Arch Gen Psychiat
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Randomized Controlled Trial Clinical Trial
Integrated medical care for patients with serious psychiatric illness: a randomized trial.
This randomized trial evaluated an integrated model of primary medical care for a cohort of patients with serious mental disorders. ⋯ On-site, integrated primary care was associated with improved quality and outcomes of medical care.
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The need for mental health and substance abuse services is great among those with human immunodeficiency virus (HIV), but little information is available on services used by this population or on individual factors associated with access to care. ⋯ The magnitude of mental health and substance abuse care provided to those with known HIV infection is substantial, and challenges to providers should be recognized. Inequalities in access to care are evident, but differ among general medical, specialty mental health, and substance abuse treatment sectors.
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Comparative Study
Psychiatric disorders among tortured Bhutanese refugees in Nepal.
The impact of torture on the distribution of psychiatric disorders among refugees is unknown. ⋯ Among Bhutanese refugees, the survivors had higher lifetime and 12-month rates of ICD-10 psychiatric disorder. Men were more likely to report torture, but tortured women were more likely to report certain disorders. The results indicate the increased need for attention to the mental health of refugees, specifically posttraumatic stress disorder, persistent somatoform pain disorder, and dissociative (amnesia and conversion) disorders among those reporting torture.
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We investigated a possible mechanism of action for the antidepressant response to light-phase advances of the circadian clock-by measuring the onset of melatonin secretion before and after light treatment in the morning or evening. ⋯ The antidepressant effect of light is potentiated by early-morning administration in circadian time, optimally about 8.5 hours after melatonin onset or 2.5 hours after the sleep midpoint.
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In patients with schizophrenia, deficient generation of mismatch negativity (MMN)-an event-related potential (ERP) indexing auditory sensory ("echoic") memory-and a selective increase of "context dependent" ("BX") errors in the "A-X" version of the Continuous Performance Test (AX-CPT) indicate an impaired ability to form and use transient memory traces. Animal and human studies implicate deficient N-methyl-D-aspartate receptor (NMDAR) functioning in such abnormalities. In this study, effects of the NMDAR antagonists ketamine on MMN generation and AX-CPT performance were investigated in healthy volunteers to test the hypothesis that NMDARs are critically involved in human MMN generation, and to assess the nature of ketamine-induced deficits in AX-CPT performance. ⋯ The NMDARs are critically involved in human MMN generation. Deficient MMN in schizophrenia thus suggests deficits in NMDAR-related neurotransmission. N-methyl-D-aspartate receptor dysfunction may also contribute to the impairment of patients with schizophrenia in forming and using transient memory traces in more complex tasks, such as the AX-CPT. Thus, NMDAR-related dysfunction may underlie deficits in transient memory at different levels of information processing in schizophrenia. Arch Gen Psychiatry. 2000;57:1139-1147.