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Drug abuse and its consequences remain a significant public health issue. An increasing number of individuals are present in the emergency room with life-threatening drug intoxication. It is imperative that emergency room physicians are cognizant of the signs, symptoms, and treatment to improve the chances of early recognition and treatment. As a result, the proportion of lives saved will increase significantly. In this article, we present some of the most prevalent life-threatening drugs that lead to emergency room admission. The signs, symptoms, and treatment modalities are discussed.

The provision of good quality and cost effective mental healthcare remains a significant public health issue. The objective of this study was to improve the transition from inpatient to outpatient aftercare services, thereby reducing readmission rates. A total of 1,707 patients in acute inpatient psychiatry units participated in the intervention program over a period of 12 months. The readmission was reduced by 27 percent (9.54% to 6.95%, p = 0.004). The data suggest that these modalities significantly lower readmission rates and therefore improve the cost effectiveness and quality of mental health care.

The utilization of restraints is an important quality measure of psychiatric services including the emergency and inpatient services. The practice, however, continues to generate controvers...

This study explores socio-demographic characteristics of individuals with history of crack cocaine use. Data from the 29th Round of General Social Survey was used. Respondents with history of crack cocaine use were compared to respondents without such history. T test was applied to identify differences between groups. Approximately 6 % of respondents reported lifetime history of crack cocaine use. Groups with and without history of crack cocaine use differed significantly in gender, marital status, education, income distribution, employment, health perception, family and financial satisfaction, criminal history, happiness, sexual history, history of injection drug use, and HIV testing. There were no significant differences for race. The study provides insights that could improve identification and prevention of substance use disorders.

Introduction Reduction of aggression rate is a major challenge in acute inpatient psychiatric units and may adversely affect the wellbeing of both staff and patients The lifetime risk for assault on nurses working on inpatient psychiatric units has been reported to be approximately The efficacy of current risk assessment strategies in lowering incidence of violence on acute inpatient psychiatry units is still unclear Methods Electronic Medical Records were retrospectively reviewed for violent and aggressive incidents reported by the staff over a six month period in acute inpatient adult psychiatry units Results A total of aggressive incidents were reported of which were patient on patient and patient on staff The highest risk factors for being involved in an aggressive incident included a male gender b schizoaffective and schizophrenia diagnosis c substance use disorder Approximately of patients involved in aggressive actions had a secondary diagnosis of substance use disorders Conclusion The data suggest that the majority of aggressive behaviors on inpatient units are patient on patient At least of the individuals involved in aggressive behavior have a secondary diagnosis of substance use disorder

Psychogenic polydipsia is a common problem in patients with chronic schizophrenia with prevalence rates varying from 5%-10%. No definitive treatment guidelines exist for pharmacological treatment of psychogenic polydipsia. There have been conflicting reports on antipsychotics causing and being used for treatment of polydipsia. We report a unique case of a 53 year old patient presenting with schizophrenia with catatonic features and psychogenic polydipsia treated with Clozapine. Dramatic improvement was seen not only in the polydipsia and correction of hyponatremia but also in catatonic behavior within few weeks. Clozapine may be a possible alternative option for patients presenting with catatonia and psychogenic polydipsia especially in settings where there is no availability for Electroconvulsive therapy (ECT).

More than 35,000 individuals are estimated to have responded to the World Trade Center (WTC) site following the terrorist attacks of September 11, 2001. The federally funded WTC Medical Monitoring and Treatment Program (WTCMMTP) provides medical monitoring and occupational medicine treatment as well as counseling regarding entitlements and benefits to the workers and volunteers who participated in the WTC response. A major component of the WTCMMTP is the WTC Mental Health Program (WTCMHP), which offers annual mental health assessments and ongoing treatment for those found to have 9/11 associated mental health problems. In the program's 9.5 years of evaluating and treating mental health problems in thousands of Ground Zero responders, diversity in multiple domains (e.g., gender, family, profession and employment status, state of physical health, cultural identity, and immigration status) has been a hallmark of the population served by the program. To illustrate the types of issues that arise in treating this diverse patient population, the authors first present a representative case involving a Polish asbestos worker with an alcohol use disorder. They then discuss how accepted alcohol treatment modalities can and often must be modified in providing psychiatric treatment to Polish responders, in particular, and to foreign-born patients in general. Treatment modalities discussed include cognitive and behavioral therapy, relapse prevention strategies, psychodynamic therapy, motivational approaches, family therapy, group peer support, and pharmacotherapy. Implications for the practice of addiction psychiatry, cultural psychiatry, and disaster psychiatry are discussed.

A 14-week double blind study compared the efficacy of olanzapine to risperidone in reducing marijuana/cocaine craving and use in individuals with schizophrenia. The study consisted of three phases: a two-week assessment phase, a two-week cross-taper phase onto olanzapine/risperidone, and a ten-week period of maintenance on olanzapine/risperidone. The proportion of cocaine-positive urines decreases over time for both groups with a trend for a greater reduction for the olanzapine group compared to risperidone group. In the last six weeks, marijuana craving was more likely for the risperidone group compared to the olanzapine group, although there was no group difference in the proportion of negative marijuana urines. The data suggest some potential for the utility of olanzapine for the treatment of cocaine dependence in individuals with schizophrenia.

There is a noticeable lack of targeted treatment options for marijuana dependence, in particular pharmacologic approaches. This is the first study evaluating a targeted pharmacologic approach for marijuana dependence. The goals of the study were to determine if such patients would seek pharmacologic treatment, whether these patients could be retained in treatment using a design previously developed for cocaine-dependent patients, and especially whether divalproex sodium showed promise as a treatment agent for marijuana dependence. We found that marijuana-dependent patients will seek treatment, and such patients can be adequately maintained in a pharmacologic trial. Regardless of treatment group, patients reported a significant reduction in their frequency and amount of marijuana use as well as a reduction in irritability. Given the lack of proven effective treatments for marijuana dependence, pharmacotherapies should be sought. The design of a preliminary clinical trial should include a psychosocial/behavioral intervention emphasizing motivation and medication compliance and a placebo control group.

Substance use in the general population is a significant public health problem. Problems associated with substance use are aggravated by concomitant psychiatric illness, particularly schizophrenia and schizoaffective disorder. Although there is a general agreement on the need to address this problem, a wide range of opinions exists on exactly what is the best modality. In this article, we provide a brief overview of the etiology and consequences of substance use in individuals with schizophrenia, followed by a more detailed review of pharmacological and psychotherapeutic trends in the treatment of this population. Research studies indicate that, while some evidence supports the self-medication hypothesis, individuals with schizophrenia or schizoaffective disorder frequently use substances for the same reasons and in the same manner as the general population. In the pharmacotherapy section, we briefly discuss the rationale for current medication strategies, their efficacy, and directions for future research. This is followed by an assessment of current psychotherapeutic interventions, their limitations, and potential modifications to improve treatment outcome. The research literature suggests that integrated treatment and well-tailored interventions that take into account psychosocial factors and motivation offer the most promise for the future. More controlled trials are necessary to validate this hypothesis.