The attention deficit hyperactivity disorder (ADHD) is one of the most common neuropsychiatric disorders affecting 3% to 6% of children1 and almost 5% of adults2. Across population, Prevalence rates vary from 2.2% to 16.1% in clinical versus community cohorts. Its frequency has been reported as high as 34% ADHD in clinical setting in Pakistan3. There was a myth for many years that the disorder remits during adolescence, but it is now well established that it can be experienced by a patient in adulthood as well. There is a bidirectional overlap between ADHD and drug abuse and dependence4 and affect 27% of adult population5. The co-occurrence of ADHD and addiction is very common. Previous studies have shown that adults with ADHD are a risk for substance use disorder (SUD) and almost 52% of adult had a lifetime history of SUD2, 3. The co-morbidity between ADHD and SU shows relativity and relevant to research and clinical development in psychiatry, pediatrics and psychology5. The diagnosing and specific risk factor associated with SU within ADHD may lead to a better targeted pharmacotherapy and psychotherapeutic treatments for both the disorders upon expression at early stage of their lives7, 8. Higher rates of ADHD have been reported in patients having SUD relative to controls9, 10. 15% to 25% adults with SUD history have been estimated to have ADHD9. Studies have conducted in juvenile adolescents for assessing ADHD and other disorders in substance abusing groups had overrepresentation of ADHD10, 11. ADHD predominates from 15% to 25% in individuals with SUD12, 13. Two studies showed that the 24% of 201 inpatients14 and 10% cocaine abusers for drug detoxification treatment had ADHD15. The treatment of ADHD is usually done with stimulants like methylphenidate, amphetamine etc., with the behavioral therapy of the patient and family counseling.
Crimson Publishers-Alcohol Abstinence and Relapse in ALD Patients, Predicting...CrimsonGastroenterology
Alcohol Abstinence and Relapse in ALD Patients, Predicting the Unpredictable by Neeraj Nagaich in Gastroenterology Medicine & Research: Liver Disease
Objectives: Alcoholism is a chronic relapsing disorder. Alcoholism is common, and continues to be the source of great cost to afflicted individuals, their families and the community at large. Alcohol dependence is characterized by a prolonged course of alcohol-related problems and a persistent vulnerability to relapse. Even though there is an improvement in multiple domains of life after alcohol treatment, the risk of relapse remains high following treatment. This prospective and retrospective study of 451 patients with alcohol use disorders was done with an intent to assess various factors affecting remission and relapse and improve outcome for individuals with alcohol dependence. Demographic variables, clinical parameters and certain psychosocial factors were evaluated. Early identification of risk factors may help us in defining a more rigorous follow up protocol in these sub group of patients.
Method: Patients with ethanol related liver disease and alcohol dependence were enrolled after their presentation in gastroenterology clinic and followed thereafter at 1, 3, 6, and 12 months. Initial assessments included USG abdomen LFT RFT, UGI Endoscopy and other relevant investigations. Semi structured clinical interviews, the Symptom Checklist 90-Revised (SCL90-R), Addiction Severity Index (ASI), the Beck Depression Inventory (BDI) were recorded. High-Risk Alcoholism Relapse Scale based score was calculated.2Patients were reassessed at six and twelve months to determine treatment outcome (abstinence status and duration of continuous abstinence). Data were coded, validated and analyzed using descriptive statistics.
Results: A majority of the sample 70 percent (n=315) had significant psychiatric symptoms at intake: 22 percent (N=70) presented with depressive symptoms, 17 percent (N=15) with anxiety symptoms, and 41 percent (N=192) with combined depressive and anxiety symptoms. Forty percent of patients who presented with combined depression and anxiety symptoms were abstinent at six months. These patients had worse prognosis than less symptomatic cohort at intake, including those who presented with depression symptoms alone; in the latter group, 60 percent were abstinent at six months. Key predictor variables included days in treatment, primary drug of abuse, frequency of drug use, and report of concurrent depression or anxiety symptoms at intake.
Journal Club presentation on Outbreak Investigation Study Kunal Modak
The following presentation is based on: Concurrent Multiple Outbreaks of Varicella, Rubeola,
German Measles Outbreak in Unvaccinated Children of
Co-Educational Mount Carmel Senior Secondary School,
Thakurdwara Palampur of Northern Himachal, India
The efficacy of supplementation with the novel medical food, Souvenaid, in pa...Nutricia
The efficacy of supplementation with the novel medical food, Souvenaid, in patients with Alzheimer’s disease: A systematic review and meta-analysis of randomized clinical trials
Suicides and suicide attempts during long term treatment with antidepressants...Daryl Chow
Abstract
Background: It is unclear whether antidepressants can pre- vent suicides or suicide attempts, particularly during long- term use. Methods: We carried out a comprehensive review of long-term studies of antidepressants (relapse prevention). Sources were obtained from 5 review articles and by search- es of MEDLINE, PubMed Central and a hand search of bibli- ographies. We meta-analyzed placebo-controlled antide- pressant RCTs of at least 3 months’ duration and calculated suicide and suicide attempt incidence rates, incidence rate ratios and Peto odds ratios (ORs). Results: Out of 807 studies screened 29 were included, covering 6,934 patients (5,529 patient-years). In total, 1.45 suicides and 2.76 suicide at- tempts per 1,000 patient-years were reported. Seven out of 8 suicides and 13 out of 14 suicide attempts occurred in an- tidepressant arms, resulting in incidence rate ratios of 5.03 (0.78–114.1; p = 0.102) for suicides and of 9.02 (1.58–193.6; p = 0.007) for suicide attempts. Peto ORs were 2.6 (0.6–11.2; nonsignificant) and 3.4 (1.1–11.0; p = 0.04), respectively. Dropouts due to unknown reasons were similar in the anti-
depressant and placebo arms (9.6 vs. 9.9%). The majority of suicides and suicide attempts originated from 1 study, ac- counting for a fifth of all patient-years in this meta-analysis. Leaving out this study resulted in a nonsignificant incidence rate ratio for suicide attempts of 3.83 (0.53–91.01). Conclu- sions: Therapists should be aware of the lack of proof from RCTs that antidepressants prevent suicides and suicide at- tempts. We cannot conclude with certainty whether antide- pressants increase the risk for suicide or suicide attempts. Researchers must report all suicides and suicide attempts in RCTs.
Crimson Publishers-Alcohol Abstinence and Relapse in ALD Patients, Predicting...CrimsonGastroenterology
Alcohol Abstinence and Relapse in ALD Patients, Predicting the Unpredictable by Neeraj Nagaich in Gastroenterology Medicine & Research: Liver Disease
Objectives: Alcoholism is a chronic relapsing disorder. Alcoholism is common, and continues to be the source of great cost to afflicted individuals, their families and the community at large. Alcohol dependence is characterized by a prolonged course of alcohol-related problems and a persistent vulnerability to relapse. Even though there is an improvement in multiple domains of life after alcohol treatment, the risk of relapse remains high following treatment. This prospective and retrospective study of 451 patients with alcohol use disorders was done with an intent to assess various factors affecting remission and relapse and improve outcome for individuals with alcohol dependence. Demographic variables, clinical parameters and certain psychosocial factors were evaluated. Early identification of risk factors may help us in defining a more rigorous follow up protocol in these sub group of patients.
Method: Patients with ethanol related liver disease and alcohol dependence were enrolled after their presentation in gastroenterology clinic and followed thereafter at 1, 3, 6, and 12 months. Initial assessments included USG abdomen LFT RFT, UGI Endoscopy and other relevant investigations. Semi structured clinical interviews, the Symptom Checklist 90-Revised (SCL90-R), Addiction Severity Index (ASI), the Beck Depression Inventory (BDI) were recorded. High-Risk Alcoholism Relapse Scale based score was calculated.2Patients were reassessed at six and twelve months to determine treatment outcome (abstinence status and duration of continuous abstinence). Data were coded, validated and analyzed using descriptive statistics.
Results: A majority of the sample 70 percent (n=315) had significant psychiatric symptoms at intake: 22 percent (N=70) presented with depressive symptoms, 17 percent (N=15) with anxiety symptoms, and 41 percent (N=192) with combined depressive and anxiety symptoms. Forty percent of patients who presented with combined depression and anxiety symptoms were abstinent at six months. These patients had worse prognosis than less symptomatic cohort at intake, including those who presented with depression symptoms alone; in the latter group, 60 percent were abstinent at six months. Key predictor variables included days in treatment, primary drug of abuse, frequency of drug use, and report of concurrent depression or anxiety symptoms at intake.
Journal Club presentation on Outbreak Investigation Study Kunal Modak
The following presentation is based on: Concurrent Multiple Outbreaks of Varicella, Rubeola,
German Measles Outbreak in Unvaccinated Children of
Co-Educational Mount Carmel Senior Secondary School,
Thakurdwara Palampur of Northern Himachal, India
The efficacy of supplementation with the novel medical food, Souvenaid, in pa...Nutricia
The efficacy of supplementation with the novel medical food, Souvenaid, in patients with Alzheimer’s disease: A systematic review and meta-analysis of randomized clinical trials
Suicides and suicide attempts during long term treatment with antidepressants...Daryl Chow
Abstract
Background: It is unclear whether antidepressants can pre- vent suicides or suicide attempts, particularly during long- term use. Methods: We carried out a comprehensive review of long-term studies of antidepressants (relapse prevention). Sources were obtained from 5 review articles and by search- es of MEDLINE, PubMed Central and a hand search of bibli- ographies. We meta-analyzed placebo-controlled antide- pressant RCTs of at least 3 months’ duration and calculated suicide and suicide attempt incidence rates, incidence rate ratios and Peto odds ratios (ORs). Results: Out of 807 studies screened 29 were included, covering 6,934 patients (5,529 patient-years). In total, 1.45 suicides and 2.76 suicide at- tempts per 1,000 patient-years were reported. Seven out of 8 suicides and 13 out of 14 suicide attempts occurred in an- tidepressant arms, resulting in incidence rate ratios of 5.03 (0.78–114.1; p = 0.102) for suicides and of 9.02 (1.58–193.6; p = 0.007) for suicide attempts. Peto ORs were 2.6 (0.6–11.2; nonsignificant) and 3.4 (1.1–11.0; p = 0.04), respectively. Dropouts due to unknown reasons were similar in the anti-
depressant and placebo arms (9.6 vs. 9.9%). The majority of suicides and suicide attempts originated from 1 study, ac- counting for a fifth of all patient-years in this meta-analysis. Leaving out this study resulted in a nonsignificant incidence rate ratio for suicide attempts of 3.83 (0.53–91.01). Conclu- sions: Therapists should be aware of the lack of proof from RCTs that antidepressants prevent suicides and suicide at- tempts. We cannot conclude with certainty whether antide- pressants increase the risk for suicide or suicide attempts. Researchers must report all suicides and suicide attempts in RCTs.
Abstract—Prevalence of degenerative dementias and dementias associated with cerebrovascular disease is increasing with the time. Dementia is one of the most significant public health problems. Demographic data, medical history, general biochemical data and serum total homocysteine (tHcy) levels was used in this study to examine the differences between dementia and normal control groups. A cross-sectional study was conducted on 236 individuals who were above the age of 65 years. These participants went through the Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), demographic characteristics, biochemical data and tHcy level. Each of the above mentioned factors was assessed. There were significant differences in the history of hypertension, diabetes mellitus, marital status, alcohol consumption (AC), BMI value, and triglyceride (TG) and serum tHcy levels. The logistic regression analysis showed significant differences in marital status, AC and tHcy. So it can be concluded that elevated serum tHcy, no AC and no partner are associated with the risk of dementia in elders of Southern Taiwan. It needs further researches to identify and reduce the risk of dementia.
Not Only Depressed. A Pilot Study on Quality of Life of Women with Urinary In...inventionjournals
The urinary incontinence syndrome is a common disease, whose etiology is still unclear. The survey of psychological variables generally highlights a poverty quality of life, depressive features, and difficulties in sexual life. The goal of this pilot study – sample of 97 women with urinary incontinence - is to give these patients a more complex picture, evaluating aspects of pain (depression and other mental illness indicators, alexithymia, sex life), but also investigating if there are good aspects in their life which act as counterweight. It 's so emerged as the patients lead a healthy life and have generally good relations, it is a good couple relationship, both good relationships with parents and have different interests in life. In particular, the women with self-interest are not depressed and have no traits of alexithymia. It is so important in clinical practice to not take for granted the presence of a psychological suffering and rather encourage patients to cultivate self-interests.
A Study of Clinical and Socio-Demographic Profile of Patients with Dissociati...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Journal Club: Genetic Predisposition to Schizophrenia Associated with Increas...Ashutosh Ratnam
Here's a Journal Club Presentation I made on the article 'Genetic Predisposition to Schizophrenia Associated with Increased Use of Cannabis' which appeared in the Nov 14 issue of Molecular Psychiatry. It explored the possibility of whether people with high genetic risk scores for Schizophrenia somehow had a propensity for cannabis, establishing a biological basis for 'reverse causality'.
The utility of psychotropic drugs on patients with fetal alcohol spectrum dis...BARRY STANLEY 2 fasd
ABSTRACT
BACKGROUND: Treatment of the complications arising from Prenatal Alcohol Exposure (PAE) has largely been focused on psychosocial and environmental approaches. Research on the
use of medications, especially psychotropic medications, has lagged behind.
OBJECTIVES: This systematic review sought to investigate psychotropic medication related findings and outcomes in those diagnosed with Fetal Alcohol Spectrum Disorder (FASD).
METHODS: Comprehensive searches were conducted in seven major databases (Medline/
PubMed, Scopus, Web of Knowledge, Embase, PsycINFO, Cochrane Library, and
PsycARTICLES) up to February 2017. Key search terms with synonyms were mapped on these databases. There were no timeline restrictions and no grey literature searches. Two reviewers
independently assessed 25 studies that met the inclusion criteria. Most studies were reviews of treatment and retrospective case series.
RESULTS: Two crossover randomized trials were reported, and the findings were not amenable to meta-analysis. Several conditions (depression, agitation, seizures, and outburst) combined with the most frequent presentation, ADHD, to represent the rationale for prescribing psychotropic medications. Second-generation antipsychotics were found to improve social skills, but the paucity of data limited the extent of clinical guidance necessary for the field.
CONCLUSIONS: The systematic review showed that there are some clinical evidence displaying
the validity of psychopharmacological interventions in people with FASD, which varies across the spectrum of disease severity, age, and gender. There is a need for more clinical evidencebased studies in addition to clinical expert opinions to substantiate an optimal ground for individualized management of FASD.
The study protocol for this review was registered in PROSPERO with registration number
CRD42016045703
Introduction: Migraine is a chronic disease evolving through recurrent attack; it constitutes a frequent reason of consultation in
neurology. It has a signifi cant impact that can affect all spheres of life. Thus, it is one of the most disabling primary headaches.
Objective: To evaluate the impact of migraine in population of Brazzaville
The Epidemiology of Deliberate Self-Poisoning Presenting at a Tertiary Care ...Faizan Qaisar
Faizan Qaisar1*, Mohsin Shafi1, Ayesha Majeed1, DileepKumar1, Awais Memon1and Umer Memon1
1Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro,
Sindh, Pakistan
Comparison of Quality of Life of Care Giver of Chronic Psychiatric and Chronic Medical Patients-Chronically ill patients need assistance or supervision in their daily activities often placing a major burden on caregivers, placing them at a great risk of mental and physical problems and an impaired quality of life. An observational analytical study conducted in year 2013 in SMS Medical College, Jaipur aiming to compare the quality of life (QOL) of caregivers of patients with chronic psychiatric disorders with that of chronic medical illnesses. WHO-QOL BREF was used to assess quality of life in both the groups. It was observed that quality of life of caregivers of chronic psychiatric illness were significantly (p<0.05)poorer than quality of life of caregivers of chronic medical illness and that too more in Psychosocial domain followed by social, environmental and physical domain.
Abstract—Prevalence of degenerative dementias and dementias associated with cerebrovascular disease is increasing with the time. Dementia is one of the most significant public health problems. Demographic data, medical history, general biochemical data and serum total homocysteine (tHcy) levels was used in this study to examine the differences between dementia and normal control groups. A cross-sectional study was conducted on 236 individuals who were above the age of 65 years. These participants went through the Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), demographic characteristics, biochemical data and tHcy level. Each of the above mentioned factors was assessed. There were significant differences in the history of hypertension, diabetes mellitus, marital status, alcohol consumption (AC), BMI value, and triglyceride (TG) and serum tHcy levels. The logistic regression analysis showed significant differences in marital status, AC and tHcy. So it can be concluded that elevated serum tHcy, no AC and no partner are associated with the risk of dementia in elders of Southern Taiwan. It needs further researches to identify and reduce the risk of dementia.
Not Only Depressed. A Pilot Study on Quality of Life of Women with Urinary In...inventionjournals
The urinary incontinence syndrome is a common disease, whose etiology is still unclear. The survey of psychological variables generally highlights a poverty quality of life, depressive features, and difficulties in sexual life. The goal of this pilot study – sample of 97 women with urinary incontinence - is to give these patients a more complex picture, evaluating aspects of pain (depression and other mental illness indicators, alexithymia, sex life), but also investigating if there are good aspects in their life which act as counterweight. It 's so emerged as the patients lead a healthy life and have generally good relations, it is a good couple relationship, both good relationships with parents and have different interests in life. In particular, the women with self-interest are not depressed and have no traits of alexithymia. It is so important in clinical practice to not take for granted the presence of a psychological suffering and rather encourage patients to cultivate self-interests.
A Study of Clinical and Socio-Demographic Profile of Patients with Dissociati...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Journal Club: Genetic Predisposition to Schizophrenia Associated with Increas...Ashutosh Ratnam
Here's a Journal Club Presentation I made on the article 'Genetic Predisposition to Schizophrenia Associated with Increased Use of Cannabis' which appeared in the Nov 14 issue of Molecular Psychiatry. It explored the possibility of whether people with high genetic risk scores for Schizophrenia somehow had a propensity for cannabis, establishing a biological basis for 'reverse causality'.
The utility of psychotropic drugs on patients with fetal alcohol spectrum dis...BARRY STANLEY 2 fasd
ABSTRACT
BACKGROUND: Treatment of the complications arising from Prenatal Alcohol Exposure (PAE) has largely been focused on psychosocial and environmental approaches. Research on the
use of medications, especially psychotropic medications, has lagged behind.
OBJECTIVES: This systematic review sought to investigate psychotropic medication related findings and outcomes in those diagnosed with Fetal Alcohol Spectrum Disorder (FASD).
METHODS: Comprehensive searches were conducted in seven major databases (Medline/
PubMed, Scopus, Web of Knowledge, Embase, PsycINFO, Cochrane Library, and
PsycARTICLES) up to February 2017. Key search terms with synonyms were mapped on these databases. There were no timeline restrictions and no grey literature searches. Two reviewers
independently assessed 25 studies that met the inclusion criteria. Most studies were reviews of treatment and retrospective case series.
RESULTS: Two crossover randomized trials were reported, and the findings were not amenable to meta-analysis. Several conditions (depression, agitation, seizures, and outburst) combined with the most frequent presentation, ADHD, to represent the rationale for prescribing psychotropic medications. Second-generation antipsychotics were found to improve social skills, but the paucity of data limited the extent of clinical guidance necessary for the field.
CONCLUSIONS: The systematic review showed that there are some clinical evidence displaying
the validity of psychopharmacological interventions in people with FASD, which varies across the spectrum of disease severity, age, and gender. There is a need for more clinical evidencebased studies in addition to clinical expert opinions to substantiate an optimal ground for individualized management of FASD.
The study protocol for this review was registered in PROSPERO with registration number
CRD42016045703
Introduction: Migraine is a chronic disease evolving through recurrent attack; it constitutes a frequent reason of consultation in
neurology. It has a signifi cant impact that can affect all spheres of life. Thus, it is one of the most disabling primary headaches.
Objective: To evaluate the impact of migraine in population of Brazzaville
The Epidemiology of Deliberate Self-Poisoning Presenting at a Tertiary Care ...Faizan Qaisar
Faizan Qaisar1*, Mohsin Shafi1, Ayesha Majeed1, DileepKumar1, Awais Memon1and Umer Memon1
1Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro,
Sindh, Pakistan
Comparison of Quality of Life of Care Giver of Chronic Psychiatric and Chronic Medical Patients-Chronically ill patients need assistance or supervision in their daily activities often placing a major burden on caregivers, placing them at a great risk of mental and physical problems and an impaired quality of life. An observational analytical study conducted in year 2013 in SMS Medical College, Jaipur aiming to compare the quality of life (QOL) of caregivers of patients with chronic psychiatric disorders with that of chronic medical illnesses. WHO-QOL BREF was used to assess quality of life in both the groups. It was observed that quality of life of caregivers of chronic psychiatric illness were significantly (p<0.05)poorer than quality of life of caregivers of chronic medical illness and that too more in Psychosocial domain followed by social, environmental and physical domain.
Professional Development Learning Module created by Akosua Joiner and Alexis Scranton on the topic of Internet Addiction. This topic falls under the Health & Wellness strand of Digital Literacy.
To find the students awareness of social networks.
b. To find for what purposes the students are using social networks.
c. To find effects of social networks on studies of the students.
d. To find Student’s ideas on how social networks can be used positively for education purposes.
e. To find average time spent on social networks by UNIVOTEC students
f. To find average expenditure spend by students on sustenance in social network
Integrated Care Model: Interventions and Strategies for Addressing Co-Morbidities in Early Recovery by Dr. Alkesh Patel, M.D., M.R.O. Addiction Psychiatrist and Assistant Clinical Professor Icahn School of Medicine at Mount Sinai, NYC.
ABSTRACT- Background: The occurrence of psychiatric disorders is more in the prisoners than in general population. Co-morbidity is seen to be an important and complex entity in clinical assessment of mental state competence (diminished mental capacity, temporary insanity and insanity) in the offenders at the time of the offence. It has a great role in determining all possible options in future treatment of violent offenders. Aim: This research article is focused on the co-morbid psychiatric diagnoses and the treatment outcomes in the mentally ill prisoners referred to the tertiary care mental health facility. Materials and Method: Total 100 mentally ill prisoners referred to the tertiary care psychiatric hospital during the study period (Jan 2015 - Dec 2015) was the sample size. It was a prospective study and the sampling method was of the purposive type. Results: Besides their primary diagnosis, the referred prisoners had more than one co-morbid psychiatric diagnosis in 46% of the cases. The most frequent co-occurring conditions were learning disabilities, personality disorders, and substance use disorders. The outcomes for the psychiatric conditions were positive as patients responded well to the line of management. Conclusion: The study provides valuable data to understand the mental health needs and the treatment gaps in this population so as to plan adequate services to tackle these issues. Key-words- Mentally ill prisoners, Psychiatric co-morbidities, Treatment outcomes, Substance use disorders, Personality disorders
Genetics of attention deficit hyperactivity disorder (adhd)Joy Maria Mitchell
Attention deficit hyperactivity disorder (ADHD) is a developmental disorder. ADHD is the commonly studied and
diagnosed as psychiatric disorder. Here we shall see the relation between extraversion and ADHD, neuroticism,
biological relation, Environmental factors and with diagnosis of ADHD. It is known that Genetics is one of the factors
that may contribute to, or exacerbate ADHD. Recent research probing towards the environmental and Genetic factors
causing ADHD differences is the main source for investigation
Journal Club #4 Appraisal WorksheetStudent Names1. Based .docxcroysierkathey
Journal Club #4: Appraisal Worksheet
Student Names:
1. Based on the purpose of the study, was a correlational design appropriate for the research question? Why or why not?
2. What type of sampling method was used for this study? What extraneous variables did the inclusion and exclusion criteria control for? Did this sufficiently reduce bias in the study? Why or why not?
3. What were the five measurement instruments used and what did each measure? In your opinion, were the measurement instruments sufficiently valid and reliable? Use information from the article to support your opinion.
4. What were the findings on the relationships among the variables?
Journal Club #4: Exit Ticket
Student Names:
Based on the conclusions of the study, what independent or collaborative nursing assessments and interventions could you implement to assist patients with heart failure?
550 Home Healthcare Nurse www.homehealthcarenurseonline.com
Introduction
Heart failure (HF) is a progres-
sive disease, which commonly
results in functional impairment
and activity intolerance (Yancy
et al., 2013). As symptom se-
verity increases, the ability to
perform activities of daily liv-
ing is affected, creating a barrier
to effective self-care (Riegel et
al., 2009). In fact, HF is one of
the most common reasons for
hospitalization among individu-
als 65 years and older and the
main reason for about 16 million
visits to ambulatory care cen-
ters each year (American Heart
Association, 2013). Thus, many
patients rely on home healthcare
clinicians to assist with daily
tasks and disease management
(e.g., treatment adherence, daily
weight monitoring, etc.) to pre-
vent these adverse outcomes.
Living with HF not only has
physiological ramifications, but
psychological effects as well.
For example, prior research indi-
cates that approximately 50% of
individuals with HF experience
depressive symptoms (Gottlieb
et al., 2004) secondary to HF
symptoms and functional im-
pairment (Carels, 2004; Cully et
al., 2010). Depressive symptoms
are known barriers to effective
self-care (Suter et al., 2012) and
influence morbidity and mortal-
ity in HF (Yancy et al., 2013).
How one copes with increasing
symptoms of HF may influence
the development of depressive
symptoms. Although findings
FACTORS ASSOCIATED WITH
in Patients With Heart Failure
Depressive Symptoms
Home healthcare clinicians commonly provide care for individu-
als with heart failure (HF). Certain factors may influence the de-
velopment of depressive symptoms in those with HF. This cross-
sectional, descriptive, correlational pilot study (N = 50) examined
interrelationships among HF symptoms, social support (actual and
perceived), social problem-solving, and depressive symptoms. Find-
ings indicated that increased HF symptoms were related to more
depressive symptoms, whereas higher levels of social support were
related to fewer depressive symptoms. The use of more maladaptive ...
Review of the alcohol use disorders identification testJohn G. Kuna, PsyD
A brief review of the AUDIT (Alcohol Use Disorders Identification Test). Includes administration procedures, scoring, target population usage, validity and reliability
Addiction is a disease that affects your brain and behavior. When you’re addicted to drugs, you can’t resist the urge to use them, no matter how much harm the drugs may cause. The earlier you get treatment for drug addiction (also called substance use disorder) the more likely you are to avoid some of the more dire consequences of the disease.
Drug addiction isn’t about just heroin, cocaine, or other illegal drugs. You can get addicted to alcohol, nicotine, sleep and anti-anxiety medications, and other legal substances.
You can also get addicted to prescription or illegally obtained narcotic pain medications, or opioids. This problem is at epidemic levels in the United States. In 2018, opioids played a role in two-thirds of all drug overdose deaths.
At first, you may choose to take a drug because you like the way it makes you feel. You may think you can control how much and how often you use it. But over time, drugs change how your brain works. These physical changes can last a long time. They make you lose control and can lead to damaging behaviors.
Journal Review: Rates of Treatment-Resistant Schizophrenia from First-Episode...Robert Ferris
Review of British Journal of Psychiatry publication by Siskind et. al. in 2022 entitled 'Rates of Treatment-Resistant Schizophrenia from First-Episode Cohorts: Systematic Review and Meta-Analysis', presented by Dr. Robert Ferris and Dr. Daere Akobo.
Note: uploading to SlideShare causes disruption of slide layout, creating text overlap. Original layout visible on download.
Sources for all imagery and resources listed in references section. I do not claim ownership of any images or graphics. Slides for educational purposes only, and should not replace clinical judgement. No monetary gain was made for this work.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
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June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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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
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Relationship of Attention Deficit Hyperactivity Disorder with Substance Abuse
1. Substance Abuse Patients CoMorbid With Attention Deficit
Hyperactivity Disorder
Relationship of ADHD with substance abuse?
OR
ADHD: A risk factor for the exacerbation of addictions?
2. Saad Salman
Undergraduate training of ADHD King’s College
London 2009.
Undergraduate Residency in Psychiatry and
Public Health from Massachusetts General
Hospital, Boston 2010.
Certified Health Researcher from NIH USA 2012.
(Online)
Department of Pharmacy UOP
saadirph@gmail.com
4. Methodology
Objectives: To study the tone of attentiondeficit hyperactivity disorder (ADHD) with
substance abuse.
Study design: A cross-sectional, hospital
based study.
Place and duration of study: The study was
carried out at Lady Reading Hospital and
Khyber Teaching
Hospital, Peshawar, Pakistan from 4th April
2012 to 29th August 2012.
Exclusion criteria: Included other
psychiatric illnesses.
5. Introduction
The attention deficit hyperactivity disorder
(ADHD) is one of the most common
neuropsychiatric disorders affecting 3% to 6% of
children [1] and almost 5% of adults [2].
Across population, Prevalence rates vary from
2.2% to 16.1% in clinical versus community
cohorts.
Its frequency has been reported as high as 34% in
clinical setting in Pakistan. [3].
6. Introduction (Cont.)
There is a bidirectional overlap between ADHD
and drug abuse and dependence [4] and affect
27% of adult population [5].
The co-occurrence of ADHD and addiction is
very common.
The co-morbidity between
Psychiatry
Psychology
ADHD and SU shows relativity
and relevant to research and
Pediatrics
clinical development.
7. Introduction (Cont.)
Studies have conducted in juvenile adolescents for
assessing ADHD and other disorders in substance
abusing groups had overrepresentation of ADHD
[10, 11].
ADHD predominates from 15% to 25% in
individuals with SUD [12, 13].
Two studies showed that the 24% of 201 inpatients
[14] and 10% cocaine abusers for drug
detoxification treatment had ADHD [15].
8. Material and Methods
One hundred and ten consecutive patients
admitted in Psychiatry ward of LRH and KTH for
drug detoxification were included in the study.
All the patients were analyzed through an
extended clinical semi-structured interview
previously validated against the Structured
Clinical Interview for DSM-IV-TR
[13-15].
And a structured interview provided by J.
Biederman, M.D. [2, 4].
9. Material and Methods
Adult patients with various drug and alcohol
dependence gave their consent to participate in
this study.
At a clinical interview, all 110 patients met the
diagnostic criteria required for
heroine, THC, opium, poly drug and alcohol
addiction criteria according to DSM-IV.
The examination was performed only after a 10day detoxification therapy.
Approval for this study was given by the Ethics
Committee of Lady Reading Hospital.
10. Material and Methods
The Wender Utah Rating Scale (WURS) and the DSMIV symptom checklist for ADHD served as investigating
instruments for the retrospective assessment of the
presence of ADHD in childhood.
DSM-IV criteria were used to divide the patients into
diagnostic sub-groups (inattentive type, impulsive
type, combined type.
The Conners Adult ADHD Rating Scales
(CAARS, Short Version) were used to assess persisting
ADHD symptoms in adulthood as a part of a
comprehensive intake valuation battery.
11. Statistical Analyses
Demographic differences between groups, using
chi-square tests for categorical variables and
comparisons of proportions.
The unpaired t-test was used to compare means
between two groups.
A principal components analysis using varimax
rotation was performed on the 25 test items of
WURS and CAARS-S.
The number of factors retained was determined by
the screen plot and use of the Kaiser-Guttman
rule (i.e., eigenvalues greater than 1.0).
Cronbach's alpha was calculated as a measure of
internal consistency on all the items of WURS
and CAARS-S.
14. Table 2: Total IV users in the sample (n=31, affected n=21)
Types
of No.
%age
THC
Opium
Poly-
Alcohol
users
Indications
Heroin
users
users
drug
users
abuse
HBV
13
23.8%
61.9%
Present
Present
N=3
HCV
5
N=1
Present
Absent
N=7
HIV
3
14.2%
Present
Absent
Present
21
100%
approx.
Absent
N=3
Absent
11(52.3) 1(4.7)
Absent
N=1
Absent
N=1
Total N (%)
Present
Present
N=3
Present
Absent
N=2
3(14.2)
3(14.2)
3(14.2)
15. Table 3: Attention deficit hyperactivity disorder diagnosed with
Wender Utah Rating Scale (WURS), DSM-IV symptom check-list
for ADHD and Conners’ Adult ADHD Rating Scales (CAARS)
n=110
Type of Addicts
DSM-IV
Inattentive
Hyperactive-
Combined
WURS,
CAARS,
n (%)
n (%)1
type, n (%)
impulsive
type, n (%)
n (%)2
(%) (DSM-IV
type, n (%)
pos,
n = )3
Heroin
20 (37.7)
2 (10)
11 (55)
7 (35)
22 (41.5)
19 (35.8)
addicts 7 (30.4)
2 (28.5)
1 (14.2)
4 (57.1)
8 (34.7)
8 (34.7)
addicts 6 (40)
5 (83.3)
1 (16.6)
7 (46.6)
7 (46.6)
addicts 53(48.1)
THC
23(20.9)
Opium
-
15(13.6)
Poly drug addicts 6 (54.5)
-
1 (16.6)
5 (83.3)
11 (63.6)
5 (33.3)
-
2 (66.6)
1 (33.3)
4 (50)
3 (37.5)
11(10)
Alcohol
8(7.2)
addicts 3 (37.5)
n
16. Results (cont.)
Screen-test and eigenvalues greater than
one, exclusion of factor loadings less than
0.30, factors loading greater than 0.30 not on
more than one factor.
A varimax rotation yielded the four factors:
(1)Inattention/memory
(2)Hyperactivity/restlessness
(3)Impulsivity/emotional liability
(4) problems with self-concept [28]
17. Results (cont.)
The correlation matrix was subjected to principal
axis factoring, yielding 11 factors with
eigenvalues greater than 1.0. Conners et al.
decided on an orthogonal rotation to obtain
independent
factors
of
inattention, hyperactivity, and impulsivity. Since
it is unlikely that these three dimensions are
totally unrelated, we did not limited our analyses
to varimax rotation, but also used oblique
rotations. Items were eliminated from further
analyses if they failed to load above 0.30 on any
one factor, or if they loaded greater than 0.30 on
more than one factor.
18. Results (cont.)
The first factor accounted for 12.91% of the
total variance. The eight items that loaded on
this factor were related to
inattention/distractability (Cronbach’s a 0.82).
The second factor explained 8.12% of the total
variance. The five items loading on that factor
tapped on problems with self-concept
(Cronbach’s a 0.75). The third factor accounted
for 4.82% of the variance and the four items
loading on it are related to emotional instability
(Cronbach’s a 0.77). The fourth factor
explained 4.27% of the total variance with six
items related to impulsivity (Cronbach’s a
0.71).
19. Results (cont.)
Five items loaded on the fifth factor that
explained 2.25% of the total variance, tapping on
hyperactivity (Cronbach’s a 0.87). The sixth
factor accounted for 2.36% of the total variance
and the six items loading on it are related to
sensation seeking (Cronbach’s a 0.67).
There was an inconsistency-adjusted sensitivity of
1.0, a specificity of 0.71, a positive predictive
value of 0.52, and a negative predictive value of
1.0
20. Table 4: Showing addiction with and
without co-morbid ADHD.
Addicts
Addiction with ADHD (n, Addiction without ADHD
%)
(n, %)
19 (35.8)
34 (64.1)
THC addicts 23(20.9)
8 (34.7)
15 (65.21)
Opium addicts 15(13.6)
7 (46.6)
8 (53.3)
Poly drug addicts 11(10)
5 (33.3)
6 (54.5)
Alcohol addicts 8(7.2)
3 (37.5)
5 (62.5)
Heroin
addicts 53(48.1)
21. Discussion
This study comprised of sample of adults
admitted
in
psychiatry
ward
seeking
detoxification treatment for substance use to
study whether they were ADHD in childhood and
this disorder is persisting in adulthood or not.
Impulsivity/emotional liability, and problems
with self-concept characterize the WURS and
CAARS-S. These four factors are found in both
the retrospective childhood and the adult
assessment in the corresponding instruments.
22. Discussion (cont.)
Our study found a rather moderate rate of persisting
ADHD in the entire group of SUD.
Studies performed on ADHD patients suggest that
persisting ADHD can lead to continued misuse and
abuse of substances following dependence, a longer
duration of SUD and a lower rate of remission
(Biederman et al., 1998; Wilens et al., 1998). [13]
Similarly, adults with ADHD seeking treatment for
substance abuse have been shown to display a more
chronic and severe form of SUD along with a slower
recovery from drug-dependence and SUD (Carroll and
Rounsaville, 1993; Pomerleau et al., 1995; Schubiner
et al., 2000). [6, 7, 9]
23. Discussion (cont.)
It was found that hyperactive ADHD patients with
drug dependence were more likely to have an
additional other addictions compared to those
patients with just attention disorders (Saules et al.,
2003). [16]
Our data provide evidence that a high percentage
of alcohol-dependent patients had ADHD in
childhood (23.1%), many of whom also had
ADHD persisting in adulthood (33.3%).
Kessler et al. (2006) found quite a high prevalence
of ADHD in alcohol addicts of 4.4%.
24. Discussion (cont.)
In another study, Martin D. Ohlmeier et al (2007) found
Nicotine and Alcohol dependence in patients with comorbid ADHD; their results confirmed retrospectively the
ADHD diagnosis in childhood in 21 patients (23.1%)
through DSM-IV.
In 7 (33.3%) of these 21 alcohol-dependent patients who
were affected by ADHD in childhood, the CAARS gave
evidence of persisting ADHD also in adulthood.
In an another study of Lambert NM and Hartsough CS
(1998) Among adult smokers, 35% with ADHD smoked
daily as compared to 16% of the age-mate controls. [33]
25. Conclusion
It was confirmed that ADHD is an
association of multi-drug addiction and that
many patients suffering from an addiction
may also have comorbid ADHD.
With the help of CAARS, it could be
demonstrated that a significant number of
patients who fulfilled the diagnostic criteria
of ADHD, according to DSM-IV, had
persisting ADHD in adulthood.
An ADHD patient poses a marked risk for the
development of different types of addictions.
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27. Martin D. Ohlmeier et al, Nicotine and alcohol dependence in patients
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