Substance Use, Hospitalizations, and Co-Occurring Disorders among Patients Transferred from a Needle Exchange Program to Opioid Maintenance Treatment

Opioid use disorders (OUD) is a relapsing condition with high mortality. Opioid maintenance treatment (OMT) reduces heroin use, and overall morbidity and mortality. The prevalence of psychiatric and substance use disorders, potential baseline predictors for psychiatric hospitalization, and psychiatric diagnoses at follow-up were investigated and may give hints about possible preventative strategies. The medical records for 71 patients were reviewed 36 months following referral to OMT from a needle exchange program (NEP). Their psychiatric diagnoses and hospitalizations were identified. Their baseline characteristics were assessed for potential differences between hospitalized versus non-hospitalized patients and between patients with and without psychiatric diagnoses in a longitudinal observational study without controls. A regression analysis was performed to identify predictors for hospitalization when controlling for OMT status. Sixty-five percent of the patients were hospitalized at least once with a psychiatric diagnosis. Substance-related reasons were prevalent, and detoxification occurred among 59% of patients, with sedative- hypnotics (benzodiazepines, zopiclone, zolpidem, and pregabalin) being the substance used by 52% of patients. Baseline use of these drugs and/or buprenorphine predicted for hospitalization when controlling for OMT status. During the follow-up period, 72% of patients met the criteria for a psychiatric diagnosis other than OUD. The prevalence of non-substance use disorders overlapping with SUD was 41%, and that overlapping with anxiety disorder was 27% of all participants. Increased attention to psychiatric co-occurring disorders in the treatment of OUD is required and the importance of addressing sedative-hypnotics use when initiating OMT is highlighted.

Mental health assessment of Israeli adolescents before and during the COVID-19 pandemic

The measures used to contain the COVID-19 pandemic caused severe disruption to the lives of children and adolescents, compromising their mental health and wellbeing. In this study we assessed the incidence rates of psychiatric diagnoses and drugs in Israeli adolescents before and during the COVID-19 pandemic. Analysis of health records data of over 200,000 12-17 years old adolescents identified a significant increase in all mental health diagnoses and most psychiatric drugs dispensation during the COVID-19 period compared to a corresponding pre-COVID period. A gender sub-analysis revealed that most of this increase was associated with adolescent girls. Girls exhibited increases of 68% in depression, 67% in eating disorders, 42% in anxiety and 29% in stress-related diagnoses during the COVID-19 period, which are significantly higher rates than those seen in boys and in the pre-COVID period. Sector sub-analysis showed that the increase was mainly in the general Jewish sector with almost no significant increases in the Arab and ultra-orthodox sectors. Our study highlights the mental health burden of Israeli adolescents during the pandemic and suggests that careful consideration should be given to it while deciding on measures to mitigate the pandemic.

A System-wide Retrospective Cohort Analysis of Psychiatric Diagnoses and Persistent Symptoms Following Concussion

ObjectiveTo evaluate the epidemiologic features of psychiatric comorbidities following mild traumatic brain injury (MTBI, or concussion) in a state-wide hospital system cohort over a 10-year period.BackgroundThe epidemiology of neuropsychiatric symptoms and diagnoses following concussion are poorly understood. Despite the rebirth of post-concussion syndrome (PCS) as persistent post-concussion symptoms (PPCS), entailing diverse and complex somatic, cognitive, and emotional components with significant potential overlap or confounding of psychiatric comorbidities, there is scarce characterization of the incidence of such comorbidities following concussion. The study of demographic factors as they relate to psychiatric diagnoses following concussion remains in infancy.Design/MethodsWe conducted an observational retrospective cohort study of all patients who received a diagnosis of concussion within Ochsner Health (OH) over a 10-year period. System-wide electronic medical records were evaluated using ICD-10 codes to collect data on patients with a diagnosis of MTBI or concussion, as compared to patients with no diagnosis of concussion over the same period. Data on subpopulations corresponding to psychiatric diagnostic outcomes following diagnosis of concussion were collected and evaluated to determine timeline-related incidences of outcomes, as well as on demographic and morbid features corresponding to each outcome. These included age, sex, race, ethnicity, household income, neurologic and psychiatric history, cause of concussion, and presence of loss of consciousness.ResultsWe report incidence, demographic, and morbid factor data on patients with a diagnosis of concussion, and as related to outcomes following diagnosis of concussion, including: (1) new diagnosis of PCS, (2) meeting PPCS Berlin Sport Concussion Consensus criteria, (3) new unclassified neuropsychiatric symptoms, (4) any new psychiatric diagnosis, (5) new psychiatric diagnosis excluding PCS, (6) new anxiety, dissociative, stress-related, or somatoform disorder diagnosis, (7) new reaction to severe stress or adjustment disorder diagnosis, and (8) new PTSD diagnosis.ConclusionsWe call for multidisciplinary awareness, screening, and longitudinal research of patients with concussion.

The Prognostic Utility of Personality Traits Versus Past Psychiatric Diagnoses: Predicting Future Mental Health and Functioning

Past psychiatric diagnoses are central to patient case formulation and prognosis. Recently, alternative classification models such as the Hierarchical Taxonomy of Psychopathology (HiTOP) proposed to assess traits to predict clinically relevant outcomes. In the current study, we directly compared personality traits and past diagnoses as predictors of future mental health and functioning in three independent, prospective samples. Regression analyses found that personality traits significantly predicted future first onsets of psychiatric disorders (change in [∆] R2 = .06–.15), symptom chronicity (∆ R2 = .03–.06), and functioning (∆ R2 = .02–.07), beyond past and current psychiatric diagnoses. Conversely, past psychiatric diagnoses did not provide an incremental prediction of outcomes when personality traits and other concurrent predictors were already included in the model. Overall, personality traits predicted a variety of outcomes in diverse settings beyond diagnoses. Past diagnoses were generally not informative about future outcomes when personality was considered. Together, these findings support the added value of personality traits assessment in case formulation, consistent with the HiTOP model.

Yoga in Psychiatry: feasibility of a yoga-intervention for severely affected children and young adults with non-internalizing psychiatric disorders

Yoga-based interventions are increasingly being introduced to improve the lives of individuals with widely varying psychiatric diagnoses and symptoms. We developed a yoga-program for two severely affected populations at our psychiatric department: young adults with psychosis from our inpatient clinic, and children with severe developmental disorders and/or behavioral problems from our inpatient clinic or outpatient treatment program. The participants, clinic staff and yoga-instructors assessed the feasibility of our yoga program. They participated in evaluation meetings and gave feedback. Participants also filled in an evaluation form before and after every session. Results showed that our yoga-program is feasible for severely affected populations. The program can and should be tailored to meet the differing needs of individuals. Participants benefitted from and enjoyed sessions and reported feeling calmer, more goal-oriented and more relaxed after the sessions.

Psychiatric disorders and offending in an Australian birth cohort: Overrepresentation in the health and criminal justice systems for Indigenous Australians

Objective: Most studies that examine psychiatric illness in people who offend have focused on incarcerated samples, with little known about the larger population of individuals with criminal justice system contact. We examine the overlap between proven offences and psychiatric diagnoses with an emphasis on experiences for Indigenous Australians. Methods: In a population-based birth cohort of 45,141 individuals born in Queensland, Australia, in 1990 (6.3% Indigenous), psychiatric diagnoses were identified from hospital admissions between ages 4/5 and 23/24 years and proven offences were identified from court records (spanning ages 10–24 years). Prevalence rates for offending, psychiatric diagnoses and their overlap were examined for Indigenous and non-Indigenous individuals. Associations between specific psychiatric diagnoses and types of offending were examined using logistic regressions. Results: There were 11,134 (24.7%) individuals with a finalised court appearance, 2937 (6.5%) with a diagnosed psychiatric disorder and 1556 (3.4%) with a proven offence and diagnosed psychiatric disorder, with Indigenous Australians significantly overrepresented across all outcomes. Compared with non-Indigenous Australians, Indigenous Australians were younger at their first court finalisation (Cohen’s d = −0.62, 95% confidence interval = [−0.67, −0.57]), experienced a higher number of finalisations ( d = 0.94, 95% confidence interval = [0.89, 1.00]) and offences ( d = 0.64, 95% confidence interval = [0.59, 0.69]) and were more likely to receive custodial ( d = 0.41, 95% confidence interval = [0.36, 0.46]) or supervised ( d = 0.55, 95% confidence interval = [0.50, 0.60]) sentences. The overlap between offending and psychiatric illness was more pronounced for Indigenous Australians compared with non-Indigenous Australians (14.8% vs 2.7%). Substance use disorders were the most prevalent psychiatric diagnosis among individuals with a court finalisation (9.2%). Conclusions: Indigenous Australians were significantly overrepresented in court finalisations and psychiatric diagnoses. Indigenous Australians with a psychiatric diagnosis were at highest risk of experiencing a court appearance, emphasising the importance of culturally appropriate mental health responses being embedded into the criminal justice system.

Changes in Tobacco Use Patterns among Veterans in San Diego during the Recent Peak of the COVID-19 Pandemic

The prevalence of tobacco use increases in times of stress; however, during the initial stage of the COVID-19 pandemic, tobacco use rates stayed the same in most populations. Previous work focused on the initial months of the pandemic, while this study examined the changes in tobacco use during a later peak period of the pandemic. We used data from 61,852 visits to the VA San Diego Healthcare System from November 2019 to February 2021, divided into pre-, early, and peak pandemic periods. Multinomial logistic regression was used to test whether the odds of being a daily or non-daily tobacco user varied over time, by demographic group, or with the presence of specific psychiatric diagnoses. Younger Veterans had a greater reduction in the prevalence of non-daily tobacco use between the early and peak periods, while older Veterans had a rise in daily use from pre- to the early pandemic, which returned to baseline during the peak. Individuals with substance use disorder and serious mental illness diagnoses were more likely to report tobacco use, but psychiatric diagnoses did not predict change over time. These findings demonstrate factors that potentially contribute to changes in tobacco use during a public health crisis and may help guide future targeted cessation efforts.