These slides are from on lecture on the role of psychotropic drugs in mental health treatment. Topics covered include the pharmaceutical industry, direct-to-consumer advertising, the CATIE and STAR*D studies, Medicare Part-D, and the role or pharmacy benefit managers.
Mental Health Policy - The Affordablle Care Act and Mental HealthDr. James Swartz
These slides are from a lecture describing some of the main provisions of the Patient Protection and Affordable Care Act (P.L. 111-148) also known as the ACA or "Obamacare". Medicaid expansion and the health insurance exchanges are considered. Information on the status of ACA implementation is also presented.
Mental Health Policy - Defining mental illness, epidemiology, service use, an...Dr. James Swartz
These slides are from a mental health policy course. Topics covered include defining mental illness, the history and politics of the DSM, the epidemiology of mental illness in the United States, and trends in service use and access.
Mental Health Policy - Mental Illness and the Criminal Justice SystemDr. James Swartz
These slides are from a lecture on the criminal justice system and mental illness and considers factors related to the criminalization of those with mental illnesses, characteristics of those with mental illness under criminal justice supervision, and the role of drug and mental health courts.
Psychological Illness and Crime Growing in Urban life by Dr.Mahboob Khan PhdHealthcare consultant
“I believe that -Weather it is MH 370 Co-Pilot or recent thane mass murderer these people have some sort of psychological illness in common and there is greater need to do psychological assessment of every one as a mandatory test”.Public opinion surveys suggest that many people think mental illness and violence go hand in hand. A 2012 national survey found, for example, that 60% of indians thought that people with schizophrenia were likely to act violently toward someone else, while 32% thought that people with major depression were likely to do so.
Mental Health Policy - The Affordablle Care Act and Mental HealthDr. James Swartz
These slides are from a lecture describing some of the main provisions of the Patient Protection and Affordable Care Act (P.L. 111-148) also known as the ACA or "Obamacare". Medicaid expansion and the health insurance exchanges are considered. Information on the status of ACA implementation is also presented.
Mental Health Policy - Defining mental illness, epidemiology, service use, an...Dr. James Swartz
These slides are from a mental health policy course. Topics covered include defining mental illness, the history and politics of the DSM, the epidemiology of mental illness in the United States, and trends in service use and access.
Mental Health Policy - Mental Illness and the Criminal Justice SystemDr. James Swartz
These slides are from a lecture on the criminal justice system and mental illness and considers factors related to the criminalization of those with mental illnesses, characteristics of those with mental illness under criminal justice supervision, and the role of drug and mental health courts.
Psychological Illness and Crime Growing in Urban life by Dr.Mahboob Khan PhdHealthcare consultant
“I believe that -Weather it is MH 370 Co-Pilot or recent thane mass murderer these people have some sort of psychological illness in common and there is greater need to do psychological assessment of every one as a mandatory test”.Public opinion surveys suggest that many people think mental illness and violence go hand in hand. A 2012 national survey found, for example, that 60% of indians thought that people with schizophrenia were likely to act violently toward someone else, while 32% thought that people with major depression were likely to do so.
Mental Health in a Time of COVID-19: Preparing Faith and Community PartnersStephen Grcevich, MD
Key Ministry’s President & Founder, Dr. Steve Grcevich, co-presented with Kay Warren and former congressman Dr. Tim Murphy for this webinar from the U.S. Department of Health and Human Services. The aim was to help churches and religious leaders of all faiths respond to #mentalhealth support needs arising from #COVID19. Link to video: https://youtu.be/C8Zzgw4ihOg
This presentation about ‘Valuing Mental Health’ by Dr Geraldine Strathdee, National Clinical Director of Mental Health, NHS England, was delivered to the Foundation Trust Network on 16 October 2013.
Geraldine covers:
- Why does the NHS need to value mental health: The impact of mental health on outcomes and costs
- Parity between mental health and physical health: What would it mean in practice
- Fast tracking Value in the NHS: What role can the Foundation Trust Network have in delivering it?
Selected Psychological and Social Factors Contributing to Relapse among Relap...inventionjournals
Drug abuse is a major global problem and in Kenya there has been increasing drug and alcohol abuse with serious negative effects. Treatment and rehabilitation of alcoholism is expensive and non-conclusive due to consequent relapse. This study sought to find out selected psychological and social factors contributing to relapse among recovering alcoholics of Asumbi and Jorgs Ark rehabilitation centres in Kenya. This study adopted the descriptive survey design. The population of the study comprised of all relapsed alcoholics and rehabilitation counsellors in Asumbi and Jorgs Ark rehabilitation centres in Kenya. A sample of 67 recovering alcoholics and 13 counsellors was drawn from the two purposively selected rehabilitation centres and used in the study. The study used two sets of questionnaires, one for relapsed alcoholics and another for rehabilitation counsellors. The questionnaires were piloted to validate and establish its reliability before the actual data collection. Data was collected through administration of two sets of questionnaires to the selected respondents. The data was then processed and analyzed using descriptive statistics including frequencies and percentages with the aid of Statistical Package for Social Sciences (SPSS) version 20.0 for windows. The key findings of this study indicated that the selected psychological factor that mostly contributed to relapse was dwelling on resentment that causes anger and frustration due to unresolved conflict. The social factor that mostly contributed to relapse was hanging around old drinking friends. The key conclusion was that in view of selected factors dwelling on resentment that causes anger and frustration due to unresolved conflict was the major contributor to relapse. The research findings may benefit NACADA, Ministry of Public Health, mental health agencies, psychologists, counsellors, Non-Governmental organizations, policy makers, researchers, drug abusers and alcoholics in Kenya to better understand factors contributing to relapse and devise ways and means of reducing relapse. Based on the major findings of this study, it is recommended that all stakeholders undertake measures aimed at providing a solution to continued relapse of alcoholics by improvement of rehabilitation and follow-up programmes.
Running head OPIOID CRISIS PUBLIC POLICY PAPER .docxglendar3
Running head: OPIOID CRISIS PUBLIC POLICY PAPER 1
OPIOID CRISIS PUBLIC POLICY PAPER 7
Opioid Crisis Public Policy Paper
Anniesha Overton
Strayer Umiversity
Summary of the policy
The opioid crisis has been a significant public health concern in the United States since the late 1990s. The inability to develop strategic legislation and regulation to control the use of opioid has been critical to the development of the opioid crisis. The opioid crisis involves the use of both prescription and non-prescription opioid drugs. According to the Center for Disease control and prevention, the rate of opioid addiction has been significantly increasing over the years. From 1999 to 2016, at least 350,000 individuals have died from related opioid addiction, which includes prescription and illicit opioids.
Unlicensed pharmacies and overdependence on these drugs in pain management have been major concepts, which have created a challenging setting where the abuse of prescription drugs can be controlled. The underlying basis of this problem is the current assumption in the United States that medical practitioners can cure almost everything. Even though it is essential to understand that prescription drugs are effective in pain management, the drugs are required to be offered based on the prescriptions issued (McDonald & Lambert, 2016). It is also noted that they should not be used regularly since they created a very detrimental habit to patient wellbeing because they have addictive properties, which make it dangerous when consumed in large portions.
Confronting opioid addiction requires significant efforts by all stakeholders in healthcare in ensuring that there is a common objective in providing that there is a crucial focus in integrating quality focus in preventing opioid addiction. Considering the fact that a prescribed drug mainly propagates opioid addiction. It is essential to ensure that they are issued through consideration of critical healthcare knowledge regarding the admissibility of opioid drugs (Bihel, 2016). Nurses have a significant role to play regarding the overall development of the opioid addiction crisis. Critical issues that have been identified in opioid drug abuse include improper use, lack of the required knowledge and related interpretation in the use of opioid prescribed drugs and decreased regulation and legislation from the government regarding the existing concern on the increasing addiction levels across the country.
Players
The increase in opioid crisis has had a direct and indirect influence on different stakeholders. Therefore developing a strong focus on essential strategies that can help limit the overall impact of the opioid crisis on the lives of an individual is critical. The national institute on drug abuse reported that in 2015, 33,091 deaths were reported be.
Mental Health in a Time of COVID-19: Preparing Faith and Community PartnersStephen Grcevich, MD
Key Ministry’s President & Founder, Dr. Steve Grcevich, co-presented with Kay Warren and former congressman Dr. Tim Murphy for this webinar from the U.S. Department of Health and Human Services. The aim was to help churches and religious leaders of all faiths respond to #mentalhealth support needs arising from #COVID19. Link to video: https://youtu.be/C8Zzgw4ihOg
This presentation about ‘Valuing Mental Health’ by Dr Geraldine Strathdee, National Clinical Director of Mental Health, NHS England, was delivered to the Foundation Trust Network on 16 October 2013.
Geraldine covers:
- Why does the NHS need to value mental health: The impact of mental health on outcomes and costs
- Parity between mental health and physical health: What would it mean in practice
- Fast tracking Value in the NHS: What role can the Foundation Trust Network have in delivering it?
Selected Psychological and Social Factors Contributing to Relapse among Relap...inventionjournals
Drug abuse is a major global problem and in Kenya there has been increasing drug and alcohol abuse with serious negative effects. Treatment and rehabilitation of alcoholism is expensive and non-conclusive due to consequent relapse. This study sought to find out selected psychological and social factors contributing to relapse among recovering alcoholics of Asumbi and Jorgs Ark rehabilitation centres in Kenya. This study adopted the descriptive survey design. The population of the study comprised of all relapsed alcoholics and rehabilitation counsellors in Asumbi and Jorgs Ark rehabilitation centres in Kenya. A sample of 67 recovering alcoholics and 13 counsellors was drawn from the two purposively selected rehabilitation centres and used in the study. The study used two sets of questionnaires, one for relapsed alcoholics and another for rehabilitation counsellors. The questionnaires were piloted to validate and establish its reliability before the actual data collection. Data was collected through administration of two sets of questionnaires to the selected respondents. The data was then processed and analyzed using descriptive statistics including frequencies and percentages with the aid of Statistical Package for Social Sciences (SPSS) version 20.0 for windows. The key findings of this study indicated that the selected psychological factor that mostly contributed to relapse was dwelling on resentment that causes anger and frustration due to unresolved conflict. The social factor that mostly contributed to relapse was hanging around old drinking friends. The key conclusion was that in view of selected factors dwelling on resentment that causes anger and frustration due to unresolved conflict was the major contributor to relapse. The research findings may benefit NACADA, Ministry of Public Health, mental health agencies, psychologists, counsellors, Non-Governmental organizations, policy makers, researchers, drug abusers and alcoholics in Kenya to better understand factors contributing to relapse and devise ways and means of reducing relapse. Based on the major findings of this study, it is recommended that all stakeholders undertake measures aimed at providing a solution to continued relapse of alcoholics by improvement of rehabilitation and follow-up programmes.
Running head OPIOID CRISIS PUBLIC POLICY PAPER .docxglendar3
Running head: OPIOID CRISIS PUBLIC POLICY PAPER 1
OPIOID CRISIS PUBLIC POLICY PAPER 7
Opioid Crisis Public Policy Paper
Anniesha Overton
Strayer Umiversity
Summary of the policy
The opioid crisis has been a significant public health concern in the United States since the late 1990s. The inability to develop strategic legislation and regulation to control the use of opioid has been critical to the development of the opioid crisis. The opioid crisis involves the use of both prescription and non-prescription opioid drugs. According to the Center for Disease control and prevention, the rate of opioid addiction has been significantly increasing over the years. From 1999 to 2016, at least 350,000 individuals have died from related opioid addiction, which includes prescription and illicit opioids.
Unlicensed pharmacies and overdependence on these drugs in pain management have been major concepts, which have created a challenging setting where the abuse of prescription drugs can be controlled. The underlying basis of this problem is the current assumption in the United States that medical practitioners can cure almost everything. Even though it is essential to understand that prescription drugs are effective in pain management, the drugs are required to be offered based on the prescriptions issued (McDonald & Lambert, 2016). It is also noted that they should not be used regularly since they created a very detrimental habit to patient wellbeing because they have addictive properties, which make it dangerous when consumed in large portions.
Confronting opioid addiction requires significant efforts by all stakeholders in healthcare in ensuring that there is a common objective in providing that there is a crucial focus in integrating quality focus in preventing opioid addiction. Considering the fact that a prescribed drug mainly propagates opioid addiction. It is essential to ensure that they are issued through consideration of critical healthcare knowledge regarding the admissibility of opioid drugs (Bihel, 2016). Nurses have a significant role to play regarding the overall development of the opioid addiction crisis. Critical issues that have been identified in opioid drug abuse include improper use, lack of the required knowledge and related interpretation in the use of opioid prescribed drugs and decreased regulation and legislation from the government regarding the existing concern on the increasing addiction levels across the country.
Players
The increase in opioid crisis has had a direct and indirect influence on different stakeholders. Therefore developing a strong focus on essential strategies that can help limit the overall impact of the opioid crisis on the lives of an individual is critical. The national institute on drug abuse reported that in 2015, 33,091 deaths were reported be.
Running head OPIOID CRISIS PUBLIC POLICY PAPER .docxtodd581
Running head: OPIOID CRISIS PUBLIC POLICY PAPER 1
OPIOID CRISIS PUBLIC POLICY PAPER 7
Opioid Crisis Public Policy Paper
Anniesha Overton
Strayer Umiversity
Summary of the policy
The opioid crisis has been a significant public health concern in the United States since the late 1990s. The inability to develop strategic legislation and regulation to control the use of opioid has been critical to the development of the opioid crisis. The opioid crisis involves the use of both prescription and non-prescription opioid drugs. According to the Center for Disease control and prevention, the rate of opioid addiction has been significantly increasing over the years. From 1999 to 2016, at least 350,000 individuals have died from related opioid addiction, which includes prescription and illicit opioids.
Unlicensed pharmacies and overdependence on these drugs in pain management have been major concepts, which have created a challenging setting where the abuse of prescription drugs can be controlled. The underlying basis of this problem is the current assumption in the United States that medical practitioners can cure almost everything. Even though it is essential to understand that prescription drugs are effective in pain management, the drugs are required to be offered based on the prescriptions issued (McDonald & Lambert, 2016). It is also noted that they should not be used regularly since they created a very detrimental habit to patient wellbeing because they have addictive properties, which make it dangerous when consumed in large portions.
Confronting opioid addiction requires significant efforts by all stakeholders in healthcare in ensuring that there is a common objective in providing that there is a crucial focus in integrating quality focus in preventing opioid addiction. Considering the fact that a prescribed drug mainly propagates opioid addiction. It is essential to ensure that they are issued through consideration of critical healthcare knowledge regarding the admissibility of opioid drugs (Bihel, 2016). Nurses have a significant role to play regarding the overall development of the opioid addiction crisis. Critical issues that have been identified in opioid drug abuse include improper use, lack of the required knowledge and related interpretation in the use of opioid prescribed drugs and decreased regulation and legislation from the government regarding the existing concern on the increasing addiction levels across the country.
Players
The increase in opioid crisis has had a direct and indirect influence on different stakeholders. Therefore developing a strong focus on essential strategies that can help limit the overall impact of the opioid crisis on the lives of an individual is critical. The national institute on drug abuse reported that in 2015, 33,091 deaths were reported be.
Global Medical Cures™ | Responding to America's Prescription Drug Abuse CrisisGlobal Medical Cures™
Global Medical Cures™ | Responding to America's Prescription Drug Abuse Crisis
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
By Beth Han, Wilson M. Compton, Carlos Blanco, and Lisa J. ColTawnaDelatorrejs
By Beth Han, Wilson M. Compton, Carlos Blanco, and Lisa J. Colpe
Prevalence, Treatment, And Unmet
Treatment Needs Of US Adults
With Mental Health And
Substance Use Disorders
ABSTRACT We examined prevalence, treatment patterns, trends, and
correlates of mental health and substance use treatments among adults
with co-occurring disorders. Our data were from the 325,800 adults who
participated in the National Survey on Drug Use and Health in the period
2008–14. Approximately 3.3 percent of the US adult population, or
7.7 million adults, had co-occurring disorders during the twelve months
before the survey interview. Among them, 52.5 percent received neither
mental health care nor substance use treatment in the prior year. The
9.1 percent who received both types of care tended to have more serious
psychiatric problems and physical comorbidities and to be involved with
the criminal justice system. Rates of receiving care only for mental
health, receiving treatment only for substance use, and receiving both
types of care among adults with co-occurring disorders remained
unchanged during the study period. Low perceived need and barriers to
care access for both disorders likely contribute to low treatment rates of
co-occurring disorders. Future studies are needed to improve treatment
rates among this population.
S
ubstance use disorders and mental
disorders influence each other, and
their combined presentation (here-
after referred to as co-occurring
disorders) results in more profound
functional impairment; worse treatment out-
comes; higher morbidity and mortality; in-
creased treatment costs; and higher risk for
homelessness, incarceration, and suicide than
each of the individual disorders.1–4 Current treat-
ment guidelines recommend that people with co-
occurring disorders receive treatments for both
disorders.5–7 However, little is known about the
twelve-month prevalence, service use patterns,
correlates of mental health and substance use
treatments, and unmet treatment need among
US adults with co-occurring disorders.
Recent studies indicate that the prevalence of
opioid use disorders and marijuana use among
adults has increased in recent years.8,9 It is im-
portant to determine whether these specific in-
creases led to greater overall prevalence of co-
occurring disorders, because adults with opioid
or marijuana use disorders are likely to have co-
occurring mental illness.8,9 Also, two recent stud-
ies reported that between 2005–07 and 2014 and
between 2004 and 2013, respectively, among the
overall US adult population, receipt of mental
health care increased (primarily as a result of
increasing use of psychiatric medications), and
receipt of substance use treatment remained
stable.10,11 However, it is unknown whether there
have been similar changes in patterns of care for
adults with co-occurring disorders.
The Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of 2008
required insurance coverage of mental he ...
Treatment Programs HARPS Program (Helping At-Risk Pregnant Women Succeed) - C...ErikaAGoyer
NATIONAL PERINATAL ASSOCIATION CONFERENCE 2014 - Treatment Programs HARPS Program (Helping At-Risk Pregnant Women Succeed)
- Chris Cooper, MSN, NNP-CB, APRN and Dawn Forbes, MD
Mental Health Policy - Substance Abuse and Co-Occurring ConditionsDr. James Swartz
These slides are from a mental health policy lecture that focuses on substance use disorders and their relationship to mental health issues. The latter half of the lecture is devoted to discussing key points in the history of drug policy in the US and is based on information from the related text: Substance Abuse in America: A Documentary and Reference Guide
Global Medical Cures™ | Get Smart about Drugs- How Teens Abuse Medicine Global Medical Cures™
Global Medical Cures™ | Get Smart about Drugs- How Teens Abuse Medicine
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
6. Recent Trends in the Use of Psychotropic Drugs
Mental Health Policy II
Mental Health Policy and Psychotropic Drugs
10/28/2015 Mental Health Policy II Jane Addams College of Social Work 6
7. Recent General Trends in the Use of Psychotropic Drugs
Mental Health Policy II
Mental Health Policy and Psychotropic Drugs
• Psychiatric medications are among the most widely prescribed and biggest-
selling class of drugs in the U.S. In 2010, Americans spent $16.1 billion on
antipsychotics to treat depression, bipolar disorder and schizophrenia, $11.6
billion on antidepressants and $7.2 billion on treatment for ADHD.
• Overall use of psychiatric medications among adults grew 22% from 2001 to
2010.
• HHS projects US prescription drug spending to increase from $234.1 billion
in 2008 to $457.8 billion in 2019, almost doubling over the 11-year period.
• From 1995 to 2002, pharmaceutical manufacturers were the nation’s most
profitable industry (profits as a percent of revenues). They ranked 3rd in
profitability in 2003 and 2004, 5th in 2005, 2nd in 2006, and 3rd in 2007 and
2008, with profits of 19.3% in 2008.
10/28/2015 Mental Health Policy II Jane Addams College of Social Work 7
8. Drug-Specific Trends and the Use of Psychotropic Drugs
Mental Health Policy II
Mental Health Policy and Psychotropic Drugs
• Use of antipsychotics such as J&J's Risperdal and Bristol-Myers
Squibb Co.'s Abilify grew substantially in the past decade in both kids
and adults (only a minority of patients on these medicines is getting
their blood sugar checked annually).
• (If you have such clients on your caseload and can advise on
medical issues, you need to check if they are having regular blood
tests for blood sugars, triglycerides, etc.).
• There was a pronounced increase in medications to treat ADHD
among young and middle-aged adults, particularly in women. Use of
ADHD drugs such as Concerta and Vyvanse tripled among those
aged 20 to 44 between 2001 and 2010, and it doubled over that time
among women in the 45-to-65 group. Use in the over-65 population
also increased about 30% for men and women between 2001 and
2010.10/28/2015 Mental Health Policy II Jane Addams College of Social Work 8
9. Drug-Specific Trends and the Use of Psychotropic Drugs
Mental Health Policy II
Mental Health Policy and Psychotropic Drugs
• Reasons for the rise (in ADHD treatment) could include people who
were diagnosed and treated as children who continue to suffer from
symptoms, adults who were never treated previously but suspect
they have symptoms, and increased awareness from marketing
pushes by companies approved to market these drugs to adults.
• While the use of most psychiatric drugs grew strongly, there were
declines in antidepressant use in children and anti-anxiety drug use
in the elderly, likely in part because of concern over potential side
effects.
10/28/2015 Mental Health Policy II Jane Addams College of Social Work 9
10. Decline in Antidepressant Use among Children
Mental Health Policy II
Mental Health Policy and Psychotropic Drugs
• In 2004 the Food and Drug Administration required a "black box"
warning—its most serious—about the possible increase in suicidal
thoughts in children and teens taking antidepressants, and in 2005 it
warned about the increased risk of death with certain antipsychotics
in elderly patients with dementia.
• The evidence suggests that such warnings have impact:
Antidepressant use in children peaked in 2004 and dropped last year
to 2001 levels, around 2.5% for girls and just over 2% for boys.
10/28/2015 Mental Health Policy II Jane Addams College of Social Work 10
11. Decline in Antianxiety (Anxiolytic) Use among the Elderly
Mental Health Policy II
Mental Health Policy and Psychotropic Drugs
• There has been a 44% decrease in use of anti-anxiety drugs in the
elderly representing a major shift in usage patterns in the last
decade.
• The trend is likely in part related to the fact that these drugs were not
originally covered by Medicare part D, which offers the drug
coverage for seniors and came into effect in 2006. However, this ban
was lifted in 2008 meaning that more recent data might show an
increase in use.
10/28/2015 Mental Health Policy II Jane Addams College of Social Work 11
12. We spend much more on drugs than on “talk therapy”.
• Prescription drugs are “free” inputs to the specialty mental health
delivery system, and carve-out vendors have a strong economic
incentive to substitute drug treatments for other mental health
services when possible.
• They (MBHC) do this by making it easier for patients to obtain
referrals for medication management and psychopharmacology
than referrals for psychotherapy.
• Private insurance plans frequently only 50 percent per
psychotherapy visit compared with requiring only $10 or $20
copayments for drugs.
Mental Health Policy II
Mental Health Policy and Psychotropic Drugs
10/28/2015 Mental Health Policy II Jane Addams College of Social Work 12
13. • Medicare continues to require 50 percent coinsurance for
psychotherapy and other outpatient mental health services that do
not involve medication management, in contrast to most private
insurance plans, which impose the same cost sharing for outpatient
mental health services as for other medical services.
Mental Health Policy II
Mental Health Policy and Psychotropic Drugs
We spend much more on drugs than on “talk therapy”.
10/28/2015 Mental Health Policy II Jane Addams College of Social Work 13
14. Drugs are not risk free
• A 2009 study found that the cost of drug-related morbidity, including
poor adherence (not taking medication as prescribed by doctors)
and suboptimal prescribing, drug administration, and diagnosis, is
estimated to be as much as $289 billion annually, about 13% of
total health care expenditures.
• The barriers to medication adherence are many: cost, side effects,
the difficulty of managing multiple prescriptions, patients’
understanding of their disease, forgetfulness, cultural and belief
systems, imperfect drug regimens, patients’ ability to navigate the
health care system, cognitive impairments, and a reduced sense of
urgency due to asymptomatic conditions.
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15. Selected PPACA Changes
Affecting the Pharmaceutical Industry
• Imposes an annual fee on certain manufacturers and importers of
brand name drugs (including biological products but excluding
orphan drugs) whose branded sales exceed $5 million: an annual
fee of $2.5 billion beginning in 2011, rising to $4.1 billion in 2018
and dropping to $2.8 billion in 2019 and thereafter, allocated across
the industry according to the proportion of sales for government
programs.
• Changes certain drug labeling requirements and requires the HHS
Secretary to determine whether adding certain information to a
prescription drug’s labeling and advertising would improve health
care decision-making.
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16. • Both prescription use and shifts to higher-priced drugs are influenced
by advertising, which is usually conducted for brand name rather than
generic drugs. Manufacturer spending on advertising was over 1.5
times as much in 2009 ($10.9 billion) as in 1999 ($6.6 billion).
• The share directed toward consumers in 2009 (through advertising on
television, radio, magazines, newspapers, and outdoor advertising),
was over twice the amount spent in 1999 ($4.3 billion compared to
$1.8 billion).
• The share directed toward physicians (through the sales activities of
pharmaceutical representatives and through professional journals) in
2009 ($6.6 billion) was almost 1.5 times the amount in 1999 ($4.8
billion).
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The Role of Advertising
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17. Mental Health Policy II
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18. • These forces have translated into a greater willingness by
physicians to make psychotherapeutic drugs a central feature of
treating mental illness.
• In 1977, about 63 percent of visits for the care of mental disorders
in the United States included the use of psychotropic drugs. By 1996
psychotropic drugs were prescribed in about 77 percent of such
visits.
• A significant portion of these visits were made to primary care
physicians, who may be more likely to use these medications
because of the ease of dosing and the greater safety of the new
psychotropic drugs, particularly the SSRIs.
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Direct to Consumer Advertising
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19. • Reflecting how we pay for health care generally, paying for
prescription drugs is a mix of:
• Employer-sponsored insurance
• Self-pay
• Medicaid
• Medicare (Part-D)
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How do Americans Pay for Prescription Drugs?
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20. • The Medicaid Drug Rebate Program is a partnership between CMS,
State Medicaid Agencies, and participating drug manufacturers that
helps to offset the Federal and State costs of most outpatient
prescription drugs dispensed to Medicaid patients.
• All fifty States and the District of Columbia cover prescription drugs
under the Medicaid Drug Rebate Program.
• The program requires a drug manufacturer to enter into a national
rebate agreement with the Department of Health and Human Services
in exchange for State Medicaid coverage of most of the manufacturer’s
drugs. Manufacturers are responsible for paying a rebate on those
drugs each time that they are dispensed to Medicaid patients.
• Rebates are paid by drug manufacturers on a quarterly basis and are
shared between the States and the Federal government to offset the
overall cost of prescription drugs under the Medicaid Program.
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21. • Prior to January 1, 2006, the traditional Medicare program (the
federal health program for the elderly and disabled) did not provide
coverage for outpatient prescription drugs.
• As a result, about one-quarter (27%) of seniors age 65 and older,
and one-third of poor (34%) and near-poor (33%) seniors, had no
drug coverage in 2003.
• The Medicare Prescription Drug, Improvement, and Modernization
Act of 2003 established a voluntary Medicare outpatient prescription
drug benefit (known as Part D), effective January 1, 2006, under
which the 47 million eligible Medicare beneficiaries can enroll in
private drug plans. These plans vary in benefit design, covered
drugs, and utilization management strategies.
Medicare
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22. • Reliance on stand-alone drug plans in the context of the Part D
benefit creates strong incentives for prescription drug plans (PDPs)
to compete in order to avoid expensive enrollees (adverse
selection; e.g., It is possible in theory to offer a plan with a
formulary that does not cover the drugs most frequently used in the
modern treatment of depression.)
• However, for certain therapeutic categories—antidepressants,
antipsychotics, anticonvulsants, anticancer drugs, immuno-
suppressants, and HIV/AIDS drugs—plans are required to list "all or
substantially all" of the drugs in the category.
• Medicare is prohibited by law from directly negotiating drug prices or
rebates with manufacturers to control costs. In the 110th Congress,
the 2008 presidential campaign, and the 111th Congress, proposals
to allow or require Medicare to negotiate drug prices with drug
makers have been considered but not enacted.
Medicare Modernization Act (MMA)
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23. • Department of Health and Human Services data show that as of
February 16, 2010, approximately 41.8 million (90%) of the 46.5
eligible Medicare beneficiaries had drug coverage.
• About 4.7 million Medicare beneficiaries (10%) had no drug
coverage.
Medicare
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24. Medicare Part D and Antidepressant prescriptions
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25. Medicare Part D and Antipsychotic prescriptions
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26. Selected ACA Changes Affecting
Prescription Drug Coverage for Medicaid and Medicare
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• ACA provides that prescription drugs is one of the “essential health
benefits” that must be included in health plans in the Exchanges and
in the benchmark benefit package or benchmark-equivalent for newly
eligible adults under Medicaid.
• Provided for a $250 rebate to Medicare Part D beneficiaries with out-
of-pocket spending in the Medicare Part D coverage gap in 2010, a
50% discount for brand name drugs for beneficiaries in the coverage
gap in 2011, a phasing-in of coverage in the gap for generic and brand
name drugs that will reduce the beneficiary coinsurance rate from
100% in 2010 to 25% in 2020, and a reduction between 2014 and
2019 in the threshold that qualifies enrollees for catastrophic
coverage.
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27. • Lack of insurance coverage for prescription drugs can have adverse
effects. An April 2009 survey found that uninsured nonelderly adults
(ages 18-64) are more than twice as likely as insured nonelderly
adults to say that they or a family member did not fill a prescription
(45% vs. 22%) or cut pills or skipped doses of medicine (38%
vs.18%) in the past year because of the cost.
• Among nonelderly adults in 2008, 27% of the uninsured could not
afford a prescription drug in the past 12 months, compared to 13%
of those with Medicaid or other public coverage, and 5% of those
with employer or other private coverage.
• A September 2009 survey found that during the past 12 months,
26% of American adults did not fill a prescription, and 21% cut pills
in half or skipped doses of medicine, because of cost.
How does insurance coverage (or lack thereof) affect
prescription drug use?
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28. Incentive PDLs cover about 67 percent of privately insured people.
PDLs (previously called formularies) are used to control rising
prescription drug costs. A popular form of an incentive PDL is the three-
tiered (or sometimes four-tiered) PDL, under which insured consumers
are offered three levels of copayment for prescription drugs.
• PBMs create competition among manufacturers within a therapeutic
class (such as the SSRIs) for the placement of their products in the
second rather than the third tier. This permits PBMs to bargain for
price concessions from manufacturers.
• Other PBM incentives and rules: prior authorization, appeals
process for non-included drugs (how onerous), and generic
substitution requirements.
Pharmacy Benefit Managers and Preferred Drug Lists
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29. • In 2009, over three-quarters (78%) of workers with employer-
sponsored coverage were in plans with 3 or more 4 tiers of cost
sharing for prescription drugs, almost 3 times the proportion in 2000
(27%).
• Worker copayments have increased from 2000-2009: 25% for
generic drugs, 80% for preferred drugs, 59% for non-preferred
drugs, and 44% for fourth-tier drugs (data from 2004-2009)
• The average copayment amounts in 2009 were $10 for generics,
$27 for preferred drugs, $46 for non-preferred drugs, and $85 for
fourth-tier drugs.
• Twelve percent of covered workers had a separate annual drug
deductible which averaged $108.
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30. Clinical Antipsychotic Trials of Intervention Effectiveness
(“CATIE Study”)
• CATIE was designed to determine comparative effectiveness of
newer atypical antipsychotics vs an older conventional neuroleptic.
• One primary outcome measure was time to discontinuation of
treatment for any reason; another was the length of time the patient
and treating clinician continued assigned antipsychotic before
completion of trial or treatment discontinuation.
• Note: In approving a new drug, the FDA does not require that you
show it is more effective or even equivalent to an existing drug, just
that it is better than a placebo…
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31. “CATIE Study”
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32. “CATIE Study”
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33. “CATIE Study”
• Only a minority of patients in each group took their assigned drug
for the duration of phase 1 (rates of discontinuation ranged from 64
to 82 percent). This outcome indicates that antipsychotic drugs,
though effective, have substantial limitations in their effectiveness in
patients with chronic schizophrenia.
• Within this limited range of effectiveness, the olanzapine (Zyprexa)
group had the lowest rate of discontinuation, which might lead one
to consider olanzapine the most effective of the medications studied.
• However, olanzapine was associated with greater weight gain and
increases in glycosylated hemoglobin, cholesterol, and triglycerides
(metabolic syndrome).
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34. Criticisms of CATIE (Naber and Lambert)
• Treatment resistant population – might not be best to test
effectiveness of drugs.
• Improved subjective well-being of SGA’s not well assessed.
• Lower risk of tardive dyskinesia not well assessed.
• Did trial encourage patients to switch drugs prematurely?
• Correct dosages given/used?
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35. “Sequenced Treatment Alternatives to Relieve Depression”
• The overall goal of the STAR*D trial was to assess the effectiveness
of depression treatments in patients diagnosed with major
depressive disorder, in both primary and specialty care settings. It
was the largest and longest study ever conducted to evaluate
depression treatment.
• Each of the four levels of the study tested a different medication or
medication combination. The primary goal of each level was to
determine if the treatment used during that level could adequately
treat participants’ major depressive disorder (MDD). Those who did
not become symptom-free could proceed to the next level of
treatment.
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36. “Sequenced Treatment Alternatives to Relieve Depression”
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37. “Sequenced Treatment Alternatives to Relieve Depression”
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38. “Sequenced Treatment Alternatives to Relieve Depression”
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39. “Sequenced Treatment Alternatives to Relieve Depression”
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40. “Sequenced Treatment Alternatives to Relieve Depression”
• The design of the STAR*D study reflects what is done in clinical
practice because it allowed study participants to choose certain
treatment strategies most acceptable to them and limited the
randomization of each participant only to his/her range of acceptable
treatment strategies. No prior studies have evaluated the different
treatment strategies in broadly defined participant groups treated in
diverse care settings.
• Over a seven-year period, the study enrolled 4,041 outpatients,
ages 18-75 years, from 41 clinical sites around the country, which
included both specialty care settings and primary medical care
settings. Participants represented a broad range of ethnic and
socioeconomic groups. All participants were diagnosed with MDD
and were already seeking care at one of these sites.
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41. “Sequenced Treatment Alternatives to Relieve Depression”
• Of the initial 4,041 participants, 1,165 were excluded because they
either did not meet the study requirements of having “at least
moderate” depression (based on a rating scale used in the study) or
they chose not to participate.
• 2,876 “evaluable” people were included in level 1 results.
• Level 2 results include 1,439 people who did not become
symptom-free in level 1 and chose to continue.
• Level 3 results include 377 people, and
• Level 4 results include 142 people.
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42. “Sequenced Treatment Alternatives to Relieve Depression”
• In level 1, about one-third of the participants reached remission and
about 10-15 percent more responded, but did not reach remission.
Still, these are considered good results because study participants
had high rates of chronic or recurrent depression and other
psychiatric medical problems.
• It took an average of six weeks of treatment for participants to
improve enough to reach a response and nearly seven weeks of
treatment for them to achieve a remission of depressive symptoms.
In addition, participants visited their care providers an average of
five to six times. Participants who achieved remission stayed on the
treatment for an average of 12 weeks before going on to a 12-month
follow-up period.
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43. “Sequenced Treatment Alternatives to Relieve Depression”
• In the level 2 switch group, about 25 percent of participants became
symptom-free. All three of the switch medications performed about
the same and were equally safe and well-tolerated. In the add-on
group, about one-third of participants became symptom-free.
• Patients who received cognitive psychotherapy (either alone or in
combination with citalopram) had similar response and remission
rates compared with those assigned to medication-only strategies.
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44. “Sequenced Treatment Alternatives to Relieve Depression”
• In the level 3 switch group, 12 to 20 percent of participants became
symptom-free, and the two medications used fared about equally
well, suggesting no clear advantage for either medication in terms of
remission rates or side effects.
• In the add-on group, about 20 percent of participants became
symptom-free, with little difference between the two treatments.
However, the T3 treatment was associated with fewer troublesome
side effects than lithium.
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45. “Sequenced Treatment Alternatives to Relieve Depression”
• In level 4, seven to 10 percent of participants became symptom-free,
with no statistically significant differences between the medications
in terms of remission, response rates or side effect burden.
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46. “Sequenced Treatment Alternatives to Relieve Depression”
Conclusions:
• About half of participants in the STAR*D study became symptom-
free after two treatment levels.
• Over the course of all four treatment levels, almost 70 percent of
those who did not withdraw from the study became symptom-free.
• The rate at which participants withdrew from the trial was meaningful
and rose with each level—21 percent withdrew after level 1, 30
percent withdrew after level 2 and 42 percent withdrew after level 3.
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47. “Sequenced Treatment Alternatives to Relieve Depression”
Conclusions:
• Patients with difficult-to-treat depression can get well after trying
several treatment strategies, but the odds of beating the depression
diminish with every additional treatment strategy needed.
• Those who become symptom-free have a better chance of
remaining well than those who experience only symptom
improvement. And those who need to undergo several treatment
steps before they become symptom-free are more likely to relapse
during the follow-up period.
• Those who required more treatment levels tended to have more
severe depressive symptoms and more co-existing psychiatric and
general medical problems at the beginning of the study than those
who became well after just one treatment level.
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