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
We've put many of the clinical scales online, hoping healthcare professionals—whether in specialty practices, primary-care settings, or emergency services—will find this format convenient. … Read More
Epidemiological studies show that, 4% to 5% of the general population have severe ADHD.1 Of this number, half have a comorbid substance use disorder, such as cigarette smoking.2 As it stands, few physicians feel comfortable diagnosing and managing ADHD in adults, and even fewer would contemplate... More »
DSM-IV provides separate categories for Substance Abuse and Substance Dependence. The typical substance abuser is someone who gets into recurrent, but intermittent, trouble as a consequence of recreational binges. This is in contrast to the continuous and compulsive pattern of use that is typical... 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 »
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 »
Should ART be deferred in patients at risk for nonadherence?
Since nonadherence to antiretroviral therapy (ART) may hasten the development of resistance, it may seem reasonable to defer ART in HIV-infected patients who have risk factors for nonadherence, such as substance abuse. More »
With the introduction of immunosuppressive drugs, solid organ transplant (SOT) has progressed such that potential recipients significantly outnumber available organs. In 2007, there were 14,394 donors of 28,353 organs, but 98,645 persons were on a waiting list as of March 2008.1 More »
Catastrophic antiphospholipid syndrome (CAPS), first described by Asherson and colleagues1 in 1992, refers to a clinical scenario in which multiple vascular occlusive events involving small vessels that supply blood to organs occur over a short period. More »
Cocaine and amphetamine intoxication continue to be common causes of emergency department and hospital admissions. The differential diagnosis includes hypoglycemia, hyperglycemia, hypoxia, metabolic encephalopathy, and thyrotoxicosis, as well as other drug intoxications. The presence of... More »
The high rate of comorbid substance abuse in women with bulimia nervosa (BN) has remained consistent in the literature. This article reviews the prevalence of substance abuse in BN and summarizes treatment approaches for persons with BN and comorbid substance abuse. More »
Because widespread use of highly active antiretroviral therapy
has made it possible for persons with HIV infection to live
longer, the epidemiology of HIV/AIDS has shifted in several
ways. The number of persons 50 years and older living with
HIV/AIDS has risen in recent years, and there has been a... More »
Increasingly, financial reinforcement interventions based on behavioral economic principles are being applied in health care settings, and this study examined the use of financial reinforcers for enhancing adherence to medications.|Electronic databases and bibliographies of relevant references were searched, and a meta-analysis of identified trials was conducted. The variability in effect size and the impact of potential moderators (study design, duration of intervention, magnitude of reinforcement, and frequency of reinforcement) on effect size were examined.|Fifteen randomized studies and 6 nonrandomized studies examined the efficacy of financial reinforcement interventions for medication adherence. Financial reinforcers were applied for adherence to medications for tuberculosis, substanceabuse, human immunodeficiency virus, hepatitis, schizophrenia, and stroke prevention. Reinforcement interventions significantly improved adherence relative to control conditions with an overall
To determine the impact of standard care and contingency management treatments on the utilization of general health-care services by substance abusers. PARTICIPANTS, DESIGN AND MEASUREMENTS: This secondary analysis pooled 1028 treatment-seeking substance abusers from five randomized clinical trials that compared the effects of standard care (SC, n=362) to standard care plus contingency management (CM, n=666). In each trial, subjects in the CM condition showed significantly greater reductions in substance use than their SC counterparts. For each subject, utilization of 15 general health-care services was measured 1 year prior to treatment intake and up to 9 months following treatment intake. Post-intake utilization data were pro-rated to be comparable to the 1-year pre-intake data. Paired t-tests evaluated changes in service utilization pre- and post-intake, and difference-in-differences regression models were used to estimate the impact of CM, compared to SC, on
The British Association for Psychopharmacology guidelines for the treatment of substanceabuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short- and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substanceabuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people.
Previous research has indicated a high prevalence of childhood sexual abuse (CSA) among men who have sex with men (MSM) in the United States, and has suggested that CSA history is a risk factor for HIV infection in MSM. We conducted a systematic review to identify, synthesize, meta-analyze, and critique the current state of relevant literature. Systematic review methodology was utilized to identify 12 studies that compared MSM with a history of CSA to MSM without a history of CSA on HIV risk indicators including HIV serostatus, sexually transmitted infections (STIs), sexual behaviors, and illicit drug use. Overall, 27.3% (n = 4,263) of the MSM in all included studies (n = 15,622) reported a CSA history. Across the studies that used probabilistic sampling (n = 8,240), the estimated prevalence of CSA was 21.8% (n = 1,800). Meta-analysis indicated that MSM with CSA history were more likely to be HIV positive [odds ratio (OR) = 1.54; 95% confidence interval (CI) = 1.22-1.95)] and to
This chapter reviews empirical research on risk-factors for adolescent onset of substance use and misuse, with a particular focus on a recent body of literature aimed at understanding the link between early onset substance use, neuropsychological impairment and future addiction risk. The evidence suggests a causal pathway with some studies showing that adolescents might be more sensitive to the neurotoxic effects of substances, which contributes to their heightened addiction vulnerability. While questions remain pertaining to the extent to which cognitive precursors to early onset substance use account for these impairments, the evidence from a few studies suggests that early substance misuse produces some cognitive or emotional processing impairment beyond these premorbid deficits. The possible interaction between premorbid deficits and the effects of substance use on cognitive development might also explain why early onset substance use so rapidly spirals into substanceabuse and
In this 15-year longitudinal study the authors investigated individual and contextual factors that predispose adolescents from a disadvantaged urban area to drug dependence in adulthood. Adolescents were recruited from schools serving East Harlem in New York City. Of the 838 participants followed to adulthood, 59% were women, 55% were African American, and 45% were Puerto Rican. Self-report data were obtained on externalizing and internalizing problems, substance use, and contextual influences across adolescence and young adulthood. Drug dependence was assessed in adulthood. Multivariate logistic regressions of drug dependence were performed on the whole sample and separately by gender. Each of the domains was associated with adult drug dependence. Although mean gender differences were found, most associations of risk factors with drug dependence did not vary significantly by gender. Treating externalizing and internalizing problems, reducing substance use, and providing coping skills
Increases in multimorbidity and obesity have been noted in HIV-infected populations in the current treatment era. Patterns of multimorbid disease clustering and the impact of obesity on multimorbidity are understudied in this population.|We examined obesity and multimorbidity patterns among 1844 HIV-infected patients in the UAB 1917 Clinic. Exploratory factor analysis was used to identify the underlying factor structure responsible for clustering. Patterns among the resulting morbidity factors by body mass index (BMI) category were explored. Multivariable logistic regression models were fit to identify predictors of multimorbidity cluster patterns.|The prevalence of multimorbidity was 65% (1205/1844). Prevalence increased with progressive BMI categories from underweight (64%) to obese (79%). Three multimorbidity clusters were identified: "metabolic," including hypertension, gout, diabetes mellitus, and chronic kidney disease (range, 0.41-0.84; P < 0.001); "Behavioral," including mood
To review published studies that use an authentic community-based participatory research (CBPR) approach in child health to highlight the benefits, barriers, and scope of this approach with pediatric populations.|Studies using CBPR in child health were identified using PubMed, Scopus, and Web of Science through MeSH heading and keyword searches. Keywords included "community-based participatory research" and "child," "youth," and "adolescent." Literature reviews and community-placed articles were excluded.|A total of 34 CBPR studies focused on child health were identified and analyzed for this review. The most common child health issue in these studies was obesity/diabetes. Other child health topics included health needs assessments, reproductive health, female health, HIV treatment, physical activity, mental health, maternal/child health, substanceabuse, asthma, and youth with disabilities/special healthcare needs. IMPLICATIONS/CONCLUSION: CBPR offers a unique approach for
For over 100 years, nurses' particular work conditions have been anecdotally associated with increases in substanceabuse. Reasons include job-related stress and easy access to medications. Current research has suggested that prevalence of nurses with substance use problems is actually similar to, if not less than, that seen in the general population. However, given nurses' proximity to critical patient care, the potential threat to public health, as well as the current shortage of practitioners and problems related to retention, the lack of research on the effectiveness of the two existing treatment protocols (disciplinary and alternative-to-discipline [ATD]) is a pressing issue of concern to the nursing profession.|The aims of this study were to estimate the 1-year prevalence of employed nurses requiring an intervention for substance use problems in the United States and the 1-year prevalence of nurses enrolled in substanceabuse monitoring programs and to compare the sum total of
Reviews the evidence for and against hundreds of preventive health services, recommending tests, and counseling interventions when evidence exists that it is effective.
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.
