Importance No highly effective interventions to prevent delirium have been identified. Objective To examine whether ramelteon, a melatonin agonist, is effective for the prevention of delirium. Design, Setting, and Participants A multicenter, rater-blinded, randomized placebo-controlled trial was performed in intensive care units and regular acute wards of 4 university hospitals and 1 general hospital
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.
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
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.
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.
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.
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.
Importance Pediatric anxiety disorders are highly prevalent and impairing and are considered gateway disorders in that they predict adult psychiatric problems. Although they can be effectively treated in the short term, data are limited on the long-term outcomes in treated children and adolescents, particularly those treated with medication.
Abstract: Objectives: This study investigates the possibility of introducing depression and developmental screening tools into the National Programme on Immunization (NPI) in southeast Nigeria. The specific objectives were to determine the prevalence of postpartum depression (PPD) among mothers attending immunization clinics and to assess the association of maternal PPD and infant growth in relation to World Health Organization (WHO) recommendations.Methods: Four hundred and eight (408) mothers completed the sociodemographic questionnaire and the self-report Edinburgh Postnatal Depression Scale (EPDS).
Abstract: Purpose: The purpose of the study was to compare behavioral outcomes (physical activity, sedentary behavior, smoking cessation, diet) between the intervention and usual care conditions from the TEAMcare trial.Methods: TEAMcare was a randomized trial among 214 adults with depression and poorly controlled diabetes and/or coronary heart disease that promoted health behavior change and pharmacotherapy to improve health. Behavioral outcomes were measured with the International Physical Activity Questionnaire (physical activity, sitting time) and the Summary of Diabetes Self-Care Activities Measure (smoking, diet, exercise).