Antipsychotic Drug Reduction through the Implementation of a Neurologically Oriented, Interdisciplinary Psycho-Diagnostic and Antipsychotic Stewardship Program.

Antipsychotic utilization in skilled nursing facilities (SNFs) is a major focus of regulatory compliance and a key theme in resident care. This created opportunities for innovations in clinical care of behavioral and psychological symptoms of dementia (BPSD). In a shared initiative with one of our SNF operators, the authors implemented a joint clinician/facility program focused on rigorous clinical diagnosis and "best practices" in clinical care, specifically aimed at assessing and reducing antipsychotic use where appropriate.

Apolipoprotein E Isoform-specific changes related to stress and trauma exposure.

Post-Traumatic Stress Disorder (PTSD) is a highly prevalent mental health disorder. Due to the high level of variability in susceptibility and severity, PTSD therapies are still insufficient. In addition to environmental exposures, genetic risks play a prominent role and one such factor is apolipoprotein E.

Experiencing Mental Illness: Suffering, Hope, and Healing.

The experience of mental illness can be painful and isolating for those suffering in silence. Early symptoms frequently are confusing and disorienting for individuals and families, and stigma towards mental illness in societies across the globe contributes to further isolation from sources of support during the healing process. The evocative personal stories from a variety of cultures in this symposium provide a window into universal elements of the experience of mental illness, with the accompanying fear, shame, and stigma.

Alpha Omega Alpha Honor Medical Society: A Commitment to Inclusion, Diversity, Equity, and Service in the Profession of Medicine.

With a motto of "Be Worthy to Serve the Suffering," Alpha Omega Alpha Honor Medical Society (AΩA) supports the importance, inclusion, and development of a culturally and ethnically diverse medical profession with equitable access for all. The underrepresentation of minorities in medical schools and medicine continues to be a challenge for the medical profession, medical education, and AΩA. AΩA has worked, and continues to work, to ensure the development of diverse leaders, fostering within them the objectivity and equity to be inclusive servant leaders who understand and embrace diversity in all its forms.

Medical Approach to the Management of Traumatized Refugees.

Refugees are a highly traumatized and culturally diverse group of patients who present many clinical challenges. Refugees have a high prevalence of traumas from torture, ethnic cleansing, and the effects of long civil wars. The most common diagnoses associated with the effects of such traumas are posttraumatic stress disorder (PTSD) or PTSD with comorbid depression; however, psychosis and neurocognitive disorders are also common.

"If you build it, they will come": attitudes of medical residents and fellows about seeking services in a resident wellness program.

Background: High rates of burnout and distress in resident physicians suggest a significant number would benefit from counseling.

Intervention: A resident wellness program (RWP) was designed to lower known barriers limiting resident access to services.

Methods: In 2011, medical residents and fellows were surveyed and logistic regression analyses were conducted to identify demographic and training program differences in perceived barriers and willingness to access the RWP.

Prospective one-year treatment outcomes of tortured refugees: a psychiatric approach.

The treatment of torture survivors from diverse cultures has been a difficult task involving issues of loss, massive trauma, cultural style, and adjusting to a new country. Research on treatment outcomes has shown inconsistent results. This report presents a prospective one year treatment outcome of 22 severely tortured patients from Ethiopia, Somalia, Iran and Afghanistan.

Circadian misalignment in major depressive disorder.

It has been hypothesized that the circadian pacemaker plays a role in major depressive disorder (MDD). We sought to determine if misalignment between the timing of sleep and the pacemaker correlated with symptom severity in MDD. Depression severity correlated with circadian misalignment: the more delayed, the more severe the symptoms.

Cross-cultural psychiatric residency training: the Oregon experience.

Objective: The purpose of this article is to describe the goals and structure of cross-cultural psychiatric training at Oregon Health and Science University (OHSU). This training in core knowledge, skills, and attitudes of cultural psychiatry over the past three decades has included medical students, residents, and fellows, along with allied mental health personnel. The curriculum includes both didactic sessions devoted to core topics in the field and varied clinical experiences in community settings and the Intercultural Psychiatric Program under the supervision of experienced academic faculty.

High prevalence rates of diabetes and hypertension among refugee psychiatric patients.

There is increasing evidence that immigrants and traumatized individuals have elevated prevalence of medical disease. This study focuses on 459 Vietnamese, Cambodian, Somali, and Bosnian refugee psychiatric patients to determine the prevalence of hypertension and diabetes. The prevalence of hypertension was 42% and of diabetes was 15.

Pharmacologic reduction of CNS noradrenergic activity in PTSD: the case for clonidine and prazosin.

This article reviews the neurobiologic rationale for and presents clinical guidance concerning the use of medications that reduce central nervous system noradrenergic activity in the treatment of intrusive symptoms of posttraumatic stress disorder. The authors reviewed neurobiological studies, nonclinical studies using animal models, clinical case reports, open-label drug studies, and blinded, placebo-controlled drug studies. This review of the basic science and clinical literature, and the authors' clinical experience with culturally and demographically diverse populations, indicate that clonidine and prazosin can play a useful role in treating sleep disturbance and hyperarousal in posttraumatic stress disorder, with minimal adverse effects and low financial cost.

Immigrants and refugees: the psychiatric perspective.

Psychiatric studies of immigrants have yielded contradictory findings regarding rates of mental illness. Current evidence suggests that rates of schizophrenia (and probably other disorders) among immigrant groups are low compared with native-born populations when sending and receiving countries are socially and culturally similar. The rates for immigrants are higher when sending and receiving countries are dissimilar, probably because of multiple social problems faced by immigrants in the receiving country.

Traumatized refugee children: the case for individualized diagnosis and treatment.

The first 131 traumatized refugee children evaluated and treated in a child specialty clinic indicated a wide variety of trauma including war-related traumas (21%) for areas of recent conflict and domestic violence (28%) predominantly occurring in patients from Mexico and Latin America. Clinical diagnoses indicate PTSD was common (63%) in the war trauma group but was found less (25%) in the domestic violence group. Otherwise, the refugee clinic population showed a wide variety of diagnoses, including 20% having learning or cognitive disability or clear mental retardation.

Cortisol production rate in posttraumatic stress disorder.

Context: Several authors have reported the unsuspected finding of low cortisol levels (urinary, salivary, and serum) in patients with posttraumatic stress disorder (PTSD).

Objective: Our objective was to assess concentrations of cortisol and its predominant metabolites, cortisol production rate (CPR), and glucocorticoid receptor (GR) binding characteristics in PTSD compared with normal subjects.

Design: Matched PTSD patients and control subjects had CPR determined by a stable isotope dilution technique after infusion of deuterated cortisol.

Psychological distress among recent Russian immigrants in the United States.

Background: The purpose of this study was to examine the psychological status of Russian immigrants who have recently come to the United States.

Aims: The project included creation of a Russian version of the Hopkins Symptom Checklist-25 (HSCL-25) in order to identify anxiety and depression in members of the Russian-speaking immigrant population.

Methods: Translation and adaptation included (a) cross-cultural adaptation; (b) translation; (c) pre-testing; and (d) analysis of validity, reliability and internal consistency.

Psychometric properties of a Russian version of the SF-12 Health Survey in a refugee population.

This project examined psychometric properties of a Russian translation of the 12-item Short-Form health survey questionnaire (SF-12) to assess physical and mental health status in members of the Russian-speaking refugee population. Translation and adaptation included (a) cross-cultural adaptation; (b) translation; (c) pre-testing; and (d) analysis of validity, reliability, and internal consistency. Seventeen Russian-speaking patients at a Russian psychiatric clinic were recruited for the study and were compared to a sample of 42 Russian-speaking members of the community.

A ten-year treatment outcome study of traumatized Cambodian refugees.

The purpose of this study was to assess treatment outcome among 23 severely traumatized Cambodian refugee patients with posttraumatic stress disorder who had been in continuous treatment for 10 or more years. Primary outcome parameters were symptom severity, social and vocational disability, and subjective quality of life. All patients were interviewed using standard assessment tools by a research psychiatrist not connected with the treatment, and charts were reviewed for past and current traumas and for treatment history.