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Psychiatry Notes: Patients With Guns, Refugee Psychiatry, Even Longer Shifts

Psychiatry Notes: Patients With Guns, Refugee Psychiatry, Even Longer Shifts

  • A 10-1 federal appeals court decision allows Florida doctors to discuss guns with their patients; a psychiatrist on the front lines in war-torn areas; a new rule that allows for 24-hour shifts plus an additional 4 hours for residents—these and other recent stories are covered in this roundup. Scroll through the slides for links to the stories.

    View the notes in PDF Format.

  • Discussing guns with patients. “A federal appeals court says doctors in Florida must be allowed to discuss guns with their patients, striking down portions of a Florida law that restricts what physicians can say to patients about firearm ownership. In a 10-1 decision, the full panel of the 11th U.S. Circuit Court of Appeals found that the law, known as the Privacy of Firearm Owners act, violates the First Amendment rights of doctors. Court Strikes Down Florida Law Barring Doctors From Discussing Guns With Patients. NPR, February 17, 2017

  • Psychiatry in a humanitarian crisis. With a focus on mental health services in the midst of displacement, trauma, and war, Andres Barkil-Oteo, MD, Clinical Assistant Professor of Psychiatry at Yale School of Medicine and co-founder of the Syrian Tele-mental Health Network writes, “There is strong evidence from studies done in other countries with mass exposure to trauma and protracted conflict, that community based programs do have positive impact on increasing people’s resilience and promoting adaptive coping strategies. Empowering communities’ sense of agency and control increases their collective efficacy and their social capital. These are the building blocks for community recovery after mass trauma events in protracted conflict settings.” Agency and Hope: Helping Communities Healing Themselves. SyriaUntold, March 2017 (originally posted in September 2016)

  • Burnout waiting to happen. “Following through on a proposal announced last November, the Accreditation Council for Graduate Medical Education (ACGME) said Friday that the cap on residents' duty hours would be set to 80 hours per week with shifts not lasting more than 28 hours, beginning July 1…The official maximum shift length will be 24 hours, but the new rule -- as in the earlier proposal -- allows for an additional 4 hours ‘to manage necessary care transitions.’ Limits on duty hours will now be the same for first-year residents as well as for those further along in their training, including fellows. ACGME Raises Ceiling on Residents' Duty Hours. Medpage Today. March 20, 2017

  • This can’t be good. Half of teens go online several times a day and many are active online every waking moment. Little is known why drug use in teens aged 12 to 17 years has declined but researchers are considering the culprit may be electronic use. Both substances and electronic devices stimulate the same part of the brain and both can be addictive. “The possibility is worth exploring, they say, because use of smartphones and tablets has exploded over the same period that drug use has declined. This correlation does not mean that one phenomenon is causing the other, but scientists say interactive media appears to play to similar impulses as drug experimentation, including sensation-seeking and the desire for independence.” Are Teenagers Replacing Drugs With Smartphones? The New York Times, March 13, 2017

  • An even more dangerous opioid. “An advisory panel convened by the Food and Drug Administration to evaluate the health risks of the powerful opioid painkiller Opana ER says that the danger it poses as a drug of abuse outweighs its benefits as a prescription painkiller. The time-release opioid was reformulated in 2012 to make it harder to crush. The goal was to reduce abuse by snorting it. But users quickly figured out that the new formulation could be dissolved and injected.” -Dangers of Opana Opioid Painkiller Outweigh Benefits, FDA Panel Says. NPR, March 16, 2017


  • Worldwide restriction on fentanyl ingredients. The UN Office on Drugs and Crime (UNODC) has added two ingredients in fentanyl and a fentanyl-like substance to the international control list. The two fentanyl precursors, known as 4-anilino-N-phenethylpiperidine (ANPP) and N-phenethyl-4-piperidone (NPP), as well as butyrfentanyl, a fentanyl analog. A US State Department spokesperson said, “This vote will make it harder for the criminals that are illicitly producing fentanyl to access the necessary resources. It will require countries to regulate the production, sale, and export of the precursors to fentanyl, and to criminalize sale or trafficking outside of those regulations." The decision comes too late for the 20,000 US heroin and synthetic opioid deaths in 2015, but the prevention measure should deter fentanyl producers by making the chemicals illegal. U.N. drugs body places fentanyl ingredients on control list, Reuters, March 16, 2017

  • Depression and heart disease: an unfortunate link. “Depression has become recognized as a major issue for people with heart disease. Studies have found that between 17 and 44 percent of patients with coronary artery disease also have major depression. According to the American Heart Association, people hospitalized for a heart attack are roughly three times as likely as the general population to experience depression. As many as 40 percent of patients undergoing coronary artery bypass surgery suffer from depression.” Mental illness and heart disease are often found in the same patients. Washington Post, February 18

View the notes in PDF Format.


I wonder why oxymorphone is 'an even more dangerous opioid'? Is it because the prescriber or law enforcement may have it off their radar, with the thinking that it would be more difficult to abuse simply because of an extended release dosage formulation? Because, aren't any opioids used but not indicated in the wrong person are just as dangerous as another? This sort of logic eventually made propoxyphene (in Darvon, Darvocet, etc) go away.

Catharine @

Means more lethal. May be for various reasons. Could be cheaper or cut with unknown agents. Usually means a new designer drug that is stronger and the addict doesn't know the safe dosage.

anna @

Is "Burnout waiting to happen" with the revised work hours for first-year residents and transition time? Not necessarily. The key to preventing even increasing rates of burn-out, now up to 70% in some residencies, is not mainly the amount of hours worked; it is how those hours are worked. Back when I started medicine, burn-out was virtually unheard despite working many more consecutive hours than in recent years. No, the problem is how the system helps or hinders one's work, how much empowerment is given to medical students, residents, and physicians to do what they can do best as healers to help patients. If time is wasted on unnecessary tasks, including aspects of EHRs, or if business ethics overrides healthcare ethics, then burn-out is liable to rise. As to the hours themselves, little breaks can really help, as well as learning how to do walking meditation.

Thank you for called attention to this change, Laurie.

Steven Moffic, M.D.

Lynn and Steve @

Thank you, Dr. Moffic. Certainly the recent change has been met with mixed reaction. The comments on a KevinMD blog by Pamela Wible, MD corroborate your position that more than just additional hours play a part in burnout: http://www.kevinmd.com/blog/2017/03/secret-horrors-sleep-deprived-doctor....

Laurie Martin
Digital Managing Editor
Psychiatric Times

PsychTimes @

no one's business what happens in therapy.

looking on as a Mental Health professional in Australia, asking an apparently suicidal person about their planned method and access to high lethality methods (including guns..the MOST lethal) in our view is professional. In fact to fail to explore that would be negligent. The aim is to prevent an unecaessay death rather thjan to protect a person's right to shoot themselves or spare the gun lobby any anxiety. It is not, I gather, one's fundamental right to kill themselves. the accessibility of guns in the US MUST contribute to the death of many more with suicidal thoughts than were likely to occur if citizens only had access to lower lethality methods. Blind Freddy can see that.

Andrew @

It is just plain wrong for the State to interfere IN ANY WAY with what a patient and his therapist talk about. None of their business. Leave us alone!

Peter @

Here we go again with the liberal agenda that makes no common sense at all. Are we going to also ask if the patient possesses any sharp 10" kitchen knives? How about a chain saw for cutting wood? A machete for clearing weeds? But no, somehow firearms have some unique inherent risk that separates them from every other dangerous item in the world. Hog wash. As a mental health professional, I know only too well that danger to self and others comes in any and all forms and to single out firearms, well, it's just a political agenda and nothing else. I, for one, respect my patients right to bear arms unless they are a danger to themselves or others and then I would have the common sense to simply ask if they have a plan.

Carol @

I believe you misinterpret the article. The state law FORBiD professionals from asking about guns. As a professional with a depressed patient expressing suicidal thoughts, you may ask if they have a plan but if they said I am going to shoot myself, you could not ask if they had a gun. Common sense? No. This is not a liberal/conservative issue at all. And yes, guns are much more likely to be used than a chainsaw, although razed blades and opioids work too. So you could ask about those but not the guns.

Richard @

Yes. Do you have a plan and the means to carry it out? If it's a gun you ask if they have one and if so how it is stored and if a family member could take temporary possession. You give statistics. How you can injure yourself and be left severely handicapped and dependent. Describe the still alive gun injuries. How someone trying to stop you could end up hurt. What you'll look like when your body is discovered. How sons are more likely to shoot themselves if their dad shot himself.

anna @

Although, guns are not the only way a person dies by suicide. They are the most lethal way. In Utah 80% of our gun deaths are suicides. Suicide is the leading cause of death for our youth 10-17. Nationally it's 5 th. Top choice of completers ... guns. We know that preventing access to means is the number one way to prevent death. Personally and professionally NOT asking if a person has access to this very lethal means of death is irresponsible. So happy this change has been made.

Dustine @

I wonder if there are any programs for mental health therapists who, like the psychiatrists mentioned above, could help victims of trauma in war-torn countries. I would certainly volunteer for that.

Victoria @

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