Current psychiatry reports
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Substance use disorders are a large public health problem in the United States. Over the past decade, there has been a trend of increased prescription drug misuse, morbidity, and mortality related to prescription opioids. ⋯ Acute, chronic, and palliative each present distinct issues in pain treatment. A best practices model of pain treatment, including risk stratification and integrative treatment, may provide the best prospect for safe and effective treatment.
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Bereavement, one of life's most difficult experiences, usually triggers acute grief with yearning and longing for the deceased person that is often intense and preoccupying, along with frequent thoughts and memories of the person who died and relatively little interest in anything unrelated to the deceased loved one. Anxiety is a very common feature of grief that is often neglected. ⋯ In addition, loss of a loved one can trigger the onset of a DSM-IV anxiety disorder that, when present, can derail the mourning process and prolong acute grief. Bereavement-related anxiety disorders need to be recognized and treated.
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Curr Psychiatry Rep · Oct 2011
ReviewBarriers to use of pharmacotherapy for addiction disorders and how to overcome them.
Substance use disorders are highly prevalent, debilitating conditions for which effective pharmacotherapies exist with a broad evidence base, yet pharmacotherapy for the treatment of addiction disorders is underutilized. The goals of this review are to describe the barriers that may contribute to poor adoption and utilization of pharmacotherapy for alcohol and opioid dependence at the system, provider, and patient level and to discuss ways to overcome those barriers. ⋯ Strategies to promote adoption of pharmacotherapy for addiction disorders should be modified to fit the needs of the practice, system, and individual patients. Pharmacotherapy is a valuable tool in the clinical armamentarium of addiction treatment; thus, overcoming barriers to implementation may improve clinical and social outcomes.
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Curr Psychiatry Rep · Aug 2011
ReviewCurrent status of deep brain stimulation for obsessive-compulsive disorder: a clinical review of different targets.
Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder that affects 2% of the general population. Despite optimal cognitive-behavioral and pharmacologic therapy, approximately 10% of patients remain treatment resistant. Currently, deep brain stimulation (DBS) is being investigated as an experimental therapy for treatment-refractory OCD. ⋯ The frequency of adverse events seems to be limited. Larger prospective studies including neuroimaging are needed to estimate adequately the true potential of DBS in treatment of OCD and to elucidate its underlying mechanism of action and optimal brain target. We conclude that DBS may be a promising and safe therapy for treatment-resistant OCD.
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Curr Psychiatry Rep · Feb 2011
ReviewPost-traumatic stress disorder in medical settings: focus on the critically ill.
The relevance of the post-traumatic stress disorder (PTSD) concept to medically ill patients is becoming increasingly clear. Some medical conditions (e.g., rheumatologic diseases) are likely related to PTSD indirectly. Others, such as myocardial infarction and critical illness/intensive care unit (ICU) treatment, are likely traumatic stressors. ⋯ PTSD is particularly common among survivors of critical illness and ICU treatment. Further research is needed to determine how specific ICU interventions (e.g., administration of benzodiazepines, corticosteroids, and catecholamines) affect PTSD risk. In the meantime, given the negative impact of PTSD on patients' quality of life, it is important for psychiatrists and other clinicians to be aware of the syndrome in survivors of critical illness so as to ensure that such patients receive the care that they deserve.