Journal of Psychiatric Practice最新文献

Objective: The goal of this study was to describe the demographic characteristics of sex-trafficked patients encountered through one of the few hospital-based anti-human trafficking specialty programs available nationally and assess how these characteristics relate to substance use.

Method: The sample involved 336 survivors of sex trafficking (mean age=32.39 y). Structured interviews and human trafficking screening tools were used to assess the history of sex trafficking. Demographic and substance use information was collected from patient records.

Results: A significant proportion of patients were female (91.7%), homeless (53.3%), and Black/African American (48.5%), and 72.9% reported using substances at the time of intake. When age, sex, race/ethnicity, and housing status were included in the same model, our logistic regressions did not show a significant effect on substance use.

Conclusions: Although our logistic regressions did not find differences between demographic characteristics and substance use, the high level of substance use in this population underscores the importance of this issue across demographic categories. Given the high prevalence of substance use and the role of substance use in both the coercion and continued exploitation of trafficking victims, it is important to assess and treat substance use as a central and universal concern among trafficked individuals.​​.

Background and aim: Previous research has recognized the dual role of opioids [agonists at μ-opioid receptors (MOP-r agonists)] in modulating immunity and neuroinflammation in individuals with opioid use disorder (OUD). This cross-sectional study investigates the interplay between chronic use of MOP-r agonists and inflammatory parameters in individuals with OUD, with the goal of providing insights into the relationship between immunological responses and OUD.

Materials and methods: A cohort of 129 patients with OUD seeking treatment at an addiction detoxification center underwent detailed clinical assessments. Blood samples were collected for analyses of serum alanine aminotransferase, aspartate aminotransferase, and C-reactive protein levels, and a complete blood count. Participants were categorized into inflammation and noninflammation groups based on C-reactive protein levels. Hematological and inflammation indices, along with pain severity, were compared between these groups.

Results: Significant differences were observed between the inflammation and noninflammation groups on variables such as duration of MOP-r agonist intake, daily buprenorphine/naloxone dose, consumption route, severity of withdrawal symptoms, and level of self-reported pain. The inflammation group exhibited higher neutrophil counts and an increased neutrophil-to-lymphocyte ratio. The binary logistic regression models revealed that self-reported pain level, daily buprenorphine/naloxone dosage, Beck Depression Inventory scores, and age were significant predictors of inflammation.

Conclusions: This study contributes to our understanding of OUD as a chronic inflammatory condition, shedding light on the intricate relationships between MOP-r agonist addiction, inflammatory responses, and withdrawal-related parameters. The findings offer valuable perspectives on effective management, emphasizing the need for further research in diverse populations to enhance understanding of this complex condition.

Most patients who die by suicide receive care outside mental or behavioral health settings in the year before their deaths. As such, effective suicide prevention efforts require screening and assessment of suicide risk broadly across treatment settings, not just within mental health services. Clinical suicide risk assessment (CSRA) is also a fundamental component of therapeutic risk management. This column provides an approach for suicide risk screening and assessment that is consistent with current best practices and applicable guidelines. Theoretical, empirical, and practical considerations for suicide risk screening and CSRA processes are reviewed. Specific topic areas include therapeutic alliance and goal setting, suicidal ideation and behaviors, risk and protective factors, warning signs, and providing assessment feedback. CSRA is framed as a method for gathering information, as well as a form of brief therapeutic intervention. In doing so, the CSRA can inform future treatment decisions, as well as directly mitigate risk, by helping the patient and provider better understand the patient's suicidal ideation and behaviors.

We present divergent experiences of 2 patients who participated in a clinical trial of psilocybin-assisted cognitive behavioral therapy for major depressive disorder. Both patients participated in an open trial involving 2 drug administration sessions separated by one month (10 and 25 mg, respectively) along with 12 sessions of cognitive behavioral therapy. The first of the 2 patients had powerful and beneficial experiences on psilocybin that led to immediate and sustained antidepressant effects over the 7-month study. The second participant reported significant challenges with psilocybin and minimal to no antidepressant effects following the drug administration. We present the clinicians' experiences who treated both patients. Finally, we theorize and discuss areas of future research to elucidate how psilocybin can yield the greatest psychiatric benefit, the conditions within the patient that can lead to (or inhibit) psychiatric benefit, and the psychosocial environment that can best facilitate psilocybin therapy.

Psychotic disorders, including schizophrenia, carry a substantial risk of suicide, particularly during the first-episode psychosis (FEP) phase. This narrative review aims to identify key symptomatic predictors of suicidal behavior in individuals experiencing FEP by thoroughly analyzing existing literature. Studies highlight that the highest suicide risk occurs around the initial presentation for psychiatric services. This critical period encompasses the month before and the 2 months after the first contact with mental health professionals. Severe depressive symptoms and a prolonged duration of untreated psychosis emerge as primary risk factors for suicidal behavior. Depression, when combined with cognitive impairments and a history of childhood trauma, significantly increases the risk of suicidality. These combined factors create a compounded effect, making it more difficult for individuals to cope and increasing their feelings of hopelessness and despair. In addition, poor premorbid functioning-referring to the level of psychological and social functioning before the onset of psychosis-and substance abuse, particularly the use of stimulants, further exacerbate the risk. Substance abuse can also intensify symptoms and impair judgment, leading to an increased likelihood of suicidal behavior. This review underscores the critical importance of timely, comprehensive, and tailored interventions. Early detection and intervention can significantly mitigate the risk of suicide in patients with FEP. Providing targeted treatments that address depressive symptoms, cognitive impairments, and substance abuse issues can improve overall outcomes and enhance the quality of life for these individuals. Comprehensive care approaches and strategies to improve functioning are also essential in reducing suicidality and promoting long-term recovery.

Psychiatrists increasingly practice psychotherapy by integrating their therapeutic training into brief medication visits. Insurance companies reimburse this approach using the 90833 Current Procedural Terminology code, which corresponds to 16 to 37 minutes of add-on psychotherapy combined with pharmacotherapy. As scholarship focused on such short-form combined therapy is scarce, this 4-part series addresses the practice gap, providing guidance to practicing professionals. This installment addresses supportive psychotherapy, an elemental, affect-focused treatment with an evidence base for treating major depression.

Background: There is inconsistent evidence concerning the association between thyroid dysfunctions and depression. Therefore, we conducted this population-based study to investigate the relationship between thyroid-stimulating hormone (TSH) and depression using the Patient Health Questionnaire-9 (PHQ-9).

Method: We included patients (≥18 y) who received care at the Marshfield Clinic Health System and completed a TSH level and a PHQ-9 within 2 weeks, between 2015 and 2020. We used a logistic regression model adjusted for covariates to estimate the effect of TSH level on clinically relevant depression (PHQ-9 score ≥10).

Results: Our cohort included 31,099 patients, mean age 50.9±19.5 years, 73.5% females, and 96.3% White, 39.7% of whom had clinically relevant depression. The patients with clinically relevant depression had higher TSH levels compared with those without such depression (P=0.01). In this cohort, we found that low TSH levels (<0.5 mIU/L) and very elevated TSH levels (≥10 mIU/L) both had increased odds of being associated with clinically relevant depression: [1.30 (95% CI: 1.15-1.46) and OR 1.50 (95% CI: 1.25-1.81), respectively]. Subgroup analysis showed similar findings in patients with mood disorders, females, younger adults (<65 y), and those with untreated thyroid disorders. In males, only low TSH was associated with clinically relevant depression, whereas in patients with treated thyroid disorders, only very elevated TSH was associated with clinically relevant depression.

Conclusions: In this large cross-sectional study, we found that low TSH and very elevated TSH levels were both associated with higher odds of depression. Similar trends were observed in patients with mood disorders, females, younger adults (<65 y), and those with untreated thyroid disorders. Large prospective population-based studies are needed to further investigate the relationship between TSH levels and clinical depression.

Catatonia is a diagnosis characterized by a combination of abnormal movements, behaviors, and withdrawal. It has been linked to mental health diagnoses such as schizophrenia and mood disorders. Catatonia is both traumatic for the patient and linked to multiple negative downstream medical diagnoses. Marijuana is a frequently utilized recreational drug that has been shown to have various neuropsychiatric effects in recent years. This report describes the case of a young adult male presenting with catatonia in the setting of cannabis use without other predisposing factors. It adds to the growing evidence of cannabis-associated catatonia, and it highlights the need for further research and increased counseling regarding the neuropsychiatric effects of marijuana.

The goal of this column is to give an autobiographical perspective on what I saw and learned as a trainee about the origins and the people behind the development of criteria-based psychiatric diagnosis. These individuals' own words are used to explain their rationale and goals. I further explain the transition from the Washington University (or Feighner) criteria to the Research Diagnostic Criteria to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). The column ends with an example of how research inclusion and exclusion criteria added to DSM-III diagnoses can result in positive results by making the populations being studied both more homogenous and discrete from one another.