Psychedelics - A Cure for Sexual Trauma or a Risk Factor in Recreational and Treatment Settings?

Assessing the prevalence of HIV, HBV, and HCV infection among people with severe mental illness

Best practices are recommended for assessing risk of violence and utilizing those findings to communicate with other mental health providers to manage the potential for violence as clients are transferred or referred. These recommendations are the fruition of a five-year collaboration of the Forensic Risk Assessment Work Group of the Ohio Department of Mental Health's statewide Forensic Product Line Leadership Team. Accurate assessment of static and dynamic risk factors, effective communication of risk of violence, incorporation of dynamic risk factors into the treatment planning process, and implementation of evidence-based risk-management practices are all emphasized as best practices.

Identifying key risk factors for premature discontinuation of opioid use disorder treatment in the United States: A predictive modeling study

Recurrence of major depressive disorder across different treatment settings: Results from the NESDA study

This study aimed to evaluate the administration of endocarditis prophylaxis (EP) in children and adolescents with cardiac findings requiring invasive dental therapy according to the newest European Society of Cardiology (ESC) guidelines from 2023. The research question focused on comparing EP protocols between chairside treatment (CS) and general anesthesia (GA) settings, given clinical protocol differences observed between these modalities. This retrospective analysis included 201 patients with cardiac findings who attended the Department of Pediatric Dentistry at Giessen University Hospital between 2018 and 2023 and underwent dental interventions with bacteremia risk. Patient data included cardiac findings, EP administration protocols, antibiotic agents used, treatment settings, and patient outcomes defined as infective endocarditis (IE) occurrence within three months post-intervention. EP indications were evaluated according to ESC guidelines. Fisher’s exact test was used to statistically test differences (GA vs. CS) regarding the outcome and the type of EP medication (α = 0.05). Of all patients, 58.7% received treatment under GA and 41.3% chairside. According to ESC guidelines, EP indication existed in 36.4% of GA patients and 22.9% of CS patients. However, EP was administered in 84.7% of GA patients and 59.0% of CS patients. A significant correlation was found between the variables “treatment setting” and “antibiotic preparation EP” (p < 0.001). No cases of IE occurred within 3 months, regardless of EP administration or indication status.Conclusion: Besides the limitations of our retrospective study, frequent EP over-administration beyond guideline recommendations was detected, and no IE cases occurred. This aspect could question whether EP indications should be more restrictively defined, particularly in children and adolescents with healthy dental status. What is Known:• The indication for antibiotic endocarditis prophylaxis (EP) during dental treatment is based on cardiac and dental risk factors.• In 2023, the European Society of Cardiology (ESC) published new guidelines for the prevention of infective endocarditis (IE) [1].What is New:• This study highlights the difficulties in implementing guideline-adhering endocarditis prophylaxis and emphasizes the need for strict and comprehensible EP indication in children and adolescents.

ABSTRACTBackground: Data on achieving National Cholesterol Education Program Adult Treatment Panel III (ATP III) goals in Asia are limited.Objective: To examine treatment patterns, goal attainment, and factors influencing treatment among patients in 6 Asian countries who were taking statins.Methods: A retrospective cohort study was conducted in China, Korea, Malaysia, Singapore, Taiwan, and Thailand, where 437 physicians (41% cardiologists) recruited adults with hypercholesterolemia newly initiated on statin monotherapy.Results: Of 2622 patients meeting inclusion and exclusion criteria, approximately 66% had coronary heart disease (CHD)/diabetes mellitus, 24% had no CHD but ≥2 risk factors, and 10% had no CHD and <2 risk factors. Most patients (∼90%) received statins at medium or lower equipotency doses. Across all cardiovascular risk categories, 48% of patients attained ATP III targets for low-density lipoprotein cholesterol (LDL-C), including 38% of those with CHD/diabetes (goal: <100 mg/dL), 62% of those without CHD but with ≥2 risk factors (goal: <130 mg/dL), and 81% of those without CHD and <2 risk factors (goal: <160 mg/dL). Most patients who achieved goals did so within the first 3 months. Increasing age (odds ratio (OR) = 1.015 per 1-year increment; 95% confidence interval (CI) = 1.005–1.206; p = 0.0038) and initial statin potency (OR = 2.253; 95% CI = 1.364–3.722; p = 0.0015) were directly associated with goal attainment, whereas increased cardiovascular risk (OR=0.085; 95% CI = 0.053–0.134; p < 0.0001 for CHD/diabetes mellitus at baseline compared with <2 risk factors,) and baseline LDL-C (OR = 0.990; 95% CI = 0.987–0.993); p < 0.0001 per 1-mg/dL increment) were inversely associated with LDL-C goal achievement. Limitations of this study include potential differences in treatment settings and cardiovascular risk factors between different countries and centers. In addition, the effects on cholesterol goal achievement of concomitant changes in lifestyle were not assessed.Conclusion: LDL-C goal attainment is low in Asians, particularly those with CHD/diabetes. More effective patient monitoring, treatments, including combining regimens and dose titration, and adherence to these treatments along with therapeutic lifestyle counseling may facilitate goal attainment.

Background: Febrile neutropenia (FN), a major hematologic adverse event in perioperative chemotherapy for breast cancer, is more prevalent among Asians than in Caucasian populations. Four main guidelines, i.e., ASCO, EORTC, NCCN, and ESMO, provide recommendations regarding the appropriate use of hematopoietic growth factors. These guidelines recommend primary prophylaxis with granulocyte colony-stimulating factor (G-CSF) based on the estimated incidence of FN, primarily defined by the chemotherapy regimen. G-CSF administration is recommended when the incidence of FN is ≥20% or 10–20% with risk(s). However, the incidence of FN varies depending on the trial and design, and patient-specific risk factors for FN remain unclear. We previously performed a multicenter prospective cohort study in Japan, the CSPOR-BC FN study, evaluating the incidence of FN during perioperative chemotherapy for breast cancer. Herein, we conducted an additional analysis to explore thresholds of patient-specific risk factors for FN that could be evaluated before chemotherapy. We analyzed the risk factors for FN and verified the appropriateness of patient selection for prophylactic G-CSF administration. Methods: The previously reported CSPOR-BC FN study (PubMed ID=33631458) consecutively enrolled 1005 patients with stage I–III breast cancer between August 2015 and July 2017. In the current additional analysis, we intended to have 477 patients in the visiting group that evaluated true-FN, defined as ≥37.5℃ and grade 4 neutropenia. Multivariate analysis of risk factors for FN was performed, followed by the determination of cutoff values for age and pretreatment absolute neutrophil count (ANC) as risk factors. Results: Chemotherapy regimens administered were FEC (fluorouracil, epirubicin, and cyclophosphamide) in 170 patients (36%), E(A)C (epirubicin (doxorubicin) + cyclophosphamide) in 165 patients (35%), and TC (docetaxel + cyclophosphamide) in 142 patients (30%). The incidence of FN was 28.7% (N = 137). To evaluate the risk factors for FN, we predefined regimens, age, performance status (PS), stage, chemotherapy or radiotherapy history, infectious wounds, open wounds, ANC, and renal and liver dysfunction as potential risk factors. Multivariate analysis of risk factors for FN identified regimen (TC), age (≥65), low pretreatment ANC, treatment setting, and no primary pegfilgrastim prophylaxis as significant risk factors. Two patient-specific risk factors (age and pretreatment ANC) were analyzed. Logistic regression analysis revealed that age≥65 years was a significant risk factor (odds ratio=2.24, 95% confidence interval: 1.34–3.75). Applying a cutoff of 65 years (age) to predict FN, the sensitivity and specificity were 28.4 and 83.8%, respectively, which were inaccurate. Despite applying a cutoff of 67 years optimized from the receiver operating characteristic (ROC) curve, the sensitivity (22.4%), specificity (90.7%), and area under the curve (0.519) indicated low discrimination for predicting FN. The incidence of FN by age group was as follows: &amp;lt; 45 years, 30.8%; 45–55 years, 26.4%; 55–64 years, 20.9%; ≥65 years, 39.6%. Additionally, applying a cutoff of 2436/µL (pretreatment ANC) optimized from the ROC curve, the observed sensitivity (27.6%) and specificity (83.8%), and area under the curve (0.558) also indicated low discrimination for predicting FN. The incidence of FN by stratum of pretreatment ANC was as follows: &amp;lt; 2000, 33.3%; 2000–3000, 30.7%; 3000–4000, 29.9%; and &amp;gt;4000, 24.6. Accordingly, setting a cutoff value to predict FN incidence using age and/or pretreatment ANC was deemed inappropriate. Conclusion: Selecting patients for primary prophylactic G-CSF based on the existing FN risk can be challenging. Primary prophylactic G-CSF would be considered for every patient undergoing perioperative chemotherapy for breast cancer, especially Asians. ROC curve for FN and age. The AUC was 0.519. ROC curve for FN and neutrophil count. The AUC was 0.558. Citation Format: Kazutaka Narui, Takashi Ishikawa, Ikumi Takashima, Kosuke Kashiwabara, Yukari Uemura, Yuichiro Kikawa, Naruto Taira, Hirofumi Mukai. Is it appropriate to select patients for primary prophylactic use of pegfilgrastim based on the risk of febrile neutropenia? [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-12-06.

The present review aims to help specialists remain up-to-date on research from the past 2 years on epidemiology, risk factors, biological correlates, treatment, and outcomes for purging disorder, a DSM-5 other specified feeding and eating disorder. Purging disorder affects 2.5-4.8% of adolescent females in population-based samples, but purging disorder remains relatively rare in treatment settings. Higher premorbid body mass index, body dissatisfaction, and dieting prospectively predict purging disorder onset. In studies of biological correlates, women with purging disorder demonstrated significantly greater postprandial increases in the satiety peptide, peptide tyrosine tyrosine, compared to women with bulimia nervosa and controls, and these differences predicted greater gastrointestinal distress in purging disorder. Less than half of those with purging disorder are free from an eating disorder at the end of treatment and at one or more years of follow-up, supporting the need for improved interventions. Purging disorder may occupy a space that falls between anorexia and bulimia nervosa, making it 'not quite' anorexia and 'not quite' bulimia and difficult to reliably distinguish from each. Improved recognition and understanding of purging disorder requires more research specifically designed to test models of risk and maintenance factors to advance interventions for those who purge without binge eating.

Methamphetamine use is a global concern, and methamphetamine-associated psychosis (MAP) is a particular harm resulting from regular use of the drug that causes significant distress and burden on health and social services. This paper aims to provide a clinically focussed and up-to-date overview of the prevalence, risk factors, and clinical and cognitive features of MAP. The prevalence of MAP ranges between 15 and 30% in recreational settings and up to 60% in some inpatient treatment settings, with up to a third of people with MAP later diagnosed with persistent psychotic disorders. The frequency of methamphetamine use and severity of dependence are the most consistent risk factors for MAP, but other predictors such as genetic vulnerability, a family history of psychotic illness, or trauma also play a role. People with MAP can vary in their presentation, from brief delusional experiences, to persistent psychosis characterised by first-rank symptoms and cognitive impairment. Contemporary conceptualisations of MAP need to incorporate this spectrum of clinical presentations in order to inform clinical decision-making, service provision, and research directions.

This practice parameter describes the assessment and treatment of children and adolescents with substance use disorders and is based on scientific evidence and clinical consensus regarding diagnosis and effective treatment as well as on the current state of clinical practice. This parameter considers risk factors for substance use and related problems, normative use of substances by adolescents, the comorbidity of substance use disorders with other psychiatric disorders, and treatment settings and modalities. (Reprinted with permission from the Journal of the American Academy of Child and Adolescent Psychiatry 2005; 44(6):609–621)

Nails in the coffin of fresh frozen plasma to prevent or treat bleeding in cirrhosis?

Objective: Mental health comorbidities among individuals with a substance use disorder are common. This study provides an analysis of the prevalence, risk factors, and treatment outcomes (depression, anxiety and stress, and cravings) of individuals with comorbid depression, anxiety, posttraumatic stress disorder (PTSD), obsessive compulsive disorders (OCD), and/or eating disorders attending residential substance use treatment centers. Methods: Intake and three-month post-discharge assessments of 603 (69.3% men) people attending residential substance use treatment services were conducted using the Mental Health Screening Scale, Addiction Severity Index, Depression, Anxiety Stress Scale, and a cravings measure. Results: Anxiety disorders were common (94.5%), followed by depression (89.6%), PTSD (62.0%), OCD (33.7%), and eating disorders (21.4%). Nearly a quarter reported two comorbidities and 8.5% reported five comorbidities. Higher comorbidity levels were associated with having poorer mental health but not cravings at three-month post-discharge follow-up. Conclusions: Comorbidity is common and complex in presentations to residential substance use treatment settings. Higher levels of comorbidity are linked to poorer mental health, which remains over time.

This study examined rates of and risk factors associated with suicide attempts by psychiatric patients under active care. It was especially focussed on the relative rates across three standard treatment settings: acute inpatient care, long-stay inpatient care and community-based care. A total of 12,229 patients in 13,632 episodes of care were rated on the Health of the Nation Outcome Scales (HoNOS) Item 2. For the purposes of the current investigation, a score of 4 was deemed to indicate a suicide attempt. Incidence densities per 1000 episode days were 5.4 (95% CI = 4.8-6.1) for patients under care in acute inpatient settings, 0.6 (95% CI = 0.5-0.8) for patients under care in long-stay inpatient settings, and 0.5 (95% CI = 0.5-0.6) for patients under care in community-based arrangements. Predictors varied by treatment setting. Risk was elevated for personality disorders across all settings: 22.7 attempts per 1000 episode days (95% CI = 17.2-30.0) in acute inpatient care; 2.1 (95% CI = 1.0-4.5) in long-stay inpatient care; and 2.3 (95% CI = 1.7-3.0) in community-based care. This effect remained after adjustment for demographics. Rates of suicide attempts among psychiatric patients are a major issue facing contemporary mental health care systems, and risk factors vary across different treatment settings.

Neumonía adquirida en la comunidad. Normativa de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Actualización 2020

Psychiatric management of Patients in intensive care units.