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HIV-risk behaviors among psychiatrically hospitalized adolescents with and without comorbid SUD
- Authors:
- ABRANTES Ana M., et al
- Journal article citation:
- Journal of Dual Diagnosis, 2(3), 2006, pp.85-100.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The purpose of this American study was to examine HIV-risk behaviours among a sample of psychiatric inpatient adolescents with and without comorbid SUD. Two hundred and thirty nine adolescents (60.7% female; mean age = 15.3) were interviewed while hospitalized in a psychiatric inpatient treatment facility. Adolescents with and without substance use disorder (SUD) were compared on a number of HIV-risk behaviours and the association between HIV-risk behaviours and other types of mental health problems were examined. Compared to those without SUD, adolescents with SUD, after controlling for age, gender, and other psychiatric disorders, were at an increased risk for being currently sexually active and for having used alcohol or drugs prior to last sexual intercourse. HIV-risk behaviours were more evident among adolescents with externalizing disorders and those with higher levels of self-reported distress. Conclusion: Adolescents in psychiatric settings, especially those with substance use disorders and/or externalizing problems, are an important population for whom prevention efforts are needed to reduce the risk of HIV infection. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Treating dangerous and severe personality disorder in high security: lessons from the Regional Psychiatric Centre, Saskatoon, Canada
- Authors:
- MADEN A., et al
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 15(3), September 2004, pp.375-390.
- Publisher:
- Taylor and Francis
Describes the approach to risk reduction at the Centre, making legal and institutional comparisons with the new Dangerous and Severe Personality Disorder (DSPD) Service to be established in high security hospitals in England and Wales. The Centre applies cognitive behavioural techniques to reduce recidivism, and current evidence suggests the same approach should form the core of the treatment regime in DSPD units. The key to success is the strict management of programme integrity, to deliver intensive treatment tailored to the individual's abilities and readiness to accept change. The Stages of Change model, derived from addictions, allows planning, monitoring and evaluation. It plays an important role in maintaining staff morale by providing an objective measure of success within a reasonable time frame. The service will require effective management and sophisticated information systems to support these developments. The Centre has the advantage of clear pathways through the service. Patients are able to return to an ordinary prison whenever they wish, and the average length of stay is about 2 years. The service will have to guard against beds becoming blocked by long-stay patients with no way out of the service. Long term hospital incarceration is an expensive and inefficient way of protecting the public, and a unit with a high proportion of long-stay patients would find it hard to sustain a therapeutic ethos, with a consequent threat to staff morale.
Electroshock: healing mental illness
- Author:
- FINK Max
- Publisher:
- Oxford University Press
- Publication year:
- 1999
- Pagination:
- 157p.,bibliog.
- Place of publication:
- Oxford
Psychiatrists unfamiliar with electroconvulsive treatment may be embarrassed to discover that concern about its risk is greatly exaggerated and that relapse after electroconvulsive treatment indicates a need for maintenance treatment, not a lack of efficacy. Even authorities on drug treatment are puzzled by the broad spectrum of efficacy of electroconvulsive treatment. For example, all antidepressants can cause mania, but only electroconvulsive treatment can treat it, and no antidepressant drug has been shown to be as effective as electroconvulsive treatment for treating schizophrenia. In bipolar disorder, electroconvulsive treatment is often effective when mood stabilizers fail. In treating catatonic states for which benzodiazepines are the best drug treatment, electroconvulsive treatment succeeds when these drugs fail. These findings do not fit with any data from the neurosciences on receptor mechanisms or second and third messengers. After briefly defining electroconvulsive treatment and outlining its uses, the author discusses the patient's experience. He then describes the risks and technical features of the treatment and the contraindications to it. There are chapters on each of the principal indications for electroconvulsive treatment: depression, mania, thought disorders, and movement disorders, which include catatonic states and parkinsonian rigidity. There is some speculation about the mechanism of action (which is unknown), a brief account of the fascinating origins of electroconvulsive treatment, and considerable discussion of how electroconvulsive treatment became controversial. Each of the clinical chapters contains detailed case reports, and some chapters also contain autobiographical accounts from the popular literature. These profiles reiterate the benefits of the treatment, the often tragic consequences of withholding it or using it inappropriately without consideration of the need for maintenance treatment, and the minimal medical risks and cognitive side effects with current practice. The discussion of informed consent for use in minors and incompetent patients is exemplary. Despite intensive pharmaceutical research, it now appears that the benefits of the new drugs for depression and schizophrenia are mostly decreased side effects and improved compliance; there is little increased efficacy in refractory conditions, which underscores the need for a trial of electroconvulsive treatment. Although new agents for bipolar disorder are more promising, the need for electroconvulsive treatment to treat refractory conditions remains.
Poor mental and physical health differentially contributes to disability in hospitalized geriatric patients of different ages
- Authors:
- MARENGONI Alessandra, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(1), January 2004, pp.27-34.
- Publisher:
- Wiley
This article seeks to evaluate the relationship between depressive symptoms, cognition and somatic diseases on functional status of geriatric patients at hospital discharge. Patients 65+ years consecutively admitted to the acute care geriatric ward of the Internal Medicine Department I, Civil Hospital of Brescia, Italy, from February 1998 to December 2000 (n = 830) were examined. Functional disability was defined as need of physical assistance in at least one of the basic Activities of Daily Living (ADL). The Greenfield Index of Disease Severity (IDS) and the Geriatric Index of Comorbidity (GIC) were used to measure number and severity of diseases. The Mini-Mental State Examination (MMSE) assessed cognitive status and the Geriatric Depression Scale (GDS) measured depressive symptoms. Prevalence of functional disability at discharge was 29.3% in the younger age group (65-74 years) and 55.2% in the older age group (75+ years). Using logistic regression models, older age, poorer cognitive status, and depressive symptoms were independently associated with functional disability in the younger and older age group, respectively. Additionally cognitive impairment and depressive symptoms showed an additive association with disability, especially in younger patients, while comorbidity was correlated with functional status only in the oldest old, in particular among those who were cognitively impaired. Functional disability after acute hospitalization is highly prevalent in geriatric patients. Depressive symptoms, comorbidity, and cognitive impairment often coexist, interact and are differentially associated with function depending on age. Considering that depressive symptoms are a modifiable problem, their detection in hospital settings may help clinicians in targeting subjects at high risk of functional disability.
Ethnic differences in prisoners: risk factors and psychiatric service use
- Authors:
- COID Jeremy, et al
- Journal article citation:
- British Journal of Psychiatry, 181(12), December 2002, pp.481-487.
- Publisher:
- Cambridge University Press
The aim of this article is to compare early environmental risks, stressful daily living experiences and reported use of psychiatric services in prisoners from different ethnic groups. Fewer Black and South Asian male prisoners reported childhood traumas and conduct disorder, and fewer Black prisoners experienced stressful prison experiences, than White prisoners. Fewer Black women had received previous psychiatric treatment, and fewer Black men had their psychiatric problems identified in prison. Black prisoners were less likely to have received psychiatric treatment than Whites. The lower prevalence of psychiatric morbidity observed in Black prisoners corresponds with reduced exposure to risk factors. Higher rates of imprisonment might be explained by higher rates of conduct disorder, adolescent-onset criminality and disadvantage within the criminal justice system.
Being there in a crisis: a report of the learning from eight mental health crisis services
- Editors:
- FAULKNER Alison, PETIT-ZEMAN Sophie, SHERLOCK Joanne, WALLCRAFT Jan
- Publisher:
- Mental Health Foundation,|Sainsbury Centre for Mental Health
- Publication year:
- 2002
- Pagination:
- 89p.,bibliog.
- Place of publication:
- London
Report demonstrates the value of partnerships between mental health users and providers in the development of community-based crisis services. Service users and the user movement have been calling for 24 access to care and admissions . Most of the services reported were strongly led, staffed or supported by service users or those with personal experience of crisis.