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substance related disorder [keywords]
- Housing First: exploring participants' early support needs. [Journal Article]
- BMC Health Serv Res 2014; 14(1):167.
Housing First has become a popular treatment model for homeless adults with mental illness, yet little is known about program participants' early experiences or trajectories. This study used a mixed methods design to examine participant changes in selected domains 6 months after enrolment in a Canadian field trial of Housing First.The study sample included 301 participants receiving the Housing First intervention at the Toronto site of the At Home/Chez Soi project. This study used a pre-post design to compare quantitative 6-month outcome data to baseline values in key domains and multivariate regression to identify baseline demographic, clinical or service use variables associated with observed changes in these domains. In addition, qualitative data exploring participant and service provider perspectives and experiences was collected via stakeholder interviews and focus groups, and analyzed using thematic analysis.The majority (60 to 72%) of participants followed the expected trajectory of improvement, with the remaining experiencing difficulties in community integration, mental health symptom severity, substance use, community functioning and quality of life 6 months after program enrolment. Diagnosis of psychotic disorder was associated with a reduction in quality of life from baseline to 6-months, while substance use disorders were associated with reduced mental illness symptoms and substance use related problems and an improvement in quality of life. Participants housed in independent housing at 6-months had greater improvements in community integration and quality of life, and greater reduction in mental illness symptoms, compared to those not independently housed. The quality of the working alliance was positively associated with improvements in physical and psychological community integration and quality of life. Qualitative data provided a unique window into the loneliness and isolation experienced by Housing First participants, as well as problems related to substance use and a need for life skills training and support.Additional strategies can help support Housing First participants in the early stages of program participation and address potential causes of early difficulties, including lack of life skills and social isolation. This study highlights the importance of early and ongoing evaluation, monitoring and program adaptations to address consumer support needs.Current Controlled Trials ISRCTN42520374.
- Prevalence of psychiatric disorders and related factors in male prisoners. [Journal Article]
- Iran Red Crescent Med J 2014 Jan; 16(1):e15205.
Prisoners are at risk of mental disorders. Therefore attention to mental health of prisoners is important.This study aimed determine to the prevalence of mental disorders among Kashan prisoners.This cross sectional study was carried out in Kashan prison (Iran). 180 Subjects were selected by using stratified random sampling and evaluated with Symptoms Check List-90-Revised (SCL-90-R) questionnaire and clinical interview based on Diagnostic Statistical Manual of Disease-IV (DSM-IV) check list by two psychiatrists. Data were analyzed by SPSS-16 software and Chi square, Kolmogrov Smirnov, Mann-whiteny and Leven tests.The mean age of prisoners was 31.9 ± 8.96. The prevalence of psychiatric disorders in prisoners was 43.4 %. The most frequent disorders were major depressive disorders (27.9 %), Post traumatic Stress Disorder (17.4%) and substance use disorder (17.4 %). 28.3% of prisoners had personality disorders, that the most prevalent were antisocial personality and borderline personality. The comorbidity of psychiatric disorders was (36 %) in axis I. Suicidal thoughts there were in 44.6 % of prisoners. History of head trauma in Prisoners with psychiatric disorders was (52.2 %). There was significant difference between head trauma and psychiatric disorders (P = 0.05). Significant difference was between marital status and duration of imprisonment with psychiatric disorders P < 0.05. There was not significant difference between type of crime and educational level with psychiatric disorders.About half of all prisoners suffered from psychiatric disorders; therefore treatment psychiatric disorder in this group is essential for prevention of crime. Prisoners are at risk of mental disorders. Therefore attention to mental health of prisoners is important.
- Attempted suicide in bipolar disorder: risk factors in a cohort of 6086 patients. [Journal Article]
- PLoS One 2014; 9(4):e94097.
Bipolar disorder is associated with high risk of self-harm and suicide. We wanted to investigate risk factors for attempted suicide in bipolar patients.This was a cohort study of 6086 bipolar patients (60% women) registered in the Swedish National Quality Register for Bipolar Disorder 2004-2011 and followed-up annually 2005-2012. Logistic regression was used to calculate adjusted odds ratios for fatal or non-fatal attempted suicide during follow-up.Recent affective episodes predicted attempted suicide during follow-up (men: odds ratio = 3.63, 95% CI = 1.76-7.51; women: odds ratio = 2.81, 95% CI = 1.78-4.44), as did previous suicide attempts (men: odds ratio = 3.93, 95% CI = 2.48-6.24; women: odds ratio = 4.24, 95% CI = 3.06-5.88) and recent psychiatric inpatient care (men: odds ratio = 3.57, 95% CI = 1.59-8,01; women: odds ratio = 2.68, 95% CI = 1.60-4.50). Further, those with many lifetime depressive episodes were more likely to attempt suicide. Comorbid substance use disorder was a predictor in men; many lifetime mixed episodes, early onset of mental disorder, personality disorder, and social problems related to the primary group were predictors in women.The principal clinical implication of the present study is to pay attention to the risk of suicidal behaviour in bipolar patients with depressive features and more severe or unstable forms of the disorder.
- Pregnancy, obstetric and perinatal health outcomes in eating disorders. [JOURNAL ARTICLE]
- Am J Obstet Gynecol 2014 Apr 3.
To study pregnancy, obstetric, and perinatal health outcomes and complications in women with lifetime eating disorders.Female patients (n=2 257) treated at the Eating Disorder Clinic of Helsinki University Central Hospital during 1995-2010 were compared with unexposed women retrieved from the population (n=9028). Register-based information on pregnancy, obstetric, and perinatal health outcomes and complications were acquired for all singleton births during the follow up time among women with broad anorexia nervosa (AN, n=302 births), broad bulimia nervosa (BN, n=724), binge eating disorder (BED, n=52), and unexposed women (n=6319).Women with AN and BN gave birth to babies with lower birth weight compared to unexposed women, while the opposite was observed in BED. Maternal AN was related to anemia, slow fetal growth, premature contractions, short duration of the first stage of labor, very premature birth, small for gestational age, low birth weight, and perinatal death. Increased odds of premature contractions, resuscitation of the neonate, and very low Apgar score at 1 min were observed in mothers with BN. BED was positively associated with maternal hypertension, long duration of the first and second stage of labor, and birth of large for gestational age infants.Eating disorders appear to be associated with several adverse perinatal outcomes, particularly in offspring. We recommend close monitoring of pregnant women with either past or current eating disorder. Attention should be paid to children born to these mothers.
- Improving European cooperation on medication errors. [Letter]
- Lancet 2014 Apr 5; 383(9924):1209-10.
- Pain in mental health setting and community: an exploration. [Journal Article]
- Indian J Psychol Med 2014 Jan; 36(1):98-100.
Pain is a commonly experienced complaint in the general population. It aims to determine the occurrence of pain complaints among the general population as well as the clinical group. The sample for the current study was drawn from the ongoing study on development of NIMHANS Screening tool for psychological problems. It includes males and females (119 males and 110 normal and 200 males and 100 clinical subjects) above age 18 years. Subjects were assessed on the question related to frequent experience of body ache and headache in the past one week in an individual setting. Data was analyzed using percentage scores. It indicate that 27% (16% in females and 11% in male) experience pain in the normal group, whereas in clinical categories, 14.5% of anxiety disorder (9.5% in females and 5% in males), 13.9% of depression (8.9% in females and 5% in males), 17.9% of obsessive compulsive disorder (OCD) (8.5% in females and 9.4% in males) and 13.9% of substance users reported pain in last seven days. It implies the need for sensitization among professionals and general population to identify pain complaints.
- Sex Differences in Animal Models of Psychiatric Disorders. [JOURNAL ARTICLE]
- Br J Pharmacol 2014 Apr 4.
Psychiatric disorders are characterized by sex differences in their prevalence, symptomatology and treatment response. Animal models have been widely employed for the investigation of the neurobiology of such disorders and the discovery of new treatments. However, mostly male animals have been used in preclinical pharmacological studies. In this review, we highlight the need for the inclusion of both males and females in experimental studies aiming at gender-oriented prevention, diagnosis and treatment of psychiatric disorders. We present behavioural findings on sex differences from animal models of depression, anxiety, post-traumatic stress disorder, substance related disorders, obsessive-compulsive disorder, schizophrenia, bipolar disorder, and autism. Moreover, when available, we include studies conducted across different stages of the estrous cycle. By inspection of the relevant literature, it is obvious that robust sex differences exist in models of all psychiatric disorders. However, many times results are conflicting and no clear conclusion regarding the direction of sex differences and the effect of the estrous cycle is drawn. Moreover, there is a lack of considerable amount of studies using psychiatric drugs in both males and females, in order to evaluate the differential response between the two sexes. Notably, while in most cases animal models successfully mimic drug response in both sexes, test parameters and treatment-sensitive behavioural indices are not always the same for male and female rodents. Thus, there is an increasing need to validate animal models for both sexes and use standard procedures across different laboratories.
- Prognosis for Emergency Physician with Substance Abuse Recovery: 5-year Outcome Study. [Journal Article]
- West J Emerg Med 2014 Feb; 15(1):20-5.
Introduction: Emergency physicians (EPs) are reported to have a higher rate of substance use disorder (SUD) than most specialties, although little is known about their prognosis. We examined the outcomes of emergency physician compared to other physicians in the treatment of substance use disorders in Physician Health Programs (PHP).
Methods:This study used the dataset from a 5-year, longitudinal, cohort study involving 904 physicians with diagnoses of SUD consecutively admitted to one of 16 state PHPs between 1995 and 2001. We compared 56 EPs to 724 other physicians. Main outcome variables were rates of relapse, successful completion of monitoring, and return to clinical practice.
Results:EPs had a higher than expected rate of SUD (odds ratio [OR] 2.7 confidence interval [CI]: 2.1-3.5, p<0.001). Half of each group (49% of EPs and 50% of the others) enrolled in a PHP due to alcohol-related problems. Over a third of each group (38% of EPs and 34% of the others) enrolled due to opioid use. During monitoring by the PHPs, 13% of EPs had at least one positive drug test compared to 22% of the other physicians; however, this difference was not significant (p=0.13). At the end of the 5-year follow-up period, 71% of EPs and 64% of other physicians had completed their contracts and were no longer required to be monitored (OR 1.4 [CI: 0.8-2.6], p = 0.31). The study found that the proportion of EPs (84%) continuing their medical practice was generally as high as that of other physicians (72%) (OR 2.0 [CI: 1.0-4.1], p = 0.06).
Conclusion:In the study EPs did very well in the PHPs with an 84% success rate in completion and return to clinical practice at 5 years. Of the 3 outcome variables measured, rates of relapse, successful completion of monitoring, and return to clinical practice, EPs had a high rate of success on all variables compared to the other physician cohort. These data support the conclusion that EM physicians do well following treatment of SUD with monitoring in PHPs and generally return to the practice of emergency medicine.
- Doctors criticise UN's approach to global drugs control. [News]
- Lancet 2014 Mar 29; 383(9923):1114.
- Fears over future of opioid substitution therapy in Crimea. [News]
- Lancet 2014 Mar 29; 383(9923):1113.