General hospital psychiatry
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Gen Hosp Psychiatry · Jul 2014
Case ReportsPutting a face on the prescription opioid epidemic: a case report.
Skilled clinical decision making in the diagnosis and treatment of chronic pain can create unique clinical and ethical challenges, particularly when opioid medications are involved. This report presents the case of a pregnant woman who sought treatment for an illicit opioid dependence, initiated by opioid analgesic treatment of chronic pain. While recognizing opioids' high level of effectiveness for pain relief, the case demonstrates the potential harms of opioid medications for particular patients. Using a framework informed by medical ethics, the report discusses how clinicians might assess the benefits and risks of opioid treatment by careful data gathering, knowledge of the evidence base and patient-centered, shared decision making.
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Gen Hosp Psychiatry · Jul 2014
Multiple chronic medical conditions: prevalence and risk factors--results from the Singapore Mental Health Study.
The objective was to establish the prevalence and risk factors for multiple chronic medical conditions (MCMC) in the Singapore population. ⋯ The study identified two important yet potentially modifiable risk factors for MCMC--psychiatric conditions and obesity--in the general population. Screening for mood and alcohol use disorder, as well as lifestyle interventions targeted at obesity, must be a part of disease management for MCMC.
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Gen Hosp Psychiatry · Jul 2014
Preexisting cognitive status is associated with reduced behavioral functional capacity in patients 3 months after cardiac surgery: an extension study.
To examine whether preexisting cognitive status rather than short- and middle-term postoperative cognitive decline (POCD) may differentially account for behavioral functional capacity 3 months after cardiac surgery. ⋯ Preexisting cognitive deficit, especially working memory deficit, rather than short- and middle-term POCD related to intraoperative risk factors is associated with poor behavioral functional capacity 3 months after cardiac surgery. The present study therefore suggests that a preoperative cognitive evaluation is essential to anticipate which patients are likely to show a decline in behavioral functional capacity after cardiac surgery.