Primary Support Group Research Articles

Social Determinants of Health–Related Z Codes and Health Care Among Patients With Hypertension

Tracking social needs can provide information on barriers to controlling hypertension and the need for wraparound services. No recent studies have examined ICD-10-CM social determinants of health-related Z codes (Z55-Z65) to indicate social needs with a focus on patients with hypertension. Three cohorts were identified with a diagnosis of hypertension during 2016-2017 and continuously enrolled in fee-for-service insurance through June 2021: (1) commercial, age 18-64 years (n=1,024,012); (2) private insurance to supplement Medicare (Medicare Supplement), age ≥65 years (n=296,340); and (3) Medicaid, age ≥18 years (n=146,484). Both the proportion of patients and healthcare encounters or visits with social determinants of health-related Z code were summarized annually. Patient and visit characteristics were summarized for 2019. In 2020, the highest annual documentation of social determinants of health-related Z codes was among Medicaid beneficiaries (3.02%, 0.46% commercial, 0.42% Medicare Supplement); documentation was higher among inpatient than among outpatient visits for all insurance types. Z63 (related to primary support group) was more common among commercial and Medicare Supplement beneficiaries, and Z59 (housing and economic circumstances) was more common among Medicaid beneficiaries. The 2019 total unadjusted medical expenditures were 1.85, 1.78, and 1.61 times higher for those with social determinants of health-related Z code than for those without commercial, Medicare Supplement, and Medicaid, respectively. Patients with social determinants of health-related Z code also had higher proportions of diagnosed chronic conditions. Among Medicaid beneficiaries, differences in the presence of social determinants of health-related Z code by race or ethnicity were observed. Although currently underreported, social determinants of health-related Z codes provide an opportunity to integrate social and medical data and may help decision makers understand the need for additional services among individuals with hypertension.

Z-code documentation to identify social determinants of health among Medicaid beneficiaries.

Social determinants of health (SDoH) are non-medical factors that impact individuals' health. SDoH can be documented in claims data using International Classification of Disease (ICD) 10th revision codes Z55 - Z65. The study objective was to describe the documentation of SDoH Z-codes among Medicaid beneficiaries in Texas. Texas Medicaid medical and enrollment claims data were utilized. Beneficiaries with at least one claim associated with SDoH Z-codes between 2016 and 2019 were identified excluding those 65+ years of age and others dually eligible for Medicare. SDoH Z-code documentation was associated with approximately 1.2 million claims for 181,136 unique beneficiaries. Females (54.3%) and Hispanics (47.9%) comprised a majority of beneficiaries with Z-code documentation, and the average age was 14.2±13.4 years. Nearly 40% had Z-code documentation of "problems related to upbringing" (Z62) (N=68,478, 37.8%), followed by "problems related to primary support group including family circumstances" (Z63) (N=42,378, 23.4%), and "problems related to education and literacy" (Z55) (N=28,848, 15.9%). SDoH Z-code documentation increased slightly over the years from 1% of Medicaid beneficiaries in 2016 to 1.3% in 2019. A steady increase in SDoH Z-code documentation was observed among Medicaid beneficiaries but represented a relatively small proportion of the beneficiaries overall.

Social Determinants of Health and Risk of Stillbirth in the United States.

Our aim was to evaluate the impact of social determinants of health (SDoH) risk factors on stillbirth among pregnancy-related hospitalizations in the United States. We conducted a cross-sectional analysis of delivery-related hospital discharges using annualized data (2016-2017) from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. The International Classification of Diseases, 10th Revision ICD-10-CM codes were used to select women with singleton stillbirth. Z-codes were utilized to identify SDoH risk factors and their subtypes. The association between SDoH risk factors and stillbirth was assessed using survey logistic regression models. We analyzed 8,148,646 hospitalizations, out of which 91,140 were related to stillbirth hospitalizations, yielding a stillbirth incidence of 1.1%. An increased incidence was observed for non-Hispanic (NH) Blacks (1.7%) when compared with NH Whites (1.0%). The incidence of stillbirth was greater in hospitalizations associated with SDoH risk factors compared with those without risk factors [2.0% vs. 1.1% (p <0.001)]. Among patients with SDoH risk factors, the rate of stillbirth was highest in those designated as NH other (3.0%). Mothers that presented with SDoH risk factors had a 60% greater risk of stillbirth compared with those without (odds ratio [OR] = 1.61 [95% confidence interval (CI) = 1.33-1.95], p < 0.001). The SDoH issues that showed the most significant risk for stillbirth were: occupational risk (OR = 7.05 [95% CI: 3.54-9.58], p < 0.001), upbringing (OR = 1.87 [95% CI: 1.23-2.82], p < 0.001), and primary support group and family (OR = 5.45 [95% 3.84-7.76], p < 0.001). We found pregnancies bearing SDoH risk factors to be associated with a 60% elevated risk for stillbirth. Future studies should target a variety of risk reduction strategies aimed at modifiable SDoH risk factors that can be widely implemented at both the population health level as well as in the direct clinical setting. · Health disparities exist in stillbirth rates, especially among NH Black women.. · Social determinants of health risk factors increase the risk of stillbirth.. · There is a need for further study on the impact of specific SDoH risk factors on stillbirth risk..

Revisão sistemática: critérios de qualidade no projeto de programas de orientação vocacional

ABSTRACT The present investigation explores the design of vocational guidance programs for formal education at the secondary level, to address the lack of an effective vocational guidance program suited to the sociodemographic conditions of the student population. The objective was to develop a critical synthesis of the scientific literature related to vocational and professional orientation, through applied research based on the systematic review methodology. From the analysis, it was concluded that there are essential actions in professional orientation programs to determine high levels of quality: to offer information about academic supply and labor demand, to develop occupational profiles of different careers, to offer information on interests, aptitudes and preferences, carry out training in decision making, link to the primary support group, provide strategies for the development of self-efficacy and vocational maturity, support the use of ICTs, provide strategies for the transition, prioritize the role of mentor and peers, establish a project or life plan, counting on a theoretical foundation and developing a constant evaluation of the vocational programs, during the different stages of the life cycle.

Cognitive Conflicts in Functional Gastrointestinal Disorders

The importance of psychological factors in functional gastrointestinal disorders (FGID) is well-stablished in the literature; however, cognitive factors have hardly been researched and, in particular, cognitive conflicts have not been explored for these disorders. The aim of this study is to compare the cognitive and symptomatic characteristics of a group of 66 FGID patients (33 diagnosed with irritable bowel syndrome and 33 with functional dyspepsia) with a control group of participants without FGID or psychopathological symptoms. Both groups were matched by sex and age. The evaluation of the clinical sample was carried out following the criteria of the DSM-IV-TR. The SCL 90-R, and also the Repertory Grid for the identification of cognitive conflicts (implicative dilemmas) and self-ideal discrepancy, were administered to both the clinical sample and the control group. Results showed that 85% of FGID patients met the criteria for one axis I disorder of the DSM-IV-TR, mainly anxiety and somatization disorders. Regarding axis II, 23% presented at least one personality disorder, the most common ones being those of avoidance and dependence. Regarding axis IV, the patients reported a higher number of problems relative to the primary support group. FGID patients showed greater symptoms compared to the control group on various SCL 90-R scales. On the other hand, FGID patients presented more implicative dilemmas than healthy controls, as well as lower self-esteem. No significant differences were observed depending on the type of FGID (irritable bowel syndrome or functional dyspepsia).

Absence of Biological Mothers in Infancy in Children and Adolescents on Diagnosis of Mental Disorders at Ikeswar Outpatient Clinic, Prof. Dr. Soerojo Mental Hospital, Magelang

Introduction. Globally, psychopathological problems in children and adolescents will become one of five problems that cause disability, morbidity, and even mortality in the next 20 years. The quality of a child's early attachment relationship is closely related to future brain and personality development. Attachment disorders are associated with the development of psychopathology in childhood and adulthood. This study aims to describe mental disorders in children and adolescents due to mothers who leave their children in infancy on Java, especially around Magelang.&#x0D; Methods. The type of this research is cross-sectional, namely descriptive research. The sample in this study were all patients and their parents/guardians who came for a consultation to the Ikeswar Polyclinic, Mental Hospital Prof. Dr.Soerojo Mental Hospital started on February 18, 2019. The examination uses the mental status determined and guided by PPDGJ III (Guidelines for Classifying the Diagnosis of Mental Disorders).&#x0D; Results. Most of the research respondents was male, both in children with excellent or poor attachment. As much as 26.1% in the group with suitable attachment. The age of most respondents is ten years old. The fourth axis diagnosis regarding psychosocial and environmental problems that most respondents experienced was primary support group (family) problems&#x0D; Conclusion. The attachment of the biological mother to the child at the age of fewer than two years is essential for the emotional mentality of the child at the age afterward and there is no visible picture of the difference in diagnosing mental disorders in children with suitable attachment and poor attachment.

Why strong employment support for persons with disabilities has not brought about positive outcomes? A qualitative study in mainland China

Employment is an important way for persons with disabilities (PwDs) to participate in society and fulfil their potential. However, despite the impression that employment support for PwDs is improving, why is the actual employment situation in China stagnant or even worsening? In order to answer this question, this paper uses a qualitative study in BTQ City, QL Province, China to analyze the causes of the general problems in employment support for PwDs by breaking them down into official government, quasi-government, and primary support groups. This study finds that the prioritization of 'economic development' dominates people's thinking and actions, to the detriment of social and economic goals. Consequently, the responses of the three employment support systems are: (a) an official government focus on “productivism” means PwDs employment is not a priority, and official support is usually “all talk, no action”; (b) bureaucratic quasi-government organizations are reluctant to assist beyond mere formalities to boost PwDs employment as this does not form part of their performance assessment; and (c) individualism resulting from societal breakdown makes the primary support group perceive a lack of benefit in assisting PwDs, and any assistance they render is done purely out of self-interest and are therefore unsustainable. We hope that the findings of this study will provide some inspiration and reference for improving the employment policy of PwDs in China.

Supportive Psychotherapy and Psychoeducation as a Media for Changing and Convincing Behavior in Clients with Paranoid Schizophrenia

Schizophrenia is a psychiatric diagnosis that describes mental disorders with character abnormalities in perception or disorders regarding reality. Perception abnormalities can be in the form of disorders in the five senses, usually in the form of auditory hallucinations, paranoia, bizarre delusions, and can also be in the form of speech disorganization and disruption of real social communication. Case. Mr.SA, age 43, came with complaints of rampage to his family and surrounding community for no apparent reason. The patient was treated at Menur General Hospital Surabaya 2 years ago with a similar complaint. Psychiatric status obtained clear awareness, bad insight, blunt affect, auditory hallucinations, visuals, followed by delusions of control, suspicious. Diagnosis of axis I: paranoid schizophrenia, axis II and III: none, axis IV: Primary Support Group (Family) GAF axis scale 20.11 (danger of self-injury / others when entering hospital). Psychopharmaca therapy is chlorpromazine tab 1 x 100 mg, haloperidol tab 3 x 5 mg, and trihexyphenidyl 3 x 2 mg, and psychotherapy that is support. Conclusion The paranoid schizophrenia of this patient is due to work problems

Socio-demographic Characteristics and Psychosocial Stressors in the Children and Adolescents with Somatoform Disorders

Introduction: Somatoform disorders are characterized by physical symptoms that suggest a medical condition, and which are not fully explainable by general medical condition, or by the direct effects of a substance, or by another mental disorder.&#x0D; Objectives: to study the socio-demographic characteristics and psychosocial stressors in children and adolescents with somatoform disorders.&#x0D; Methods: From 1st January, 2018 to 30th June 2018, Children and adolescents from 3 to 18 years of age with unexplained physical st thsymptoms were evaluated using DSM – IV criteria. Detailed evaluation followed for those meeting inclusion criteria.&#x0D; Results: Among 65 patients (18, 27.69% boys and 47, 72.31% girls) meeting inclusion criteria, conversion disorder was the most common (37, 56.92%), followed by undifferentiated somatoform disorder (15, 23.08%). Girls were significantly more represented among conversion disorder patients compared to other groups of somatoform disorders (68.08% vs. 27.78%, X2 =8.63, p&lt;0.01) Stressors 2 were identified in 95% and acute precipitating stressors were present in 75% patients. Both the boys and girls had significantly higher rates of academic problems. Boys found to have social and environmental problems while girls had problems in primary support group.&#x0D; Conclusion: Somatoform disorder, particularly conversion disorder is more common and it is found more in girls. Academic problems, poor interpersonal relations and conflict in the family are the important psychosocial stressors.

Psychosocial stressors contributing to emergency psychiatric service utilization in a sample of ethno-culturally diverse clients with psychosis in Toronto

BackgroundUnderstanding the psychosocial stressors of people with psychoses from minority ethnic groups may help in the development of culturally appropriate services. This study aimed to compare psychosocial factors associated with attendance at an emergency department (ED) for six ethnic groups. Preventing crises or supporting people better in the community may decrease hospitalization and improve outcomes.MethodA cohort was created by retrospective case note analysis of people of East-Asian, South-Asian, Black-African, Black-Caribbean, White-North American and White-European origin groups attending a specialized psychiatric ED in Toronto with a diagnosis of psychosis between 2009 and 2011. The psychological or social stressors which were linked to the presentation at the ED that were documented by the attending physicians were collected for this study. Logistic regression models were constructed to analyze the odds of presenting with specific stressors.ResultsSeven hundred sixty-five clients were included in this study. Forty-four percent of the sample did not have a psychiatrist, and 53% did not have a primary care provider. Social environmental stressors were the most frequent psychosocial stressor across all six groups, followed by issues in the primary support group, occupational and housing stressors. When compared to White-North American clients, East-Asian and White-European origin clients were less likely to present with a housing stressor, while Black-African clients had decreased odds of presenting with primary support group stressor. Having a primary care provider or psychiatrist were predominantly protective factors.ConclusionIn Toronto, moving people with chronic mental health conditions out of poverty, increasing the social safety net and improving access to primary care and community based mental health services may decrease many of the stressors which contribute to ED attendance.

Understanding Depressive Symptoms and Psychosocial Stressors on Twitter: A Corpus-Based Study.

BackgroundWith a lifetime prevalence of 16.2%, major depressive disorder is the fifth biggest contributor to the disease burden in the United States.ObjectiveThe aim of this study, building on previous work qualitatively analyzing depression-related Twitter data, was to describe the development of a comprehensive annotation scheme (ie, coding scheme) for manually annotating Twitter data with Diagnostic and Statistical Manual of Mental Disorders, Edition 5 (DSM 5) major depressive symptoms (eg, depressed mood, weight change, psychomotor agitation, or retardation) and Diagnostic and Statistical Manual of Mental Disorders, Edition IV (DSM-IV) psychosocial stressors (eg, educational problems, problems with primary support group, housing problems).MethodsUsing this annotation scheme, we developed an annotated corpus, Depressive Symptom and Psychosocial Stressors Acquired Depression, the SAD corpus, consisting of 9300 tweets randomly sampled from the Twitter application programming interface (API) using depression-related keywords (eg, depressed, gloomy, grief). An analysis of our annotated corpus yielded several key results.ResultsFirst, 72.09% (6829/9473) of tweets containing relevant keywords were nonindicative of depressive symptoms (eg, “we’re in for a new economic depression”). Second, the most prevalent symptoms in our dataset were depressed mood and fatigue or loss of energy. Third, less than 2% of tweets contained more than one depression related category (eg, diminished ability to think or concentrate, depressed mood). Finally, we found very high positive correlations between some depression-related symptoms in our annotated dataset (eg, fatigue or loss of energy and educational problems; educational problems and diminished ability to think).ConclusionsWe successfully developed an annotation scheme and an annotated corpus, the SAD corpus, consisting of 9300 tweets randomly-selected from the Twitter application programming interface using depression-related keywords. Our analyses suggest that keyword queries alone might not be suitable for public health monitoring because context can change the meaning of keyword in a statement. However, postprocessing approaches could be useful for reducing the noise and improving the signal needed to detect depression symptoms using social media.

Sociodemographic and Clinical Profile of Frequent Visitors to Psychiatric Emergency

Introduction The frequent use of psychiatric emergency poses problems due to the loss of their adaptative capacity and diagnosis, orientation and therapeutic difficulties for clinicians. Aims To estimate the prevalence of frequent visitors to psychiatric emergency and to describe their sociodemographic and clinical characteristics. Methods It is a cross-sectional study of twelve months including patients who consulted at least twice to medical emergency department in the university hospital of Mahdia. Data were collected using a predefined questionnaire. Results The prevalence of recurrence was 30,2%. The main characteristics were: a mean age of 35,5 years, a male gender (64,5%), being unemployment (72,3%), a single status (71%), a request from the family (55,5%) and the presence of psychiatric personal history (91,6%). Previous hospitalizations were noticed in 69% of cases. 44,5% of the patients had problems with the primary support group and the social environment. In 78,6% of cases, patients had visited emergency twice to four times. The most encountered reason for consultation was heteroagressivity (27%) and the most frequent syndromic diagnosis was psychomotor excitation (25.2%). Hospitalization concerned 47.1% of patients. Schizophrenia and bipolar disorder were the most diagnosed disorders in 54,2% and 25% of cases. Conclusion Absence of intermediate structures and lack of coordination between the various stakeholders involved in the management of patients are the two main encountered problems.

Clinical characteristics and precipitating factors of adolescent suicide attempters admitted for psychiatric inpatient care in South Korea.

ObjectiveWe aimed to examine the rates, correlates, methods, and precipitating factors of suicide attempts among adolescent patients admitted for psychiatric inpatient care from 1999 to 2010 in a university hospital in Korea.MethodsThe subjects consisted of 728 patients who were admitted for psychiatric inpatient care in a university hospital over a 12-year period and who were aged 10-19 years at the time of admission. We retrospectively investigated the information on suicidal behaviors and other clinical information by reviewing the subjects' electronic medical records. Whether these patients had completed their suicide on 31 December 2010 was determined by a link to the database of the National Statistical Office.ResultsAmong 728 subjects, 21.7% had suicidal ideation at admission, and 10.7% admitted for suicidal attempts. Female gender, divorced/widowed parents, and the presence of mood disorders were associated with a significantly increased likelihood of suicide attempts. Most common method of suicide attempts was cutting, and most common reason for suicide attempts was relationship problems within the primary support group. A diagnosis of schizophrenia was associated with increased risk of death by suicide after discharge.ConclusionThese results highlight the role of specific psychosocial factor (e.g., relational problems) and psychiatric disorders (e.g., mood disorders) in the suicide attempts of Korean adolescents, and the need for effective prevention strategies for adolescents at risk for suicide.

Psychosocial factors and antiepileptic drug use related to delayed diagnosis of refractory psychogenic nonepileptic seizures.

We analyzed clinical and psychosocial factors in patients with refractory psychogenic nonepileptic seizures, seeking characteristics that could hasten diagnosis. Psychogenic nonepileptic seizures remain a diagnostic challenge. Prognosis is best if patients are treated within 2 years of symptom onset. Psychosocial factors have been shown to provide important information for differential diagnosis. Over a year and 1132 consecutive patients, our hospital's Epilepsy Unit suspected 93 patients of having psychogenic nonepileptic seizures and confirmed refractory psychogenic nonepileptic seizures in 67. We referred these patients to our psychiatric consultation unit for detailed diagnostic interviews, and 53 of the patients followed through. Two months after the psychiatric evaluation we gave them a psychiatric intervention, explaining the diagnosis and treating their comorbidities. We also tracked the patients' use of antiepileptic drugs for 3 months, from just before the psychiatric evaluation until a month after they started the intervention. Women, patients with an inadequate primary support group, and patients who had tried many antiepileptic drugs were most likely to have their diagnosis of psychogenic nonepileptic seizures delayed by >2 years after onset. A stepwise logistic regression showed that the 2 best predictors of late diagnosis were lack of availability of a primary support group and patients trying many antiepileptic drugs. Clinicians evaluating patients with questionable seizures should raise their suspicion of psychogenic nonepileptic seizures especially in female patients with an insufficient primary support group and a history of taking multiple antiepileptic drugs.

A study into the psycho-socio-demographic profile and suicidal intent in the persons making suicide attempt : Search for a distinctive group

Introduction : Epidemiological studies simultaneously investigating the combined effects of psychiatric and psychosocial risk factors for suicide are sparse. Presently no distinctive grouping has been done combining the suicide intent and lethality of attempt though there are significant variations in psycho-socio-demographic character within the persons making suicide attempt.Aims : To study the psycho-socio-demographic profile, suicide intent and lethality of attempt in survivors of suicide attempt and finally to categorize them in distinct groups by two dimensions – suicide intent and lethality of suicide attempt.Design : Cross-sectional study.Methods and Material : Two hundred patients who attempted suicide were evaluated by a psychiatrist. The data was recorded for socio demographic variables , psychiatric disorder, suicide intent and for lethality of attempt. Groupings were done first by single dimension, suicide intent, then by two dimensions, suicide intent and lethality of attempt. Two procedures were then compared statistically.Results : The mean age of the study population was 26.36 years, mostly female (50.5%), housewives (35.5%) and students (10%), from nuclear family (55.5%), with no psychiatric disorder (29%). Organophophorus poisoning (79.5%) was the principal mode of suicide attempt, out of problem with primary support group (89.5%). Grouping was more significant when based on combining two dimensions, suicide intent and lethality of attempt, rather than only single dimension, suicide intent.Conclusions : Both suicide intent and lethality of suicide attempt are important dimensions to categorize suicide attempters. There exists four groups and they are different in psycho-socio- demographic profile.Declaration of interest – None.Key-words : Suicide, Suicide intent, Lethality, Deliberate self harm

Engaging in argument and communicating information: A case study of english language learners and their science teacher in an urban high school

This study documents how an urban high school science teacher engaged her English Language Learners (ELLs) in the discourse-intensive science and engineering practices of (1) arguing from evidence and (2) obtaining, evaluating, and communicating information. The teacher taught an introductory integrated science course to classes with a large percentage (44%) of students who spoke Spanish as their first language. We investigated the instructional strategies this teacher used to support her ELLs in the practices of argumentation and communication, and the ways ELLs constructed and communicated claims, evidence, and reasons in whole class and small group settings as a result. From qualitative analyses of teacher interviews, classroom interactions, and student products, we found that the teacher routinely implemented three types of instructional supports to help ELL students argue from evidence and communicate information: primary language support (although she herself was not fluent in Spanish), deliberate scaffolds, and small group instruction. Further, given these multiple opportunities for engagement, we found that ELLs experienced both successes and challenges participating in class, crafting arguments from evidence, and reading and producing written texts: While ELL students constructed aspects of arguments in small groups, the substance of their discussions was not necessarily reflected in their whole class participation or written products. Taken together, our findings emphasize the need to more closely attend to the teaching and learning of discourse in science. We end with ways to strengthen both research on and teaching of science for ELLs. © 2013 Wiley Periodicals, Inc. J Res Sci Teach 51: 31–64, 2014

Putative Effect of Alcohol on Suicide Attempters: An Evaluative Study in a Tertiary Medical College

Context:Alcohol abuse is a known risk factor for suicide. Alcohol increases aggression and impulsivity, which are strongly related to suicidal behavior. Sociocultural factors influence both alcohol use and suicide rates. Studies, conducted in one population, are not applicable to other and the results cannot be generalized.Aims:The aim was to study the putative role of alcohol in suicide cases in the rural Indian population by analysis of various sociodemographic variables.Settings and Design:This was a cross-sectional study in conducted in a tertiary medical college.Materials and Methods:Two hundred consecutive patients who survived a suicide attempt were evaluated by a psychiatrist. The data were recorded for sociodemographic variables, psychiatric disorders, suicide intent, lethality of the suicide attempt, and history of alcohol intake prior to the suicide attempt. Using alcohol intake prior to the suicide attempt as a determining dimension, various sociodemographic variables were analyzed for their statistical significance and the role of alcohol in suicide cases was assessed.Results:Seventeen percent suicide attempt survivors had a history of alcohol intake prior to the suicide attempt. Fifteen percent had a history of alcohol use disorder. Alcohol use affected the suicide rate in the male population in the late twenties to mid-thirties age group, illiterate and people with high school education, semiskilled workers, shop owners, and student population. Alcohol dependence, bipolar II disorder, intermittent explosive disorder, and dysthymic disorder had higher rate of suicide attempt with the use of alcohol prior to the suicide attempt. Alcohol users attempted a more lethal suicide attempt and were found to have problems with primary support group and occupational problem as precipitating stressor for suicide attempt.Conclusions:Alcohol use increases the suicide rate, in the specific rural Indian population.

Distinctive characteristics of methamphetamine users presenting at public clinics: Steep rise in South Carolina, United States, 2000–2005

BackgroundIllicit methamphetamine use has risen dramatically over the last decade. We sought to examine methamphetamine use among individuals presenting for drug treatment in South Carolina, USA, to assess trends over time, correlates of methamphetamine use, and the relationship between methamphetamine use and functional/behavioral problems. MethodsData from 2000 to 2005 were obtained from a state-wide network of substance abuse clinics. We examined time trends, and compared sociodemographic characteristics and problems with daily functioning (Axis IV and Axis V disorders) of methamphetamine users vs. other drug users. ResultsOf 235,415 individuals presenting or being admitted to a clinic, 3526 reported illicit methamphetamine use. The prevalence of methamphetamine use as a presenting problem increased dramatically across the six-year period, especially in the rural Upstate region (0.4–6.1%). In comparison to other drug users presenting or admitted to treatment during this same time period, methamphetamine users were more likely to be female, between 20 and 40 years old, and non-Hispanic white ethnicity. In addition, more methamphetamine users had occupational (49% vs. 43%, p<0.001) or economic problems (41% vs. 35%, p<0.001), and problems with their primary support group (58% vs. 54%, p<0.05). However, the prevalence of Axis IV and Axis V problems were not statistically different between the two groups. ConclusionsThe rapid escalation of methamphetamine use in South Carolina and elsewhere highlights the need for longitudinal studies to better understand the etiology and characteristics associated with methamphetamine uptake and addiction, and to develop the knowledge base required for more effective prevention and treatment.

Behavioral and Psychological Issues in Long-Duration Head-Down Bed Rest

This report is one of a series on the Flight Analogs Project, which is designed to lay the groundwork for a standard bed rest protocol. Behavioral health services, similar to those offered to the U.S. astronauts who undertake 6-mo missions onboard the International Space Station, were provided to 13 long-duration head-down bed rest participants. Long-duration missions pose unique challenges and stressors, including separation from primary support group, monotonous environment, and loss of privacy and autonomy. The psychological services team, consisting of a psychiatrist, a psychologist, and a master's level psychological support scientist, provided behavioral health services throughout all phases of the Flight Analogs Project (FAP) long-duration head-down bed rest study. During the initial screening phase, potential candidates completed 4 h of psychological testing and a 1.5-h clinical interview with a psychologist to assess their psychological fitness and ability to complete the study successfully. Additionally, the psychological services team provided pre-admission trainings on time management, stress management, and communication skills and conflict resolution. Throughout their stay on the research unit, study participants received regular individual and group visits from the psychological services team. Training was also provided to study personnel to address personality and behavioral management challenges. Psychological support and training provided to both subjects and study personnel have successfully improved the well being of study participants. Behavioral health services are indispensable to long-duration head-down bed rest studies.

Type of presentation of dissociative disorder and frequency of co-morbid depressive disorder.

To determine the frequency distribution of various types of dissociative disorders, along with existing co-morbid depression and its level of severity in patients with dissociative disorder. Observational, cross-sectional study. The Institute of Psychiatry, Rawalpindi General Hospital from October 2004 to March 2005. Fifty consecutive patients were included in the study through non-probable purposive sampling technique. Encounter form included socio-demographic profile and brief psychiatric history. ICD 10 diagnostic criteria for research were administered for determining the presentation of dissociative disorder. Present state examination was applied to make diagnosis of depressive disorder in the studied patients. Descriptive statistics for frequency analysis of sociodemographic variables, type of presentation of dissociative disorder and the frequency of depressive disorder in patients of dissociative disorder. The mean age was 23.6+/-8.67 years with female preponderance (n=40, 80% patients). Most of them were single, unemployed and belonged to urban population. Main stress was primary support group issue. Mixed category of dissociative disorder was highest (n=18, 38%) followed by unspecified and motor symptoms (n=13, 26%) in each group. Depression was present in 42 (84%) patients. Moderate depression was most frequent (n=19, 38%). Mixed dissociative symptoms were found in 38%, while 26% had motor and unspecified category of dissociative symptoms respectively. Depressive disorder was present in 42 (84%) cases of dissociative disorder with 38% having moderate depression.