Psychiatry

The compositional skills are analyzed to determine whether college students have improved their writing ability after the two years additional in the senior high school curriculum. This study examines the errors committed by first-year engineering students. There were 90 student respondents written outputs collected and subjected to Grammarly software. The researchers analyzed the data using the Scheffe test, comparing the difference between clarity, engagement, and delivery. Analysis of variance (ANOVA) was employed to test whether there is a significant difference among other variables. Findings revealed that clarity is the most common error committed by the student-respondents. The errors committed between male and female respondents do not show a difference. The K-12 graduates' compositional errors do not differ significantly from that in the Alternative Learning System (ALS) passers or the old basic education curriculum graduates. It is in delivery that students vary. This finding implies that college students' compositional skills still need strengthening. Instructors are encouraged to provide comprehensive activities and writing exercises to both genders, regardless of their curriculum. It is recommended that university language instructors identify specific interventions to help students struggling with writing. Therefore, providing enough written opportunities and practices is vital to make college students enhance their compositional skills.

The two psychiatrists portrayed in the award-winning movie Silence of the Lambs-Dr. Hannibal Lector and his keeper, Dr. Chilton-represent two of the more prevalent caricatures of the profession: the evil wizard and the pretentious buffoon. As commonly as such stereotypes are applied to physicians, they are even more commonly applied to psychiatrists. They are conjured up perhaps most intensely in relation to those psychiatrists who sail the treacherous shoreline where psychiatry and the law meet: forensic psychiatry. This shoreline might be considered an endangered area, having survived repeated tidal waves of public sentiment to have it declared off-limits. The latest such tidal wave arose in the early 1980s, particularly in the aftermath of the verdict of "not guilty by reason of insanity" in the trial of John Hinckley, who nearly succeeded in assassinating President Ronald Reagan. Most politicians are lawyers. It is thus no surprise that lawyer/politicians often find it easier to attack psychiatrists than fellow attorneys, especially those who have become judges. As the distinguished jurist David Bazelon is said to have remarked, "The problem with forensic psychiatry in the courtroom is that the average attorney does not know how to consult the average forensic psychiatrist." Despite such barriers to open-minded consideration of forensic psychiatric testimony, the specialty of forensic psychiatry has continued to grow. Attorneys and judges who practice in the Bazelon tradition find the deep human understanding offered by psychiatrists indispensable to the administration of justice. This article explores what that understanding is, what it contributes to From the Program in Psychiatry and the Law,

Postoperative delirium (POD) is a prevalent clinical entity characterized by reversible fluctuating altered mental status and cognitive impairment with acute and rapid onset a few days after major surgery. Postoperative cognitive decline (POCD) is a more permanent extension of POD characterized by prolonged global cognitive impairment for several months to years after surgery and anesthesia. Both syndromes have been shown to increase morbidity and mortality in postoperative patients making their multiple risk factors targets for optimization. In particular, nutrition imparts a significant and potentially reversible risk factor. Malnutrition and frailty have been linked as risk factors and predictive indicators for POD and less so for POCD. This review aims to outline the association between nutrition and perioperative cognitive outcomes as well as potential interventions such as prehabilitation.

Zdravstvena mreža jugoistocne Europe (JIE) je institucionalni forum uspostavljen od Vlada Albanije, Bosne i Hercegovine, Bugarske, Crne Gore, Hrvatske, Makedonije, Moldavije, Rumunjske i Srbije usmjeren jacanju mira, suradnje i unaprjeđenja zdravlja u regiji. Naime 2001. godine u okviru Pakta o stabilnosti u JIE  Inicijativi za socijalnu koheziju dodana je komponenta zdravlja u svrhu povezivanja zemalja jugoistocne Europe na zajednickom rjesavanju zdravstvenih prioriteta. Zdravstvena mreža je nastala na temelju sporazuma ministara zdravlja utvrđenih u Dubrovnik Pledge  i Skopje Pledge,  potvrđenih na Ministarskim forumima 2001. i 2005. godine s ciljem razmjene informacija, znanja i iskustava te zajednickog djelovanja na podrucju unaprjeđenja zdravlja, a vezano uz spoznaju da je zdravlje integralna odrednica socijalne kohezije i znacajan preduvjet socio ekonomskog napretka. Od 2001. do 2009. godine Svjetska zdravsvena organizacija – Regionalni ured za Europu - pružao je glavnu strucn...

Artificial intelligence (AI) is rapidly changing the world, and education is no exception. AI-powered technologies are being used to automate tasks, personalize learning, and create new educational experiences. This has led to a great deal of excitement about the potential of AI to transform education. However, there are also concerns about the ethical implications of AI in education. In this paper, we explore the potential benefits and risks of AI in education. We argue that AI has the potential to improve education in many ways, but that it is important to carefully consider the potential challenges before widespread adoption. By carefully planning for the future of AI in education, we can ensure that it is used to improve education for all students. The findings from this study contribute to the ongoing discussion on the role of AI in higher education institutions in the changing economic environment and provide insights into the effective integration of AI to enhance educational quality, relevance, and employability outcomes.

Background End-stage renal disease (ESRD) is a growing cause of morbidity worldwide. Protein malnutrition is common among patients with ESRD. Peritoneal dialysis (PD) offers greater lifestyle flexibility and independence compared to the widely used treatments for ESRD. This study aimed to assess the nutritional status and the quality of life (QOL) of Palestinian patients undergoing PD, as well as the variables affecting these two outcomes. Methods A cross-sectional study was conducted on patients receiving PD at

Major pathways of progression among legal, illegal. and medically prescribed psychoactive drugs from adolescence to young adulthood are described. The data are based on a follow-up cohort of former adolescents representative of high school students in grades 10 and 11 in New York State who were reinterviewed nine years later at ages 24-25. Various models of progression are tested for their goodness of fit. The patterns formerly observed in adoles- Stages of involvement in legal and illegal drugs have been described for adolescents. Adolescents are very unlikely to experiment with marijuana without prior experimentation with one of the alcoholic beverages or with cigarettes; very few try illicit drugs other than marijuana without prior use of marijuana, as documented in particular by our own earlier work-5 and the work of Jessor,/ O'Donnell and his colleagues,7-"' Johnston,'" Huba and Bentler,'2-'5 and others. '6'-To date, the empirical support for the concept of stages in drug use derives from cross-sectional data'0'2" 18 or from a short-term longitudinal follow-up.' 3 No results have been reported that are based on a follow-up of young people over several years with a detailed monitoring of their drug behavior past the period of risk for initiation into the relevant drugs. Such data are presented in this paper for a cohort of former high school students who were followed into young adulthood, at ages 24 to 25. By that age, the period of risk for initiation to the legal drugs, to marijuana, and to most other illicit drugs, with the exception of cocaine, is over, as reported in the first article of this series in this issue of the Journal.22 In investigating pathways of progression among drugs, we address two related issues: I) whether the pattern of progression observed in adolescence over a short-term inter- val-i.e., from the use of at least one class of licit drug (alcohol or cigarettes), to the use of marijuana, to the use of other illicit drugs including the non-medical use of drugs available by prescription-holds when the same cohort of individuals is followed to young adulthood; and 2) whether the use of medically prescribed psychotropic drugs can be characterized as a later stage of progression. The analyses are based on a follow-up in 1980-1981 of two cohorts representative of adolescents formerly enrolled From the

Possible linkages of influence among classes of drugs in the observed sequential progression from adolescence to young adulthood are investigated through event history analyses. Three stages are examined: initiation to marijuana, to the use of other illicit drugs, and to prescribed psychoactive drugs. The data are based on a follow-up cohort of former adolescents representative of high school students in grade 10 and 11 in New York State who were reinterviewed nine years later at ages 24-25. The sequential order between alcohol and/or cigarettes and marijuana reflects not only the effect of the use of legal drugs on marijuana initiation, but also age effects on onset of these drugs, controlling for individual characteristics measured in adolescence; marijuana use by one's

This study examined gender differences in posttraumatic stress disorder (PTSD) symptoms and symptom factors in the total U.S. active duty force. Data were drawn from the 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel including 17,939 men and 6751 women from all services. The results indicated that women expressed more distress than men across almost all the symptoms on the PTSD Checklist except for hypervigilance. Women also scored significantly higher on all four factors examined: Re-experiencing, Avoidance, Emotionally Numb, Hyperarousal. More women than men were distressed by combat experiences that involved some type of violence, such as being wounded, witnessing or engaging in acts of cruelty, engaging in hand-to-hand combat, and, to a lesser extent, handling dead bodies. Men who had been sexually abused had a greater number of symptoms and were consistently more distressed than women on individual symptoms and symptom factors.

Possible linkages of influence among classes of drugs in the observed sequential progression from adolescence to young adulthood are investigated through event history analyses. Three stages are examined: initiation to marijuana, to the use of other illicit drugs, and to prescribed psychoactive drugs. The data are based on a follow-up cohort of former adolescents representative of high school students in grade 10 and 11 in New York State who were reinterviewed nine years later at ages 24-25. The sequential order between alcohol and/or cigarettes and marijuana reflects not only the effect of the use of legal drugs on marijuana initiation, but also age effects on onset of these drugs, controlling for individual characteristics measured in adolescence; marijuana use by one's

Due to increasing competition and market saturation, textile companies try to find new solutions to attract customers. Companies propose new materials, reorganize distribution strategies and develop interactive communication. Producers, distributors and retailers of textile products have also started to implement alternative strategies like sensory strategy. However, the study showed that the influence of the senses on the purchase behaviour of the consumer and their perception of textile products is not high. As was proved in the study, men and women do not perceive and react equally to sensory cues in the choice and evaluation of textile products. Contrary to female respondents, male purchase behaviour was not explained by either emotional or cognitive variables. Therefore it is suggested that the design and implementation of the sensory strategy should be more focused on the female rather than male target group due to their higher sensitivity to sensory stimuli.

Lodz University of Technology, Faculty of Organization and Management Department of European Integration and International Marketing ul. Żeromskiego 116 90-924 Łodź, Poland e-mail: magdalena.grebosz@p.lodz.pl Abstract Due to increasing competition and market saturation, textile companies try to find new solutions to attract customers. Companies propose new materials, reorganize distribution strategies and develop interactive communication. Producers, distributors and retailers of textile products have also started to implement alternative strategies like sensory strategy. However, the study showed that the influence of the senses on the purchase behaviour of the consumer and their perception of textile products is not high. As was proved in the study, men and women do not perceive and react equally to sensory cues in the choice and evaluation of textile products. Contrary to female respondents, male purchase behaviour was not explained by either emotional or cognitive variables. The...

Background: The 'perfect' journey through an Irish Methadone Maintenance Treatment Programme (MMTP) would have a client engage appropriately with all relevant services available to them, inclusive of psychiatry, counselling, out-reach support, nursing and psychology. Concurrently, a client would ideally adhere to their prescribed methadone-dosing regimen, until a client is stabilised allowing them to function optimally. At this point, a client should transfer to the GP community setting. Unfortunately, this fails to occur. To date, very few studies have specifically investigated the reasons why a cohort of clients remain 'trapped' in the high risk, specialist clinical setting. Methods: Qualitative detailed semi-structured interviews were undertaken with 17 clients of one of Ireland's Health Service Executive (HSE) Drug and Alcohol Services, entitled 'HSE Mid-West Limerick Drug and Alcohol Service'. Each client had a severe Opioid Use Disorder (OUD) and clients had spent on average 7.5 years engaging with the MMTP. Results: Participants' life journey prior to an OUD included Adverse Childhood Experiences (ACEs) and early exposure to illicit drug use. Shared life events resulting in their initiating and sustaining an OUD involved continuous hardship into adulthood, mental illness and concurrent benzodiazepine use disorder, often resulting in harrowing accounts of participants' loneliness and lack of life purpose. Their living environments, an erroneous understanding of their illness and poor communication with allied health professionals further perpetuated their OUD. Positive factors influencing periods of abstinence were familial incentives and a belief in the efficacy of methadone. Clients own suggestions for improving their journeys included employing a multi-sectorial approach to managing OUD and educating themselves and others on opioid agonist treatments. If clients were not progressing appropriately, they themselves suggested enforcing a 'time-limit' on clients to engage with the programme or indeed for their treatment to be postponed. Conclusions: To optimise the functioning of the MMTP, three tasks need to be fulfilled: 1) Reduce the incidences of ACEs, 2) Diagnose and treat clients with a dual diagnosis 3) Educate clients, their families, the public and allied health care professionals on all aspects of OUD. A cross-departmental, inter-governmental approach is needed to address opioid misuse as a societal issue as a whole.

Background: The 'perfect' journey through an Irish Methadone Maintenance Treatment Programme (MMTP) would have a client engage appropriately with all relevant services available to them, inclusive of psychiatry, counselling, out-reach support, nursing and psychology. Concurrently, a client would ideally adhere to their prescribed methadone-dosing regimen, until a client is stabilised allowing them to function optimally. At this point, a client should transfer to the GP community setting. Unfortunately, this fails to occur. To date, very few studies have specifically investigated the reasons why a cohort of clients remain 'trapped' in the high risk, specialist clinical setting. Methods: Qualitative detailed semi-structured interviews were undertaken with 17 clients of one of Ireland's Health Service Executive (HSE) Drug and Alcohol Services, entitled 'HSE Mid-West Limerick Drug and Alcohol Service'. Each client had a severe Opioid Use Disorder (OUD) and clients had spent on average 7.5 years engaging with the MMTP. Results: Participants' life journey prior to an OUD included Adverse Childhood Experiences (ACEs) and early exposure to illicit drug use. Shared life events resulting in their initiating and sustaining an OUD involved continuous hardship into adulthood, mental illness and concurrent benzodiazepine use disorder, often resulting in harrowing accounts of participants' loneliness and lack of life purpose. Their living environments, an erroneous understanding of their illness and poor communication with allied health professionals further perpetuated their OUD. Positive factors influencing periods of abstinence were familial incentives and a belief in the efficacy of methadone. Clients own suggestions for improving their journeys included employing a multi-sectorial approach to managing OUD and educating themselves and others on opioid agonist treatments. If clients were not progressing appropriately, they themselves suggested enforcing a 'time-limit' on clients to engage with the programme or indeed for their treatment to be postponed. Conclusions: To optimise the functioning of the MMTP, three tasks need to be fulfilled: 1) Reduce the incidences of ACEs, 2) Diagnose and treat clients with a dual diagnosis 3) Educate clients, their families, the public and allied health care professionals on all aspects of OUD. A cross-departmental, inter-governmental approach is needed to address opioid misuse as a societal issue as a whole.

There is a strong link between childhood adversity and subsequent substance misuse. We describe a case of childhood adversity consisting of physical and sexual abuse, experience of homelessness in childhood and adulthood, intimate partner violence and polysubstance misuse in a 32 year old woman currently attending the methadone maintenance programme in the Drug Treatment Centre Board, Trinity Court, Dublin. The relevant literature to the case is reviewed in relation to the aetiology and symptoms of this complex case.

Introduction-Abuse experiences can have negative health consequences for women. Many women present to the emergency department for episodic, non-emergent care and may have unique needs as survivors of abuse. The purpose of this study was to describe child sexual abuse experiences, intimate partner violence, substance use, and reproductive health outcomes in a sample of adult women who were seeking care from a rural emergency department to better understand the health care needs of this unique population. Methods-One hundred forty-five (145) adult women (18-45 years old) were recruited at an emergency department in southeastern United States. Questionnaires were used to assess for demographic characteristics, history of child sexual abuse (CSA), intimate partner violence (IPV), reproductive health, and substance use. Results-In the sample, 42.8% (n = 62) women reported a positive history of CSA and 34.7% (n = 49) experienced past year intimate partner physical violence. Over 46% (n = 65) of the women had harmful drinking patterns in the past year and greater than 50% reported some type of substance use in the past 3 months. Women who experienced CSA had significantly greater number of lifetime sexual partners, were more likely to report pain with sexual intercourse, and report a past medical history of abnormal pap smear. Discussion-The women in this sample had high rates of abuse, harmful drinking patterns, substance use and were at risk for sexually transmitted infections. Through screening for lifetime

Child victims of sexual abuse may present with physical findings that can include anogenital problems, enuresis or encopresis. Behavioral changes may involve sexual acting out, aggression, depression, eating disturbances and regression. Because the examination findings of most child victims of sexual abuse are within normal limits or are nonspecific, the child's statements are extremely important. The child's history as obtained by the physician may be admitted as evidence in court trials; therefore, complete documentation of questions and answers is critical. A careful history should be obtained and a thorough physical examination should be performed with documentation of all findings. When examining the child's genitalia, it is important that the physician be familiar with normal variants, non-specific changes and diagnostic signs of sexual abuse. Judicious use of laboratory tests, along with appropriate therapy, should be individually tailored. Forensic evidence colle...

Communicating the scientific consensus that climate change is real increases climate change beliefs, worry, and support for public action in the US. Recent science goes beyond the mere reality of climate change—there is now broad agreement that climate change is a crisis. In this preregistered 27-country experiment (N = 10,527), we tested two scientific consensus messages, a classic message on the reality of climate change and an updated message additionally emphasizing the crisis status agreement. The classic message corrects misperceptions and slightly increases climate change beliefs and worry but not support for public action. The updated message is equally effective but provides no added value. Both messages are more effective for audiences with lower message familiarity and higher misperceptions, including those with lower trust in climate scientists and right-leaning ideologies. Overall, scientific consensus messaging is an effective, non-polarizing tool for climate change co...

The aim of this study is to determine functioning of adults with Autism Spectrum Disorders (ASDs) diagnosed in childhood and also depression and burnout levels among their parents. 261 adults with ASDs and their parents were recruited for the study. Both parents completed the Beck Depression and Maslach Burnout Inventories and reported the functioning of their adult offspring with ASDs. Only 5.4 % of our sample reported “good” or “very good” outcome. The most common psychiatric comorbidities were intellectual disabilities and attention-deficit/ hyperactivity disorder. Maternal burnout and depression scores were significantly elevated compared to those of fathers. There is an undeniable urgent need for more research to identify the needs of adults and families suffering from ASD.

patient for distribution to their sexual partner(s) without evaluating the partner. To understand the implementation and uptake of EPT, we evaluated pharmacists' knowledge and practices related to EPT in 41 EPT-permissible states in the U.S. METHODS: A randomized cohort of pharmacists were invited to complete a telephone interview from November 2017 through January 2018. Descriptive statistics were calculated for each variable of interest overall and stratified by EPT-adopter status. Fisher's exact test was used to compare categorical measures such as EPT awareness and acceptance of EPT prescriptions by EPT-adopter status. One-way analyses of variance were used to compare continuous measures. RESULTS: We contacted a national sample of 619 pharmacies; of those, 350 responded with 147 opting to complete the survey, resulting in a 42% (n¼147/350) response rate. Participating outpatient pharmacies were characterized as independent (32.7%, n¼48/147), chain or commercial (65.3%, n¼96/147), or academic (2%, n¼3/147). The majority of pharmacists, 76.3% (n¼258/ 338), reported no prior knowledge of EPT. At the close of our interview, 97.3% (n¼142/146) of pharmacists reported they would fill an EPT prescription if they received one in the future. These findings were stable across strata defined by high or low incidence rates of chlamydia and early, mid, or late EPT-adopter status. CONCLUSIONS: Increasing STI incidence rates may be associated with a lack of knowledge and awareness amongst pharmacists of EPT as an STI treatment strategy. Pharmacists in early-adopter states, in which EPT has been permissible five years are similarly unaware of EPT, suggesting that EPT and current outreach methods to inform healthcare providers does not increase its utilization. The majority of pharmacists would fill an EPT prescription in the future, suggesting that targeted pharmacist education may improve EPT utilization. Without engagement of pharmacists in the use of EPT, we may continue to observe a rise in STI incidence rates.

BackgroundEmpathy in healthcare service refers to the ability of healthcare workers (HCWs) to put themselves in patients’ shoes, which is necessary to ensure a good physician-patient relationship and provide quality care. Various studies have shown that empathy varies depending on the country, the instrument used, the evaluator, and the HCW’s specialty. This systematic review aims to estimate the levels of empathy among HCWs in South American countries between 2000 and 2019.MethodsWe conducted searches in 15 databases (PubMed, Scopus, Web of Science, EMBASE, Scielo, PsycoInfo, ScientDirect, Latindex, and LILIACS), four preprint servers (medRxiv, bioRxiv, SportRxiv, and Preprints), and other search engines such as Dimensions (20), Google Scholar, Yahoo!, and Alicia CONCyTec (c). We followed the PRISMA guidelines, and this study was registered in PROSPERO (CRD42023454007).ResultsOut of 18,532 documents identified from November 10 to 28, 2021, 10 articles were included (n = 2,487 parti...

DepEd Order No. 26, s. 2013 promotes inclusive education by ensuring equitable access for all learners, including those with special needs. While MAPEH subjects are interactive and physical, they provide opportunities for LSEN to engage, express themselves, and develop essential skills. This study explores the lived experiences of MAPEH (Music, Arts, Physical Education, and Health) teachers in educating learners with special educational needs (LSEN) in Kabacan National High School, Osias High School and Aringay High School, Kabacan, North Cotabato. Using a qualitative-phenomenological transcendental research design, the study involved ten (10) randomly selected participants. Data was collected through semi-structured interviews and analyzed using thematic analysis. The study highlights the challenges and strategies in teaching LSEN in MAPEH. Teachers face difficulties in managing diverse classrooms, handling emotional and behavioral issues, and overcoming communication barriers. Teachers must balance the needs of LSEN and other students while managing behavioral and communication challenges, especially in movement-based activities like Physical Education. Teachers use Differentiated Instruction (DI), Universal Design for Learning (UDL), visual aids, and assistive tools to enhance engagement. They balance flexibility and structure while providing individualized support through the Zone of Proximal Development (ZPD). Ongoing training, collaboration with experts, and access to resources are crucial for effective inclusive education. Strengthening these areas will enhance MAPEH instruction for LSEN, ensuring a more inclusive learning environment. It is recommended that schools should provide continuous training, resources, and support for MAPEH teachers to effectively manage diverse classrooms, implement inclusive teaching strategies, and enhance learning experiences for LSEN.

Background-The acceptability of and retention on extended-release naltrexone (XR-NTX), an FDA-approved medication for the treatment of alcohol and opioid use disorders, among persons living with HIV disease (PLH) under criminal justice setting (CJS) supervision has not been evaluated to date. Methods-Two double-blind placebo-controlled randomized trials of XR-NTX for inmates with HIV disease transitioning to the community with (1) alcohol use disorders (AUDs) or (2) opioid use disorders, are underway. Reasons for not accepting XR-NTX and an evaluation of differences in demographic features between those who were retained on study drug and those who did not return for their second injection post-release are discussed. Results-70% of eligible persons consented to participate; almost 90% received their first injection; and almost 60% returned for their second injection after release. Variables found to be associated (p<0.10) with returning for the second injection included: not meeting criteria for hazardous drinking (p=0.035; OR 0.424 (CI 0.191-0.941)); being prescribed antiretroviral therapy (p=0.068; OR 2.170 (CI 0.943-4.992)); expressing experiencing serious depression 30 days prior to incarceration (p=0.068; OR 1.889 (CI 0.955-3.737)); not having a positive cocaine urine screen on the day of release (DOR) (p=0.011; OR 0.258 (CI 0.091-0.729)); and not meeting criteria for an AUD plus any substance use disorder (p=0.068; OR 0.521

Women in the United States are increasingly affected by HIV/AIDS. The SAVA syndemic-synergistic epidemics of substance abuse, violence, and HIV/AIDS-is highly prevalent among impoverished urban women and potentially associated with poor HIV outcomes. A review of the existing literature found 45 articles that examine SAVA's impact on (1) HIV-associated risk-taking behaviors, (2) mental health, (3) healthcare utilization and medication adherence, and (4) the bidirectional relationship between violence and HIV status. Overall, results confirm the profound impact of violence and victimization and how it is intertwined with poor decision making, increased risk taking and negative health consequences, particularly in the context of substance abuse. Among current findings, there remain diverse and inconsistent definitions for substance abuse, violence, mental illness, adherence, and healthcare utilization that confound interpretation of data. Future studies require standardization and operationalization of definitions for these terms. Development and adaptation of evidencebased interventions that incorporate prevention of violence and management of victimization to target this vulnerable group of women and thereby promote better health outcomes are urgently needed.

A majority of inmates in the state of Connecticut Department of Corrections use opioids or are opioid dependent before incarceration. None of the state's prisons offer opioid substitution therapy other than for detoxification or maintenance therapy for women during pregnancy. On release to the community, most prisoners relapse to drug use and this has been associated with higher recidivism rates, and less adherence to antiretroviral medications for HIV-infected persons. Nationally and internationally, methadone (METH) and buprenorphine (BUP) have been found to decrease relapse to drug use, decrease recidivism rates, improve adherence to antiretroviral medications, decrease HIV-risk taking behaviors, and improve mortality. However, the general knowledge about opioid substitution therapy among correctional facility staff has been reported as substandard. This pilot study compiled results of answers to anonymous surveys from 27 individuals who work directly with inmates in a patient-care capacity for the Connecticut Department of Corrections (CT DOC) and CT DOC case-management referral program (Project TLC) in the year 2006. The surveys included questions regarding current attitudes and knowledge about opioid substitution therapy for prisoners. A minority of respondents refer released prisoners with a history of opioid dependency to METH or BUP treatment. The majority of correctional workers and case-management referral workers did not have knowledge about BUP or METH's ability to improve health and decrease HIV risk taking behaviors. This study found that more education of individuals treating and caring for HIV-infected opioid dependent prisoners is needed.

Psychotic disorders are associated with neurobehavioral impairments in mental state attribution (mentalizing). These impairments are most severe in psychotic patients with elevated symptom levels, particularly negative and cognitive symptoms. There have been few studies of functional connectivity related to mentalizing in psychotic disorders and associations with symptoms. We conducted a functional MRI study of affective mentalizing in individuals with psychotic disorders and varying symptom levels (positive, negative, cognitive). Participants were drawn from an adjudicated inpatient forensic psychiatric population (criminal offenders). Functional MRI scans were acquired using a 32-channel ultra-fast multiband imaging sequence. Mentalizing task performance and functional connectivity were assessed in psychotic criminal offenders (n = 46) and nonpsychotic offenders (n = 41). Temporal coherent brain networks were estimated with group independent component analysis (ICA). Relative to n...

This study examined the association between suicidal ideation and posttraumatic stress disorder (PTSD) symptom trajectories in a nationally representative sample of United States Reserve Component soldiers. PTSD symptoms related to a traumatic event during the most recent deployment were assessed in four annual waves in 2010-2013 among 682 Reserve Component soldiers. Latent Growth Mixture Modeling (LGMM) was used to examine the longitudinal trajectories of PTSD symptoms. The association between the PTSD trajectories and suicidal ideation at waves 2 to 4 was examined in logistic regression analyses. Four trajectories were identified: resilience (73.0%), recovery (11.7%), late onset (11.6%) and chronic (3.6%). Pairwise comparisons demonstrated significant differences between trajectories in risk of suicidal ideation. Among the chronic trajectory group, 50.9% reported suicidal ideation (25.8% late onset group; 11.3% recovery group; 4.0% resilience group). After controlling for baseline...

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To investigate, via network meta-analyses (NMA), the comparative e ectiveness and safety of di erent newer generation antidepressants in children and adolescents with a diagnosed major depressive disorder (MDD). Specific objectives, in order of priority, are to: New generation antidepressants for depression in children and adolescents: a network meta-analysis (Protocol)

Eating disorders often develop during adolescence and young adulthood, and are associated with significant psychological and physical burden. Identifying evidence-based interventions is critical and there is need to take stock of the extant literature, to inform clinical practice regarding well-researched interventions and to direct future research agendas by identifying gaps in the evidence base. Aim: To investigate and quantify the nature and distribution of existing high-quality research on the prevention and treatment of eating disorders in young people using evidence mapping methodology. Method: A systematic search for prevention and treatment intervention studies in adolescents and young adults (12-25 years) was conducted using EMBASE, PSYCINFO and MEDLINE. Studies were screened and mapped according to disorder, intervention modality, stage of eating disorder and study design. Included studies were restricted to controlled trials and systematic reviews published since 1980. The eating disorders evidence map included 197 trials and 22 systematic reviews. Prevention research was dominated by trials of psychoeducation (PE). Bulimia nervosa (BN) received the most attention in the treatment literature, with cognitive behavioural therapy (CBT) and antidepressants the most common interventions. For anorexia nervosa (AN), family based therapy (FBT) was the most studied. Lacking were trials exploring treatments for binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS). Relapse prevention strategies were notably absent across the eating disorders. Conclusions: Despite substantial literature devoted to the prevention and treatment of eating disorders in young people, the evidence base is not well established and significant gaps remain. For those identified as being at-risk, there is need for prevention research exploring strategies other than passive PE. Treatment interventions targeting BED and EDNOS are required, as are systematic reviews synthesising BN treatment trials (e.g., CBT, antidepressants). FBTs for AN require investigation against other validated psychological interventions, and the development of relapse prevention strategies is urgently required. By systematically identifying existing interventions for young people with eating disorders and exposing gaps in the current literature, the evidence map can inform researchers, funding bodies and policy makers as to the opportunities for future research.

Depressive disorders are common in children and adolescents and, if left untreated, are likely to recur in adulthood. Depression is highly debilitating, affecting psychosocial, family and academic functioning. To evaluate the effectiveness of psychological therapies and antidepressant medication, alone and in combination, for the treatment of depressive disorder in children and adolescents. We have examined clinical outcomes including remission, clinician and self reported depression measures, and suicide-related outcomes. We searched the Cochrane Depression, Anxiety and Neurosis Review Group&#39;s Specialised Register (CCDANCTR) to 11 June 2014. The register contains reports of relevant randomised controlled trials (RCTs) from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). RCTs were eligible for inclusion if they compared i) any psychological therapy with any antidepressant medication, or ii)...

Mental disorders account for a large proportion of the disease burden in young people in all societies. Most mental disorders begin during youth (12-24 years of age), although they are often fi rst detected later in life. Poor mental health is strongly related to other health and development concerns in young people, notably lower educational achievements, substance abuse, violence, and poor reproductive and sexual health. The eff ectiveness of some interventions for some mental disorders in this age-group have been established, although more research is urgently needed to improve the range of aff ordable and feasible interventions, since most mental-health needs in young people are unmet, even in high-income countries. Key challenges to addressing mental-health needs include the shortage of mental-health professionals, the fairly low capacity and motivation of non-specialist health workers to provide quality mental-health services to young people, and the stigma associated with men...

Introduction. Depression in adolescents and young people is associated with reduced social, occupational, and interpersonal functioning, increases in suicide and self-harm behaviours, and problematic substance use. Age-appropriate, evidence-based treatments are required to provide optimal care. Methods. &quot;Evidence mapping&quot; methodology was used to quantify the nature and distribution of the extant high-quality research into the prevention and treatment of depression in young people across psychological, medical, and other treatment domains. Results. Prevention research is dominated by cognitive-behavioral- (CBT-) based interventions. Treatment studies predominantly consist of CBT and SSRI medication trials, with few trials of other psychological interventions or complementary/alternative treatments. Quality studies on relapse prevention and treatment for persistent depression are distinctly lacking. Conclusions. This map demonstrates opportunities for future research to addr...

IntroductionAs social animals, our health depends in part on interactions with other human beings. Yet millions suffer from chronic social isolation, including those in nursing/assisted living facilities, people experiencing chronic loneliness as well as those in enforced isolation within our criminal justice system. While many historical studies have examined the effects of early isolation on the brain, few have examined its effects when this condition begins in adulthood. Here, we developed a model of adult isolation using mice (C57BL/6J) born and raised in an enriched environment.MethodsFrom birth until 4 months of age C57BL/6J mice were raised in an enriched environment and then maintained in that environment or moved to social isolation for 1 or 3 months. We then examined neuronal structure and catecholamine and brain derived neurotrophic factor (BDNF) levels from different regions of the brain, comparing animals from social isolation to enriched environment controls.ResultsWe ...

Becoming a first-time parent is a major life-changing event and can be challenging regardless of the pregnancy outcome. However, little is known how different adverse pregnancy outcomes affect the father's risk of psychiatric treatment post partum. OBJECTIVE To examine the associations of adverse pregnancy outcomes with first-time psychiatric treatment in first-time fathers.

The authors review the complex relationship between insight, adherence and symptoms with the functioning of the patient with diagnose of psychosis, either directly or as intermediary factors of each other. Insight has been proposed to act through symptoms or psychodynamic factors. But in turn, adherence and insight are related in a bidirectional way and the first is one of the best predictors of outcomes in psychosis. Similarly symptoms, especially negative ones, are associated with a worse evolution of the disease. The authors suggest that insight plays a role in the functioning of the patient, producing both a direct effect and also as a mediator by the improvement of adherence. It is proposed that insight becomes a key therapeutic target in combined programs in order to favor better outcomes in the evolution of psychosis.

BackgroundBipolar disorder and schizophrenia are associated with increased mortality relative to the general population. There is an international emphasis on decreasing this excess mortality.AimsTo determine whether the mortality gap between individuals with bipolar disorder and schizophrenia and the general population has decreased.MethodA nationally representative cohort study using primary care electronic health records from 2000 to 2014, comparing all patients diagnosed with bipolar disorder or schizophrenia and the general population. The primary outcome was all-cause mortality.ResultsIndividuals with bipolar disorder and schizophrenia had elevated mortality (adjusted hazard ratio (HR) = 1.79, 95% CI 1.67-1.88 and 2.08, 95% CI 1.98-2.19 respectively). Adjusted HRs for bipolar disorder increased by 0.14/year (95% CI 0.10-0.19) from 2006 to 2014. The adjusted HRs for schizophrenia increased gradually from 2004 to 2010 (0.11/year, 95% CI 0.04-0.17) and rapidly after 2010 (0.34/ye...

To test the hypothesis that perceived stigma scores in young adults bereaved by suicide are significantly higher than in young adults bereaved by other sudden deaths, whether blood-related to the deceased or not. We conducted a cross-sectional study of all staff and students aged 18-40 at 37 UK higher educational institutions in 2010, and identified 3432 respondents who had experienced a sudden bereavement of a close contact since reaching the age of 10, either due to sudden natural causes, sudden unnatural causes, or suicide. We used multivariable regression to compare scores on the stigma, shame, responsibility and guilt subscales of the Grief Experience Questionnaire, adjusting for socio-demographic factors and pre-bereavement psychopathology. People bereaved by suicide (n=614) had higher stigma scores than people bereaved by sudden natural death (n=2106; adjusted coefficient=2.52; 95% CI=2.13-2.90; p=&lt;0.001) and people bereaved by sudden unnatural death (n=712; adjusted coeff...

Background. Major depression is often chronic or recurrent and is usually treated within primary care. Little is known about the associated morbidity and costs. Objectives. To determine socio-demographic characteristics of people with chronic or recurrent depression in primary care and associated morbidity, service use, and costs. Method. 558 participants were recruited from 42 GP practices in the UK. All participants had a history of chronic major depression, recurrent major depression, or dysthymia. Participants completed questionnaires including the BDI-II, Work and Social Adjustment Scale, Euroquol, and Client Service Receipt Inventory documenting use of primary care, mental health, and other services. Results. The sample was characterised by high levels of depression, functional impairment, and high service use and costs. The majority (74%) had been treated with an anti-depressant, while few had seen a counsellor (15%) or a psychologist (3%) in the preceding three months. The g...

Problematic health areas such as maternal and child health is one of the target areas to be addressed so that by 2030, reduction of maternal mortality by less than 70 per 100,000 live births will be attained. Mental illness that happens in postpartum women is significantly associated with morbidity and disability. There are about 10% of pregnant women and 13% of mothers who experience mental disorder, especially depression worldwide. This study aimed to determine and analyze the obstetrical factors associated with postpartum depression. This study used quantitative design with descriptive survey method. A total of 88 participants were included coming from the two General Hospital in Banjarmasin, South Kalimantan, Indonesia. EPDS, BDI-II, and PPDRF checklist were used. It was found out that there is no significant association between the level of depression and desire to be pregnant, complication in pregnancy, and history of abortion. However, there is a significant relationship betw...

Aims: To evaluate sociodemographic correlates associated with transitions from alcohol use to disorders and remission in a Brazilian population. Methods: Data are from a probabilistic, multi-stage clustered sample of adult household residents in the São Paulo Metropolitan Area. Alcohol use, regular use (at least 12 drinks/year), DSM-IV abuse and dependence and remission from alcohol use disorders (AUDs) were assessed with the World Mental Health version of the Composite International Diagnostic Interview. Age of onset (AOO) distributions of the cumulative lifetime probability of each alcohol use stage were prepared with data obtained from 5037 subjects. Correlates of transitions were obtained from a subsample of 2942 respondents, whose time-dependent sociodemographic data were available. Results: Lifetime prevalences were 85.8% for alcohol use, 56.2% for regular use, 10.6% for abuse and 3.6% for dependence; 73.4 and 58.8% of respondents with lifetime abuse and dependence, respectively, had remitted. The number of sociodemographic correlates decreased from alcohol use to disorders. All transitions across alcohol use stages up to abuse were consistently associated with male gender, younger cohorts and lower education. Importantly, low education was a correlate for developing AUD and not remitting from dependence. Early AOO of first alcohol use was associated with the transition of regular use to abuse. Conclusion: The present study demonstrates that specific correlates differently contribute throughout alcohol use trajectory in a Brazilian population. It also reinforces the need of preventive programs focused on early initiation of alcohol use and highrisk individuals, in order to minimize the progression to dependence and improve remission from AUD.

BACKGROUND: There are still few studies on predictors of smoking cessation in Brazilian samples. Experimentation with tobacco during adolescence (ETA) may be one of the important predictors. OBJECTIVE: This study aimed, within the context of a treatment-seeking group of subjects, to test the hypothesis that ETA negatively affects the outcome of smoking cessation during adulthood. DESIGN AND SETTING: Retrospective (historic) cohort study conducted at a psychosocial care center in São Paulo, Brazil, between 2007 and 2010. METHODS: Data on sociodemographics, smoking and medical profiles were obtained through self-report questionnaires that were completed at the baseline and at any follow-up appointment. Logistic regression models were constructed to describe factors associated with the outcome of smoking cessation, measured according to the self-reported four-week success rate among 367 outpatient smokers. RESULTS: ETA was found to be associated with not quitting smoking through the treatment (odds ratio = 0.57; 95% confidence interval = 0.33-0.96; P < 0.05), even after adjustment for dependence level, sociodemographics, nicotine patch use and number of years of smoking. CONCLUSIONS: Early exposure to nicotine may lead to higher risk of continuing smoking after treatment, in adulthood.