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African Immigrants in the United States account for a rapidly growing population of immigrants in the country, constituting about four percent of the foreign-born population. The group has seen a significant population increase from 881,300 in 2010 to 1,606,914 in 2010. African immigrants are however not a monolithic population, as this number and diversity increases, there continues to be a growing need for mental health professionals to assess the peculiar mental health care needs and practices of this population. The primary African immigrant groups in the United States include Nigerians, Ethiopians, Egyptians, Ghanaians, and Kenyans. The delivery of optimal mental health care to this population involves a thorough comprehension of factors that influence mental health in African Immigrant populations. Such factors include the ethno-cultural background of families, the diversity of religions, immigration status, socio-economic status, language, family and sibling subsystems, identity issues and various forms of mental health stigma. Due to the complexity of these socioeconomic and cultural nuances, the mental illness presented by adolescents and young adult Africans are often atypical and their treatment requires appropriate cultural competence by physicians and mental health professionals.

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...

The course is designed to train Humanitarian field staff in providing single-session psychotherapy in context of humanitarian situations. The participants of the course are expected to have basic background knowledge in mental health and psychotherapy. The course is typically focused on training of healthcare professionals providing counseling services in the field during humanitarian missions. Participants may include psychiatrists, psychologists, nurses, and clinical social workers. The course includes presentations of didactic material, clinical simulations and discussion based workshop. The course participants will acquire skills necessary to be able to do as follows: Identify individuals that are eligible for single session therapy; provide single-session psychotherapy in humanitarian situations; refer Individuals for additional help with appropriate tool kit. The theoretical part of the course (didactic presentation) requires around 45 min presentation followed by 30 min of question time. Cl...

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.

Objectives: The objective of this investigation was to characterize the pharmacokinetic profile of lofexidine. Lofexidine is an orally bioavailable α 2-adrenergic receptor agonist analogue of clonidine that acts centrally to suppress opiate withdrawal symptoms. Methods: During the detoxification period of a phase 3 placebo-controlled, randomized, double-blind trial, six subjects were entered in this preliminary pharmacokinetic study. Results: Pharmacokinetic analysis of plasma samples collected during study day 7 indicated that Cmax was 3242 ± 917 ng/L. The mean trough levels between the study days were not significantly different (p >. 05), suggesting that the subjects were at steady-state. Conclusions: Although preliminary due to the limited number of subjects, these findings are the first to document lofexidine clinical pharmacokinetics in opiate addicts using a highly sensitive liquid chromatography tandem mass spectrometric analysis.

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.

Context Lofexidine is an alpha-2-adrenergic receptor agonist that is approved in the United Kingdom for the treatment of opioid withdrawal symptoms. Lofexidine has been reported to have more significant effects on decreasing opioid withdrawal symptoms with less hypotension than clonidine. Objective To demonstrate that lofexidine is well tolerated and effective in the alleviation of observationally defined opioid withdrawal symptoms in opioid dependent individuals undergoing medically supervised opioid detoxification as compared to placebo. Design An inpatient, Phase 3, placebo-controlled, double-blind, randomized multi-site trial with three phases: (1) opioid agonist stabilization phase (days 1–3), (2) detoxification/medication or placebo phase (days 4–8), and (3) post detoxification/medication phase (days 9–11). Subjects Sixty-eight opioid dependent subjects were enrolled at three sites with 35 randomized to lofexidine and 33 to placebo. Main outcome measure Modified Himmelsbach Opiate Withdrawal Scale (MHOWS) on study day 5 (second opioid detoxification treatment day). Results Due to significant findings, the study was terminated early. On the study day 5 MHOWS, subjects treated with lofexidine had significantly lower scores (equating to fewer/less severe withdrawal symptoms) than placebo subjects (least squares means 19.5 ± 2.1 versus 30.9 ± 2.7; p = 0.0019). Lofexidine subjects had significantly better retention in treatment than placebo subjects (38.2% versus 15.2%; Log rank test p = 0.01). Conclusions Lofexidine is well tolerated and more efficacious than placebo for reducing opioid withdrawal symptoms in inpatients undergoing medically supervised opioid detoxification.

Opioid dependence is a growing public health problem. Maintenance on the antagonist naltrexone for clinic- or office-based treatment of opioid dependence is plagued by high rates of relapse. This paper identifies critical determinants of lapses to opioid use during naltrexone maintenance. Time retained in treatment was examined as a function of whether lapses to opioid use occurred while adherent to naltrexone (blocked use), or after having missed naltrexone doses (unblocked). Method Participants ( N = 83) met DSM-IV criteria for opioid dependence and identified a significant other willing to participate in their treatment. Following inpatient detoxification, participants were enrolled in a 26-week outpatient course of therapy and naltrexone maintenance. Results Patients with unblocked use had a very high rate of dropout (10% retained at 6 months), dropout usually occurring within 2 weeks after unblocked use. Patients with only blocked use had less dropout (33% retained at 6 months). However, episodes of blocked use were often followed by unblocked use and dropout. Conclusions During naltrexone maintenance for opioid dependence unblocked opioid use calls for immediate intervention, such as detoxification or switching to the partial agonist buprenorphine. Episodes of blocked use warrant increased clinical attention, such as direct observation of naltrexone ingestion, increased dose, or increased intensity of treatment contact. Maintenance on oral naltrexone is a fragile treatment because it is so easily undermined by episodes of opioid use while non-compliant. New long-acting injectable or implantable formulations of naltrexone may address this limitation and should be investigated for treatment of opioid dependence.

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.