Quantification of prefrontal cortical neuronal ensembles following conditioned fear learning in a Fos-LacZ transgenic rat with photoacoustic imaging in Vivo

Understanding the neurobiology of complex behaviors requires measurement of activity in the discrete population of active neurons, neuronal ensembles, which control the behavior. Conventional neuroimaging techniques ineffectively measure neuronal ensemble activity in the brain in vivo because they assess the average regional neuronal activity instead of the specific activity of the neuronal ensemble that mediates the behavior. Our functional molecular photoacoustic tomography (FM-PAT) system allows direct imaging of Fos-dependent neuronal ensemble activation in Fos-LacZ transgenic rats in vivo. We tested four experimental conditions and found increased FM-PAT signal in prefrontal cortical areas in rats undergoing conditioned fear or novel context exposure. A parallel immunofluorescence ex vivo study of Fos expression found similar findings. These findings demonstrate the ability of FM-PAT to measure Fos-expressing neuronal ensembles directly in vivo and support a mechanistic role for the prefrontal cortex in higher-order processing of response to specific stimuli or environmental cues.

Palestinian Muslim College Students' Attitudes to Mental Health Treatment: A Comparative Study

This study examined the association between the degree of religiosity, combined with cultural beliefs, social stigmas, and attitudes towards mental-health treatment in two groups, who, despite having similar cultural and religious affiliation, have experienced different socio-political contexts: Palestinian Muslim college students living in the Occupied Palestinian Territory (OPT) and Israel. The study was guided by Tanhan and Young's (2021) conceptual framework. Methods: A snowball recruitment strategy was applied, using a cross-sectional survey. A total sample size was 214 students, 105 from the OPT and 109 from Israel. Results indicate that students from the OPT (n = 105) did not differ from those living in Israel (n = 109) on religiosity using the Islamic Belief scale, or Attitudes Towards Mental Health treatment (F(1, 189) = 1.07, p = 0.30). However, students from the OPT had higher confidence in mental-health professionals (M = 15.33) than their counterparts (M = 14.59), and women had higher confidence (M = 16.03) than men (M = 13.90). The reliance on traditions for Muslim students over Western mental-health approaches is a critical factor in predicting the attitudes towards students' mental problems and their chosen treatment. Sociopolitical context played a significant role in shaping attitudes toward mental-health providers.

Comparisons of injection and non-injection opioid use among Black people in methadone treatment: A pilot in Detroit

Rates of injection drug use (IDU) of opioids have been consistently lower among Black people relative to Non-Hispanic White people despite rising IDU estimates. While explanations have been proposed, no study has explored differences within a clinical sample of Black people in treatment who prefer IDU to non-IDU opioid administration. The purpose of this pilot study was to explore these differences guided by a seminal framework (e.g., market force, social network, and risk-taking characteristics), along with mental health symptoms, needle phobia, and injection perception variables. A purposive sample of 50 Black participants (58.0% male) were recruited from an opioid treatment program in Detroit by their preference for IDU (n = 16) versus non-IDU. The IDU group was younger, less educated, and younger at first treatment episode. They were more likely to report having been told they had bipolar disorder, PTSD, or anxiety, receiving mental health services as adults, and have a spouse/partner and close friends who injected opioids. The non-IDU group endorsed more symptoms of needle phobia. The non-IDU group also agreed more with statements that family and friends believe police mistreat people who inject drugs, and that people who inject opioids have a harder time quitting, are more likely to die from overdose, and have a harder time hiding it from family. These initial findings provide a rationale for a larger study with sex-specific analysis on factors associated with IDU among Black people to inform harm reduction efforts.

Perceived health, adversity, and posttraumatic stress disorder in Syrian and Iraqi refugees

BACKGROUND

Exposure to armed conflict and fleeing country of origin for refugees has been associated with poorer psychological health.

METHODS

Within the first month following their arrival in the United States, 152 Syrian and Iraqi refugees were screened in a primary care setting for posttraumatic stress disorder (PTSD), anxiety, and depression and rated their perceived health, and perceived level of adversity of violence, armed conflict/flight. The moderating effects of psychiatric symptoms on the relation between perceived adversity and perceived health were assessed.

RESULTS

Three models based on diagnosis (PTSD, anxiety, and depression) were tested. While significant effects were found on perceived adversity negatively influencing perceived health across diagnoses, slightly different patterns emerged based on diagnosis.

DISCUSSION

Findings suggest that refugees' perception regarding adversity of violence, armed conflict, and flight may contribute to perceived health, with a moderating role of clinically significant symptoms of PTSD, anxiety, and depression.

The Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Healthcare Workers with Pre-Existing Psychiatric Conditions

Both healthcare workers (HCWs) and psychiatric patients during the COVID-19 pandemic appear to have elevated prevalence of psychiatric symptoms, but little is known about HCWs with psychiatric diagnoses. To examine their response to the pandemic, we analyzed their perspective, and association with psychiatric symptoms and stress among HCW with psychiatric diagnosis. Using an online survey of HCW, we analyzed demographics, work information, health factors, open-ended question, sources of stress and standardized mental health scales (Perceived Stress Scale (PSS), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8), and Posttraumatic Stress Disorder Checklist (PCL)). Sixteen out of 129 HCWs reported a pre-existing psychiatric diagnosis (median age 32 years, 8 were females, 8 work in the emergency department). Their perception of the impact severity on symptoms was significantly correlated with all the mental health scales and with stress from avoiding physical contact. In multivariate analysis, PSS score and PCL score were associated with self-rated impact of the COVID-19 pandemic on symptoms (standardized beta = .51 for PCL and standardized beta = .55 for PSS). GAD-7 score was significantly related to both impact (standardized beta = .44) and stress from avoiding physical contact (standardized beta = .53). HCWs with psychiatric diagnoses reported a range of perception of the impact of the pandemic on their symptoms with increased severity associated with worse psychiatric outcomes and more stress from avoiding physical contact with others. There is a growing importance to protect HCWs mental health, including those with pre-existing psychiatric diagnosis, and proactively counter psychosocial consequences of healthcare crises.

Rapid assessment of mental health of Detroit-area health care workers during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic may adversely impact the mental health of health care workers (HCWs). To address this issue, it is essential to determine levels of anxiety, depression, and traumatic stress, and sources of stress, and to identify subgroups of HCWs at a higher risk of adverse mental health outcomes during the COVID-19 pandemic.

METHODS

We conducted a cross-sectional study of symptoms of mental illness in HCWs in the area surrounding Detroit, Michigan. The online survey included questions about demographics, health and clinical factors, and sources of stress. Several tools were used to assess psychiatric symptoms among HCWs, including the Perceived Stress Scale, the Patient Health Questionnaire depression scale, the Generalized Anxiety Disorder 7-item assessment, and the Posttraumatic Stress Disorder Checklist for DSM-5. The adequacy of personal protective equipment, patient resources, and training for highly contagious diseases were rated.

RESULTS

The sample (N = 129) was predominantly female (51.2%) and White (65.9%), with 30.2% screening positive for clinical follow-up to assess anxiety, 20.9% for moderate to severe depression, and 16.3% for elevated traumatic stress. Differences were found by self-reported psychiatric diagnosis and chronic conditions, and role on treatment teams.

CONCLUSIONS

Frontline HCWs demonstrate high levels of stress and trauma symptoms. Timely screening and accommodations may be needed during health care crises, such as the COVID-19 pandemic.

Commercial and public payer opioid analgesic prescribing policies: a case study

Background

One strategy to address the high number of U.S. opioid-related deaths is to restrict high-risk or inappropriate opioid analgesic prescribing and dispensing. Federal and state laws and regulations have implemented restrictions but less is known about commercial and public payers’ policies aside from clinician anecdotal reports that these policies are increasing. To assess the number and types of policies with temporal trends, we examined commercial and public (Medicaid) payer policies in one state, Michigan, that has high opioid-related deaths and implemented opioid analgesic prescribing laws.

Methods

Policies for seven large commercial payers and the public payer for 2012–2018 were reviewed and categorized by actions. Joinpoint regression was used to summarize temporal trends on number of policies for all payers and subgroups.

Results

Across the 7 years, there were 529 action policies (75.57 (95% confidence intervals (CI) 35.93, 115.22) actions per year) with a range of 36 to 103 actions by payer. Limitations on number of days for initial prescriptions and prior authorizations were the most frequently implemented policy. The temporal trend showed a decline in new policies from 2012 to 2013 but a steady increase from 2014 to 2018 (average annual percent change or AAPC=29.6% (95% confidence intervals 13.2, 48.5%)). The public payer (n=47 policies) showed no increase in number of policies over time (AAPC=2.9% (95% CI -41.6, 61.6%).

Conclusions

The eight commercial and public payers implemented many new policies to restrict opioid analgesic prescribing with a steady increase in the number of such policies implemented from 2014 to 2018. This case study documented that at least in one state with high opioid-related deaths and multiple commercial payers, new and different policies were increasingly implemented creating barriers to patient care. The impact of these policies is understudied, complicating recommendation of best practices.

US national treatment admissions with opioids and benzodiazepines

INTRODUCTION AND AIMS

Opioids and benzodiazepines (O/BZD) are increasingly involved in drug overdose deaths in the USA. Expanding treatment capacity may reduce these deaths. Knowledge about co-occurring O/BZD admissions compared to opioid admissions (opioid) is needed to plan this expansion.

DESIGN AND METHODS

US treatment admissions to specialty facilities for 2011-2017 were analysed for trends and 2017 for group differences. Due to 1.9 million admissions in 2017, comparisons between O/BZD and opioid admissions were summarised as effect sizes. Additional analysis compared the administratively pre-coded category 'other opiates and synthetics' to other opiates and synthetics/benzodiazepines admissions to control for possible similarity in drug source. Differences within O/BZD admissions by primary drug were explored.

RESULTS

Although opioid admissions showed a steady increase over time (25.9% to 38.2%), O/BZD admissions showed increases until decline in 2017 (3.2% to 4.0%). In 2017 no factor reached moderate effect size (≥0.2) in group comparisons or within the O/BZD admissions. Heroin was self-reported in 70% of both O/BZD and opioid admissions.

DISCUSSION AND CONCLUSIONS

No meaningful US national differences on data routinely collected were found for O/BZD compared to opioid admissions including the subgroup with other opiates and synthetics only. Efforts to expand existing opioid treatment in specialty treatments may help reduce opioid and O/BZD deaths. However, the analysis could not address whether changes in treatment would improve outcomes.

Immigrant Arab Americans and alcohol use: longitudinal study

English proficiency is associated with alcohol use in some immigrants groups, but little is known about its association among Arab Americans. Ethnographic work suggests gender, religion, education, and age influence prevalence of alcohol use among Arab Americans. Two years prospective study of recent Iraqi refugees and non-Iraqi Arab immigrants in Michigan using bilingual surveys and interviewers. At Time 1, prevalence of lifetime alcohol use was 20.5 % with males, Christians, better educated, older, and those with greater proficiency in English more likely to report ever drank. At Time 2, lifetime prevalence of drinking had increased to 34.0 %. In analysis of male new drinkers, risk factors were Christian, older age and greater proficiency in English. This study confirms drinking among recent immigrant Arab Americans varies by subgroups and suggests English proficiency may contribute to the increase in prevalence over time.

Clinicians' Beliefs and Awareness of Substance Abuse Treatments in Research- and Nonresearch-Affiliated Programs

Clinicians' beliefs and awareness of treatment techniques may influence what innovations are perceived as needed and adoption of them. Clinicians at research-affiliated programs, however, may differ from clinicians at programs without research affiliation. We surveyed 162 clinicians at 15 substance abuse treatment programs (five research-affiliated programs and 10 matched nonresearch-affiliated programs) on addiction treatment belief items and awareness of Clinical Trials Network treatment innovations currently being tested. The research-affiliated clinicians had a higher percentage of clinicians with advanced degrees. In bivariate analyses, three differences in beliefs and four differences in awareness by research affiliation were found. Most of these differences disappeared during multivariate analyses. The results suggest that beliefs and awareness toward addiction treatment of research-affiliated clinicians, when controlling for demographic and professional characteristics, may be similar to those of other clinicians. This similarity should help in wider dissemination for those innovations found acceptable to clinicians at research-affiliated programs.

Visual Acuity, Visual Disabilities and Falling in the Elderly

Poor vision has been suggested as a risk factor for falling in the elderly. We analyzed the findings from a cohort of community-dwelling elderly (N = 875) to determine the relative risks for impaired visual acuity and various visual disabilities with falling, recurrent falling, and serious injurious falls. The prevalences of impaired visual acuity and four visual disabilities were low. None of the vision variables examined predicted time to first serious injurious fall after controlling for balance, cognition, age, and gender. However, bumping into objects predicted falling and recurrent falling. The lack of associations between visual disabilities and falling suggests that poor vision, as measured here, plays a limited role in predicting falling in relatively well community-dwelling elderly.

Potentially traumatic events and mental health problems among children of Iraqi refugees: The roles of relationships with parents and feelings about school

This study examined mental health problems among children of Iraqi refugees, most of whom were Christian. Exposure to potentially traumatic events was hypothesized to predict more symptoms of depression and traumatic stress. Moreover, youth reports of supportive relationships with parents and positive feelings about school were examined in relation to mental health problems. These promotive factors were expected to mitigate the hypothesized association between traumatic event exposure and mental health problems. Participants were 211 youth recruited from agencies and programs serving Iraqi refugees in a large metropolitan area in the United States. The hypotheses were partially supported. Youth who reported experiencing more potentially traumatic events endorsed more traumatic stress and depression symptoms. After accounting for exposure to potentially traumatic events and other covariates, youth who reported more positive feelings about school endorsed fewer symptoms of traumatic stress, and youth who reported more supportive relationships with parents endorsed fewer symptoms of depression. In addition, there was an interaction between potentially traumatic events and relationships with parents when predicting depression symptoms. Youth endorsed higher levels of depression symptoms when they reported less supportive relationships, regardless of the amount of traumatic event exposure, whereas youth endorsed lower levels of depression symptoms when they reported more supportive relationships with parents, but only at low levels of traumatic event exposure. Otherwise, the main effects were not qualified by interactions between potentially traumatic event exposure and the promotive factors. The findings from this study have implications for future research, policy, and practice with children of refugees. (PsycINFO Database Record

Pilot Study of Waterpipe Tobacco Smoking Among US Muslim College Students

Waterpipe smoking is common among the young in Muslim-majority countries despite recent Islamic rulings on tobacco. US Muslim college students, especially immigrants, may be at high risk for smoking, but information is lacking. In this pilot study, respondent-driven sampling was used to sample 156 Muslim college students. Waterpipe smoking was common (44.3%). Leading motivations to smoke were social and perceived low tobacco harm. Independent risk factors among the Muslim students were perception that friends and other students smoked, and ever drank alcohol. Personal belief that waterpipe smoking is prohibited in Islam was not significant. This pilot suggests that Muslim students are at high risk for waterpipe smoking and more definitive studies are needed.

Intervention to reduce inpatient psychiatric admission in a metropolitan city

When psychiatric hospitalization is over-used, it represents a financial drain and failure of care. We evaluated implementation and cessation of transporting people medically certified for psychiatric hospitalization to a central psychiatric emergency service for management and re-evaluation of hospitalization need. After implementation, the hospitalization rate declined 89% for 346 transported patients; only four of the nonhospitalized patients presented in crisis again in the next 30 days. Following cessation, the hospitalization rate jumped 59% compared to the preceding year. Costs declined 78.7% per diverted patient. The findings indicate that it is possible to reduce hospitalization and costs, and maintain quality care.

Who goes to treatment? Predictors of treatment initiation among gambling help-line callers

BACKGROUND AND OBJECTIVES

Although the consequences of problem gambling can be severe, few ever seek treatment for this disorder. Problem gambling help-lines represent a crucial point of entry into the treatment system. Through brief telephone counseling, help-lines have the potential of enhancing callers' motivations to engage in longer-term treatment. We prospectively examined treatment initiation and its predictors among individuals calling a state help-line.

METHODS

Participants (n = 143) were assessed shortly after their initial call and re-contacted at least two months later.

RESULTS

Overall 67% of the re-contacted help-line callers had attended at least one treatment session at the time of the follow-up interview (92.7% formal treatment and 28.1% peer-support meetings). Multivariate analysis revealed that gambling-related financial difficulties and past treatment for problem gambling (but not for mental health or substance abuse) predicted treatment initiation.

CONCLUSIONS AND SIGNIFICANCE

Enhanced counseling focusing on motivational factors may result in better treatment engagement for some problem gamblers.

Economic grand rounds: experience with mandated use of generic medications for patients covered by the mental health safety net

Reducing pharmacy costs without increasing adverse outcomes would relieve some pressure on mental health budgets. This column describes the experience of a publicly funded provider network in a Michigan county that mandated generic use of psychotropic medications to address financial challenges. The percentage of brand-name medications and cost per prescription declined with the policy change, resulting in lower total pharmacy expenditures. No increase was noted in prescriptions per patient or psychiatric hospitalizations. Changes were sustained after the initial implementation period. Mandating generic use may be feasible as a tool for constraining pharmacy costs in mental health budgets.

The status of sleep abnormalities as a diagnostic test for major depressive disorder

BACKGROUND

Psychiatry lags other fields in development of diagnostic tests.

METHODS

A literature review and meta-analysis was conducted to ascertain if polysomnographic abnormalities (REM density, REM latency, sleep efficiency, slow wave sleep, stage 1 and stage 2 sleep) warrant additional effort to develop them into a clinical diagnostic test for major depressive disorder (MDD). The 31 publications meeting inclusion criteria were then classified into one of three progressive steps using guidelines for evaluating the clinical usefulness of a diagnostic test.

RESULTS

Most of the abnormalities found in MDD patients, when compared to healthy controls, occurred in the expected direction with moderate effect sizes but with substantial publication bias and heterogeneity. Eleven studies compared abnormalities in MDD to other psychiatric disorders (step 2a), and four studies provided data on the sensitivity or specificity of the findings in differentiating among the psychiatric disorders that frequently appear on the same differential diagnostic list as MDD (step 2b). No multicenter trial has been conducted prospectively to test the clinical utility of the diagnostic test (step 3).

LIMITATIONS

Only published articles in the English language were used.

CONCLUSIONS

Sleep studies for the detection of MDD appear replicable with a moderate effect size. However, additional step 1 studies are needed to define the sensitivity and specificity. The heterogeneity of sleep recording, scoring techniques, and MDD must also be addressed.

Respondent-driven sampling of Muslim undergraduate U.S. college students and alcohol use: pilot study

PURPOSE

Prevention of alcohol abuse requires information about all demographic groups. However, little is known about drinking among people affiliated with proscriptive religions due to omission of religious affiliation in many surveys and challenges sampling them. Our objective was to pilot a sampling technique frequently used in the HIV literature, respondent-driven sampling, to assess potential association of alcohol use with religiosity, personal proscriptive belief, and social influences among Muslim U.S. college students.

METHODS

Self-identified Muslim undergraduate students (N = 156) at one urban commuter university completed a web-based survey.

RESULTS

Prevalence adjusted for sampling was 9.1 % (95 % CI: 0.2-17.1 %) with in-group recruitment of 0.36 for drinkers and 0.43 for abstainers. In unadjusted analyses, students who were lifetime abstainers were more likely than drinkers to hold personal proscriptive belief and strongly agree with a measure of private religiosity. There was no difference on public religiosity measures between groups. Lifelong abstainers were more likely to report fewer students, fewer Muslim students, and fewer of their friends drank alcohol. They also were more likely to report that they attended high school with more Muslims and currently live in neighborhoods with more Muslims.

CONCLUSIONS

In this pilot study, lifetime abstinence was associated with high private religiosity, personal proscriptive religious beliefs, and more proscriptive social influences. The findings suggest that respondent-driven sampling may be feasible in recruiting Muslim students. However, validation against other sampling techniques is needed.

Binge drinking among Arab/Chaldeans: an exploratory study

Focus groups were conducted with young Arab/Chaldeans (N = 82) from different ethno-religious groups (Chaldeans, Orthodox Christians, and Muslims) to explore the potential risk and the protective factors associated with the high level of binge (or episodic heavy) drinking among Arab/Chaldeans reported by general population surveys. Most of the participants were aware of and knowledgeable about the problem in their community. Themes identified as contributory factors consistent across ethno-religious groups included the availability of alcohol, the importance of family, conformity to group behavior, and social reasons. Differences included the context for drinking and gender roles. These findings can be used to tailor culturally appropriate interventions.

Alcohol use among Arab Americans: what is the prevalence?

Information is limited on alcohol use among Arab Americans. The purpose of this study was to describe and analyze the alcohol use pattern among Arab Americans by reviewing existing surveys using an acculturation model. Secondary data analysis. Nationally, English-speaking immigrant Arab Americans reported lower rates of lifetime alcohol use (50.8%), past month use (26.4%) and binge drinking (10%) than the White majority group. In a state survey, self-identified English-speaking Arab Americans were less likely to report past month use (45.6%) than the White majority group but reported similar rate of binge drinking (17.0%). Locally, lifetime drinking was reported by 46.2% of the immigrants but only 13.4% of refugees fleeing war. Few databases are available to estimate alcohol use pattern among Arab Americans; the limited data suggest a drinking pattern consistent with acculturation. However, the potential influence of other factors is unknown and needs to be investigated.

Neuroendocrinal study of depression in male epileptic patients

Endocrine changes are reported in both epilepsy and depression. The interrelationships between mood, epilepsy, and endocrine changes are not well characterized. The authors included 40 epileptic patients (20 depressed, 20 nondepressed) and 20 healthy subjects. All patients had an electroencephalogram, and were given the Hamilton Rating Scale for Depression. All subjects were tested for serum levels of cortisol, prolactin, testosterone, and thyroid hormones. Patients were medication-free. Patients had elevated prolactin and cortisol and reduced serum testosterone relative to control subjects. Depressed patients had higher cortisol levels than nondepressed. Data suggest that the effects of epilepsy and depression on cortisol, but not other hormones, may be additive.

Advances in electrophysiology in the diagnosis of behavioral disorders

INTRODUCTION

Diagnosis in psychiatry remains largely subjective. Developing biological observations in psychiatric disorders into laboratory-based diagnostic tests can significantly impact diagnosis and management of these disorders. Diagnostic electrophysiological techniques are non-invasive and relatively inexpensive.

AREAS COVERED

In this review, the authors propose that enough knowledge has accumulated to allow the establishment of psychiatry-based clinical electrophysiology laboratories (PCELs). A brief summary of established clinical indications for electrophysiology tests, summary of highly promising technologies and a presentation of a proposed four-step approach to facilitate the translation of promising biological observations into diagnostic tests are provided. The reader should develop an appreciation of the current status of the clinical applications of psychiatric electrophysiology. The authors propose to capitalize on the widely accepted indication to rule out medical causes of psychiatric symptoms (e.g., epileptic activity) to begin developing PCELs as the equipment and skills necessary are basic to the entire discipline. The potential impact of the growing knowledge on the practice of psychiatry is explored to update clinicians and administrators as they develop laboratory and service plans.

EXPERT OPINION

Psychiatric electrophysiology currently plays a limited role in the diagnosis and management in psychiatry. This status is not supported by the existing literature. The underutilization of electrophysiological tests in psychiatry is propagated by the fact that the laboratories providing the service are not managed by psychiatrists. The authors propose that the first steps are to establish such laboratories and train psychiatrists to competently provide the service.

Survey of the importance of professional behaviors among medical students, residents, and attending physicians

OBJECTIVE

The authors compared the importance of items related to professional behavior among medical students rotating through their psychiatry clerkship, psychiatry residents, and attending psychiatrists.

METHOD

The authors sent an electronic survey with 43 items (rated on the scale 1: Not at All Important; to 5: Very Important) to medical students, psychiatry residents, and attending psychiatrists at one academic center.

RESULTS

Medical students rated several items in the categories Personal Characteristics and Interactions With Patients significantly less important than did residents and attending psychiatrists. Both medical students and attending psychiatrists rated the category Social Responsibility significantly less important than did residents.

CONCLUSION

All three groups surveyed rated the majority of items as Important or Very Important, indicating that they value professional behavior. Resident physicians had the highest mean score in every category measured. Overall, medical students rated most items related to professionalism as less important than the two other groups surveyed.

Probing the relative contribution of the first and second responses to sensory gating indices: a meta-analysis

Sensory gating deficit in schizophrenia patients has been well-documented. However, a central conceptual issue, regarding whether the gating deficit results from an abnormal initial response (S1) or difficulty in attenuating the response to the repeating stimulus (S2), raise doubts about the validity and utility of the S2/S1 ratio as a measure of sensory gating. This meta-analysis study, therefore, sought to determine the consistency and relative magnitude of the effect of the two essential components (S1 and S2) and the ratio. The results of weighted random effects meta-analysis revealed that the overall effect sizes for the S1 amplitude, S2 amplitude, and P50 S2/S1 ratio were -0.19 (small), 0.65 (medium to large), and 0.93 (large), respectively. These results confirm that the S2/S1 ratio and the repeating (S2) stimulus differ robustly between schizophrenia patients and healthy controls in contrast to the consistent but smaller effect size for the S1 amplitude. These findings are more likely to reflect defective inhibition of repeating redundant input rather than an abnormal response to novel stimuli.

Alcohol use among U.S. Muslim college students: risk and protective factors

Drinking behavior among Muslim college students in the United States is unknown. To obtain estimates and examine risk factors, the authors conducted secondary data analysis of the public access database from the 2001 Harvard School of Public Health College Alcohol Study. Two variables were associated with drinking-religious activities, which were protective against drinking, and parental approval of drinking, which was a risk factor for drinking. Although American Muslim students had a low rate of drinking in the past year (46.6%) compared to their U.S. college counterparts, they had a higher rate of alcohol consumption compared to their counterparts in predominately Muslim countries.

Survey of sexual education among residents from different specialties

OBJECTIVE

This study aims to determine how residents are being educated regarding sexual health, and it assesses attitudes toward sexual education and barriers to evaluating patients' sexuality.

METHODS

An anonymous Internet survey was sent to 195 residents in family practice, internal medicine, obstetrics and gynecology, and psychiatry at a single site.

RESULTS

One hundred seventeen surveys were completed, for a response rate of 60%. Participants reported a lack of formal education on sexual health. Although participants perceived their patients' sexuality as important and appeared to have the appropriate knowledge to evaluate sexual issues, they failed to inquire about sexual health regularly, especially for patients from non-Western cultures. Lack of comfort or confidence did not appear to impose major barriers to the evaluation of sexual health; instead, most respondents reported lack of time.

CONCLUSION

Implementation of a formal curriculum will signal to residents that patients' sexuality is an important topic to address.

Sexual health education: a psychiatric resident's perspective

OBJECTIVE

This report discusses psychiatric residents' perceptions of sexual health education and their opinions regarding curricular improvements.

METHODS

An anonymous, web-based survey was sent to residents in one general psychiatry program (N=33). The response rate was 69.7%.

RESULTS

Residents reported inadequate experience in multiple areas of sexual health. In every topic surveyed, 61.5% or more of the early residency group and 20% or more of the late residency group reported "none" or "too little" to both clinical and didactic experiences. Approximately one-half of residents responded that more time should be spent on every topic surveyed. The teaching modalities of didactics and outpatient clinical work were thought to provide the greatest educational benefit.

CONCLUSION

Psychiatric residents value education regarding sexual health and would like more opportunities to learn about this topic.

Expanding treatment capacity for opioid dependence with office-based treatment with buprenorphine: National surveys of physicians

Office-based treatment of opioid dependence with buprenorphine has the potential to expand treatment capacity in the United States. However, nationally, little is known about the number, characteristics, and experiences of physicians certified to prescribe buprenorphine. Moreover, little is known about the impact of easing federal regulations on the number of patients a physician is allowed to treat concurrently. To address these questions, surveys of national samples of physicians certified to prescribe buprenorphine (2004-2008) were analyzed (N = 6,892). There has been a continual increase in the number of physicians certified to prescribe buprenorphine, increase in the mean number of patients treated by physicians, and decrease in patients turned away, coinciding temporally with easing of federal regulations. In addition, most physicians prescribed buprenorphine outside of traditional treatment settings. The U.S. experiment in expanding Schedule III-V medications for opioid dependence to physicians outside of formal substance abuse treatment facilities appears to have resulted in expanded capacity.

Acculturation and polysubstance abuse in Arab-American treatment clients

Acculturation to U.S. culture by Latinos and Asian Americans has been associated with increased prevalence of substance abuse. However, little is known about the association between acculturation and substance use among Arab Americans, or more specifically, among Arab-American treatment clients. In 156 Arab-American male treatment clients, we found that higher levels of U.S. acculturation were positively associated with increased prevalence of polysubstance abuse. This first report on a large series of Arab-American clients also found considerable within-group variability. These results can be used to develop treatment plans and work-force training on the importance of U.S. acculturation and variability within Arab Americans.

Substance abuse treatment and services by criminal justice and other funding sources

Studies have found funding source, whether public or private, is associated with treatment and services offered in community-based agencies. However, the association of criminal justice funding with community-based treatment and services is unknown. Using a mixed method case study approach with 34 agencies within one state we assessed administrators' perspectives of the most important funding source, treatment and services offered. We found that agencies rely on multiple funding sources and the source rated most important was associated with treatment and services offered in the agency. Those agencies citing a criminal justice entity as the most important funder were more likely to offer specific ancillary services and adopt motivational interviewing than those citing private funds. Although client characteristics or training opportunities may determine these services and practices, the agency's most important funding source may have implications for services offered.

Departments of corrections as purchasers of community-based treatment: a national study

Community-based substance abuse treatment for offenders has been shown to reduce both substance use and recidivism. One strategy to ensure treatment availability for offenders is to have each state's Department of Corrections (DOC) fund treatment directly. Purchasing treatment implies regulation, but DOC as both a purchaser and regulator of community-based services has been underexamined. This national survey of administrators from the Single State Authority (SSA) and DOC in each state found DOCs purchase treatment in 35 states, with most states purchasing it directly from community-based providers utilizing a variety of funding sources. Fewer states reported DOCs purchased ancillary services than SSAs (68% vs. 81%). Although both DOCs and SSAs had workforce and program requirements, there were differences within and between states. Most (41/42) SSA administrators reported a strong relationship with DOC. This report represents the first step in describing the availability, mechanisms, and regulations of these two publicly funded community-based treatment systems.

Level of analysis issues in assessing treatment beliefs in substance abuse clinics

The current study applies the growing literature in the organizational sciences regarding levels of analysis issues to the analysis of substance abuse treatment beliefs. Research on clinicians' beliefs in substance abuse treatment is often based on the assumption that the beliefs are sufficiently shared by clinicians within a clinic and sufficiently vary across clinics that they can be treated as a group-level phenomenon. Further, efforts to introduce new innovations are often focused at the group or clinic level without testing this assumption, which can lead to failure to adopt or to successfully implement the innovation. We tested the assumption of sharedness by examining if there was sufficient agreement about treatment beliefs within clinics, within groups of clinics or within groups of clinicians to justify treating these aggregations as meaningful groups. Using three statistical approaches to examining level of analysis (Within and Between Analysis (WABA I), Intraclass Correlation Coefficients (ICC(1)), and r(wg)), we found that variability in treatment beliefs largely occurred at the individual rather than at the tested aggregate levels of analysis. These findings serve as an example of the importance of testing the assumption of shared perceptions in future research.

Comparing credentialing requirements of substance abuse treatment staff by funding source

Studies have found that clinicians with higher education and/or attainment of national certification have a more favorable outlook regarding the adoption of evidence-based practices. However, staff hiring decisions may be based on a multitude of factors, including available resources and demands stemming from different funders. Using a mixed-methods case study approach with 34 agencies within one state, we assessed administrators' perspectives of the most important funding source, views on clinical hiring practices, and current staffing. We found that funding source predicted views and actual staff level of credentialing and education. Those agencies citing a criminal justice entity as the most important funder had the lowest requirements for credentialing and education. As the substance abuse treatment delivery system evolves and expands, we must ensure that vulnerable groups have access to more highly--rather than less--skilled workers to assess and facilitate recovery.

Characteristics of facilities with specialized programming for drinking drivers and for other criminal justice involved clients: analysis of a national database

Background

Offering specialized programming at substance abuse treatment facilities can help diversify clientele and funding sources, potentially enhancing the facilities' ability to survive and/or expand. Past research has shown that facilities only offering specialized programming for driving under the influence/driving while intoxicated offenders (DUI) are predominately private-for-profit owned. As criminal justice populations, both DUI and other criminal justice offenders, comprise a large proportion of those in community-based substance abuse treatment knowing facilities' characteristics would be important for administrators and policymakers to consider when updating programming, training staff or expanding capacity to ensure efficient use of scarce resources. However, while such characteristics are known for DUI programs, they are not known for facilities offering specialized programming for other criminal justice offenders.

Methods

Analysis of the 2004 US National Survey of Substance Abuse Treatment Facilities.

Results

Almost half the facilities (48.2%) offered either DUI or other criminal justice specialized programming. These facilities were divided between those offering DUI specialized programming (17.7%), other criminal justice specialized programming (16.6%) and both types of programming (13.9%). Certain characteristics were independently associated with offering DUI specialized programming (private ownership, rural location, for profit status) or other criminal justice specialized programming (receiving public funds, urban location, region of country).

Conclusion

Offering specialized programming for DUI or other criminal justice offenders was common and associated with distinct characteristics. These observed associations may reflect the positioning of the facility to increase visibility, or diversify clientele and possibly funding streams or the decision of policymakers. As the criminal justice populations show no sign of decreasing and resources are scarce, the efficient use of resources demands policymakers recognize the prevalence of these specialized programming, join forces to examine them for efficacy, and explicitly incorporate these characteristics into strategies for workforce training and plans for treatment expansion.

A four-step approach for developing diagnostic tests in psychiatry

A four-step approach for developing diagnostic tests in psychiatry is proposed. Step 1, a biological variable is observed to be deviant from healthy controls in a particular patient population. The demonstration of test retest reliability of the finding using blinding procedures is an essential component of this early step. Step 2, is the demonstration of potential clinical usefulness of the specific finding. The two most important objectives at this step are demonstration of difference between the target patient population and appropriate control groups (these should be groups of patients with diagnoses that commonly appear on the differential diagnostic lists of the target disorder). Estimation of the effect size of the finding could be a reasonable guide to which findings should be considered good candidates for Step 3 studies. During Step 3 the performance characteristics of the test should be established. Specifically, the sensitivity, specificity, positive and negative predictive values of the biological marker should be examined. Step 4 defines the clinical application of the test and helps standardize the technique used in large and multicenter clinical trials. Multicenter trials should pave the road towards standardization of laboratory procedures used to conduct the test, as well as providing data regarding cost effectiveness and impact on both short-term and long-term clinical outcomes.

Health issues in the Arab American community. A review: depression and smoking

The association between depression and smoking has been well-documented in multiple countries and age groups. This review examines recent publications that address the magnitude of the association and its causal patterns (ie, due to lowered success of quitting in people with depression, depression causing smoking, smoking causing depression or third factor related to both smoking and depression). We conclude that the association may be multi-factorial with each of the causal directions possibly contributing to the observed association. Also, the association extends beyond depression to other mental disorders, including consumption of illegal drugs and non-medical use of prescription medications. Although the studies emphasize cigarette smoking, it is plausible to generalize the findings to other tobacco delivery systems involving deep inhalation, such as a hookah, due to the pharmacodynamics of nicotine. Although this review did not examine any studies specific to Arab Americans, the findings should generalize if smoking is stigmatized or, alternatively, as stigmatization increases. The good news is that even with the robust association between depression and smoking, people with depression can quit smoking and continue to be smoke-free. Because 44.3% of cigarettes in the United States are consumed by individuals with mental illnesses, mental illness deserves a prominent focus to allow our public health goal of reducing the prevalence of smoking to be reached.

Health issues in the Arab American community. Arab Americans in publicly financed substance abuse treatment

OBJECTIVE

To determine the characteristics of Arab Americans receiving treatment and to compare them with individuals of other ethnic groups.

METHODS

We used admission data (FY2005) for Michigan publicly funded substance abuse treatment (N=69,989). Arab American ethnicity (n=224 or 0.3% of admissions) was defined by codes for race, ethnicities or primary language of Arabic (n=21). Other ethnicities examined were American Indian, Hispanic, African American, and White.

RESULTS

The number of Arab American admissions was lower than expected for the population (RR=0.25). Admissions were concentrated (81%) in metropolitan Detroit as is the community (82%, RR=.99), unlike other ethnicities. Primary drugs of abuse were alcohol (34.8%), marijuana (17.9%), heroin (17.4%) and crack cocaine (15.6%). Mean duration of use (11.2 yrs) was significantly lower than for other ethnicities. Arab American admissions were predominately male (76.3%), unemployed (62.1%) and with criminal justice involvement (58%), similar to other ethnicities.

DISCUSSION

Using administrative database has its limits and may misclassify ethnicities. Based upon the available data, it appears that Arab Americans accounted for a small percentage of admissions to publicly funded substance abuse treatment in Michigan. Most of the admissions listed English as the primary language, raising concern that language may be a barrier to entry. Admission profiles were generally similar across ethnicities, except that Arab Americans were entering treatment after shorter duration of use. These data can inform development of treatment programs and outreach efforts.

Treatment at the front end of the criminal justice continuum: the association between arrest and admission into specialty substance abuse treatment

Background

To reduce criminal recidivism and drug use, it has been proposed that the substance abuse treatment delivery system cut across different components of the criminal justice continuum. Arrest, at the front end of this continuum, may represent a critical moment to motivate people with substance use disorders (SUD) to seek treatment but is often over looked as an intervention point. We used data from the 2002 National Survey on Drug Use and Health (NSDUH) to compare treatment need and recent treatment admission for participants with no criminal justice (CJ) involvement in the past year, past-year arrest, and CJ supervision (i.e., probation or parole status).

Results

Of those arrested, 44.8% met criteria for an SUD. However, only 14% of those arrested with an SUD received treatment in the year of their arrest. In multivariate modelling, arrest was an independent predictor of treatment admission (odds ratio (OR) = 8.74) similar in magnitude to meeting criteria for an SUD (OR = 8.22). Those further along the continuum – under supervision – were most likely to receive treatment (OR = 22.62).

Conclusion

Arrest involves the largest number of individuals entering the criminal justice system. The NSDUH suggests that nearly 6 million individuals in the US experience an arrest annually and that nearly half meet criteria for an SUD. Although arrest involves the largest number of individuals entering the criminal justice system, it is also the most fleeting point as individuals can move in and out rather quickly. Minimally, arrest imposes contact between the individual and a law enforcement person and can be an opportunity for early intervention strategies such as pre-arraignment diversion into treatment or brief intervention strategies. Using brief intervention at this early point in the continuum may motivate a greater number of individuals to seek treatment or decrease drug and alcohol use. Training and procedural shifts at this point of contact could have important policy implications in reducing the number of subsequent arrests or preventing individuals moving further along the criminal justice continuum, as well as decreasing the fiscal and resource burdens associated with criminal justice processing and confinement.

Characteristics of U.S. substance abuse treatment facilities adopting buprenorphine in its initial stage of availability

This study examined the adoption of buprenorphine for the treatment of opiate dependence among U.S. substance abuse treatment facilities and their characteristics at the time of the initial availability of the medication. Data come from a 2003 national survey of all substance abuse treatment facilities in the U.S. Out of our sample of 13,060 facilities, 5.5% of facilities reported they offered buprenorphine. Not unexpectedly, the prevalence was higher in certified opioid treatment programs (11.3%) compared to other facilities (4.6%). For opioid treatment programs, offering Naltrexone (OR=8.34, 95% CI=5.53, 12.58) and offering medically supervised withdrawal (OR=2.76, 95% CI=1.38, 5.52) were independent and robust predictors of offering buprenorphine. These same variables were independent predictors for the non-opioid treatment programs as well (Naltrexone, OR=14.32, 95% CI=7.85, 26.10; and medically supervised withdrawal services, OR=4.42, 95% CI=3.01, 6.49). Our results suggest that the adoption of buprenorphine soon after the Food and Drug Administration approved its use for treatment of opioid dependence and the shipping of the medication commenced was associated with facilities already offering pharmacotherapies such as Naltrexone and medically assisted withdrawal. These findings provide baseline data to track the adoption of buprenorphine by substance abuse treatment programs in future years.