For pediatricians and parents, one of the most important tools is decidedly low tech. The growth chart, a simple graph of the trajectory of the normal range of height, weight, and head circumference across age, is a vital tool for detecting problems in development. Even when a child is in the normal range, identifying a change from the 80 th percentile at age 6 to the 20 th percentile at age 8 can indicate a problem.

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Opioid abuse is reaching epidemic proportions in the United States. The consequences of opioid abuse and dependence include emergency department visits, premature death, HIV, hepatitis, criminal activity, lost workdays, and economic costs that in the United States exceed $56 billion annually. Agonist maintenance is the most efficacious treatment for opioid dependence and dramatically reduces morbidity, mortality, and spread of infectious disease

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Abstract: Background: For pathological gambling (PG) a 12 month prevalence rate of up to 0.66% has been reported. Multiple financial, occupational and relationship problems and losses, humiliation of the person and the environment are possible side effects and may lead to hopelessness, suicidal ideation and behaviour. Suicide attempt rates among pathological gamblers of between 4 and 40% and suicidal ideation of between 12 and 92% have been reported.Aim: This study aims at assessing the prevalence of suicide attempts in PG and at elucidating differences between the patients with and without suicide attempt history (SAH) in a large nationwide Austrian sample.Methods: Between 2002 and 2011 the Austrian Society for the Research of Non-Substance Related Addiction collected 862 questionnaires of pathological gamblers undergoing outpatient and inpatient treatment for pathological gambling in Austria.Results: 1) Of all pathological gamblers 9.7% had a suicide attempt history

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Blazer discusses independent research by early investigators.

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Importance Psychosis-risk studies have examined help-seeking adolescents and young adults. Population-based studies evaluating psychotic symptoms and neurocognitive performance across childhood are needed for “growth charting” cognitive development.

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Abstract: Objective: This study aimed to identify primary care practice characteristics associated with the quality of depression care in patients with comorbid chronic medical and/or psychiatric conditions.Method: Using data from cross-sectional organizational and patient surveys conducted within 61 primary care clinics in Quebec, Canada, the relationships between primary care practice characteristics, comorbidity profile, and the recognition and minimally adequate treatment of depression were assessed using multilevel logistic regression analysis with 824 adults with past-year depression and comorbid chronic conditions.Results: Likelihood of depression recognition was higher in clinics where accessibility of mental health professionals was not viewed to be a major barrier to depression care (OR=1.61; 95% CI 1.13-2.30). Four practice characteristics were associated with minimal treatment adequacy: greater use of treatment algorithms for depression (OR=1.77; 95% CI=1.18-2.65), high value given to teamwork (OR=2.48; 95% CI=1.40-4.38), having at least one GP at the clinic devote significant time in practice to mental health (OR=1.54; 95% CI=1.07-2.21), and low perceived barriers to depression care due to inadequate payment models (OR=2.12; 95% CI=1.30-3.46).Conclusions: Several primary care practice characteristics significantly influence the quality of care provided to patients with depression and comorbid chronic conditions and should be targeted in quality improvement efforts.

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More than 38, 000 Americans died by suicide in 2010, the most recent year for which we have national data. This makes suicide, once again, the tenth leading cause of death for all ages; the second leading cause of death for young adults ages 25 to 34. 1 Despite changes in recent decades that might reasonably have been expected to reduce suicide rates—increased awareness about mental disorders, the availability of treatment, and community-based public health efforts aimed directly at preventing suicide—U.S.

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Growing evidence supports the hypothesis that epigenetics is a key mechanism through which environmental exposures interact with an individual’s genetic constitution to determine risk for depression throughout life. Epigenetics, in its broadest meaning, refers to stable changes in gene expression that are mediated via altered chromatin structure without modification of DNA sequence. According to this hypothesis, severe stress triggers changes—in vulnerable individuals—in chromatin structure at particular genomic loci in the brain’s limbic regions, which drive sustained changes in gene expression that contribute to episodes of depression

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In this issue of JAMA Psychiatry , Gur et al evaluated differences in age-related neurocognitive test performance and psychosis symptoms in the context of a large population-based cohort. The rationale for this study grew out of observations that psychotic symptoms are relatively common in the general population and that individuals who have had a recent emergence of psychoticlike symptoms, but of subpsychotic intensity, are at increased risk for progressing to full psychosis within a few years of ascertainment. Given that such prodromal cases show neurocognitive deficits similar to those observed in first-episode schizophrenia, the Gur et al study sought to extend evidence of this link to participants with psychotic symptoms as ascertained through primary care, independently of seeking treatment for psychiatric indications.

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Abstract: Objective: In psychiatry, pain disorders not explained by structural lesions have been classified for decades as somatoform pain disorders, the underlying concept being somatization. In a parallel move, somatic medicine has defined an expanding group of similar pain disorders, known as functional pain syndromes.

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