Drug and alcohol use among patients with schizophrenia and related psychoses : levels, consequences and changes in psychiatric symptoms and substance abuse at twelve-month follow-up

Patients with schizophrenia and related psychoses frequently use, abuse and become dependent on psychoactive substances. A cross-sectional survey was conducted to document substance abuse in 207 successive outpatients with schizophrenia and related psychoses presenting to a psychiatric continuing care facility in a large Canadian city. Nicotine, alcohol and cannabis were the most frequently abused substances. Excluding nicotine, 44.9% met criteria for lifetime and 14.0% for current abuse/dependence. Current dual diagnosis (DD) patients had significantly more positive psychotic and depressive symptoms, higher rates of medication non-compliance, as well as higher rates of tobacco smoking and significantly longer smoking histories compared to single diagnosis (SD) patients. The smoking behavior of the DD population is discussed in terms of enhanced risk for alcohol abuse, as well as effects on antipsychotic blood levels and metabolism.In the second phase of the study, the starting sample was reassessed at 4 month intervals out to 12-months of follow-up. The follow-up study was designed to test the hypothesis that current-DD patients would fare significantly worse than SD patients. This study found that during the course of standard psychiatric outpatient treatment there was little decrease in substance use or abuse over time among the DD group. However, DD subjects experienced a greater reduction in positive psychotic symptoms compared to SD patients. The follow up study demonstrated that DD patients in treatment for schizophrenia and related psychoses did reasonably well in terms of reduced psychosis; however they continued to use substances of abuse and remained more depressed than SD

Management of conventional antipsychotic-induced tardive dyskinesia

International audienc

The Best Predictor of the Future—the Metaverse, Mental Health, and Lessons Learned From Current Technologies

The metaverse—a virtual world accessed via virtual reality technology—has been heralded as the next key digital experience. It is meant to provide the next evolution of human interaction after social media and telework. However, in the context of the growing awareness of the risks to mental health posed by current social media technologies, there is a great deal of uncertainty as to the potential effects of this new technology on mental health. This uncertainty is compounded by a lack of clarity regarding what form the metaverse will ultimately take and how widespread its application will be. Despite this, given the nascent state of the metaverse, there is an opportunity to plan the research and regulatory approaches needed to understand it and promote its positive effects while protecting vulnerable groups. In this viewpoint, we examine the following three current technologies whose functions comprise a portion of what the metaverse seeks to accomplish: teleworking, virtual reality, and social media. We attempted to understand in what ways the metaverse may have similar benefits and pitfalls to these technologies but also how it may fundamentally differ from them. These differences suggest potential research questions to be addressed in future work. We found that current technologies have enabled tools such as virtual reality–assisted therapy, avatar therapy, and teletherapy, which have had positive effects on mental health care, and that the metaverse may provide meaningful improvements to these tools. However, given its similarities to social media and its expansion upon the social media experience, the metaverse raises some of the same concerns that we have with social media, such as the possible exacerbation of certain mental health problems. These concerns led us to consider questions such as how the users will be protected and what regulatory mechanisms will be put in place to ensure user safety. Although clear answers to these questions are challenging in this early phase of metaverse research, in this viewpoint, we use the context provided by comparator technologies to provide recommendations to maximize the potential benefits and limit the putative harms of the metaverse. We hope that this paper encourages discussions among researchers and policy makers

Evaluating the perceived utility of an artificial intelligence-powered clinical decision support system for depression treatment using a simulation center

Aifred is a clinical decision support system (CDSS) that uses artificial intelligence to assist physicians in selecting treatments for major depressive disorder (MDD) by providing probabilities of remission for different treatment options based on patient characteristics. We evaluated the utility of the CDSS as perceived by physicians participating in simulated clinical interactions. Twenty physicians who were either staff or residents in psychiatry or family medicine completed a study in which they had three 10-minute clinical interactions with standardized patients portraying mild, moderate, and severe episodes of MDD. During these scenarios, physicians were given access to the CDSS, which they could use in their treatment decisions. The perceived utility of the CDSS was assessed through self-report questionnaires, scenario observations, and interviews. 60% of physicians perceived the CDSS to be a useful tool in their treatment-selection process, with family physicians perceiving the greatest utility. Moreover, 50% of physicians would use the tool for all patients with depression, with an additional 35% noting that they would reserve the tool for more severe or treatment-resistant patients. Furthermore, clinicians found the tool to be useful in discussing treatment options with patients. The efficacy of this CDSS and its potential to improve treatment outcomes must be further evaluated in clinical trials.McGill University12 month embargo; available online: 11 December 2021This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

The Effect on Surgical Complications of Bevacizumab Added to Neoadjuvant Chemotherapy for Breast Cancer: NRG Oncology/NSABP Protocol B-40

BackgroundNRG Oncology/NSABP trial B-40 tested the impact of adding bevacizumab (bev) to neoadjuvant chemotherapy for operable breast cancer. Secondary endpoints included rates of surgical complications after surgery in patients who did or did not receive bev.MethodsA total of 1206 women with HER2-negative operable breast cancer were randomly assigned to receive one of three different docetaxel-plus-anthracycline-based regimens, without or with bev (15 mg/kg every 3 weeks) for the first 6 of 8 cycles and for 10 doses postoperatively. Surgical complications were assessed from date of surgery through 24 months following study entry.ResultsEarly surgical complications were significantly more frequent in the bev group (25.4 vs. 18.9%; trend test p = 0.008), but most were grade 1-2. Early noninfectious wound dehiscences were infrequent and not significantly different (5.4 vs. 3.1%; trend test p = 0.15). Long-term noninfectious wound complications were significantly higher for patients receiving bev (11.8 vs. 5.1%; trend test p = 0.0007), but the incidence of grade ≥3 wound dehiscence was low in both groups (<1%). Among 193 patients undergoing expander or implant reconstructions, 19 (19.6%) of 97 in the bev-receiving group versus 10 (10.4%) of 96 in the non-bev group had grade ≥3 complications (Pearson, p = 0.11).ConclusionsOverall, adding bev increased surgical complications, but most serious complications were not significantly increased. In particular, the need for surgical intervention in patients undergoing breast reconstruction with prosthetic implants was higher with bev but was not statistically significantly different. With precautions, bev can be used safely perioperatively in patients undergoing surgery for breast cancer