Mental Health Consultation on the College Campus

Abstract

“Mild Hypertension: When and How to Treat,” NORMAN M. KAPLAN. “Early and aggressive” drug therapy for mild hypertension, now widely prescribed in the United States, may be inappropriate for many of the 30 million patients with this condition. Although all of these patients are at greater risks of premature cardiovascular disease, the risks are manifested neither quickly nor uniformly. Drug therapy has not proved beneficial for patients with a diastolic (D) BP reading below 100 mm Hg, particularly those patients who are otherwise at low risk. Those antihypertensive drugs that are available now carry risks along with their benefits. Therefore, persons with mild hypertension who are at low risk should be encouraged to use nondrug therapies for at least six to 12 monts. If their DBP remains below 100 mm Hg, they may be better off than if they were given drugs. The drug used in initial therapy has usually been a diuretic. For many patients, however, an adrenergic inhibitor may be a more appropriate choice.     

Women at Risk for Human Immunodeficiency Virus

This article reports results from a survey among women at risk for contracting human immunodeficiency virus (HIV) as well as transmitting it in a vertical (to offspring) and horizontal (sexual partner or intravenous [IV] drug usage) mode. Little is known about the extent of HIV knowledge, sexual behaviors and IV drug usage for women at risk for HIV infection. The sample (N = 620) consisted of Black (50.6%), Caucasian (28.7%), Hispanic (13.4%) and Haitian (5.0%) adult non-pregnant women from South Florida. Data concerning their drug usage, sexual behaviors and other risk factors for HIV infection are presented alone with their knowledge about HIV infection and acquired immunodeficiency syndrome (AIDS). The women had an adequate knowledge base about HIV and AIDS; however the results indicated that our sample was at risk due to the following risk factors: (1) unprotected sexual intercourse, both vaginal and anal, with men who were at high risk for HIV infection (i.e., men who were bisexual and/or used IV drugs); (2) IV drug usage by the woman themselves including needle sharing in "shooting galleries"; (3) the practice of prostitution by the women and; (4) the use of various non-IV drugs that have been shown to impair judgement and lower inhibitions regarding sexual practices. Results indicate differences in risk behaviors and knowledge about AIDS by race/ethnicity.     

NY AG ends Emergent's exclusivity for Narcan nasal spray

Narcan, the lifesaving opioid overdose reversal drug, has been the only naloxone spray allowed on the market due to an exclusivity agreement between the pharmaceutical company that owns it — Emergent BioSolutions — and the company that makes the spray device. This deal is ending thanks to New York Attorney General Letitia James, who has made it possible, via an agreement with Emergent, for other companies to use the patented, proprietary spray technology. Emergent, which bought Adapt, the creator of Narcan, will have to renegotiate these terms, James announced on Jan. 2. “Given the tragic, devastating effects of the opioid crisis, and the urgent need for additional drugs for the emergency treatment of opioid overdoses, my office will do whatever possible to ensure that there are no unnecessary impediments to the development of additional lifesaving opioid overdose reversal drugs,” she said. “I'm proud to announce that, starting today, additional companies will be able to gain access to these nasal spray devices. With more companies able to access this easy‐to‐use technology, our hope is that we can reduce the number of opioid overdose deaths across New York and this nation and save millions of additional lives.” A little history here: Adapt Pharma launched Narcan in February 2016, a year before the State Targeted Response (STR) grants were issued. Narcan is patented, but naloxone had been used for decades in the emergency treatment of opioid overdoses, by first responders and medical workers. In October 2018, in the middle of the lucrative STR (which no longer had to be 80% treatment) and State Opioid Response funding cycles, Emergent bought Adapt — for Narcan. Adapt had already entered into the contract with the nasal spray device manufacturer. Other pharmaceutical companies had been trying to develop a nalmefene overdose reversal drug using the device.     

Cocaine use among the College Age Group: Historical Perspective—The Long and Colorful History of Erythoxylon Coca

Abstract

The rate of increase in the use of cocaine among college students has been greater even than the increase in the use of marijuana during the past ten years. Nationwide surveys indicate that 9 million Americans within the 18–25 age group, or 28.7%, have used cocaine. This compares with 2.9 million, or 9.1%, just a decade ago. The history of cocaine begins with the history of the coca plant. Even prior to the inca period the plant was used in South America; for centuries use of the plant remained restricted primarily to that continent. In 1859, an Austrian explorer brought home from Peru coca leaves that he sent to the University of Gottigen where Dr. Albert Niemann extracted and purified a crystalline compound he called cocaine. Several prominent physicians including Sigmund Freud and William Halsted, the father of modern surgery, experimented with cocaine on themselves and on their patients. Their published observations helped effect widespread use of cocaine in patent medicines, tonics, wines, and soft drinks. That earlier epidemic and the rest of the long and colorful history of cocaine brings into perspective the current epidemic of cocaine use.

“Mild Hypertension: When and How to Treat,” NORMAN H. KAPLAN. “Early and aggressive” drug therapy for mild hypertension, now widely prescribed in the United States, may be inappropriate for many of the 30 million patients with this condition. Although all of these patients are at greater risks of premature cardiovascular disease, the risks are manifested neither quickly nor uniformly. Drug therapy has not proved beneficial for patients with a diastolic (D) BP reading below 100 mm Hg, particularly those patients who are otherwise at low risk. Those antihypertensive drugs that are available now carry risks along with their benefits. Therefore, persons with mild hypertension who are at low risk should be encouraged to use nondrug therapies for at least six to 12 months. If their DBP remains below 100 mm Hg, they may be better off than if they were given drugs. The drug used in initial therapy has usually been a diuretic. For many patients, however, an adrenergic inhibitor may be a more appropriate choice. (Archives of Internal Medicine, 1983;143:255–259)

“Persistence of Normal BP After Withdrawal of Drug Treatment in Mild Hypertension,” PAUL D. LEVINSON, IBRAHIM M. KHATRI, EDWARD D. FREIS. Antihypertensive therapy was discontinued in 24 patients with mild hypertension whose BPs had been well controlled with diuretics alone. Eleven patients (46%) maintained normal diastolic BPs (≤ 90 mm Hg) for six months after stopping treatment and five patients (21%) for 12 months. All patients who remained normotensive for six to 12 months had mean diastolic BPs of 82 mm Hg or less during treatment. There was no signficant correlation between maintenance of normotension and any of the following: pretreatment BP, presence of target-organ damage, duration of known hypertension, family history of hypertension, heart size, body weight, weight gain after stopping diuretic therapy, 24-hour urinary sodium and potassium excretion, serum electrolyte values or renin profile. This study demonstrates that hypertension may be favorably modified, sometimes for many months, by effective antihypertensive treatment. (Archives of Internal Medicine 1982;142:2265–2268)     

Drug Use/Abuse and Supermarket Workers' Job Performance

In 34 stores of a supermarket chain 1,414 employees were interviewed on their histories of substance use, and were diagnosed for alcohol and drug abuse. The ratings of their job performance were obtained from their supervisors. Many statistically significant correlations were found between measures and indicators of substance use/abuse and the supervisors' ratings of job performance. Greater use of prescribed stimulant medication and greater coffee consumption were both associated with better rated job performance. In summary, while some of correlations found between the substance use measures/abuse and job performance were highly significant, due to the large sample size, this does not necessarily demonstrate that the relationship is strong enough to have practical implications for the hiring practices of management. Whether the degree of the relationship found was sufficient to warrant preemployment drug testing of supermarket employees, given the cost of testing and the privacy questions, is probably moot. There was evidence that, when they are interviewed at or near their workplace, employees tend to deny recent and current substance use more than they deny past substance use, in spite of the promise of confidentiality and anonymity.     

Cannabis and alcohol use in young adults: Connections

People with HIV, as well as those who are uninfected, do well on long‐term treatment with opioids (methadone or buprenorphine), researchers have found. There is a strong dose‐response relationship between mortality (all causes), unnatural death and overdose, with the higher morphine equivalent daily doses having the best outcomes, according to the study, by Ajay Manhapra, M.D., and colleagues and published online Sept. 16 in the Journal of Drug and Alcohol Dependence. “Opioid risk mitigation approaches should be expanded to address the potential effects of higher dose on all‐cause mortality in addition to unnatural and overdose fatalities,” the researchers conclude in the abstract. For the study, there were 22,996 patients on long‐term treatment, 6,578 (29%) with HIV and 16,418 (71%) uninfected. Among 5,222 (23%) deaths, 12% were unnatural deaths and 6% overdoses. The study, “All‐cause mortality among males living with and without HIV initiating long‐term opioid therapy, and its association with opioid dose, opioid interruption and other factors,” also found that benzodiazepine use was associated with overdose.     

Sources of drug information among adolescent students

A sample of 1023 eighth and tenth grade students in small to medium-sized central Texas school districts was assessed to determine the amount of information they receive from ten sources about six categories of drugs. The amount of information males reported receiving about each drug category was significantly greater than what females reported, and the amount of information that eighth graders reported receiving about each drug category was significantly greater than what tenth graders reported. Television was the primary source of drug information for all categories of drugs except inhalants, for which friends and television were equally important sources. Parents and printed media (magazines or newspapers) were of secondary importance, followed by friends and teachers. Adolescents were less likely to receive drug-related information from experience, siblings, church, doctors, and police. The reliance on the mass media for drug information in smaller school districts is a pattern which has been previously observed in larger urban districts. This consistency suggests that mass media approaches to drug education are likely to be as effective in rural areas and smaller towns as they are among urban adolescents. Implications for television programming are discussed.     

A critical evaluation of the cardiac toxicity of citalopram: part 1

In August 2011, the U.S. Food and Drug Administration issued a safety announcement that the antidepressant drug citalopram (Celexa(?)) should not be used at dosages greater than 40 mg per day (or greater than 20 mg per day for patients 60 and older) because it can cause abnormal changes in the electrical activity of the heart. This warning was based on the results of a "thorough QT/QTc study" of citalopram and on post-marketing reports of QT prolongation and torsade de pointes in some patients taking the drug. The statistically significant results from the "thorough QT/QTc study" were small in magnitude, and their clinical significance is questionable. Additional electrocardiogram analyses from other studies do not confirm these findings. Nearly 600 cases of citalopram overdoses have been described. Although citalopram overdose is not entirely "cardiac safe," only a proportion of patients develop QTc prolongation without serious cardiac sequelae and no deaths. Three studies comparing citalopram overdoses to other antidepressant overdoses do not demonstrate clinically meaningful differences in cardiotoxic effects.     

Challenge of infant mortality in India

The paper analyses the existing constraints in the delivery of adequate health services to children. A strategy for containing the infant mortality due to neonatal causes, diarrhoeal diseases and respiratory infections is presented: suggestions are given for better training of manpower for child health services, continuous supply of drugs and equipment and adoption of the "at risk" approach for identification of children likely to die, without intervention.     

When naloxone alone isn't enough: Deaths in year after ED OD visits

When patients are treated for nonfatal opioid overdose in the emergency department (ED) and discharged, they have a high risk of death — 67% of the time from another overdose within the next year, and especially within the next two days — new research has found. Being offered medication such as buprenorphine, counseling and referral to treatment by the ED before discharge could reduce that risk, the researchers concluded.     

Toward an ecstasy and other club drug (EOCD) prevention intervention for rave attendees

A growing body of recent research has identified that "rave" attendees are at high risk for the use of "club drugs," such as 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy"). Rave attendees, however, comprise only one of several club-going populations. In the current study, we explore the prevalence of ecstasy and other club drug (EOCD) use among a sample of club attendees in Washington, DC. Data were collected from adult, primarily homosexual, club attendees during the summer of 2003. Data collection was scheduled between 11 p.m. and 3 a.m. Participation rates were high. Of the 211 club attendees approached, 88% (n = 186) completed the interview. Drug use prevalence rates were low. With the exception of alcohol and marijuana, 2-day self-reports were less than 1% for each drug. These findings, amalgamated with results from other EOCD-related studies involving several distinct populations, offer considerable insight into the state of ecstasy in American society. Based on a meta-analysis of this literature, we offer a community-level prevention intervention for the population at highest risk for EOCD use-rave attendees.     

The Actuarial Assessment and Experiential Reality of Risk in Childhood

All children face risks in their everyday lives, although some experience more than others. Age, gender, geography and relative disadvantage are among the factors making a difference. Assessing and managing these risks has generated enormous academic interest, political activity, public debate, and emotion, but a major tension has arisen. This is between the actuarial models of risk assessment widely advocated and imposed by agencies including the government, even if prompted by individual instance and public outrage, and experiential models of risk assessment commonly adopted by children and their families. This gives rise to the issue of whether children should be protected at all cost because of the risk from both visible and hidden dangers, or whether they should be exposed to challenge and adventure to allow them to learn to assess and manage risk for themselves. It is unclear whether or not the world is a safer place for children than in the past, and it is apparent that risks constantly change. The challenge is to ensure that young people remain safe while at the same time gaining opportunities to experience excitement and develop their independence.     

Effective medication management

The effectiveness of a drug treatment is based on its efficacy, tolerability, safety, and acceptability. Effective medication management implies that the process of selecting and managing prescribed drugs results in an optimal patient outcome. Effectively prescribing medications includes gaining a mastery of drug knowledge, learning the nuts and bolts of treatment using medication, and appreciating the fundamental importance of psychotherapeutic and psychoeducational processes in medication management. Nurses have an essential role in providing effective medication management, given their direct level of patient contact and their collaborative relationship with physicians.