International journal of psychiatry in medicine
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Int J Psychiatry Med · Jan 2015
Psychosocial correlates, psychological distress, and quality of life in patients with medically unexplained symptoms: a primary care study in Karachi, Pakistan.
To examine the psychosocial correlates and association of psychological distress and quality of life (QOL) in patients with medically unexplained symptoms (MUS) compared to those with medically explained symptoms (MES) in a primary care setting in Karachi, Pakistan. ⋯ Our findings confirm that even in the developing world, patients with MUS are common among primary care attendees. However, patients with MUS in urban Karachi, Pakistan may differ from Western MUS subjects in the role of stress, support, and anxiety in their presentation, and may be reflective of a conceptually different group of difficulties.
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Int J Psychiatry Med · Jan 2015
Preparing family physicians for the care of patients with severe and persistent mental illness: Examples from two U.S. residency programs.
Individuals with severe and persistent mental illness have increased morbidity and mortality and significant barriers to accessing health care. Although primary care providers deliver most health care for this population, residency training programs generally lack specialized training in this area. ⋯ Residents educated in these programs gain experience with an underserved population, practice advanced skills in managing complex medical and psychiatric illness, and increase knowledge from collaborative work in unique care settings. Further implementation of programs like these, and rigorous study of such programs, could have significant benefits for family medicine education and the care of patients with severe and persistent mental illness.
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Int J Psychiatry Med · Jan 2014
Case ReportsThe anti-suicidal potential of buprenorphine: a case report.
The very strong relationship between suicide, depressive disorders, and substance use disorders is well recognized. Certain pain syndromes are significantly associated with suicide, irrespective of co-occurring medical or psychiatric diagnosis. Chronic pain, depression, substance use disorders, and suicide appear to involve overlapping neural pathways and brain regions that function in the processing of emotional and physical pain, as well as maintaining reward and anti-reward circuitry. ⋯ Sublingual buprenorphine was selected to treat the opioid use disorder. We propose that the unique pharmacodynamics of this drug served to stabilize dysregulated neural circuits, neurotransmitters, and neuropeptides, allowing the mitigation of pain, assuaging opioid cravings, easing depression, and resolving suicidal ideation. To our knowledge, this is the first case report to describe the possible anti-suicidal effect of sublingual buprenorphine.
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Int J Psychiatry Med · Jan 2014
Emotional reactions to pain predict psychological distress in adult patients with Sickle Cell Disease (SCD).
Differentiating somatic from emotional influences on the experience of chronic pain has been of interest to clinicians and researchers for many years. Although prior research has not well specified these pathways at the anatomical level, some evidence, both theoretical and empirical, suggest that emotional reactions influence the experience of disease and non-disease-related pains. Other studies suggest that treatments directed at negative emotional responses reduce suffering associated with pain. ⋯ We believe the current study demonstrates that negative emotional reactions to the experience of pain in adults with SCD are predictive of psychological distress above and beyond the influences of age and the direct nociceptive experience. We also believe these data to be valuable in conceptualizing the allocation of treatment resources toward a proactive approach with early identification of patients who are responding poorly for the purpose of potentially reducing later psychopathology. A deeper understanding of the ways that subpopulations cope with chronic disease-related pain may produce models that can be ultimately generalized to the consumers of the majority of healthcare resources.