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Blanco V, Tajes Alonso M, Peleteiro Pensado LF, Naveira Barbeito G, Núñez Arias D, Torres ÁJ, Arrojo M, Páramo M, Otero P, Vázquez FL. Epidemiological characteristics and hospitalization trajectories prior to suicide in Galicia between 2013 and 2016. Span J Psychiatry Ment Health 2023; 16:76-84. [PMID: 38591720 DOI: 10.1016/j.rpsm.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/20/2021] [Accepted: 11/07/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Addressing suicide requires an understanding of regional patterns of epidemiology, with health variables being central. However, the clinical profile of people who commit suicide has received little attention. The objectives of this study were to analyze the sociodemographic, clinical, and forensic characteristics of persons who committed suicide in Galicia between 2013 and 2016, analyze suicide mortality rates, and identify trajectories of hospitalizations and associated variables. MATERIAL AND METHODS A population study was carried out on the 1354 people who died by suicide in Galicia. RESULTS The most common profile was a retired man, 57.9 years old (SD=18.5), from an urban and inner area. 43.6% had been previously hospitalized, 41.6% had been diagnosed with physical disorders, and 26.8% with mental disorders. 48.2% had been prescribed psychiatric medications and 29.6% had received outpatient psychiatric care. The highest prevalence of death by suicide (27.5%) was in 2014, with the predominant method being hanging (59.1%). The average raw rate was 12.3/100,000. Three trajectories of hospitalizations emerged: 94.83% had experienced few hospitalizations; 2.95% an increasing pattern; and 2.22% a decreasing pattern. These trajectories were associated with number of psychiatric appointments, prescription of psychiatric medications, and diagnoses of physical and mental disorders. CONCLUSIONS These findings are crucial for detection and prevention.
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Affiliation(s)
- Vanessa Blanco
- Department of Evolutionary and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | | | | | | | | | - Ángela J Torres
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mario Páramo
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Patricia Otero
- Department of Psychology, University of A Coruña, A Coruña, Spain
| | - Fernando L Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
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Hage B, Watson E, Shenai N, Osborne L, Hutner L, Waltner-Toews R, Gopalan P. A Peer-to-Peer, Longitudinal Reproductive Psychiatry Educational Curriculum for Obstetrics/Gynecology Residents. Acad Psychiatry 2023; 47:43-47. [PMID: 36127485 DOI: 10.1007/s40596-022-01710-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Pregnant patients with psychiatric diagnoses are commonly advised to stop their psychiatric medications. Few studies assess the knowledge of, attitude toward, or comfort levels of obstetrics and gynecology (OB/GYN) residents in managing psychiatric conditions, which carry adverse and potentially life-threatening risks to mother and fetus. A gap remains between evidence advocating for active psychopharmacological treatment during pregnancy and implementation of curricula targeting OB/GYN physicians in mental health. The authors' goals are to assess the knowledge, attitude, and comfort that OB/GYN residents have toward assessing and managing active psychiatric conditions in pregnant/postpartum women and to develop an educational, case-based intervention targeting these conditions in the perinatal/postpartum period. METHODS Eight perinatal/postpartum psychiatric topics were developed into interactive cases designed for OB/GYN residents. Two weeks before the curriculum administration, OB/GYN residents were surveyed on prior knowledge in, attitudes toward, and comfort levels in assessing and discussing psychiatric conditions in pregnant patients. The assessment was administered again after the intervention to assess its effectiveness. RESULTS Pre- (N = 19) and post-intervention (N = 15) surveys of residents were analyzed. Most residents (94%) felt it was both important and their responsibility to discuss mental health conditions with pregnant patients. Comfort levels with counseling psychiatric patients increased for all eight topics after the educational intervention was implemented, with statistically significant increases (p < 0.05) for five of the topics. CONCLUSIONS OB/GYN residents feel responsible for caring for pregnant patients with psychiatric illness, and case-based interventions offer an interactive, helpful tool for increasing residents' knowledge and comfort level in treating this patient population.
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Affiliation(s)
- Brandon Hage
- University of Pittsburgh Medical Center, Western Psychiatric Hospital, Pittsburgh, PA, USA.
| | - Elyse Watson
- University of Pittsburgh Medical Center, Western Psychiatric Hospital, Pittsburgh, PA, USA
| | - Neeta Shenai
- University of Pittsburgh Medical Center, Western Psychiatric Hospital, Pittsburgh, PA, USA
| | - Lauren Osborne
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Priya Gopalan
- University of Pittsburgh Medical Center, Western Psychiatric Hospital, Pittsburgh, PA, USA
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Chua JL. Medication by Proxy: The Devolution of Psychiatric Power and Shared Accountability to Psychopharmaceutical Use Among Soldiers in America's Post-9/11 Wars. Cult Med Psychiatry 2020; 44:565-85. [PMID: 32279155 DOI: 10.1007/s11013-020-09673-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
With the United States military stretched thin in the "global war on terror," military officials have embraced psychopharmaceuticals in the effort to enable more troops to remain "mission-capable." Within the intimate conditions in which deployed military personnel work and live, soldiers learn to read for signs of psychopharmaceutical use by others, and consequently, may become accountable to those on medication in new ways. On convoys and in the barracks, up in the observation post and out in the motor pool, the presence and perceived volatility of psychopharmaceuticals can enlist non-medical military personnel into the surveillance and monitoring of medicated peers, in sites far beyond the clinic. Drawing on fieldwork with Army personnel and veterans, this article explores collective and relational aspects of psychopharmaceutical use among soldiers deployed post-9/11 in Iraq and Afghanistan. I theorize this social landscape as a form of "medication by proxy," both to play on the fluidity of the locus of medication administration and effects within the military corporate body, and to emphasize the material and spatial ways that proximity to psychopharmaceuticals pulls soldiers into relationships of care, concern and risk management. Cases presented here reveal a devolution and dispersal of biomedical psychiatric power that complicates mainstream narratives of mental health stigma in the US military.
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Wachman EM, Warden AH, Thomas Z, Thomas-Lewis JA, Shrestha H, Nikita FNU, Shaw D, Saia K, Schiff DM. Impact of psychiatric medication co-exposure on Neonatal Abstinence Syndrome severity. Drug Alcohol Depend 2018; 192:45-50. [PMID: 30205307 DOI: 10.1016/j.drugalcdep.2018.07.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/11/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Among opioid-exposed infants, psychiatric medication co-exposure is common. Our objective was to compare Neonatal Abstinence Syndrome (NAS) outcomes based on individual psychiatric medication co-exposures. METHODS A retrospective study of 744 opioid-exposed mother-infant dyads from a single institution was performed. Mothers on pharmacotherapy with methadone or buprenorphine at delivery were included. Data were collected on maternal demographics, psychiatric medication use, and NAS outcomes, including any medication treatment, adjunctive medication treatment, length of hospital stay (LOS), and opioid treatment days. The extent to which individual psychiatric medication and polypharmacy exposure were associated with NAS outcomes was assessed using multivariable regression. RESULTS Fifty-four percent of the mothers were on ≥1 psychiatric medication, with 32% on ≥2 or psychiatric medications (polypharmacy group). In adjusted models, polypharmacy exposure was associated with longer LOS (β = 4.31 days, 95% CI 2.55-6.06) and opioid treatment days (β = 3.98 days, 95% CI 2.24-5.72) and more treatment with adjunctive medication for NAS (aOR = 2.49, 95% CI 1.57-3.95). Benzodiazepines were associated with longer LOS (β = 4.94, 95% CI 2.86-7.03) and opioid treatment days (β = 4.86, 95% CI 2.61-6.75), and more adjunctive medication treatment (aOR = 2.57, 95% CI 1.49-4.42). Gabapentin was associated with longer LOS (β = 2.79, 95% CI 0.54-5.03), more NAS medication treatment (aOR = 2.96, 95% CI 1.18-7.42) including more adjunctive medications (aOR = 1.92, 95% CI 1.05-3.53). CONCLUSION For infants of mothers with OUD who are also on concurrent psychiatric medications, polypharmacy was associated with worse NAS severity. When medically indicated, limiting use of multiple psychiatric medications, particularly benzodiazepines and gabapentin, during pregnancy should be considered to improve NAS outcomes.
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Affiliation(s)
- Elisha M Wachman
- Department of Pediatrics, Boston Medical Center, 771 Albany Street, Boston, MA, 02118, USA.
| | - A Hutcheson Warden
- Department of Obstetrics and Gynecology, Boston Medical Center, 771 Albany Street, Boston, MA, 02118, USA.
| | - Zoe Thomas
- University of Massachusetts, 300 Massachusetts Ave, Amherst, MA, 01003, USA.
| | - Jo Ann Thomas-Lewis
- Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA.
| | - Hira Shrestha
- Department of Pediatrics, Boston Medical Center, 771 Albany Street, Boston, MA, 02118, USA.
| | - F N U Nikita
- Boston University School of Public Health, 715 Albany Street, Boston, MA, 021178, USA.
| | - Daniel Shaw
- Department of Psychiatry, Boston Medical Center, 771 Albany Street, Boston, MA, 02118, USA.
| | - Kelley Saia
- Department of Obstetrics and Gynecology, Boston Medical Center, 771 Albany Street, Boston, MA, 02118, USA.
| | - Davida M Schiff
- Division of General Academic Pediatrics, Mass General Hospital for Children, 55 Fruit Street, Boston, MA, 02114, USA.
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Peabody J, Acelajado MC, Robert T, Hild C, Schrecker J, Paculdo D, Tran M, Jeter E. Drug-Drug Interaction Assessment and Identification in the Primary Care Setting. J Clin Med Res 2018; 10:806-814. [PMID: 30344815 PMCID: PMC6188027 DOI: 10.14740/jocmr3557w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/31/2018] [Indexed: 11/11/2022] Open
Abstract
Background Drug-drug interactions (DDIs) are ubiquitous, harmful and a leading cause of morbidity and mortality. With an aging population, growth in polypharmacy, widespread use of supplements, and the rising opioid abuse epidemic, primary care physicians (PCPs) are increasingly challenged with identifying and preventing DDIs. We set out to evaluate current clinical practices related to identifying and treating DDIs and to determine if opportunities to increase prevention of DDIs and their adverse events could be identified. Methods In a nationally representative sample of 330 board-certified family and internal medicine practitioners, we evaluated whether PCPs assessed DDIs in the care they provided for three simulated patients. The patients were taking common prescription medications (e.g. opioids and psychiatric medications) along with other common ingestants (e.g. supplements and food) and presented with symptoms of DDIs. Physicians were scored on their ability to inquire about the patient's medications, investigate possible DDIs, evaluate the patient, and provide treatment recommendations. We scored the physicians' care recommendations against evidence-based criteria, including overall care quality and treatment for DDIs. Results Average overall quality of care score was 50.5% ± 12.0%. Despite >99% self-reported use of medication reconciliation practices and tools, physicians identified DDIs in only 15.3% of patients, with 15.5% ± 20.3% of DDI-specific treatment by the physicians. Conclusions PCPs in this study did not recognize or adequately treat DDIs. Better methods are needed to screen for DDIs in the primary care setting.
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Affiliation(s)
- John Peabody
- University of California, San Francisco, CA, USA.,University of California, Los Angeles, CA, USA.,QURE Healthcare, San Francisco, CA, USA
| | | | - Tim Robert
- Aegis Sciences Corporation, Nashville, TN, USA
| | - Cheryl Hild
- Aegis Sciences Corporation, Nashville, TN, USA
| | | | | | - Mary Tran
- QURE Healthcare, San Francisco, CA, USA
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Abstract
Adverse effects are common, bothersome, and a leading cause of discontinuation of treatment. The methodology for evaluating adverse effects of medications has been greatly neglected, however, especially in comparison to the methodology for assessment of efficacy of medications. Existing methods for assessment and reporting of adverse effects have important limitations leading to lack of much-needed data related to adverse effects. Lastly, there is little systematic research into management of most adverse effects. A series of recommendations are made in this article about how to improve identification, assessment, reporting, and management of adverse effects.
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Choudhury S, McKinney KA, Kirmayer LJ. "Learning how to deal with feelings differently": Psychotropic medications as vehicles of socialization in adolescence. Soc Sci Med 2015; 143:311-9. [PMID: 25779773 DOI: 10.1016/j.socscimed.2015.02.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Drawing from ethnographic research among clinicians working with adolescents at a hospital psychiatric emergency department and outpatient clinic, and with interviews with adolescent psychiatric patients and their parents, we examine how psychiatric medicines function as socializing agents. Although psychiatric medications are thought to exert their main effects through direct biological action on neural circuitry, in fact, their use mobilizes specific kinds of moral discourse and social positioning that may have profound effects on sense of self, personhood, and psychological development. Specifically, our data reveal how clinical discourse around medications aims to enlist adolescents in becoming responsible, emotionally intelligent selves through learning to manage their medications. Among doctors, adolescents and their families, talk about psychiatric medications intertwines narratives of 'growing up' and 'getting well'. Our analysis of case studies from the clinic thus demonstrates that while psychiatric medications are explicitly designed to influence behavior by acting directly on the brain, they also act to structure adolescents' selves and social worlds through indirect, rather than direct causal pathways to the brain.
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Affiliation(s)
- Suparna Choudhury
- Division of Social and Transcultural Psychiatry, McGill University, 1033 Pine Avenue West, H3A 1A1 Montreal, QC, Canada; Culture and Mental Health Research Unit, Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste Catherine Rd., Montreal, H3T 1E4 QC, Canada.
| | - Kelly A McKinney
- Department of Humanities, Philosophy and Religion, John Abbott College, 21275 Lakeshore Road, Sainte-Anne-de-Bellevue, H9X 3L9 QC, Canada
| | - Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, 1033 Pine Avenue West, H3A 1A1 Montreal, QC, Canada; Culture and Mental Health Research Unit, Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste Catherine Rd., Montreal, H3T 1E4 QC, Canada
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