Automated pharmacy databases and behavioral health care quality assurance

Randomized, double-blind, placebo-controlled trials suggest that medications can be efficacious in several psychiatric disorders. The effectiveness of medications as they are used in practice remains to be seen. Automated pharmacy data give evaluation researchers tools to examine the quality of care for people using psychotropic medications. Reasonably convincing data indicates that automated pharmacy records are valid measures of medication consumption. Evaluation research is needed in areas such as standard setting, risk adjustment, and the linking of pharmacy data to outcome measures.     

Revising a medication education program on an inpatient child and adolescent psychiatric unit

Adherence to a medication regimen can be challenging for children and adolescents with mental health disorders. Medication education can be a beneficial tool for nurses to help promote adherence to psychotropic medications. This article describes an initiative to improve medication education offered to children and adolescents and their families on an acute child and adolescent inpatient unit in a mental health facility. Strategies included adding a game to medication education groups, creating and distributing medication education handouts, and developing and implementing medication education sessions for parents. When used by the patients and families, the interventions were appreciated. Having successful interventions in place may help meet the diverse educational needs of this population as nurses seek to improve medication adherence.     

The Role of Coping Strategies in Understanding the Relationship Between Parental Support and Psychological Outcomes in Anxious Youth

The current study examined the moderating role of coping strategies on psychological outcomes at varying levels of parental support in a sample of clinically anxious youth. Youth (N?=?174, mean age 11.89) completed the Children’s Coping Strategies Checklist, Child and Adolescent Social Support Scale, Multidimensional Anxiety Scale for Children and Children’s Depression Inventory. Data was gathered at a large, university-based anxiety disorders treatment clinic. This nonexperimental design analyzed the use of active and avoidant coping strategies as a moderator of anxiety and depression, while controlling for parental support. Results revealed active coping strategies did moderate the relationship between parental support and anxiety, however, not as expected while the significant moderation role of avoidance coping was mixed. Findings showed that anxious youth with more parental support and more active coping were at risk for higher levels of anxiety, yet protected from higher depression. Avoidant coping strategies did moderate in a manner that was predicted for higher anxiety symptoms. Results suggest increased need for parental involvement in the treatment of anxiety disorders in youth.     

Therapeutic interactions in a medication education group. Using the psychopharmacology RACE.

1. The Psychopharmacology RACE is an interactive, innovative game that emphasizes group teaching about psychiatric medications and disorders at the clients' levels of functioning. 2. Implementation of the Psychopharmacology RACE provides the opportunity to structure a medication group, impart information, and facilitate the development of therapeutic group factors. 3. Interactive group learning with the Psychopharmacology RACE can be a useful tool to enhance learning when clients are unable to read and understand written materials.     

Questions to ask when selecting medication

Given the availability of a large and diverse number of medications for the treatment of various mental disorders, how should a clinician decide which medication(s) to try for any particular patient? This article explores eight questions that should be considered when selecting medication for a patient. Medication selection should be individually tailored by the answers to these questions, which take into account factors such as the diagnosis and associated symptoms, the expected efficacy/tolerability profile, medical and psychiatric comorbidity, concurrent drug use, past treatment history, family history, patient/family preferences, and cost considerations.     

The use of buspirone in primary care

1. Although clinical trials have demonstrated the effectiveness of buspirone in treating generalized anxiety disorder, more studies are needed to confirm its efficacy in treating other anxiety disorders, depression, behavior disorders, substance abuse disorders, movement disorders, and other medical conditions. 2. Clinicians prescribing buspirone must know its basic pharmacology, adverse effects, and dosing guidelines. 3. Buspirone appears to be an alternative attractive medication to traditional benzodiazepines due to its low addictive potential and lack of lethality.     

Research on the treatment of couple distress

This article reviews the research on couple therapy over the last decade. The research shows that couple therapy positively impacts 70% of couples receiving treatment. The effectiveness rates of couple therapy are comparable to the effectiveness rates of individual therapies and vastly superior to control groups not receiving treatment. The relationship between couple distress and individual disorders such as depression and anxiety has become well established over the past decade. Research also indicates that couple therapy clearly has an important role in the treatment of many disorders. Findings over the decade have been especially promising for integrative behavioral couples therapy and emotion-focused therapy, which are two evidence-based treatments for couples. Research has also begun to identify moderators and mediators of change in couple therapy. Finally, a new and exciting line of research has focused on delineating the principles of change in couple therapy that transcends approach.     

Anxiety Disorders and Family Therapy

The role of family therapy in anxiety disorders is controversial. Empirical data exist only in relation to agoraphobia and obsessive compulsive disorders. Experienced clinicians, generally working with complex cases, regard marital and family conflict as central to many cases, which require a family approach for optimal therapy. In contrast, research workers generally regard marital and family factors as irrelevant to treatment. This is because complex cases are usually excluded from empirical research. This leaves mainly uncomplicated cases without significant family conflicts, for which a family approach is rarely necessary. Techniques for treating anxiety disorders in a marital/family setting are outlined.     

Prevalence and correlates of self-injury among university students

OBJECTIVE: The authors' purpose in this research was to establish estimates of the prevalence and correlates of nonsuicidal self-injury among university students. PARTICIPANTS: The authors recruited participants (N = 2,843) from a random sample of 5,021 undergraduate and graduate students attending a large midwestern public university. METHODS: Using an Internet-based survey, the authors measured the prevalence of self-injury and potential risk factors, including depression, anxiety, eating disorders, suicidal thoughts, and negative health behaviors. RESULTS: Seven percent of students reported any self-injury over the previous 4 weeks. Factors associated with a significantly higher likelihood (p <.05) of self-injury included cigarette smoking, concurrent depressive and anxiety disorders, and for men, growing up in a family of low socioeconomic status and having symptoms of eating disorders. Only 26% of those who reported self-injury received mental health therapy or medication in the previous year. CONCLUSIONS: Students who harm themselves experience high anxiety and distress, yet are unlikely to seek help.     

A Structural Equation Modeling Analysis of the Relationships between Depression,Anxiety, and Sexual Problems over Time

Sexual dysfunctions are related to depressive and anxiety disorders, but the nature of these relationships remains unclear. This study examined the relationship among symptoms of these disorders over time by comparing (a) a model that included causal relationships, (b) a model that accounted for change over time with a shared underlying factor (or latent liability) among all the disorders, and (c) a model that conceptualized sexual dysfunctions as unrelated to depressive and anxiety disorders over time. Participants (n = 1,012) completed online self-report measures of sexual dysfunctions and depressive and anxiety disorders across six time points at either weekly or monthly intervals. Models 1 and 2 provided equal best fit for men and women based on data collected four weeks apart, but there were no evident causal relationships in Model 1. Subsequent analyses using data collected one week and six months apart found Model 2 provided robust fit for women, but these data were not examined for men due to inadequate sample sizes. The results are consistent with a shared latent liability of internalizing psychopathology driving the change in these disorders over time, which provides a clear direction for an empirically driven nosology and for future research into transdiagnostic treatments.     

Anxiety and Depression: Implications for Older Adults

By the year 2030, it is projected that one in every three Americans will be 55-years-old or older. This age group is by far the fastest growing segment of the population. With the growing number of older adults, the importance of understanding aging and common disorders of later life is essential. In particular, anxiety and depression are among the most common problems in older adults. However, differentiating anxiety and depression at the mood, symptom, and syndromal levels has been a long-standing problem in psychopathology research. In addition to a growing need for research, clinicians will also need to take an active role in the development and implementation of treatment as the population of older adults increases. In particular, mental health service providers must become informed about the economic implications for older adults as the structure of health insurance continues to change.     

The Symptom of Insomnia in University Students

Abstract

The treatment of insomnia in a university health setting is discussed. Transient, stress-related insomnia is distinguished from chronic insomnia, and methods of treatment for each condition are presented. The causes of chronic insomnia include depression, conditioned-arousal insomnia, anxiety, chronic overwork or stress, the Delayed Sleep Phase Syndrome, and abuse of alcohol and drugs. The author reviews medications used for the treatment of insomnia, emphasizing the importance of communicating to the patient that medication use is to be short term and that the aim of treatment is to restore the ability to sleep without drugs. A list of suggestions designed to help patients encourage normal sleep is included.     

Anxiety and Depression: Implications for Older Adults

By the year 2030, it is projected that one in every three Americans will be 55-years-old or older. This age group is by far thefastest growing segment of the population. With the growing number of older adults, the importance of understanding aging and common disorders of laterlife is essential. In particular, anxiety anddepression are among the most common problems in older adults. However, differentiating anxiety and depression at the mood, symptom, and syndromal levels has been a long-standing problem in psychopathology research. In addition to a growing need for research, clinicians will also need to take an active role in the development and implementation of treatment as the population of older adults increases. In particular, mental health service providers must become informed about the economic implications for older adults as the structure of health insurance continues to change.     

A nursing tool for adherence and recovery in psychosis: a pilot study

Clients with psychotic disorders are at great risk for relapse and rehospitalization. This risk is magnified by poor adherence to medications, as well as refusal to accept optimal treatment planning, including more beneficial atypical medications. Adherence can be even more compromised because of clients' poor insight into these illnesses and their inability to recognize the potential for recovery that exists when taking medications as prescribed. This poor insight makes effective collaboration in treatment more difficult and is an exceptionally troubling impediment to successful treatment. Currently, there are few effective strategies to improve insight into psychosis. We have developed the Levels of Recovery from Psychotic Disorders Scale (LORS) as a teaching tool. It is designed to identify strengths and weaknesses in insight in order to provide the basis for an intervention to enhance and promote change. This article reviews the relevant literature on adherence and insight in this population of clients with psychotic disorders. It also reviews a pilot study comparing the LORS to the BASIS-32. The findings provide the basis for future studies using the LORS to enhance insight, adherence, and recovery.     

Student Knowledge of and Attitudes toward Psychotropic Drugs

Abstract

Expanding social work roles in medication management and psychoeducation, especially in mental health, clearly require that students possess an enlarged knowledge base and a set of enlightened attitudes regarding psychotropic medications and their use. This article reports the results of a survey that investigated the knowledge of and attitudes toward psychotropic medications among a population of social work students. If the survey results were scored like a school exam, then the average student surveyed scored a “C !.” The article also suggests that both personal and professional experiences in the mental health field apparently influence knowledge of and attitudes toward psychotropic drugs. It is recommended that social work course content be expanded to include relevant information on psychotropic drugs.     

Hyper-anxiety in early sobriety: psychopharmacological treatment strategies

The importance of recognizing and treating anxiety disorders that co-occur with alcohol use disorders should not be underestimated, whether the anxiety is state (a transient condition) or trait (a chronic disorder). This article will discuss hyper-anxiety, a term the authors use to describe the uncomfortable, excessively anxious state that contributes to relapse. In addition, psychopharmacological strategies for relief of hyper-anxiety are suggested, and implications for recovery are discussed.     

Problem gambling,anxiety and poverty: an examination of the relationship between poor mental health and gambling problems across socio-economic status

Socio-economic status has been shown to be significantly related to both problem gambling and mental health problems. Additionally, forms of psychopathology such as mood and anxiety disorders have been shown to correlate with problem gambling across a variety of settings. However, relatively little research has been conducted examining whether the connection between mood and anxiety disorders and problem gambling is consistent across different levels of socio-economic status. This study examines gambling-related problems among a representative sample of Canadian adults using the 2008 Canadian Community Health Survey (N = 28,271). Generalized linear modelling is used to analyze the data. A moderation effect is found that shows the relationship between anxiety disorders and problem gambling severity varies significantly across socio-economic status. This study shows that social setting has an important influence on the assumed relationship between psychopathology and gambling problems that is downplayed in current problem gambling research. A discussion of the need for greater inclusion of socio-economic context when making assumptions about the connections between problem gambling and psychiatric disorders is made in light of the responsibilities of gambling providers and regulators.     

Briefly Noted

There are several pharmacogenetic decision support tools that have been evaluated in clinical settings, but the evidence for such testing in clinical practice is insufficient, particularly when it comes to predicting side effects of medications, researchers write in a recent issue of the American Journal of Psychiatry which can be taken as an object lesson for the substance use disorder (SUD) field, which is ripe for promotion of such tools, especially in alcohol use disorders. There have been substantial investigations into genetic variants associated with major depressive disorder, and gene‐drug interactions affecting medication response.