scholarly journals Pragmatic neuroscience for clinical psychiatry

2019 ◽  
Vol 215 (01) ◽  
pp. 404-408 ◽  
Author(s):  
J. Douglas Steele ◽  
Martin P. Paulus
Keyword(s):  
Mental Health ◽  
Machine Learning ◽  
Substance Use ◽  
Clinical Practice ◽  
Routine Clinical Practice ◽  
Pragmatic Approach ◽  
And Training ◽  
Program Grant ◽  
Significant Mortality

SummaryMental health and substance use disorders are the leading cause of long-term disability and a cause of significant mortality, worldwide. However, it is widely recognised that clinical practice in psychiatry has not fundamentally changed for over half a century. The Royal College of Psychiatrists is reviewing its trainee curriculum to identify neuroscience that relates to psychiatric practice. To date though, neuroscience has had very little impact on routine clinical practice. We discuss how a pragmatic approach to neuroscience can address this problem together with a route to implementation in National Health Service care. This has implications for altered funding priorities and training future psychiatrists. Five training recommendations for psychiatrists are identified.Declaration of interestJ.D.S. receives direct funding from MRC Program Grant MR/S010351/1 aimed at developing machine learning-based methods for routinely acquired NHS data and indirect funding from the Wellcome Trust STRADL study. M.P.P. receives payments for an UpToDate chapter on methamphetamine and is principal investigator on the following grants: NIGMS P20GM121312 and NIDA U01 DA041089 and receives support from the William K. Warren Foundation.

Development and Implementation of the ‘Clinical Assessment Summary’ for Providing Continuous Clinical Information

2003 ◽  
Vol 11 (3) ◽  
pp. 302-305 ◽  
Author(s):  
John Reilly ◽  
Annette Greenwood ◽  
Samuel Margis ◽  
Devapriya Rudolph
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Mental Health Service ◽  
Clinical Assessment ◽  
Implementation Process ◽  
Clinical Information ◽  
Discharge Summary ◽  
Routine Clinical Practice ◽  
Successful Implementation ◽  
And Training

Objective: To describe the development and implementation of a typed ‘continuous’ clinical summary, with a longitudinal formulation and modular episode-based summaries. Methods: Outline of rationale for this form of summary and the implementation process. Results: Despite identified technical and training difficulties, over 3000 clinical assessment summary documents have been created with successful implementation across a mental health service. Conclusions: A typed continuous summary offers many advantages over a traditional discharge summary and can be implemented in routine clinical practice.

scholarly journals Mental health, substance use disorder, and opioid uses disorder: updates and strategies for treatment

2021 ◽  
Vol 17 (3) ◽  
pp. 88-100
Author(s):  
Rebecca Owens ◽  
Maxine Smalling ◽  
Joyce Fitzpatrick
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Substance Use Disorder ◽  
Health Professionals ◽  
Multifaceted Approach ◽  
Medication Noncompliance ◽  
Adequate Care ◽  
And Training ◽  
Relapse Rates

Objective: to describe the main strategies to deal with gaps in the identification, treatment and training regarding substance use disorder (SUD), and opioid uses disorder (OUD). Method: this is a narrative review, based on recent articles and publications on mental health and substance use recognized internationally. Results: a prevalence of co-occurring substance use and mental health/psychiatric disorders continue to rise and are considered complex problems, with multifaceted treatment challenges including medical conditions, disabilities, homelessness, medication noncompliance, and high relapse rates. The treatment for SUD and OUD are complex. The co-occurrence of these two disorders require a multifaceted approach for the diagnosis and treatment. Conclusion: the prevalence of SUD, OUD and their co-occurrence continue to rise and nurses and other health professionals should be prepared to diagnose, treat and/or refer users to assure their adequate care and long term recovery.

scholarly journals Personalized management of differentiated thyroid cancer in real life – practical guidance from a multidisciplinary panel of experts

Endocrine ◽  
2020 ◽  
Vol 70 (2) ◽  
pp. 280-291
Author(s):  
Alfredo Campennì ◽  
Daniele Barbaro ◽  
Marco Guzzo ◽  
Francesca Capoccetti ◽  
Luca Giovanella
Keyword(s):  
Nuclear Medicine ◽  
Thyroid Cancer ◽  
Clinical Practice ◽  
Molecular Imaging ◽  
Routine Clinical Practice ◽  
Whole Body ◽  
Neck Ultrasound ◽  
Long Term Follow Up

Abstract Purpose The standard of care for differentiated thyroid carcinoma (DTC) includes surgery, risk-adapted postoperative radioiodine therapy (RaIT), individualized thyroid hormone therapy, and follow-up for detection of patients with persistent or recurrent disease. In 2019, the nine Martinique Principles for managing thyroid cancer were developed by the American Thyroid Association, European Association of Nuclear Medicine, Society of Nuclear Medicine and Molecular Imaging, and European Thyroid Association. In this review, we present our clinical practice recommendations with regard to implementing these principles in the diagnosis, treatment, and long-term follow-up of patients with DTC. Methods A multidisciplinary panel of five thyroid cancer experts addressed the implementation of the Martinique Principles in routine clinical practice based on clinical experience and evidence from the literature. Results We provide a suggested approach for the assessment and diagnosis of DTC in routine clinical practice, including the use of neck ultrasound, measurement of serum thyroid-stimulating hormone and calcitonin, fine-needle aspiration, cytology, and molecular imaging. Recommendations for the use of surgery (lobectomy vs. total thyroidectomy) and postoperative RaIT are also provided. Long-term follow-up with neck ultrasound and measurement of serum anti-thyroglobulin antibody and basal/stimulated thyroglobulin is standard, with 123/131I radioiodine diagnostic whole-body scans and 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography suggested in selected patients. Management of metastatic DTC should involve a multidisciplinary team. Conclusions In routine clinical practice, the Martinique Principles should be implemented in order to optimize clinical management/outcomes of patients with DTC.

scholarly journals Understanding the interplay of individual and social–developmental factors in the progression of substance use and mental health from childhood to adulthood

2016 ◽  
Vol 28 (3) ◽  
pp. 721-741 ◽  
Author(s):  
Tiffany M. Jones ◽  
Karl G. Hill ◽  
Marina Epstein ◽  
Jungeun Olivia Lee ◽  
J. David Hawkins ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Social Environments ◽  
Developmental Factors ◽  
Substance Use Problems ◽  
History Of ◽  
Individual Functioning ◽  
Family History Of Depression ◽  
History Of Depression

AbstractThis study examines the interplay between individual and social–developmental factors in the development of positive functioning, substance use problems, and mental health problems. This interplay is nested within positive and negative developmental cascades that span childhood, adolescence, the transition to adulthood, and adulthood. Data are drawn from the Seattle Social Development Project, a gender-balanced, ethnically diverse community sample of 808 participants interviewed 12 times from ages 10 to 33. Path modeling showed short- and long-term cascading effects of positive social environments, family history of depression, and substance-using social environments throughout development. Positive family social environments set a template for future partner social environment interaction and had positive influences on proximal individual functioning, both in the next developmental period and long term. Family history of depression adversely affected mental health functioning throughout adulthood. Family substance use began a cascade of substance-specific social environments across development, which was the pathway through which increasing severity of substance use problems flowed. The model also indicated that adolescent, but not adult, individual functioning influenced selection into positive social environments, and significant cross-domain effects were found in which substance-using social environments affected subsequent mental health.

Consequences of prenatal substance use

2012 ◽  
Vol 24 (2) ◽  
Author(s):  
Thitinart Sithisarn ◽  
Don T. Granger ◽  
Henrietta S. Bada
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Behavioral Problems ◽  
Drug Exposure ◽  
Public Health Problem ◽  
Child And Adolescent ◽  
In Utero ◽  
Major Public Health Problem ◽  
Prenatal Substance Use

Abstract Background: Prenatal substance use is a major public health problem and a social morbidity, with consequences on the drug user and the offspring. Objective: This review focuses on the child and adolescent outcomes following in utero drug exposure. Methods: Studies on the effects of specific substances, legal and illegal; i.e., tobacco or nicotine, alcohol, marijuana, cocaine, opiates, and methamphetamine were evaluated and analyzed. Results: In general, manifestations of prenatal exposure to legal and illegal substances include varying deficits in birth anthropometric measurements, mild-to-moderate transient neurobehavioral alterations in infancy and long-term behavioral problems noted from early childhood to adolescence. Severity of expression of behavioral problems is influenced by environmental factors. Further, behavioral alterations following in utero drug exposure often exist with mental health co-morbidities. Conclusion: Because of the long-term consequences of prenatal drug exposure on child and adolescent mental health, health providers need to promote substance use prevention, screen for exposure effects and provide or refer affected youths for intervention services. Preventive measures and treatment should consider other factors that may further increase the risk of psychopathology in the exposed children.

scholarly journals Psychiatry in the future

2004 ◽  
Vol 28 (8) ◽  
pp. 277-278
Author(s):  
Frank Holloway
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Evidence Based Medicine ◽  
Cochrane Collaboration ◽  
Routine Clinical Practice ◽  
Evidence Based ◽  
Policy Makers ◽  
The Future ◽  
The Cochrane Collaboration ◽  
Based Medicine

In an era of evidence-based medicine, policy-makers and researchers are preoccupied by the task of ensuring that advances in research are implemented in routine clinical practice. This preoccupation has spawned a small but growing research industry of its own, with the development of resources such as the Cochrane Collaboration database and journals such as Evidence-Based Mental Health. In this paper, I adopt a philosophically quite unfashionable methodology – introspection – to address the question: how has research affected my practice?

scholarly journals Lipodystrophy syndrome in HIV-infected children on HAART

2009 ◽  
Vol 10 (4) ◽  
pp. 76 ◽  
Author(s):  
Steve Innes ◽  
Leon Levin ◽  
Mark Cotton
Keyword(s):  
Clinical Practice ◽  
Early Detection ◽  
Nucleoside Reverse Transcriptase Inhibitor ◽  
Fat Distribution ◽  
Transcriptase Inhibitor ◽  
Routine Clinical Practice ◽  
Lipodystrophy Syndrome ◽  
Practical Guidelines ◽  
Reverse Transcriptase Inhibitor

Lipodystrophy Syndrome (LD) is common in HIV-infected children, particularly in those taking Didanosine, Stavudine, or Zidovudine. Lipoatrophy in particular causes major stigmatization and interferes with adherence. In addition, LD may have significant long-term health consequences, particularly cardiovascular. Since the stigmatizing fat distribution changes of LD are largely permanent, the focus of management remains on early detection and arresting progression. Practical guidelines for surveillance and avoidance of LD in routine clinical practice are presented. Diagnosis of LD is described and therapeutic options are reviewed. The most important therapeutic intervention is to switch the most likely offending antiretroviral to a non-LD-inducing agent as soon as LD is recognised. Typically, where lipoatrophy or lipohypertrophy is diagnosed, the thymidine nucleoside reverse transcriptase inhibitor (NRTI) is switched to a non-thymidine agent such as Abacavir (or Tenofovir in adults). Where dyslipidaemia is predominant, a dietician review is helpful, and the clinician may consider switching to a protease inhibitor (PI)-sparing regimen or to Atazanavir.

Becoming Licensed Means That I Am Now Competent

2019 ◽  
pp. 7-11
Author(s):  
Jeffrey E. Barnett ◽  
Jeffrey Zimmerman
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Clinical Competence ◽  
Education And Training ◽  
Hard Work ◽  
Mental Health Clinicians ◽  
Clinical Experiences ◽  
Graduate Coursework ◽  
And Training ◽  
Over Time

Mental health clinicians invest in many years of hard work to develop their clinical competence through graduate coursework and through supervised clinical experiences. All this is done with the ultimate goal of becoming independently licensed to practice in one’s profession. Because licensure is such an important event, signifying the culmination of so much education and training, it may be natural to believe that becoming licensed means that one is now clinically competent. This chapter addresses how clinical competence and licensure should be viewed and understood. Licensure assesses one’s competence to enter the profession, but it cannot guarantee competence in all areas of clinical practice at the time of licensure or in the future. How to maintain, update, and expand one’s competence over time is addressed. Risks and threats to competence are discussed, and recommendations are provided for ensuring one’s ongoing competence over time.

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