Psychotherapeutic Medicine Research Articles

Psychotherapeutic medicine in psychiatric residency training in Austria

ZusammenfassungDie vorliegende Arbeit beschreibt die Entwicklung der psychotherapeutischen Medizin innerhalb der ärztlich-psychiatrischen Fachärzt:innen-Ausbildung. Die Grundlage für die Kompetenzdarstellung bilden die einzelnen Rasterzeugnisse der Ausbildungsordnungen 1994, 2006, 2011 sowie 2015. Die Entwicklung der psychotherapeutischen Kompetenzen innerhalb der ärztlich-psychiatrischen Identität wird anhand des Qualifikations- und Kompetenzprofils sowie der Lernziele dargestellt.

The Screen for Cognitive Impairment in Psychiatry (German version, SCIP-G): Validation, dimensionality analysis and practical application in inpatient psychiatric treatment

IntroductionPsychiatric disorders are often characterised by cognitive impairment. The Screen for Cognitive Impairment in Psychiatry (SCIP) was developed for routine screening of psychiatric patients and is available in several languages.ObjectivesUsing the German version (SCIP-G), 3 studies were conducted: 1. feasibility, reliability, and validity of the SCIP-G were investigated [Sachs et al. Schizophr. Res. Cogn. 2021: 25, 100197], 2. a confirmatory factor analysis was performed [Sachs et al. Schizophr. Res. Cogn. 2022: 29, 100259], and 3. patients with psychotic, bipolar affective, and depressive disorders were assessed before and after standard inpatient treatment including cognitive remediation.MethodsStudy 1 included patients with schizophrenia or schizoaffective psychosis and thirty healthy controls matched for sex, age, and education. Data were collected at the Medical University of Vienna, Department of Psychiatry and Psychotherapy. In studies 2 and 3, patients from the Klinik Hietzing, 1st Department of Psychiatry and Psychotherapeutic Medicine, Vienna, Austria, were studied. In study 3, all patients received modern pharmacotherapy plus cognitive remediation using the COGPACK® software package version 6.06; based on the ICD-10 criteria for research, 54 patients received an F2 diagnosis (schizophrenia, schizotypal, and delusional disorders), 39 patients met criteria for bipolar disorder (F30 and F31), and 50 for depression (F32 and F33).ResultsIn Study 1, significant differences in cognitive performance were found between patients and healthy controls on both versions of the SCIP. The SCIP effectively discriminated between patients and the control group. In Study 2, a two-factor solution in which the Verbal Learning Test-Immediate Recall subtests, Delayed Recall Test of the VLT, and Working Memory Test loaded on the first factor and the Verbal Fluency Test and Psychomotor Speed Test subtests loaded on the second factor yielded good model fit (χ² = 6.7, df = 3, p = .08, χ²/df = 2.2). In Study 3, SCIP total score showed significant improvement after treatment in all three diagnostic groups (p < .001), with no statistically significant interaction between SCIP total score and diagnostic groups (p = .860).ConclusionsOur data indicate that the SCIP-G is a valid and reliable instrument for assessing cognitive impairment. Good model fit can be achieved with a two-factor solution for the SCIP. Our study is the first to perform a confirmatory factor analysis with the German SCIP version and to test its dimensional structure with a hypothesis-testing approach. Inpatient treatment consisting of pharmacotherapy and cognitive remediation improved cognitive deficits. This improvement in cognitive performance was observed to a similar extent in patients with psychotic disorders, bipolar disorder, and depression.Disclosure of InterestNone Declared

Care, provision of care and models of care in child and adolescent psychiatry in Austria

HintergrundDie Situation der Kinder- und Jugendpsychiatrischen Versorgung hat sich seit 2007, seit der Schaffung des Sonderfaches KJP+P, sukzessive verbessert. Die Arbeitsgruppe Versorgung der ÖGKJP gibt in diesem Heft einen Überblick über die KJP-Versorgungssituation in Österreich. In dieser Einführung geht es um die Darstellung der rechtlichen Vorgaben und deren Umsetzung. Es bestehen nach wie vor massive Defizite der KJP-Versorgung.Im Österreichischen Strukturplan Gesundheit (ÖSG) ist das momentan gültige Versorgungskonzept festgeschrieben und umfasst die ambulante, teilstationäre und stationäre Versorgung. Für die ambulante und stationäre Versorgung existieren Messzahlen, für die teilstationäre Versorgung nicht.Das Fachgebiet KJP hat verschiedene Besonderheiten: die Multimodalität, die Multiprofessionalität, die Altersgruppen der Betroffenen, pro Alter unterschiedliche und unterschiedlich ausgeprägte Erkrankungen, die Beschränkung auf eine bestimmte Altersgruppe (< 19 Jahre) und – das verbindet es mit dem Fach Psychiatrie – eine hohe Prävalenz der Erkrankungen sowie die Integration der Psychotherapeutischen Medizin in den Facharzt.SchlussfolgerungenDie aus diesen Besonderheiten sich ergebenden Konsequenzen – altersdifferenzierte Angebote, fachübergreifende Kooperation etc. – haben bisher keinen Eingang in die strukturellen und finanziellen Berechnungen gefunden. Anhand der den Begriff Versorgung beschreibenden Begriffe: „care“, „provision“ und „supply“ wird ein Modell vorgestellt, das bei der Planung von Gesundheitsmaßnahmen in diesem Bereich als Denkansatz herangezogen werden könnte. Da psychisch kranke Kinder und Jugendliche sich in allen Teilen der Gesellschaft finden, wird die Einrichtung einer zentral verantwortlichen und ressortübergreifenden Stelle für Mental Health gefordert.

Key-topics in Austrian Child and Adolescent Psychiatry 2007-2017

The medical speciality "Child and Adolescent Psychiatry" exists since 2007. 2015 a new training regulation defined an increment to "Child and Adolescent Psychiatry and Psychotherapeutic Medicine". To document the achievements in research within the last 10years for the first time, all papers listed in Pubmed and all books published by the member of the ÖGKJP were summarized. Additionally, the clinical/scientific key aspects of all large teaching centres were documented.All members of the ÖGKJP are scientifically active in various areas of child psychiatry. Most of the 284 publications (n= 115; 41%) were published on 5topics: eating disorders, forensic psychiatry, neuropediatrics, psychoses and prodromal states, suicidality. Thirteen of the papers have already been awared prices because of their high quality. All departments define clinical/scientific key areas - beside a time-consuming clinical work load - and offer specialized care. Further development of research competence should take place and should also have high priority in health politics.

Werden in Österreich Patienten mit psychosomatischen Störungen ausreichend versorgt?

Quality assurance in psychosomatic medicine in Austria is currently based on a voluntary continuing medical education programme in psychosocial, psychosomatic and psychotherapeutic medicine. It is questionable whether psychosomatic care can be sufficiently provided in this manner. In addition, a broadly based proposal to create a subspecialty in psychosomatic medicine in order to facilitate quality assurance, is investigated. The necessity to reorganize psychosomatic care was explored through semi-structured qualitative interviews with experts. Data-based analyses probed the labour market of the proposed subspecialty, and the literature was reviewed to look into the cost-benefit ratio of psychosomatic treatment. All experts expressed a need to restructure psychosomatic care in Austria. Examples exist for psychosomatic treatment with an efficient cost-benefit relation in diverse medical settings. Establishing a subspecialty in Psychosomatic Medicine seems feasible and could contribute to increased quality assurance and the nationwide provision of psychosomatic care.

Patients Paying Much More for Psychiatric Medications

Back to table of contents Previous article Next article Professional NewsFull AccessPatients Paying Much More for Psychiatric MedicationsMark MoranMark MoranSearch for more papers by this authorPublished Online:17 Aug 2007https://doi.org/10.1176/pn.42.16.0002Spending on psychotherapeutic medications increased dramatically from 1997 to 2004, according to a report by the federal Agency for Healthcare Research and Quality (AHRQ).In 2004 total expenditures on prescribed psychotherapeutic agents was at least 2.5 times as high as in 1997, rising from $7.9 billion to $20 billion.In the same time span, the total number of purchases of psychotherapeutic agents increased substantially from 141.9 million purchases to 244.3 million. The number of individuals reporting purchasing a psychotherapeutic medicine rose from 21 million to 32.6 million.And from 1997 to 2004, the average per-purchase drug expenditure for a psychotherapeutic agent increased from $55.80 to $82 (see chart).The figures are in a “statistical brief” issued by the AHRQ that draws on findings from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC) on total expenditures, number of purchases, number of people who made a purchase, and average price per purchase for the therapeutic class of prescribed psychotherapeutic agents and the therapeutic subclasses within that medication category.The subclasses are antipsychotics; central nervous system (CNS) stimulants; antidepressants; and anxiolytics, sedatives, and hypnotics.Only prescribed medications purchased in an outpatient setting are included in the estimates. Over-the-counter drugs are excluded from the estimates, as are prescription medications administered in an inpatient setting or in a clinic or physician's office.The report documents sharp increases in total spending, numbers of purchases, and average per-purchase expenditure for all of the subclasses from 1997 through 2004. Here are some highlights of the findings:Antidepressants: Total expenditures on antidepressants more than doubled, rising from $5.1 billion in 1997 to $12.1 billion in 2004, with the number of purchases of antidepressants rising from 88.3 million to 161.2 million. The total number of persons reporting purchasing an antidepressant increased from 15.3 million in 1997 to 24.8 million in 2004.Antipsychotics: Total expenditures on prescribed antipsychotics tripled, rising from $1.3 billion to $4.1 billion. In the same time period, the total number of purchases of antipsychotics increased from 17.4 million to 24.5 million, and the total number of individuals reporting purchasing an antipsychotic rose from 2.2 million to 3.4 million.Of all the subclasses, the average price per purchase increase was greatest for antipsychotics, which more than doubled from $76.10 to $168.20.Anxiolytics, sedatives, and hypnotics: Total expenditures in this subclass more than doubled, going from $0.9 billion to $2.1 billion. In the same time span, the total number of purchases of anxiolytics, sedatives, and hypnotics increased from 24.5 million to 39.0 million.CNS stimulants: Total expenditures on CNS stimulants nearly tripled, rising from $0.6 billion to $1.7 billion.MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, demographic, and economic characteristics for the civilian noninstitutionalized population. It is cosponsored by the AHRQ and the National Center for Health Statistics.The report is posted at<www.meps.ahrq.gov/mepsweb/data_files/publications/st163/stat163.pdf>.▪ ISSUES NewArchived

Erspart die Sauna den Psychiater?

The modern interpretation of functional disorders classifies them as somatoform autonomic functional disorders that are associated with the vegetative nervous system. This places them within the responsibility of psychosomatic, psychotherapeutic medicine or psychiatry. In consequence, other forms of treatment with an impact on the vegetative system are being underestimated, such as hydrotherapy and thermotherapy, the efficacy of which depends on the fact that thermoregulation predominates over the regulation of numerous other organ systems. In the present article, the effectiveness of this therapeutic approach is discussed.

Status, Möglichkeiten und Grenzen der Behandlung in psychosomatischen Tageskliniken

During the past few years, several psychosomatic day clinics have been established. The goal of this paper was to research the programs these day hospitals offer, their general set-up, as well as their indication criteria. We surveyed 18 day clinics, which we had identified via internet. Most of the day clinics have the capability to treat between ten and twenty patients and work mainly with group concepts. Mean treatment duration ranges from 7 to 12 weeks. Although having patients with different diagnoses, most day clinics treat them together, while some day clinics concentrate on special diagnoses (eating disorders, anxiety disorders, personality disorders). Overall, the day clinics' main diagnoses, therapeutic programs, and treatment durations are comparable with those of in-patient hospitals in Germany. It appears that day clinic treatment is especially appropriate for patients who have difficulties in incorporating their experiences from an (in-house) therapy into the real world, as well as patients who have to care for family members (e. g. children) while in treatment. An enquiry to the federal states of Germany showed that, in the area of psychotherapeutic medicine, there are 324 day clinic places as well as 2,639 beds for acute inpatient treatment available. Six federal states, however, do not allocate beds for psychotherapeutic medicine in particular, but assign them to the area of psychiatry.

Psychiatry and Psychosomatic Medicine in Germany: Lessons to be Learned?

To describe the reshaping of the German system of psychiatric services in the wake of the international social psychiatric movement and the beginnings of separate consultation-liaison (C-L) psychiatry and C-L psychosomatics services, to outline the differences and similarities of these two disciplines, and to see whether there are lessons to be learned from this unique development that may be relevant to other countries. The author draws on material published in German and international publications, and on his experience as co-chair of the Section of Behavioral Medicine and Consultation Liaison Psychiatry of the German Society for Psychiatry, Psychotherapy and Neurology. Consultation-liaison psychiatry services are provided in virtually all German general hospitals, mainly by the medical specialty of psychiatry and psychotherapy and to a lesser extent by the specialty of psychosomatics and psychotherapeutic medicine, exclusively so in 5%. The latter specialty includes non-psychiatric physicians. The unique history of combined neurology and psychiatry training until 1992, and of mandated psychotherapy training in both specialties shapes the service provided but also sets up tensions. Lack of empirical evidence prevents objective assessment of the advantages and/or shortcomings of this two-stranded system, but its existence may sharpen the ongoing debate about how C-L services should be structured in other countries.

Entspricht die Symptombesserung vier Wochen nach Behandlungsbeginn dem Erfolg in der Ein-Jahres-Katamnese?

This study was conducted to explore differentiated aspects of outcome throughout and one year after psychodynamic inpatient psychotherapy with special regard to symptomatic distress and interpersonal behaviour. Sixty-four patients of the Department of Psychotherapeutic Medicine of the Jerichow Hospital (Saxonia-Anhaltina) were investigated with the SCL-90-R and the IIP-D four times: at the beginning of inpatient psychotherapy (t0), four weeks after (t1), at the end (t2), and one year after discharge (t3). The improvement of symptoms four weeks after the beginning of psychodynamic inpatient psychotherapy is equivalent with long term outcome. The Global Severity Index of SCL-90-R demonstrated a statistically significant change from markedly psychological distress to lack of distress after four weeks psychodynamic inpatient psychotherapy (effect-size d(GSI) = 0.82). At the end of psychotherapy, three weeks later, the effect-size was d = 1.11, and one year after discharge the effect-size decreased again to d = 0.85. Major improvements demonstrated the SCL-90-R subscales Depression, Anxiety, and Obsessive/Compulsive. Regarding interpersonal problems, the subscales Dominance, and Competitive demonstrated statistically significant changes from low Stanine-scores at t0 to higher scores one year after discharge. The subscales Socially avoidant, Nonassertive, and Exploitable demonstrated statistical significant changes from high levels at t0 to lower scores after one year. In conclusion the first four weeks of psychodynamic psychotherapy are not sufficient to demonstrate an optimum level of low psychological distress as well as an optimum change in interpersonal problems. Regarding stability of the effects of psychodynamic inpatient psychotherapy it was demonstrated that the first four weeks initiated changes which improved at the end of psychotherapy until one year after discharge.

Entspricht die Symptombesserung vier Wochen nach Behandlungsbeginn dem Erfolg in der Ein-Jahres-Katamnese? - Eine Studie zur stationären psychodynamischen Psychotherapie

Objectives : This study was conducted to explore differentiated aspects of outcome throughout and one year after psychodynamic inpatient psychotherapy with special regard to symptomatic distress and interpersonal behaviour. Methods: Sixty-four patients of the Department of Psychotherapeutic Medicine of the Jerichow Hospital (Saxonia-Anhaltina) were investigated with the SCL-90-R and the IIP-D four times: at the beginning of inpatient psychotherapy (t°), four weeks after (t1), at the end (t2), and one year after discharge (t3). Results: The improvement of symptoms four weeks after the beginning of psycho dynamic inpatient psychotherapy is equivalent with long term outcome. The Global Severity Index of SCL-90-R demonstrated a statistically significant change from mark edly psychological distress to lack of distress after four weeks psychodynamic inpatient psychotherapy (effect-size d(GSI) = 0.82). At the end of psychotherapy, three weeks later, the effect-size was d = 1.11, and one year after discharge the effect-size de creased again to d — 0.85. Major improvements demonstrated the SCL-90-R subscales Depression, Anxiety, and Obsessive/Compulsive. Regarding interpersonal problems, the subscales Dominance, and Competitive demonstrated statistically significant changes from low Stanine-scores at t° to higher scores one year after discharge. The subscales Socially avoidant, Nonassertive, and Exploitable demonstrated statistical significant changes from high levels at t° to lower scores after one year. Discussion: In conclusion the first four weeks of psychodynamic psychotherapy are not sufficient to demonstrate an optimum level of low psychological distress as well as an optimum change in interpersonal problems. Regarding stability of the effects of psychodynamic inpatient psychotherapy it was demonstrated that the first four

Psychosomatic aspects of urogynaecology: model considerations on the pathogenesis, diagnosis and therapy

Disorders of micturition and other symptoms in the area of the lower urinary tract are frequent in gynaecological consultation. The uro-gynaecological clinical symptoms and diseases refer to the following syndromes: irritable bladder, recurrent cystitis, interstitial cystitis, urinary retention and forms of incontinence. In view of the great aetiological importance of depression and its psycho-neuroendocrine associations with urge symptoms correlating with oestrogen deficiency, the option of employing newer approaches, and also psychopharmacological approaches, must be considered. In the pathogenesis, the stress and conflict model offers approaches to explanation and treatment. The psychosomatically oriented diagnosis and treatment of symptoms and disorders of the lower urinary tract in women is primarily the task of the gynaecologist, who has to go beyond investigations for organic diseases and must also clarify and treat the psychological dimensions. If there is major psychiatric comorbidity, referral to a doctor specialising in psychotherapeutic medicine and psychotherapy is required, or to a specialist in psychiatry and psychotherapy in the case of clinical and neurophysiological implications and symptoms from the depressive spectrum.

Diagnosis related groups in psychiatry and psychotherapy--alternatives to DRGs

Diagnosis related groups (DRGs) will be introduced in Germany in 2003 as a basis for hospital funding in all areas except for psychiatry and psychotherapeutic medicine. The following article provides an overview of the use of alternative casemix-systems in the treatment of patients with mental disorders. Overall, DRGs and alternative systems have proven to be poor predictors of resource consumption due to the high variation in the length of stay and the variable treatment opportunities. Therefore, a DRG-system must include the possibility of coded therapeutic treatments, analogous to the procedures used in surgical DRGs, in order to integrate psychiatry and psychotherapeutic medicine into a DRG-based payment system.

Capacitive requirement for acute in-patient care of patients with psychosomatic diseases in bavaria

Estimations of the requirement for acute in-patient care of patients with psychosomatic diseases in Bavaria have to rely on respective data on their incidence and prevalence as valid requirement data are missing. The required capacity of in-patient beds depends on several, inconsistently figured parameters: hospitalization rate, length of stay, occupancy rate. Based on conservative assumptions the hospitalization rate was calculated to be at least 1.3 admissions per 1000 and for adequate treatment the average length of stay should not be limited to less than 50 days. In order to avoid unnecessary delay of treatment a realistic occupancy rate has to be 90 %. Thus the minimal capacity for in-patient care is assessed to be 2453 beds. At present patients with psychosomatic diseases in Bavaria receive in-patient treatment in psychosomatic departments of general hospitals, hospitals and rehab clinics of psychosomatic and psychotherapeutic medicine, and in hospitals of psychiatry and psychotherapy, in each with a different focus. When the expertise was drafted these acute care and rehab hospitals provided some 2500 beds - with only 76 beds in general hospitals. For quality assessment of the available beds for in-patient care and future planning minimal standards of structural quality have to be consented. At present it is not possible to make a clear and substantial distinction between the treatment for patients with psychosomatic diseases in acute-care hospitals and in psychosomatic rehab clinics respectively. Thus, the necessary in-patient rehab capacity can only be assessed roughly. The existing pluralism of the in-patient care providing system for patients with psychosomatic diseases is considered to be appropriate for different needs of this patient group. In the future excellent care for this patient group will acknowledge options for a more flexible and interconnected care-providing system. This is a publication of the complete expertise by the project group "Acute In-patient Care for Patients with Psychosomatic Diseases in Bavaria" which has been handed to the Bavarian Ministry of Social Affairs in December 1999.

Psychosomatic and Psychotherapeutic Medicine goes DRG - Prozeduren-Katalog OPS-301 2.1 als erster Schritt

To demonstrate the repercussions for Psychosomatic and Psychotherapeutic Medicine of the politically motivated decision to introduce case mix funding for inpatient treatment in Germany. Description of the development of an appropriate code list of procedures for Psychosomatic and Psychotherapeutic Medicine within the DRG-System. The code list OPS-301 which was valid in 2001 had no appropriate procedures for Psychosomatic and Psychotherapeutic Medicine. The scientific societies therefore had to develop possibilities for coding psychosomatic-psychotherapeutic procedures in the new OPS-301 2.1 which is valid since January 2002. This was achieved through the formulation of so-called complex codes, which are presented together with first coding tips. There are further tasks with risks and potential benefits which have to be accomplished after establishing these complex codes.

Palliative psychosomatic medicine

Psychotherapeutic medicine, the area of medicinal specialisation dealing with the foundations of psychosomatic medicine, so far dealt mostly with diagnosis and therapy of acute diseases. The course of illness in patients with bio-psycho-social disorders however ist most often chronic. Sigmund Freud the founder of scientific psychotherapy himself was a patient in palliative care for 26 years and underwent over 30 surgical procedures to treat his carcinoma of the palate and jaw. Some goals and psychotherapeutic strategies of intervention that can be used in palliative psychosomatic medicine are laid out. This important field has in itself so far not reached a wide spread recognition and there are hardly any theoretical concepts or empirical validation to be found.

Communication difficulties among psychiatrists.

COMMUNICATION DIFFICULTIES AMONG PSYCHIATRISTS* Psychotherapeutic medicine is the principal subject matter to which discussions between psychotherapists refer. Sometimes the conversation bears upon the patient's behavior in general or upon his intentional and unintentional expressions in particular. At other times, the discussion pertains to the tool of the psychotherapist-namely, communication. From the looks of things, therefore, the psychotherapist should be an expert with knowledge about and skill in communication (15). According to ordinary expectations, both of these properties should become particularly prominent when meets his equally sophisticated colleagues. But for a number of reasons, mutual understanding, tolerance of differences, and enlightening conversation frequently vanish when psychotherapists meet in groups, and the ensuing tension often is followed by a complete breakdown in communication. Let us now take a closer look at this peculiar phenomenon-the failure of the expert to apply his own skill when in contact with his fellow professionals. Failure to communicate successfully is in part due to the distortions which are introduced through the peculiarities of language. When psychiatrists meet they employ verbal language to refer to behavior. But action and movement are continuous functions which the word slices into discrete elements as if they were replaceable parts of a machine. The continuity of existence thus is split into arbitrary entities which are not so much a function of a particular patient's behavior but rather the result of language structure (22). After repetitious use, these verbal elements eventually tend to be accepted as if they had a real counterpart in nature. But splitting into part functions that which is whole is not the only sin of verbal language. Words enable us to express abstractions, to infer, and to predict. For this purpose, we telescope and condense natural and far-flung events as if they had happened at the same time and in the same place (16). This spatial and temporal distortion is particularly prominent when the psychiatrist talks about traits, attitudes, abilities, the ego, or the superego. Use of such concepts necessitates complete disregard for the time-bound characteristics of experience as well as for the specific situation in which the behavior occurred. By talking in generalities and neglecting the specificity of a behavioral act, we create such verbal monstrosities as he is a liar or he has a weak ego. Such statements represent the individual as if were characterized by these features twenty-four hours a day throughout the year. Much of what we call personality assessment is based on such distortions and frequently any resemblance of the verbal reports to the original events is purely coincidental. The distortions that language introduces in the representation of natural events are responsible for a difficulty which does not concern the psychiatrist alone. Indeed, the world of verbal unreality is shared by all those professions which are built upon communication (18). Presently medicine talks about the doctor-patient relationship; industry about labor-management relations; the army about brainwashing; and the television, radio, movie, and newspaper industries about capturing an audience. But in being concerned with communication, these disciplines teeter between one of the most essential aspects of existence on the one hand and the unreal on the other. Primarily in middleclass circles and particularly among administrators, executives, almost all politicians, psychotherapists, social scientists, and lawyers words tend to be treated as absolutes. The fact that words are sounds which refer to images and ideas and that these are products of the central nervous system is frequently lost sight of altogether. The art of speaking and writing, in the mind of the verbal professions, invests words with substance and body as if they were something separate from the human being from which they originated (2). …

Gender differences in initiation of psychotherapeutic medicine use

It has been shown that women are more likely than men to have used prescription psychotherapeutic medicines. Gender differences in the determinants of such use have also been identified. In an earlier study of adult household residents aged 18-44, we found that antecedent illicit drug use was associated with prescribed psychotherapeutic medicine use, independent of psychiatric symptoms. In this study, we explore these predictive relationships separately for males and females. For both males (n = 604) and females (n = 933) illicit drug use was associated with psychotherapeutic medicine use, although the relationship was stronger among males. Psychiatric symptoms did not account for this relationship for either gender. Among males, symptoms and illicit drug use each increased the likelihood of psychotherapeutic medicine use. Among females, no additional likelihood of psychotherapeutic medicine use over and above that for illicit drug use resulted when psychiatric symptoms were also present. Help-seeking was strongly associated with prescription psychotherapeutic medicine use among both genders.

Predictors of the initiation of psychotherapeutic medicine use.

This study examined the hypothesized predictive association between illicit drug use and the onset of prescribed psychotherapeutic medicine use. The effect of psychiatric symptoms on this relationship was also explored. Data were gathered retrospectively, through standardized household interviews conducted in 1981 for the Baltimore site of the National Institute of Mental Health Epidemiologic Catchment Area Program. For this analysis, the sample was restricted to 1,716 respondents ages 18-44 at the time of interview, drawn by probability sampling area household residents of all adult ages. Using Cox proportional hazards models, the onset of psychotherapeutic medicine use was modeled as a function of illicit drug use and psychiatric symptoms, both defined as time-dependent covariates. Newly observed in this analysis was an independent association of illicit drug use with psychotherapeutic medicine use, which was unexplained by psychiatric symptoms (relative hazard = 2.61, 95% confidence interval (CI) = 2.15, 3.18). Adjustment for age of onset of alcohol intoxication did not alter the impression that illicit drug users were more likely to initiate use of prescribed psychotherapeutic medicines (relative hazard = 2.52, 95% CI = 2.02, 3.11).

Epidemiologic issues pertinent to international regulation of 28 stimulant-hallucinogen drugs

This paper examines selected epidemiologic issues raised by the consideration of 28 stimulant-hallucinogen drugs for international drug control. New epidemiologic evidence on these drugs is presented, based on laboratory analysis of drug samples obtained from unauthorized channels of distribution in the United States. A proposal is made for experimental evaluation of international drug controls. The proposed approach is to select some of the stimulant-hallucinogen drugs which are not currently responsible for substantial drug-related morbidity and mortality, but which appear suitable for control on the basis of presumed potential for abuse and other characteristics. Then, randomly assign one-half of this group for new drug regulations, leaving the others without new regulation. If proper epidemiologic surveillance were in place, this experimental trial would produce data to help substantiate inferences about drug control efficacy. Difficulties in implementing this proposal are discussed, with emphasis on surveillance measurement problems. Some of these problems are related to the non-medical character of much stimulant-hallucinogen drug use. However, other problems such as response inconsistency may affect research in drug epidemiology generally. Data from a recent panel study of psychotherapeutic medicine use are presented to illustrate this possibility.