Current psychiatry reports
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Curr Psychiatry Rep · Oct 2011
ReviewBarriers to use of pharmacotherapy for addiction disorders and how to overcome them.
Substance use disorders are highly prevalent, debilitating conditions for which effective pharmacotherapies exist with a broad evidence base, yet pharmacotherapy for the treatment of addiction disorders is underutilized. The goals of this review are to describe the barriers that may contribute to poor adoption and utilization of pharmacotherapy for alcohol and opioid dependence at the system, provider, and patient level and to discuss ways to overcome those barriers. ⋯ Strategies to promote adoption of pharmacotherapy for addiction disorders should be modified to fit the needs of the practice, system, and individual patients. Pharmacotherapy is a valuable tool in the clinical armamentarium of addiction treatment; thus, overcoming barriers to implementation may improve clinical and social outcomes.
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Curr Psychiatry Rep · Aug 2011
ReviewCurrent status of deep brain stimulation for obsessive-compulsive disorder: a clinical review of different targets.
Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder that affects 2% of the general population. Despite optimal cognitive-behavioral and pharmacologic therapy, approximately 10% of patients remain treatment resistant. Currently, deep brain stimulation (DBS) is being investigated as an experimental therapy for treatment-refractory OCD. ⋯ The frequency of adverse events seems to be limited. Larger prospective studies including neuroimaging are needed to estimate adequately the true potential of DBS in treatment of OCD and to elucidate its underlying mechanism of action and optimal brain target. We conclude that DBS may be a promising and safe therapy for treatment-resistant OCD.
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Curr Psychiatry Rep · Apr 2011
Psychiatric diagnosis in adolescents with sickle cell disease: a preliminary report.
Sickle cell disease (SCD), the most common genetic hemoglobin disorder, affects more than 70,000 Americans, primarily those of African and Mediterranean descent. SCD, characterized by chronic hemolytic anemia; recurrent, episodic painful episodes; vaso-occlusive complications affecting multiple organ systems; and increased risk of infections, is associated with a shortened life span for affected individuals. However, recent medical advances have significantly increased survivability and quality of life for individuals with SCD. ⋯ This article describes findings from a structured psychiatric interview administered to 40 adolescents and their parents. The rates of reported psychiatric diagnosis were significantly higher than those reported for the general population. Awareness of risks for psychiatric disorders in SCD could lead to increased identification and interventions that may improve medical and psychiatric outcomes.
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Curr Psychiatry Rep · Feb 2011
ReviewPost-traumatic stress disorder in medical settings: focus on the critically ill.
The relevance of the post-traumatic stress disorder (PTSD) concept to medically ill patients is becoming increasingly clear. Some medical conditions (e.g., rheumatologic diseases) are likely related to PTSD indirectly. Others, such as myocardial infarction and critical illness/intensive care unit (ICU) treatment, are likely traumatic stressors. ⋯ PTSD is particularly common among survivors of critical illness and ICU treatment. Further research is needed to determine how specific ICU interventions (e.g., administration of benzodiazepines, corticosteroids, and catecholamines) affect PTSD risk. In the meantime, given the negative impact of PTSD on patients' quality of life, it is important for psychiatrists and other clinicians to be aware of the syndrome in survivors of critical illness so as to ensure that such patients receive the care that they deserve.
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Curr Psychiatry Rep · Oct 2010
ReviewUse of naltrexone to treat opioid addiction in a country in which methadone and buprenorphine are not available.
Opioid dependence is one of the most severe drug dependencies. Naltrexone is a medication that completely blocks the subjective and other effects of opioids and, when administered to detoxified opioid addicts and taken as directed, prevents relapse and helps maintain abstinence. The major problem with naltrexone is poor compliance, particularly in countries in which there is a treatment alternative based on substitution of illicit opioids such as heroin with orally administered opioid agonists (methadone) or partial agonist/antagonists (buprenorphine). ⋯ Due to the lack of alternatives to naltrexone and stronger family control of compliance (adherence), naltrexone is more effective for relapse prevention and abstinence stabilization in Russia than in Western countries. Long-acting, sustained-release formulations (injectable and implantable) seem particularly effective compared with oral formulations. This article summarizes the results of studies conducted in Russia during the past 10 years that demonstrate these points.