The Psychiatric clinics of North America
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Psychiatr. Clin. North Am. · Dec 2004
ReviewOccupational exposure and addictions for physicians: case studies and theoretical implications.
Risk of addiction through occupational exposure to drugs of abuse is an important but relatively neglected public health problem. Stress and access may have much less of a role in addiction among certain populations than originally was thought. ⋯ Additional studies of the relationship between exposure in the workplace and addiction are necessary. These studies should include biological measures, such as blood levels in exposed workers, and sensitive assays that quantitatively assess levels of exposure in the workplace.
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Dual diagnosis patients come to treatment with a variety of deficits,talents, and motivations. A biopsychosocial treatment plan involves multiple interventions, including medications, medical treatment, psychotherapy, family therapy, housing, and vocational rehabilitation. Treatment must be individualized and integrated, and this requires collaboration among a variety of health caregivers. ⋯ The bidirectional model is consistent with the tendency of disturbed teenagers to socialize with youth using alcohol and drugs; however, this model has not been tested rigorously in research studies. With such a disparate set of models, behavior interventions are conceptualized best as a multi-component program, a treatment plan that generates a problem list and devises an intervention to respond to each member of the list. This requires a talented, multi-disciplinary team or network that can assess carefully and package the interventions creatively, and dose the treatment components empathically to fit the patient's tolerance, motivation, and abilities.
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Psychiatric response to disasters over the last 50 years has been sporadic and inconsistent. Psychiatrists have advocated for a place in the disaster response system, and at times they have demonstrated the unique contribution they can add to disaster preparedness and response. ⋯ A psychiatrist's ability to respond to disasters requires a knowledge base in the operations of the emergency management system, the responsibilities of the public health system, and the role of voluntary agencies in disaster response. This article provides the foundation for the elements involved in US disaster response and highlights the key organizations, agencies, and disaster response systems to outline the framework in which psychiatrists may bring their professional skills to the people who need them most.
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Conventional wisdom, and even well-reasoned theoretical mechanisms, suggests that the chronic use of psychoactive substances would impair cognitive functioning of individuals. This article summarizes the research literature with regard to specific drugs of abuse. ⋯ Evidence of irreversible effects is less clear. Even subtle lingering effects can impact treatment efforts, yet they often go undetected or unaddressed.
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Psychiatr. Clin. North Am. · Sep 2003
ReviewPublic health context of women's mental health research.
As more attention is directed to the mental health care of women, sex and gender differences in research design and in regulatory policies have interfaced with clinical care and public policy. An emphasis on women's mental health issues in the provision of treatment and care as well as the design of large-scale screening strategies to identify and treat women with mental disorders promises to be effective public health approaches to reducing the burden of mental illness in women. The past decade has seen increased emphasis on women's mental health and sex/gender differences in the federal sector and in the research community. ⋯ A 2001 report of the Institute of Medicine titled "Exploring the Biological Contributions to Health: Does Sex Matter?" underscores the benefit to health care of looking for sex differences at the biological level. Basic and clinical neuroscience research is rapidly accruing a knowledge base that will provide information at the level of genes and cells of the influences of biological sex on mental health outcomes in both women and men. A focus on women's mental health and gender/sex differences research promises to yield improvement in treatments and services and thereby to improve the public health as well as to increase fundamental knowledge about the etiology and neurophysiology of mental disorders.