The Journal of clinical psychiatry
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Buprenorphine is a partial-agonist opioid that is prescribed as a medication-assisted treatment (MAT) for opioid use disorder (OUD). Buprenorphine is also a potent analgesic with high opioid-receptor affinity and binding coefficient; when buprenorphine is administered simultaneously with a μ-opioid receptor full agonist ("full agonist opioid" [FAO]), the combination can yield unexpected outcomes depending on dosing and timing. ⋯ Recognizing the risk management challenge from both analgesia and BUP-MAT perspectives, we convened a multidisciplinary group of clinicians who treat BUP-MAT patients and completed a literature review with the goal of generating a guideline for appropriate management of these patients presenting for a broad spectrum of surgical procedures. Our conclusion is that continuous simultaneous administration of buprenorphine products with FAO is safe when accounting for dose and timing, including surgeries that historically produce moderate to severe pain, and may further provide an analgesic advantage, lessen FAO burden, and reduce relapse risk to this group.
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Listen to experts and view their slides from a panel session at the American Society of Clinical Psychopharmacology (ASCP) meeting, held on May 29, 2019, in Scottsdale, Arizona. Dr Murrough described the current understanding of depression etiology and new insights into antidepressant development. ⋯ Dr Citrome discussed current best practices and new medications for the treatment of depression. Finally, Dr Ketter provided his thoughts on his colleagues' presentations.
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Opioids and benzodiazepines are commonly coprescribed medications. The mortality risk associated with their concurrent use is unknown. ⋯ New coprescription of opioids and benzodiazepines was associated with increased all-cause mortality and overdose death compared with new prescription of benzodiazepines only, opioids only, or neither medication and increased circulatory disease-related death relative to neither medication.
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Current evidence suggests that women are more sensitive to the effects of cannabinoids. The aim of this study was to investigate the relevance of sex in the association of synthetic cannabinoid (SC) use with psychosis and agitation. ⋯ SC users are more likely than nonusers to be psychotic or agitated in an inpatient setting. The potentiated rates of psychosis and agitation with SC use in women suggest that they may have a greater sensitivity to these synthetic compounds..
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To determine which sleep variables, including sleep duration, sleep quality, insomnia symptoms, and nightmares, were significantly and independently associated with subsequent adolescent suicidal behavior and non-suicidal self-injury (NSSI). ⋯ Frequent nightmares were independently associated with subsequent suicide attempt and NSSI among adolescents. Assessing and intervening for nightmares may have important implications for early identification of adolescents at risk and prevention of adolescent self-harm and suicide.