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Cho NY, Vadlakonda A, Mallick S, Curry J, Sakowitz S, Tran Z, Benharash P. Discharge against medical advice in trauma patients: Trends, risk factors, and implications for health care management strategies. Surgery 2024; 176:942-948. [PMID: 38971696 DOI: 10.1016/j.surg.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/28/2024] [Accepted: 06/03/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE Given the nonelective nature of most trauma admissions, patients who experience trauma are at a particular risk of discharge against medical advice. Despite the risk of unplanned readmission and financial burden on the health care system, discharge against medical advice among hospitalized patients continues to rise. The present study aimed to assess evolving trends and outcomes associated in patients with discharge against medical advice among patients hospitalized for traumatic injury. METHODS The 2016-2020 Nationwide Readmissions Database was queried to identify all hospitalizations for traumatic injuries. The patient cohort was stratified into those who had discharge against medical advice and those who did not. Temporal trends of discharge against medical advice and associated costs over time were evaluated using nonparametric tests. Multivariable regression models were developed to assess factors associated with discharge against medical advice. Associations of discharge against medical advice with length of stay, hospitalization costs, and unplanned 30-day readmission were subsequently evaluated. RESULTS Of an estimated 4,969,717 patients, 65,354 (1.3%) had discharge against medical advice after hospitalization for traumatic injury. Over the study period, the incidence of discharge against medical advice increased (nptrend <0.001). After risk adjustment, older age (adjusted odds ratio, 0.98/per year; 95% confidence interval, 0.97-0.98), female sex (adjusted odds ratio, 0.65; 95% confidence interval, 0.64-0.67), and management at high-volume trauma center (adjusted odds ratio, 0.71; 95% confidence interval, 0.69-0.74) were associated with lower odds of discharge against medical advice. Compared with others, discharge against medical advice was associated with decrements in length of stay by 1.3 days (95% confidence interval, 1.1-1.5 days) and index hospitalization costs by $2,200 (5% confidence interval, $1,600-2,900), while having a greater risk of unplanned 30-day readmission (adjusted odds ratio, 2.21; 95% confidence interval, 2.06-2.36). CONCLUSION The incidence of discharge against medical advice and its associated cost burden have increased in recent years. Community-level interventions and institutional efforts to mitigate discharge against medical advice may improve the quality of care and resource allocation for patients with traumatic injuries.
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Affiliation(s)
- Nam Yong Cho
- Department of Surgery, University of California, Los Angeles, CA. https://twitter.com/NamYong_Cho
| | | | - Saad Mallick
- Department of Surgery, University of California, Los Angeles, CA
| | - Joanna Curry
- Department of Surgery, University of California, Los Angeles, CA
| | - Sara Sakowitz
- Department of Surgery, University of California, Los Angeles, CA
| | - Zachary Tran
- Department of Surgery, Loma Linda University Health, CA. https://twitter.com/DrZacharyTran
| | - Peyman Benharash
- Department of Surgery, University of California, Los Angeles, CA.
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Na PJ, Deak JD, Kranzler HR, Pietrzak RH, Gelernter J. Genetic and non-genetic predictors of risk for opioid dependence. Psychol Med 2024; 54:1779-1786. [PMID: 38317430 PMCID: PMC11132928 DOI: 10.1017/s0033291723003732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Elucidation of the interaction of biological and psychosocial/environmental factors on opioid dependence (OD) risk can inform our understanding of the etiology of OD. We examined the role of psychosocial/environmental factors in moderating polygenic risk for opioid use disorder (OUD). METHODS Data from 1958 European ancestry adults who participated in the Yale-Penn 3 study were analyzed. Polygenic risk scores (PRS) were based on a large-scale multi-trait analysis of genome-wide association studies (MTAG) of OUD. RESULTS A total of 420 (21.1%) individuals had a lifetime diagnosis of OD. OUD PRS were positively associated with OD (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.21-1.66). Household income and education were the strongest correlates of OD. Among individuals with higher OUD PRS, those with higher education level had lower odds of OD (OR 0.92, 95% CI 0.85-0.98); and those with posttraumatic stress disorder (PTSD) were more likely to have OD relative to those without PTSD (OR 1.56, 95% CI 1.04-2.35). CONCLUSIONS Results suggest an interplay between genetics and psychosocial environment in contributing to OD risk. While PRS alone do not yet have useful clinical predictive utility, psychosocial factors may help enhance prediction. These findings could inform more targeted clinical and policy interventions to help address this public health crisis.
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Affiliation(s)
- Peter J. Na
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Joseph D. Deak
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Henry R. Kranzler
- Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Joel Gelernter
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Dissociative experiences of compartmentalization are associated with food addiction symptoms: results from a cross-sectional report. Eat Weight Disord 2023; 28:28. [PMID: 36867281 PMCID: PMC9984353 DOI: 10.1007/s40519-023-01555-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/04/2022] [Indexed: 03/04/2023] Open
Abstract
PURPOSE Studies have shown significant associations of dissociative symptoms with both eating and addictive disorders; however, the different forms of dissociation have been relatively understudied in relation to food addiction (FA). The main aim of this study was to investigate the association of certain forms of dissociative experiences (i.e., absorption, detachment and compartmentalization) with FA symptoms in a nonclinical sample. METHODS Participants (N = 755; 543 women; age range: 18-65; mean age: 28.22 ± 9.99 years) were evaluated using self-report measures of FA, dissociation, eating disturbances, and general psychopathology. RESULTS Compartmentalization experiences (defined as pathological over-segregation of higher mental functions) were independently associated with FA symptoms (β = 0.174; p = 0.013; CI = [0.008; 0.064]) even when confounding factors were controlled for. CONCLUSION This finding suggests that compartmentalization symptoms can have a role in the conceptualization of FA, with such two phenomena possibly sharing common pathogenic processes. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Emotion Regulation Strategies as Risk Factors for Developmental Psychopathology: a Meta-analytic Review of Longitudinal Studies based on Cross-lagged Correlations and Panel Models. Res Child Adolesc Psychopathol 2023; 51:295-315. [PMID: 36208360 DOI: 10.1007/s10802-022-00980-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 02/09/2023]
Abstract
Cross-sectional relationships between emotion regulation strategies (ERSs) and several psychopathological conditions among children and adolescents have been well-demonstrated. However, the longitudinal associations of ERSs on psychopathological manifestations during development remain unclear, especially considering their reciprocal influences over time. This meta-analytic review was based on a set of ERSs referring to a comprehensive evidence-based model of ER processes. Three hundred thirty-five studies were screened. The meta-analytic procedures were based on 60 studies (N = 20, 191; age: M [SD] = 10.27 [4.36]; years of follow-up: M [SD] = 2.23 [2.76]), which primarily assessed prospective associations between ERt1 and internalizing/externalizing psychopathology (PSY)t2. The cross-lagged correlations among these variables were also considered. Results showed: i) a small prospective association between ERt1 and PSY t2, which was independent of age and length of follow-up period. Adaptive and maladaptive domains of ER were significant moderators. Deficits in adaptive ER seemed more associated to externalizing PSY, whereas maladaptive ER was more associated to internalizing PSY; ii) cross-lagged correlations were comparable with ERt1 - PSY t2 associations. Nevertheless, the detrimental effects of PSY t1 on levels of adaptive ERt2 were larger than the protective effects of adaptive ERt1 on PSYt2. iii) When the other cross-lagged correlations were controlled for, the meta-analytic cross-lagged panel model demonstrated that maladaptive ERt1 was a significant predictor of PSYt2. ER processes should be considered transdiagnostic risk factors for psychopathology during development. Homotypic and heterotypic continuity of psychopathological conditions might reflect the stability or dynamic organization of adaptive and maladaptive ERSs over time.
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Schimmenti A, Billieux J, Santoro G, Casale S, Starcevic V. A trauma model of substance use: Elaboration and preliminary validation. Addict Behav 2022; 134:107431. [PMID: 35905595 DOI: 10.1016/j.addbeh.2022.107431] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/14/2022] [Accepted: 07/14/2022] [Indexed: 11/01/2022]
Abstract
The current study expands on and integrates previous theoretical models concerning the pathways that link child maltreatment to substance use disorder. The proposed model, based on the self-medication hypothesis, suggests that experiences of neglect and abuse during childhood can lead to substance use and abuse both directly and indirectly, via dissociation resulting from failed attempts to integrate experiences of maltreatment in childhood. The model was tested on ten substances (painkillers, stimulants, sedatives, marijuana, cocaine, ecstasy, hallucinogens, heroin, inhalants, and methamphetamine) via structural equation modeling (SEM) in a sample comprising 1040 community-dwelling adults (67 % women) aged between 18 and 78 (M = 29.55, SD = 11.37). Fit indexes of the SEM were good, thus supporting the hypothesized model. Specific forms of child maltreatment were related to increased use of specific substances; however, experience of childhood neglect (both physical and emotional) was found to have a central role in predicting use of most substances. Although no single pathway can fully explain the origins of substance abuse, the current study provides evidence of a critical developmental pathway to it, with implications for theory and clinical practice.
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Affiliation(s)
- Adriano Schimmenti
- Faculty of Human and Social Sciences, UKE - Kore University of Enna, Cittadella Universitaria, 94100 Enna, Italy.
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Géopolis CH-1015, Lausanne, Switzerland; Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), CH-1011 Lausanne, Switzerland.
| | - Gianluca Santoro
- Faculty of Human and Social Sciences, UKE - Kore University of Enna, Cittadella Universitaria, 94100 Enna, Italy.
| | - Silvia Casale
- Department of Health Sciences, Psychology Unit, University of Florence, Via di San Salvi12, 50135 Florence, Italy.
| | - Vladan Starcevic
- University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, PO Box 63, Penrith, NSW 2751, Australia.
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Ullrich D, Mac Gillavry DW. Mini-review: A possible role for galanin in post-traumatic stress disorder. Neurosci Lett 2021; 756:135980. [PMID: 34023414 DOI: 10.1016/j.neulet.2021.135980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/02/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
Several neuroendocrine systems have been implicated in post-traumatic stress disorder, including the mesocortical and mesolimbic dopamine, the norepinephrine, the β-endorphin, the serotonin, and the oxytocin systems. The interaction between these different systems remains, however, largely unknown and a generally accepted unifying theory is thus far lacking. In this review, we suggest that galanergic suppression of dopaminergic neurons in the ventral tegmental may constitute the missing link in a post-traumatic feedback loop. In addition, we address the literature on the negative cross-antagonism in this brain region between the galanin 1 and μ-opioid receptors, which suggests that behavioural patterns which stimulate β-endorphin, a natural μ-opioid receptors ligand, secretion may provide novel avenues for the treatment and prevention of PTSD, as well as for recruitment, training, and leadership processes in high-stress/high-risk professions such as the military, first responders and the police.
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Affiliation(s)
- David Ullrich
- Department of Military Leadership, University of Defence, Brno, Czech Republic
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Gainer DM, Crawford TN, Fischer KB, Wright MD. The relationship between dissociative symptoms and the medications used in the treatment of opioid use disorder. J Subst Abuse Treat 2020; 121:108195. [PMID: 33357605 DOI: 10.1016/j.jsat.2020.108195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/11/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022]
Abstract
Opioid use disorder has long been associated with psychiatric symptoms, including dissociative experiences. Medications used to treat opioid use disorder can potentially impact dissociative symptoms, but the existing literature has not explored this. We examined the relationship between dissociative symptoms and opioid use disorder using the Dissociative Experiences Scale (DES). We studied subjects who were taking prescribed methadone, buprenorphine, or naltrexone for opioid use disorder. We gave the DES, the Patient Health Questionairre-9 (PHQ-9), and the PTSD Checklist for DSM-5 (PCL-5) with Criterion A to subjects in three substance use treatment facilities in Ohio. We conducted Analysis of Variance (ANOVA) and Spearman's Rank Correlations to examine associations between the variables and outcomes. We developed three separate multiple linear regression models. We included 116 participants in our exploratory and naturalistic study. The majority of participants were female (51.7%), white (89.5%), ≤ 40 years of age (64.7%), and taking buprenorphine (55%). The average DES score was 16.1 (standard deviation = 14.9) and we considered 80.9% to have low dissociation (score < 30). Approximately 55% (n = 64) of participants were taking prescribed buprenorphine. Approximately 27% (n = 32) were taking prescribed methadone and approximately 18% (n = 21) were taking prescribed naltrexone (oral or extended release). There was a significant association between opioid medication type and log dissociative symptoms (p = .01). Participants taking prescribed buprenorphine had higher mean log dissociation symptom scores (2.7) compared to those taking prescribed methadone (2.2) and prescribed naltrexone (2.1). Log dissociation symptom scores were significantly associated with last use of any opiates (rs = -0.21; p = .02) and time on medication (rs = -0.228; p = .01). Compared to those taking buprenorphine, those taking both methadone (β = -0.26; p = .01) and naltrexone (β = -0.27; p = .006) had significantly lower dissociation scores, controlling for the other variables in the model. Dissociation scores were positively correlated with depression scores (r = 0.45; p < .0001) and with PCL-5 scores (r = 0.51; p < .0001). Our study highlights the importance of diagnosing and monitoring dissociative symptoms in individuals who are taking prescribed medications for opioid use disorder, especially since dissociative symptoms can interfere with substance use treatment.
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Affiliation(s)
- Danielle M Gainer
- Wright State University Boonshoft School of Medicine, 2555 University Blvd., Suite 100, Fairborn, OH 45324, United States of America.
| | - Timothy N Crawford
- Wright State University Boonshoft School of Medicine, 2555 University Blvd., Suite 100, Fairborn, OH 45324, United States of America
| | - Karley B Fischer
- Wright State University Boonshoft School of Medicine, 2555 University Blvd., Suite 100, Fairborn, OH 45324, United States of America
| | - Mark D Wright
- Wright State University Boonshoft School of Medicine, 2555 University Blvd., Suite 100, Fairborn, OH 45324, United States of America
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Hamilton I. Role of non-specialist nurses in supporting people who misuse drugs. Nurs Stand 2020; 35:61-66. [PMID: 32323931 DOI: 10.7748/ns.2020.e11522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2020] [Indexed: 06/11/2023]
Abstract
In their practice, nurses are likely to encounter people who misuse drugs, but they may find it daunting to support these patients. While specialist drug treatment services have an important role in providing substitution treatment and talking therapies, referral is not always appropriate for some patients. Non-specialist nurses are well placed to use techniques such as brief interventions and motivational interviewing to engage patients in discussions about their drug misuse and prompt them to consider how they could reduce it. This article defines drug misuse, describes the contributing factors that can lead to it and its associated health issues. It also discusses how non-specialist nurses can manage and provide optimal support for patients who misuse drugs.
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