Early Psychosis: Diagnosis and Treatment

2020 ◽  
Vol 09 ◽  
Author(s):  
Nataly S. Beck ◽  
Melanie L. Lean ◽  
Kate V. Hardy ◽  
Jacob S. Ballon
Keyword(s):  
United States ◽  
Early Identification ◽  
Mental Health Problems ◽  
The United States ◽  
Early Psychosis ◽  
Screening Tools ◽  
Diagnosis And Treatment ◽  
First Episode ◽  
Psychotic Episode ◽  
First Onset

Background: The typical age of onset for psychotic disorders is concurrent with the typical age of enrollment in higher education. College and graduate students often experience new academic and social demands that may leave them vulnerable to substance use and mental health problems, including the initial onset of a psychotic episode. Objective: To provide a current overview of the guidelines and literature for the diagnosis and treatment of first-onset psychosis with special consideration for the college and graduate student population in the United States. To highlight areas of need and provide recommendations for clinicians who work at educational institutions and their health services, along with general psychiatrists and psychologists who work with post-secondary education populations, to help close the treatment gap. Method: A review of interventions and best practice for the treatment of early psychosis in college students was conducted, informed by the authors’ current experience as clinicians with this population at a United States university. Results: Thorough psychiatric interviews and screening tools can help in the early identification of individuals at clinical high risk for and at first onset of psychosis. Coordinated specialty care services are the gold standard for early psychosis services, including psychotherapy (such as cognitive behavioral therapy and individual resiliency training), as well as support for a student to return to school or work. Individuals experiencing a first episode of psychosis in general respond better to lower doses of antipsychotics and may also experience more adverse effects. Conclusion: Return to a high level of functioning is possible in many cases of first onset of psychosis, and early identification and treatment is essential.

Clinical Characteristics of Patients Diagnosed with Strongyloidiasis in a United States Urban Outpatient Dermatology Department: A Case Series

2017 ◽  
Vol 1 (3) ◽  
pp. 156-160
Author(s):  
Jacqueline Watchmaker ◽  
Sean Legler ◽  
Dianne De Leon ◽  
Vanessa Pascoe ◽  
Robert Stavert
Keyword(s):  
United States ◽  
Case Series ◽  
The United States ◽  
Screening Tools ◽  
Dermatology Department ◽  
Cutaneous Manifestations ◽  
Serologic Testing ◽  
Patient Reported ◽  
History Of ◽  
Endemic Areas

Background: Although considered a tropical disease, strongyloidiasis may be encountered in non-endemic regions, primarily amongst immigrants and travelers from endemic areas.  Chronic strongyloides infection may be under-detected owing to its non-specific cutaneous presentation and the low sensitivity of commonly used screening tools. Methods: 18 consecutive patients with serologic evidence of strongyloides infestation who presented to a single urban, academic dermatology clinic between September 2013 and October 2016 were retrospectively included.  Patient age, sex, country of origin, strongyloides serology titer, absolute eosinophil count, presenting cutaneous manifestations, and patient reported subjective outcome of pruritus after treatment were obtained via chart review.  Results: Of the 18 patients, all had non-specific pruritic dermatoses, 36% had documented eosinophila and none were originally from the United States. A majority reported subjective improvement in their symptoms after treatment. Conclusion:  Strongyloides infection and serologic testing should be considered in patients living in non-endemic regions presenting with pruritic dermatoses and with a history of exposure to an endemic area.Key Points:Chronic strongyloidiasis can be encountered in non-endemic areas and clinical manifestations are variableEosinophilia was not a reliable indicator of chronic infection in this case series Dermatologists should consider serologic testing for strongyloidiasis in patients with a history of exposure and unexplained pruritus

scholarly journals Understanding and Promoting Racial Diversity in Healthcare Settings to Address Disparities in Pandemic Crisis Management

2021 ◽  
Vol 12 ◽  
pp. 215013272110183
Author(s):  
Azza Sarfraz ◽  
Zouina Sarfraz ◽  
Alanna Barrios ◽  
Kuchalambal Agadi ◽  
Sindhu Thevuthasan ◽  
...  
Keyword(s):  
United States ◽  
Health Disparities ◽  
Racial Discrimination ◽  
Clinical Training ◽  
Minority Groups ◽  
Mental Health Problems ◽  
Minority Group ◽  
Healthcare Delivery ◽  
The United States ◽  
Majority Group

Background: Health disparities have become apparent since the beginning of the COVID-19 pandemic. When observing racial discrimination in healthcare, self-reported incidences, and perceptions among minority groups in the United States suggest that, the most socioeconomically underrepresented groups will suffer disproportionately in COVID-19 due to synergistic mechanisms. This study reports racially-stratified data regarding the experiences and impacts of different groups availing the healthcare system to identify disparities in outcomes of minority and majority groups in the United States. Methods: Studies were identified utilizing PubMed, Embase, CINAHL Plus, and PsycINFO search engines without date and language restrictions. The following keywords were used: Healthcare, raci*, ethnic*, discriminant, hosti*, harass*, insur*, education, income, psychiat*, COVID-19, incidence, mortality, mechanical ventilation. Statistical analysis was conducted in Review Manager (RevMan V.5.4). Unadjusted Odds Ratios, P-values, and 95% confidence intervals were presented. Results: Discrimination in the United States is evident among racial groups regarding medical care portraying mental risk behaviors as having serious outcomes in the health of minority groups. The perceived health inequity had a low association to the majority group as compared to the minority group (OR = 0.41; 95% CI = 0.22 to 0.78; P = .007), and the association of mental health problems to the Caucasian-American majority group was low (OR = 0.51; 95% CI = 0.45 to 0.58; P < .001). Conclusion: As the pandemic continues into its next stage, efforts should be taken to address the gaps in clinical training and education, and medical practice to avoid the recurring patterns of racial health disparities that become especially prominent in community health emergencies. A standardized tool to assess racial discrimination and inequity will potentially improve pandemic healthcare delivery.

scholarly journals Mortality after a First Episode of Status Epilepticus in the United States and Europe

Epilepsia ◽  
2005 ◽  
Vol 46 (s11) ◽  
pp. 46-48 ◽  
Author(s):  
Giancarlo Logroscino ◽  
Dale C. Hesdorffer ◽  
Gregory Cascino ◽  
W. Allen Hauser ◽  
Alessandra Coeytaux ◽  
...  
Keyword(s):  
United States ◽  
Status Epilepticus ◽  
The United States ◽  
First Episode

scholarly journals CATalyst for Change: How Members of WellSpan’s Central Alert Team (CAT) Are Revolutionizing Sepsis Care

2021 ◽  
pp. 74-79
Author(s):  
Caitlyn Allen
Keyword(s):  
United States ◽  
Decision Support ◽  
Early Identification ◽  
Clinical Decision ◽  
The United States ◽  
Mortality Rates ◽  
Bundle Compliance ◽  
The Cost ◽  
State 1 ◽  
Sepsis Care

In the United States, almost 1 million patients with sepsis are admitted to hospitals annually, and the cost of managing sepsis admissions is higher than any other disease state.1 Early identification and treatment are critical for survival, though both are notoriously difficult as symptoms are often nonspecific. Four years ago, WellSpan Health asked, “What if there were a way to provide real-time, meaningful clinical decision support to bedside providers to identify sepsis sooner and start lifesaving treatment?” Meet Margaret D’Ercole, Patricia Everett, Dana Gaultney, Angela Mays, Brenna Simcoe, and Cynthia Yascavage, who share how their Central Alert Team decreased mortality rates, increased bundle compliance, and proved there is a better way.

scholarly journals Seasonal Allergies and Psychiatric Disorders in the United States

2018 ◽  
Vol 15 (9) ◽  
pp. 1965 ◽  
Author(s):  
Hans Oh ◽  
Ai Koyanagi ◽  
Jordan DeVylder ◽  
Andrew Stickley
Keyword(s):  
Mental Health ◽  
United States ◽  
Eating Disorders ◽  
Substance Use ◽  
Psychiatric Disorders ◽  
Mood Disorders ◽  
Substance Use Disorders ◽  
Mental Health Problems ◽  
The United States ◽  
Seasonal Allergies

Seasonal allergies have been associated with mental health problems, though the evidence is still emergent, particularly in the United States. We analyzed data from the National Comorbidity Survey Replication and the National Latino and Asian American Survey (years 2001–2003). Multivariable logistic regression models were used to examine the relations between lifetime allergies and lifetime psychiatric disorders (each disorder in a separate model), adjusting for socio-demographic variables (including region of residence) and tobacco use. Analyses were also stratified to test for effect modification by race and sex. A history of seasonal allergies was associated with greater odds of mood disorders, anxiety disorders, and eating disorders, but not alcohol or substance use disorders, after adjusting for socio-demographic characteristics and tobacco use. The associations between seasonal allergies and mood disorders, substance use disorders, and alcohol use disorders were particularly strong for Latino Americans. The association between seasonal allergies and eating disorders was stronger for men than women. Seasonal allergies are a risk factor for psychiatric disorders. Individuals complaining of seasonal allergies should be screened for early signs of mental health problems and referred to specialized services accordingly.

Letter to the Editor

PEDIATRICS ◽  
1994 ◽  
Vol 94 (6) ◽  
pp. 952-954
Author(s):  
Martin S. Robinette
Keyword(s):  
United States ◽  
Hearing Loss ◽  
Hearing Impairment ◽  
Early Identification ◽  
Human Services ◽  
Large Degree ◽  
The United States ◽  
Healthy People ◽  
Health And Human Services ◽  
Department Of Health

The importance of early identification of hearing loss is summarized in the report issued by the United States (US) Department of Health and Human Services,1 entitled "Healthy People 2000." The goal is to reduce the average age at which children with significant hearing impairment are identified to no more than 12 months. The report states: The future of a child born with significant hearing impairment depends to a very large degree on early identification (ie, audiological diagnosis before 12 months of age) followed by immediate and appropriate intervention.

People Who Are Homeless

2019 ◽  
pp. 195-212
Author(s):  
Elizabeth M. Moore ◽  
Theresa H. Cheng ◽  
Roya Ijadi-Maghsoodi ◽  
Lillian Gelberg
Keyword(s):  
Mental Health ◽  
United States ◽  
Mental Health Problems ◽  
Healthcare Services ◽  
The United States ◽  
Health Problems ◽  
Direct Result ◽  
Extreme Cold ◽  
Psychological Impairment ◽  
Access To Food

An estimated 100 million people globally suffer from absolute homelessness. The estimated number of people who are homeless in the United States at any given point in time is about 550,000. Mortality and disease severity of people who are homeless far exceed those of the general population because of extreme poverty, delays in seeking medical care, nonadherence to therapy, substance use disorders, and psychological impairment. Many of their health problems, such as infections due to crowded living conditions in shelters, hypothermia from exposure to extreme cold, and malnutrition due to limited access to food and cooking facilities are a direct result of homelessness. This chapter addresses in detail infectious diseases, substance abuse, obesity, mental health problems, and causes of death in this population. It also addresses access to and use of healthcare services. It addresses the roots of and underlying issues related to these problems. Finally, it addresses what needs to be done.

scholarly journals Rates and Associated Factors of Secondary Mental Health Care Utilisation among Ex-Military Personnel in the United States: A Narrative Review

Healthcare ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 18 ◽  
Author(s):  
Katharine Mark ◽  
Dominic Murphy ◽  
Sharon Stevelink ◽  
Nicola Fear
Keyword(s):  
Mental Health ◽  
United States ◽  
Health Care ◽  
Mental Health Care ◽  
Military Personnel ◽  
Mental Health Problems ◽  
The United States ◽  
Health Care Utilisation ◽  
Narrative Review ◽  
Care Utilisation

Little is known about ex-serving military personnel who access secondary mental health care. This narrative review focuses on studies that quantitatively measure secondary mental health care utilisation in ex-serving personnel from the United States. The review aimed to identify rates of mental health care utilisation, as well as the factors associated with it. The electronic bibliographic databases OVID Medline, PsycInfo, PsycArticles, and Embase were searched for studies published between January 2001 and September 2018. Papers were retained if they included ex-serving personnel, where the majority of the sample had deployed to the recent conflicts in Iraq or Afghanistan. Fifteen studies were included. Modest rates of secondary mental health care utilisation were found in former military members—for mean percentage prevalence rates, values ranged from 12.5% for at least one psychiatric inpatient episode, to 63.2% for at least one outpatient mental health appointment. Individuals engaged in outpatient care visits most often, most likely because these appointments are the most commonly offered source of support. Post-traumatic stress disorder, particularly re-experiencing symptoms, and comorbid mental health problems were most consistently associated with higher mental health care utilisation. Easily accessible interventions aimed at facilitating higher rates of help seeking in ex-serving personnel are recommended.

Pregnant Victims of Intimate Partner Homicide in the National Violent Death Reporting System Database, 2003–2014: A Descriptive Analysis

2020 ◽  
pp. 088626052094372
Author(s):  
Penelope K. Morrison ◽  
Chelsea Pallatino ◽  
Rachel A. Fusco ◽  
Tanya Kenkre ◽  
Judy Chang ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
Reporting System ◽  
Mental Health Problems ◽  
The United States ◽  
Intimate Partner ◽  
Violent Death ◽  
Intimate Partner Homicide ◽  
Service Engagement ◽  
History Of

Intimate partner homicide (IPH) is a leading cause of maternal mortality in the United States. However, very little information exists as to the circumstantial factors associated with IPH during pregnancy. We conducted a descriptive study of the demographic characteristics, psychosocial service engagement, and crises experiences (i.e., life and relationship stressors) among pregnant and nonpregnant victims to understand what differences, if any, exist in their risk profile for IPH. Data from the Centers for Disease Control and Prevention’s National Violent Death Reporting System (NVDRS) were used for this study. The NVDRS is a national opt-in tracking system of all violent deaths in the United States. Pregnant victims ( N = 293) were significantly more likely to be 5 years younger than nonpregnant victims, African American, and never married. Pregnant victims were more likely to be seen in the emergency room following the fatal incident. Nonpregnant victims ( N = 2,089) were significantly more likely to have suspected alcohol use at the time of their death. In strictly proportional terms, we also observed higher rates of mental health problems, a history of mental health treatment, and a reported history of intimate partner violence (IPV), crisis, or family problems among nonpregnant victims. A wider range of IPH-related risk factors (e.g. substance abuse) need to be included IPV assessments. Future studies should seek to develop effective interventions to prevent IPH, particularly among reproductive aged women.

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