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

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

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