Figures from the US Department of Justice indicate that more than half of prison and jail inmates have a mental health problem. Mental health courts (MHCs) were designed to divert mentally ill persons convicted of nonviolent crimes to supervised treatment instead of incarceration, but while the number of MHCs has grown substantially over the past decade, limited information has been available about outcomes and costs.
Numerous studies have documented the increasing prevalence of mental health and substance abuse issues in youths nationwide. As many as 1 in 5 children and adolescents in the United States have a behavioral or emotional disorder.
This article examines the risks involved in prescribing psychotropic medication and offers suggestions for managing those risks to ensure the best possibility for a favorable outcome.
Hypertonicity in plantar flexion is a frequent complication of traumatic brain injury (TBI), which affects more than 1.5 million persons in the United States.
Although there are many treatments and interventions available for drug abuse and dependence, few persons with substance use disorders actually use them, a new survey reports. The National Epidemiologic Survey on Alcohol and Related Conditions, conducted by scientists from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, was published in the May 2007 issue of the Archives of General Psychiatry. The survey used face-to-face interviews with over 43,000 US adults aged 18 years or older.
Patients with severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are more likely to have experienced trauma in childhood, adolescence, and throughout their adult lives than the general population. This high exposure to traumatic events such as physical and sexual abuse and assault takes a heavy toll.
Traumatic experiences are linked with a continuum of mental disorders and physical complaints. In the United States, posttraumatic stress disorder (PTSD) occurs in approximately 8% of adults during their lifetime, with different trauma types associated with varying rates of illness. PTSD is commonly associated with comorbid mental conditions such as depressive disorders, other anxiety disorders, impulse control disorders, and alcohol abuse.
The traumatic events surrounding the recent school shootings at Virginia Tech remind us that a disturbing aspect of our current culture is the rate at which America's youth are exposed to violence. Whether it is graphic episodes of violence on television, violent music, aggressive video games, hearing about or witnessing violence in the home or neighborhood, or being the direct victim of violence--violence is a pervasive part of society that disproportionately affects youth.
Rape is a crime that is defined as an unwanted sexual act that results in oral, vaginal, or anal penetration. Generally speaking, there are 2 major types of rape. Forcible rape involves unwanted sexual penetration obtained by the use of force or threat of force. Drug- or alcohol-facilitated rape occurs when the victim is passed out or highly intoxicated because of voluntary or involuntary consumption of alcohol or drugs. Rape can happen to boys and men as well as to girls and women but this article will focus primarily on women.
Methamphetamine (MA) abuse is not a new problem in the United States, but the current epidemic is more widespread and presents with more pernicious consequences than in the past. MA, frequently called "speed," "crystal," "crank," "ice," or "tina," is a potent psychostimulant that can be swallowed in pill form or administered via intranasal, intravenous, or smoking route.
Up Against the Wall
Grand mal convulsive seizures are characterized by the sudden loss of consciousness and motor inhibition, followed by tonic flexion and extension, repetitive clonic movements, and motor relaxation and lassitude. Seizures are elicited in all vertebrates that have been tested. The loss of both vigilance and the defenses of fight or flight incur life-threatening risks to the individual. In evolutionary history, we would expect this behavior to be extinguished. Its persistence prompts the query: What are the benefits of seizures?
Dr Penelope Ziegler's article was correct in the assertion that treating pain in a patient with a substance use disorder can be very difficult and requires consideration of multiple factors ("Safe Treatment of Pain in the Patient With a Substance Use Disorder," Psychiatric Times, January 2007, page 32); however, I believe several topics discussed require further clarification.
Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after severe psychological stress, eg, assault, combat, natural disasters, terrorism, or other stressors.
Four physicians work on the same patient for days at a time, continually returning to a white board, where they list the patient's changing symptoms and their own differential diagnoses. They think inside and outside the box. As data come in from tests and as interventions succeed or fail, they remain flexible in their way of thinking. The attending physician's main lesson to his 3 fellows is to remain unencumbered by preconceived notions and to constantly revise their thinking to fit the data. Only then, he tells his trainees, is there any chance of a correct diagnosis and medical treatment.
Delirium is characterized by an altered level of consciousness, decreased attention span, acute onset, and fluctuating course. Approximately 15% of elderly patients admitted to the hospital have delirium as a presenting or associated symptom. Delirium will develop in another 15% of elderly patients during hospitalization.
Diabetic polyneuropathy (DPN) has a major impact on quality of life and can contribute to significant morbidity and mortality. In the United Kingdom, the prevalence of distal symmetrical polyneuropathy, as seen in specialty care, is about 28.5%, and prevalence increases with age.
Successfully weaving together the long and complex history of melancholic depression as a severe mood disorder with strong biological underpinnings and a distinctive clinical profile.
The highly readable and informativesecond edition of Substance Use Disorders,by Stuart Gitlow, is a valuablehandbook for treatment providers ofall specialties.
Medical school graduation usually involves taking the Hippocratic oath, in which physicians vow not to intentionally harm their patients. Keeping patients safe is another basic principle of patient care. Physicians are charged with ensuring that their patients are in a safe environment and minimizing risks to their patients by carefully selecting treatment options.
The points made by Dr G. Scott Waterman in his article, "Does the Biopsychosocial Model Help or Hinder Our Efforts to Understand and Teach Psychiatry?" are right on target. Unfortunately, the biopsychosocial model of psychiatry is not merely conceptual; it is woven into the delivery of care at every level. Institutions of government, insurance, and hospital and outpatient services separate "behavioral" medicine from all other medicine and further separate substance abuse disorders from those deemed "psychiatric."
Proper suicide assessment is probably the most important part of a clinician's job; appropriately, heavy emphasis is placed on this in our education. Unfortunately, psychiatrists receive comparatively little practical guidance in documenting the history and physical examination (H&P) of a suicidal patient.
In patients with dementia who are physically aggressive and dangerous to themselves or others, the use of intramuscular haloperidol or lorazepam may be appropriate. Because haloperidol causes less drowsiness and cognitive impairment than lorazepam, it is preferred in patients with dementia and delirium. The usual dose of haloperidol for elderly patients with dementia is 0.5 to 1 mg; this dose can be repeated every 25 to 30 minutes until the patient is no longer dangerous to self or others. If benzodiazepine or alcohol withdrawal is suspected, lorazepam is the preferred medication. Physical restraints may be appropriate until the medication takes effect.
González-Pinto A, Aldama A, González C, et al. Predictors of suicide in first-episode affective and nonaffective psychotic inpatients: five-year follow-up of patients from a catchment area in Vitoria, Spain. J Clin Psychiatry. 2007;68:242-247.
In the first part of this column (Psychiatric Times, February 2007), I reviewed treatments whose beneficial effects are probably achieved through a discrete biological or pharmacological mechanism of action. These included dietary modifications; supplementation with specific vitamins, minerals, and amino acids; and medicinal herbs. In this part, I will review the evidence for approaches that reduce the risk of relapse, diminish craving, or mitigate withdrawal symptoms but for which there is no evidence for direct biological or pharmacological effect.
