Adverse Childhood Experiences and Trust in the Medical Profession among Young Adults.

Attachment theory suggests that adverse childhood experiences (ACEs) should predict lower trust in the medical profession. To test this theory, a cross-sectional survey was administered to young adults self-identifying as homeless. The purpose of the survey was to examine the relationship of ACEs, attachment style, and trust in the medical profession.

Psychiatric symptoms and synthetic cannabinoid use: Information for clinicians.

Background: Limited treatment information is available when patients present with psychotic symptoms secondary to synthetic cannabinoid (SC) use. Symptoms associated with use are often indistinguishable from those encountered with a primary mental illness and also include aggression, confusion, and anxiety. For these patients, clinicians rely on physical presentation, symptom(s) onset, and episode duration when evaluating patients.

Medical mimics: Differential diagnostic considerations for psychiatric symptoms.

Patients with underlying medical disease can present to the health care system with psychiatric symptoms predominating. Identification of an underlying medical condition masquerading as a psychiatric disorder can be challenging for clinicians, especially in patients with an existing psychiatric condition. The term or has been used to describe this clinical situation.

A design and focus group evaluation of dietary choices tools for an underserved population.

Introduction: Our objective was to develop and evaluate dietary teaching tools for a select population diagnosed with a severe mental illness and limited financial ability. Patients with severe mental illnesses face many challenges, including common health comorbidities of diabetes, high blood pressure, high cholesterol, and obesity. Cognitive deficits may limit educational programming; financial resources can affect access to a healthy diet.

Evaluating antidepressant treatment prior to adding second-line therapies among patients with treatment-resistant depression.

Background: Patients with depression can be mistakenly labeled as treatment-resistant if they fail to receive an adequate first-line antidepressant trial. Adding second-line agents to the treatment regimens can create an additional burden on both the patients and the healthcare system.

Objectives: To determine if depressed patients receive an adequate antidepressant trial prior to starting second-line therapy and to investigate the association between the type of second-line treatment and severity of illness or depression among unipolar versus bipolar patients.

Does the use of atypical antipsychotics as adjunctive therapy in depression result in cost savings? Comparing healthcare costs and utilization between second-line treatment options.

Background: Several atypical antipsychotics (AAPs) are used as second-line agents for treatment resistant depression. AAPs can be expensive compared to other treatment options and can cause several side effects.

Objectives: To estimate healthcare costs and utilization of AAPs compared to other second-line agents.

Hypertension in an Adolescent Secondary to Performance-Enhancement Supplement Use.

To describe the effects of performance-enhancing supplements and caffeine on the blood pressure (BP) of an adolescent male. An adolescent male presented to his primary care provider for a preseason athletic physical. On physical exam, his BP was 162/90, exceeding the 99th percentile for his age.

Evaluation of monitoring for metabolic effects in children treated with second generation antipsychotics in a pediatric clinic.

Objectives: The aim of this retrospective study was to identify the frequency of recommended metabolic monitoring and follow-up in pediatric patients on second-generation antipsychotic (SGA) medications from a pediatric clinic.

Methods: A retrospective review of electronic medical records of all patients on antipsychotics from an academic medical center pediatric clinic was conducted. Inclusion criteria required patients to be established members of the pediatric clinic, < 19 years of age, and on ≥ 1 SGA for at least 1 year, regardless of medical diagnosis.

Evaluation of serum prolactin levels in intellectually disabled patients using antipsychotic medications.

Background: Patients with intellectual disabilities may be treated with antipsychotic medications for a variety of diagnoses. Use of this category of medication can increase prolactin levels and place the patient at risk for sexual dysfunction and lower bone mineral density. The proposed mechanism of action is affinity for the dopamine receptor.

Mental health treatment associated with community-based depression screening: considerations for planning multidisciplinary collaborative care.

Background: Depression places a large economic burden on the US health care system. Routine screening has been recognized as a fundamental step in the effective treatment of depression, but should be undertaken only when support systems are available to ensure proper diagnosis, treatment, and follow-up.

Objective: To estimate differences in prescribing new antidepressants and referral to stress management, psychotherapy, and other mental health (OMH) counseling at physician visits when documented depression screening was and was not performed.

Use of visual cueing for blood glucose documentation in a person with schizophrenia and diabetes.

Persons diagnosed with schizophrenia are also at-risk for medical comorbidities. We present the case of one such patient with the comorbidity of diabetes. By applying the research on visual cueing for this population, we developed a glucose monitoring form that increased documentation.

Antipsychotic treatment of adolescent dual diagnosis patients.

Background: A diagnosis of schizophrenia requires development of a pharmacotherapy regimen that balances many factors in the therapeutic decision-making process. Patient age and the presence or absence of comorbid chemical dependency represent two factors. Comorbid chemical dependency can have a profound impact on the successful treatment of schizophrenia, making patients with dual diagnoses of schizophrenia and chemical dependence a uniquely challenging population.

Schizophrenia and the immune system: pathophysiology, prevention, and treatment.

Purpose: Published evidence on established and theoretical connections between immune system dysfunction and schizophrenia is reviewed, with a discussion of developments in the search for immunologically-targeted treatments.

Summary: A growing body of evidence indicates that immunologic influences may play an important role in the etiology and course of schizophrenia. A literature search identified more than 100 articles pertaining to suspected immunologic influences on schizophrenia published over the past 15 years.

Treatments for methamphetamine abuse: a literature review for the clinician.

Methamphetamine (METH) use and dependence is a serious public health concern with implications across multiple areas from societal impact to burden on psychiatric and medical resources. An estimated 8% of admissions to substance abuse treatment programs are related to stimulants with METH/amphetamine abuse. To date, effective pharmacotherapy options to enhance abstinence have not been identified.

Case report: increased patient response to intramuscular haloperidol decanoate following a change in needle length.

Introduction: Intramuscular (IM) injection is a commonly used administration route for a variety of medications. Determining the optimum needle length for administration of IM formulations based on individual patient variables has not been extensively reported in patients receiving antipsychotic medication via IM administration.

Case Report: The patient, a 23-year-old African American female diagnosed with schizophrenia, was referred to a community-based treatment program following multiple inpatient admissions.

Probable quetiapine-mediated prolongation of the QT interval.

Purpose: QT prolongation can occur with both first- (FGA) and second-generation antipsychotics (SGA). QT prolongation was identified in an adult patient who presented to the emergency room with schizophrenia, fluid and electrolyte imbalances, and pneumonia. Quetiapine, an SGA, was a component of the pharmacotherapy regimen.

Antidepressant-mediated gastroesophageal reflux disease.

Anticholinergic effects of medications are factors in autonomic control of the lower esophageal sphincter function. Changes in sphincter control often lead to gastroesophageal reflux disease (GERD), a chronic disease with a prevalence of up to 25% for adults. This effect is a consideration in the treatment of depression, the fourth-leading disease burden.

Violence among persons diagnosed with schizophrenia: how pharmacists can help.

Violence among those diagnosed with schizophrenia has been reported but is not a diagnostic component of the disorder. The position of the courts regarding fulfillment of the requisite intent to commit violent acts has not been extensively reported. This article discusses the impact of a diagnosis of schizophrenia in an individual and how the pharmacist can help integrate information into the health care system.

Commonly prescribed medications and potential false-positive urine drug screens.

Purpose: The implications of potential false-positive urine drug screen (UDS) results for patients receiving commonly prescribed medications were evaluated.

Summary: A comprehensive literature review was conducted to identify false-positive UDSs associated with all clinic formulary medications, as well as common nonprescription medications. The references of each report describing a medication whose use was associated with false-positive UDS results were also reviewed.