What routine screening for alcohol abuse is recommended to avoid alcohol-related psychiatric emergencies in older adults? How will the presence of additional staff members affect an agitated patient in a psychiatric emergency? These and more in this week's quiz.
This year, more than 1311 physicians of all specialties responded to the survey . . . 287 of the respondents are psychiatrists. The charts you see show how those 287 responded to just a few of the survey questions. Read More
Psychiatric Times presents coverage of the US Psychiatric and Mental Health Congress, covering the latest research on the assessment and treatment of psychiatric disorders. PsychCongress 2012 is on November 8-11 in San Diego, California. Read More
In this video, Senior Advisor to the NIMH Director and Professor of Psychiatry at Georgetown University School of Medicine explains how some of the latest developments in neuroscience can be used in everyday practice to treat bipolar and other mental disorders. Read More
To assess the possibility that diffusion tensor imaging (DTI) can detect white matter damage in mild traumatic brain injury (mTBI) patients via systematic review and meta-analysis.|DTI studies that compared mTBI patients and controls were searched using MEDLINE, Web of Science, and EMBASE, (1980 through April 2012).|A comprehensive literature search identified 28 DTI studies, of which 13 independent DTI studies of mTBI patients were eligible for the meta-analysis. Random effect model demonstrated significant fractional anisotropy (FA) reduction in the corpus callosum (CC) (p=0.023, 95% CIs -0.466 to -0.035, 280 mTBIs and 244 controls) with no publication bias and minimum heterogeneity, and a significant increase in mean diffusivity (MD) (p=0.015, 95% CIs 0.062 to 0.581, 154 mTBIs and 100 controls). Meta-analyses of the subregions of the CC demonstrated in the splenium FA was significantly reduced (p=0.025, 95% CIs -0.689 to -0.046) and MD was significantly increased (p=0.013, 95% CIs 0
The aim of this study was to systematically review the impact of comorbid mental disorders on health care costs in adult persons with asthma.|A comprehensive search for studies investigating adult persons (18 years) with asthma was conducted. All studies were included, which allowed a comparison of health care utilization and costs between asthma patients with mental disorders and asthma patients without.|The literature search revealed 1977 potentially relevant studies. Eighteen primary studies (20 publications) fulfilled the inclusion criteria. Mood disorders (n=14) and anxiety disorders (n=9) were studied most often. Increased rates of hospitalizations (odds ratio range, 0.9-6.1; n=7), emergency department visits (odds ratio range, 1.8-17.2; n=7) and general practitioner visits (standardized mean difference range, 0.1-1.1; n=6) were found in asthma patients with mental comorbidity. Indirect costs of work absence were investigated in two studies pointing in the same direction of
Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1(st) revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the "German Instrument for Methodological Guideline Appraisal" of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be
Prompt assessment and investigation of transient ischaemic attack (TIA) followed by early initiation of secondary prevention is effective in reducing recurrent stroke. Nevertheless, many patients are slow to seek medical advice after TIA. A systematic review was undertaken to examine potential factors associated with delay in seeking medical review after TIA.|The electronic databases MEDLINE, EMBASE, and Science Citation Index were searched for observational studies assessing patient delay in presentation after TIA. The search was restricted to studies published between December 1995 and September 2008.|The electronic search yielded nine studies with data on presentation delay in patients with TIA; variations existed in study size, population and methodology. One study included patients with TIA only (n = 241), whereas the remaining eight studies recruited both stroke and TIA patients. Overall, TIA patients (n = 821) made up only a small proportion of the total number of patients in
We set out to determine the effects of pharmacist-led medication review in older people by means of a systematic review and meta-analysis covering 11 electronic databases. Randomized controlled trials in any setting, concerning older people (mean age > 60 years), were considered, aimed at optimizing drug regimens and improving patient outcomes. Our primary outcome was emergency hospital admission (all cause). Secondary outcomes were mortality and numbers of drugs prescribed. We also recorded data on drug knowledge, adherence and adverse drug reactions. We retrieved 32 studies which fitted the inclusion criteria. Meta-analysis of 17 trials revealed no significant effect on all-cause admission, relative risk (RR) of 0.99 [95% confidence interval (CI) 0.87, 1.14, P = 0.92], with moderate heterogeneity (I(2) = 49.5, P = 0.01). Meta-analysis of mortality data from 22 trials found no significant benefit, with a RR of mortality of 0.96 (95% CI 0.82, 1.13, P = 0.62), with no heterogeneity (I(2
Little is known about patient populations that remain during or after the mandatory evacuation of a city and use hospital services. This study sought to characterize the population that presented to an emergency department during Hurricane Gustav in 2008.|This was a retrospective chart review of patients who presented to the Interim Louisiana State University Hospital emergency department in New Orleans during the 72-hour activation phase of Hurricane Gustav.|Of the 104 patients, 51 (49%) had a psychiatric diagnosis. Among the psychiatric patients, 34 (67%) had a substance use disorder diagnosis, 16 (31%) had a mood disorder, 13 (25%) had a psychotic disorder, and 4 (8%) had an anxiety disorder. The psychiatry service was the most used consultation service.|To our knowledge, this is the first report to characterize the patient population presenting to an emergency department during a hurricane evacuation. Data suggest that disaster preparedness should include psychiatric consultation
It has been suggested that patients with mental illness wait longer for care than other patients in the emergency department. We determined wait times for patients with and without mental health diagnoses during crowded and noncrowded periods in the emergency department.|We conducted a population-based retrospective cohort analysis of adults seen in 155 emergency departments in Ontario between April 2007 and March 2009. We compared wait times and triage scores for patients with mental illness to those for all other patients who presented to the emergency department during the study period.|The patients with mental illness (n = 51 381) received higher priority triage scores than other patients, regardless of crowding. The time to assessment by a physician was longer overall for patients with mental illness than for other patients (median 82, interquartile range [IQR] 41-147 min v. median 75 [IQR 36-140] min; p < 0.001). The median time from the decision to admit the patient to hospital
Screening, brief intervention, and referral to treatment (SBIRT) is a public health approach to the delivery of early intervention and treatment services for individuals at risk of developing substance use disorders (SUDs) and those who have already developed these disorders. SBIRT can be flexibly applied; therefore, it can be delivered in many clinical care settings. SBIRT has been adapted for use in hospital emergency settings, primary care centers, office- and clinic-based practices, and other community settings, providing opportunities for early intervention with at-risk substance users before more severe consequences occur. In addition, SBIRT interventions can include the provision of brief treatment for those with less severe SUDs and referrals to specialized substance abuse treatment programs for those with more severe SUDs. Screening large numbers of individuals presents an opportunity to engage those who are in need of treatment. However, additional research is needed to
We evaluated the impact of a diagnosis of serious mental illness on use of a primary care provider (vs the emergency department [ED]) as a source of care by people who were chronically homeless.|We used data from 750 chronically homeless adults enrolled in the 11-site Collaborative Initiative to Help End Chronic Homelessness and identified demographic and clinical characteristics independently associated with using a primary care provider rather than an ED.|The factor most strongly associated with using the ED as a regular source of medical care was previous-year lack of health insurance. Despite high rates of serious mental illness, neither a diagnosis of serious mental illness nor increased severity of psychiatric symptoms was associated with such use.|Findings suggest that people who are chronically homeless and have chronic medical illness would be more likely to access care if they had health insurance. Individual states' deciding not to expand Medicaid coverage will likely have
To investigate the risk of traumatic brain injury (TBI) and post-injury mortality in patients with mental disorders.|Patients with mental disorders are at higher risk of injuries. However, the association between mental disorders and TBI is still not understood. We conducted case-control studies to investigate whether people with pre-existing mental disorders are at higher risk of TBI and post-injury mortality.|Using reimbursement claims, we analysed 16,635 patients with TBI and 66,540 controls with adjustment of covariates to study the association of mental disorders and TBI. A nested case-control study was also conducted to analyse contributory factors for post-injury mortality.|People with mental disorders were at increased risk of TBI (odds ratio (OR) 1.94, 95% confidence interval (CI) 1.86 to 2.02). Men, older age, living in highly urbanised areas and patients on low income had a higher risk of TBI and post-injury mortality. Psychiatric medication intensity and frequency of
This dramatic increase in attention-deficit/hyperactivity disorder, autism and depression has exasperated the already dire workforce crisis in child and adolescent psychiatry. ... When children and adolescents are unable to get timely access to
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.