CI) and tests for heterogeneity of the results have been performed. Six previous studies have analyzed the role of A118G polymorphism in response to naltrexone for alcohol dependence. After meta-analysis, we found
Smoking contributes to reasons for hospitalisation, and the period of hospitalisation may be a good time to provide help with quitting.|To determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients.|We searched the Cochrane Tobacco Addiction Group register which includes papers identified from CENTRAL, MEDLINE, EMBASE and PsycINFO in December 2011 for studies of interventions for smoking cessation in hospitalised patients, using terms including (hospital and patient*) or hospitali* or inpatient* or admission* or admitted.|Randomized and quasi-randomized trials of behavioural, pharmacological or multicomponent interventions to help patients stop smoking, conducted with hospitalised patients who were current smokers or recent quitters (defined as having quit more than one month before hospital admission). The intervention had to start in the hospital but could continue after hospital discharge. We excluded studies of patients admitted
Naltrexone is an opioid receptor antagonist that blocks the reinforcing effects of opioids and reduces alcohol consumption and craving. It has no abuse potential, mild and transient side effects, and thus appears an ideal pharmacotherapy for opioid dependence. Its effectiveness in alcohol dependence is less evident, but compliance with naltrexone combined with psychosocial support has been repeatedly shown to improve drinking outcomes. Limited compliance with oral naltrexone treatment is a known drawback. Several naltrexone implant and injectable depot formulations are being investigated and provide naltrexone release for at least 1 month. Studies among opioid-dependent patients indicate significant reductions in heroin use, but sample sizes are usually small. In alcohol dependence, two large multicenter trials report alcohol and craving reductions for naltrexone and placebo groups, indicating a significant but moderate effect. The pharmacokinetic profile of the injectable formulation
To provide family physicians with a practical clinical summary of the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain, developed by the National Opioid Use Guideline Group.|Researchers for the guideline conducted a systematic review of the literature on the effectiveness and safety of opioids for chronic noncancer pain, and drafted a series of recommendations. A panel of 49 clinicians from across Canada reviewed the draft and achieved consensus on 24 recommendations.|Screening for addiction risk is recommended before prescribing opioids. Weak opioids (codeine and tramadol) are recommended for mild to moderate pain that has not responded to first-line treatments. Oxycodone, hydromorphone, and morphine can be tried in patients who have not responded to weaker opioids. A low initial dose and slow upward titration is recommended, with patient education and close monitoring. Physicians should watch for the development of complications such as sleep apnea
To provide family physicians with a practical clinical summary of opioid prescribing for specific populations based on recommendations from the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain.|Researchers for the guideline conducted a systematic review of the literature, focusing on reviews of the effectiveness and safety of opioids in specific populations.|Family physicians can minimize the risks of overdose, sedation, misuse, and addiction through the use of strategies tailored to the age and health status of patients. For patients at high risk of addiction, opioids should be reserved for well-defined nociceptive or neuropathic pain conditions that have not responded to first-line treatments. Opioids should be titrated slowly, with frequent dispensing and close monitoring for signs of misuse. Suspected opioid addiction is managed with structured opioid therapy, methadone or buprenorphine treatment, or abstinence-based treatment. Patients with
Only a third of patients with depression respond fully to antidepressant medication but little evidence exists regarding the best next-step treatment for those whose symptoms are treatment resistant. The CoBalT trial aimed to examine the effectiveness of cognitive behavioural therapy (CBT) as an adjunct to usual care (including pharmacotherapy) for primary care patients with treatment resistant depression compared with usual care alone.|This two parallel-group multicentre randomised controlled trial recruited 469 patients aged 18-75 years with treatment resistant depression (on antidepressants for 6 weeks, Beck depression inventory [BDI] score 14 and international classification of diseases [ICD]-10 criteria for depression) from 73 UK general practices. Participants were randomised, with a computer generated code (stratified by centre and minimised according to baseline BDI score, whether the general practice had a counsellor, previous treatment with antidepressants, and
Macrosocial changes might affect mental health. We investigated whether the prevalence of common mental disorders (CMDs) changed over a 20-year period of industrialisation in Taiwan.|We used the 12-item Chinese Health Questionnaire to assess mental status of Taiwanese adults in 1990, 1995, 2000, 2005, and 2010. Respondents with scores of 3 or higher were classified as having probable CMDs. We assessed trends of probable CMDs with the Cochran-Armitage test and their risk factors (sex, age, marital status, educational level, employment status, and physical health) with multivariable logistic regression. The trends were compared with national rates of unemployment, divorce, and suicide.|Of 10,548 respondents, 9079 (861%) completed questionnaires. The prevalence of probable CMDs doubled from 115% in 1990 to 238% in 2010 (time trend p<0001). Increases paralleled rises in national rates of unemployment, divorce, and suicide at all five timepoints. Significant risk factors for
It is essential that regulations are issued to avoid misinterpretation of the law and to ensure access to critical mental health and addiction services. ( ... Ask them to ensure parity and equality are achieved for mental health and addiction services.
Mental Health Parity: Urge Your US Representative to Sign Congressman Patrick Kennedys Letter The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 passed October
Five Steps to Improving Patient Access Judy Capko, May 21, 2013 Patient access is getting increased attention through reform initiatives. Here are five steps you can take to make sure patients get appropriate access to care in your office.
Growing HIPAA Threat – Ignore Windows XP at Your Own Peril Marion K. Jenkins, May 21, 2013 Chances are good that you have some major ticking software time bombs lurking in your medical practice's computer environment, namely Windows XP and Server 2003.
Three Areas to Reduce Costs at Your Medical Practice Greg Mertz, May 19, 2013 By taking a hard look at reducing costs for staffing, overhead, and technology at your medical practice, you may see increased physician compensation.
Dos and Don’ts for Starting a Physician Blog Michael Woo-Ming, MD, May 18, 2013 Starting a physician blog can provide your medical practice with marketing benefits, but it's important to do it right.
