Facilitating visitation for infants with prenatal substance exposure

Permanency planning for infants with prenatal substance exposure is challenging due to characteristics of the infants and the ongoing substance use or relapse of the parents. Visitation is a primary mechanism through which child welfare workers determine and support permanency planning. Productive use of visitation for permanency planning for infants with prenatal substance exposure is described, along with strategies for skillfully focusing visits on issues and needs relevant to this population.     

Racial differences in DSM diagnosis using a semi-structured instrument: the importance of clinical judgment in the diagnosis of African Americans

Schizophrenia is diagnosed more frequently among African Americans while mood disorders are identified more often among whites. Such findings have raised serious questions about the accuracy of clinical judgment. This article analyzes data on 665 African American and white psychiatric inpatients using a semi-structured diagnostic instrument. The paper explores the relationship of patient race to schizophrenia, schizoaffective disorder, major depression, and bipolar disorder. The paper also explores the extent to which patient race is related to the manner in which clinicians link individual symptoms to diagnoses. Results indicate some significant race differences in diagnosis remain even when a semi-structured instrument and DSM criteria are used, whites, were more likely than African Americans to receive a diagnosis of bipolar disorder and less likely to be diagnosed with schizophrenia. There were no race differences in major depression. Some patterns of symptom attribution differed by race. The results are consistent with previous sociological research showing that patient race is related to diagnosis even when standardized diagnostic criteria are used. These findings underscore the importance of clinical judgment within the context of cross-race and cross-ethnic diagnosis. Clinical training programs must reduce ethnocentric bias by teaching the appropriate use of the socio-cultural information necessary to employ DSM-IV's Cultural Formulation.     

DSM‐5 diagnosis of alcohol use disorder

Alcohol use disorder is a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12‐month period.     

Increased exposure to alcohol and cannabis education and changes in use patterns

The introduction of new alcohol and cannabis education programs in Ontario schools was associated with significant increases in reported exposure to alcohol and cannabis education. Significant increases were reported for both sexes, all grade levels, and geographic areas. These were associated with decreases in proportions of drinkers, especially among younger students. Little effect was seen on heavy drinking. The evidence also suggests that reported increased exposure to cannabis education was not associated with reduced cannabis use. The challenge remains to develop alcohol education programs which can reduce heavy drinking and to develop effective cannabis education programs.     

A proposed model representing the relationships between user characteristics, computer exposure and musculoskeletal symptoms in children

Children's computer exposure is rapidly growing. Several studies have suggested children using computers may be at risk of developing musculoskeletal symptoms. General models and theories relating to the causality of negative musculoskeletal outcomes in adult workers demonstrated relationships between workplace factors and musculoskeletal outcomes. When examining children's computer exposure it is evident that their use is different. Even though risk factors may be similar, due to the nature of children and their computer environments, the potential risk factors and thus a proposed model of causal relationships between exposure and outcomes may differ. Objective: To develop a model of factors influencing computer exposure and musculoskeletal symptoms in children. Methods: 1351 children (or their parents for Year 1 children) in school Years 1, 6, 9 and 11 (ages ~ 6,11,14,16 years) from 10 schools in Western Australia were surveyed on a range of user characteristics, computer exposure and musculoskeletal symptoms. Results: Potential risk factors for childrens' computer exposure and musculoskeletal outcomes were multivariable. Factors such as age, gender, somatic complaints, flow, computer anxiety, computer, TV and physical activity exposure, and SES were related to computer exposure and children's reports of musculoskeletal symptoms. Significance: Developing a child-related computer exposure model to understand relationships between potential risk factors and musculoskeletal symptoms will assist academics, teachers and parents to develop a better understanding of the risk factors for children's computer exposure.     

Responses to prenatal opioid and alcohol abuse: A review of US and Australian mandatory reporting laws

Prenatal substance use, specifically opioid and excessive alcohol use, can cause significant adverse effects for the unborn foetus in both the short-and long-term. Responses by state social systems occur on a spectrum of prevention and early intervention to support mothers. Some but not all states include reporting duties, so that professionals made aware of the situation may alert agencies that can intervene to provide appropriate support. This article will review legal duties to report maternal substance use during pregnancy in the US and Australia. We identify variations in these laws regarding who is required to report, what circumstances must be reported and what indicates child abuse or neglect. Inconsistencies in laws raise questions about the nature of different approaches, and how reforms might be made to improve provision of support. Informed by the medical literature, the contemporary context and federal policy in the US, we make recommendations for reform, and for the appropriate response to such reports.     

Research outcomes of prenatal substance exposure and the need to review policies and procedures regarding child abuse reporting

Research on the outcomes of drug-exposed children evinces elevated developmental risks from the interaction of subtle biological vulnerabilities and compromised parenting. States, however, have generally not reviewed the procedures and policies they developed in the early 1990s when there was less research and experience with these children. At that time the gravest risks related to perinatal substance exposure seemed to be excessively punitive treatment of mothers by over-zealous criminal justice prosecutors. This article clarifies policy options for reporting and serving children who are born testing positive for controlled substances and also calls for strengthening existing state policies regarding child abuse reporting and response.     

Experiences, concerns, and service needs of families adopting children with prenatal substance exposure: summary and recommendations.

Parents who adopted children from out-of-home care with prenatal substance exposure were interviewed four months after the child's placement in the home, and again after the first year regarding their experience with adoption and their concerns about their child's development, attachment, and behavior; aspects of parenting and the adoption process; effects of prenatal substance exposure; and availability and helpfulness of resources. Adoptive parents found parenting children with prenatal substance exposure to be both more rewarding and more difficult than they had imagined.     

An ethical code for AOD faculty: a proposed set of guidelines

Ethical codes of conduct are accepted requirements for membership in state and national organizations that grant credentials to those who are employed as alcohol and other drug (AOD) counselors, prevention specialists, and clinical supervisors. It seems appropriate to explore the possibility of an ethical code directly linked to addiction faculty which will outline their unique educational responsibilities and standards. The authors suggest development and adoption of such an ethical code for college-level addiction studies faculty and this proposal is offered as a move toward that possibility.     

Classification of premenstrual disorders as proposed by the International Society for Premenstrual Disorders

Premenstrual disorders have been recognized as affecting innumerable women for decades but unlike most other medical conditions universally accepted criteria for definition and diagnosis are not established. Although premenstrual syndrome (PMS) occurs throughout reproductive life, there are some women who become particularly troubled. Those approaching the menopause may also have a mixture of PMS and menopause symptoms, not to mention heavy periods. Furthermore, some of the symptoms are similar in nature and so it is a challenge to identify which set of symptoms belongs to which spectrum. This is an area that has not been explored well. Various classifications have been proposed over the last few decades. A further effort towards the classification was made by an international multidisciplinary group of experts established as the International Society for Premenstrual Disorders (ISPMD) in Montreal in September 2008. Their deliberations resulted in a unified diagnosis, classification of premenstrual disorders (PMD) along with their quantification and guidelines on clinical trial design. This classification of PMS is far more comprehensive and inclusive than previous attempts. PMD in the ISPMD Montreal consensus are divided into two categories: Core and Variant PMD. Core PMD are typical, pure or reference disorders associated with spontaneous ovulatory menstrual cycles while Variant PMD exist where more complex features are present. Further, the consensus group considered that PMD may be subdivided into three subgroups predominantly physical, predominantly psychological and mixed. Variant PMD encompass primarily four different types; premenstrual exacerbation, PMD with anovulatory ovarian activity, PMD with absent menstruation and progestogen-induced PMD.     

Improving alcohol screening for college students: Screening for alcohol misuse amongst college students with a simple modification to the CAGE questionnaire

ABSTRACT

Objective: To improve the CAGE (Cut down, Annoyed, Guilty, Eye opener) questionnaire's predictive accuracy in screening college students. Participants: The sample consisted of 219 midwestern university students who self-administered a confidential survey. Methods: Exploratory factor analysis, confirmatory factor analysis, receiver operating characteristics (ROC), and Cronbach's alpha were used to analyze factor structure, validity, and reliability. Results: The modified CAGE correctly classified students with alcohol abuse (“AA students”; area under the curve [AUC] = 0.7765) and students with alcohol dependency (“AD students”; AUC = 0.8392) more often than CAGE (AA students: AUC = 0.6977; AD students: AUC = 0.7437), and these differences are statistically significant (AA students: χ²(1) = 14.72, p < .001; AD students: χ²(1) = 7.71, p < .01). Using 2-point cut scores, CAGE correctly identified 59.38% of AD students as AD, whereas the modified CAGE correctly identified 87% of AD students as AD. Using 1-point cut scores, CAGE correctly identified 65% AA students, whereas the modified CAGE identified 85.29%. Conclusions: The modified CAGE has better accuracy than CAGE in predicting AA and AD among college populations.     

Gabapentin shows promise for treating early alcohol withdrawal symptoms

Treating alcohol use disorder (AUD) with gabapentin in the early stages of alcohol withdrawal shows promise, according to a randomized clinical trial reported in JAMA Internal Medicine. The study, “Efficacy of Gabapentin for the Treatment of Alcohol Use Disorder in Patients With Alcohol Withdrawal Symptoms: A Randomized Clinical Trial,” by Raymond F. Anton, M.D., and colleagues, evaluated gabapentin versus placebo in 145 treatment‐seeking people who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for AUD, 96 of whom were in recent alcohol withdrawal and randomized to treatment after three abstinent days. Daily drinking was recorded, and a heavy drinking blood marker was collected at baseline and monthly. The percentage of individuals with total abstinence and those with no heavy drinking days were compared between treatment groups. The participants had 83% heavy drinking days (four drinks a day for women, five for men) at baseline. More gabapentin‐treated individuals had no heavy drinking days (12 of 44 participants [27%]) compared with placebo (four of 46 participants [9%]), and more total abstinence (eight of 44 [18%]) compared with placebo (two of 46 [4%]). The prestudy high‐alcohol‐withdrawal group had positive gabapentin effects on no heavy drinking days and total abstinence compared with placebo, while within the low‐alcohol‐withdrawal group, there were no significant differences. These findings were similar for other drinking variables, where gabapentin was more efficacious than placebo in the high‐alcohol‐withdrawal group only. Gabapentin caused more dizziness, but this did not affect efficacy.