Real-World Evaluation of the Resident Assessment Instrument-Mental Health Assessment System.
Real-World Evaluation of the Resident Assessment Instrument-Mental Health Assessment System.
Filed under: Addiction Rehab
Can J Psychiatry. 2012 Nov; 57(11): 687-695
Urbanoski KA, Mulsant BH, Willett P, Ehtesham S, Rush B
Objective: We evaluated the Resident Assessment Instrument-Mental Health (RAI-MH) assessment platform at a large psychiatric hospital in Ontario during the 3 years following its provincially mandated implementation in 2005. Our objectives were to document and consider changes over time in front-line coding practices and in indicators of data quality. Method: Structured interviews with program staff were used for preliminary information-gathering on front-line coding practices. A retrospective data review of assessments conducted from 2005 to 2007 examined 5 quantitative indicators of data quality. Results: There is evidence of improved data quality over time; however, low scores on the outcome scales highlight potential shortcomings in the assessment system’s ability to support outcome monitoring. There was variability in implementation and performance across clinical programs. Conclusions: This evaluation suggests that the RAI-MH-based assessment platform may be better suited to longer-term services for severely impaired clients than to short-term, highly specialized services. In particular, the suitability of the RAI-MH for hospital-based addictions care should be re-examined. Issues of staff compliance and motivation and problems with assessment system performance would be highly entwined, making it inappropriate to attempt to allocate responsibility for areas of less than optimal performance to one or the other. The ability of the RAI-MH to perform well on clinical front lines is, in any case, essential for it to meet its objectives. Continued evaluation of this assessment platform should be a priority for future research.
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Predictors of Psychiatric Aftercare Among Formerly Hospitalized Adolescents.
Filed under: Addiction Rehab
Can J Psychiatry. 2012 Nov; 57(11): 666-676
Carlisle CE, Mamdani M, Schachar R, To T
Objective: Timely aftercare can be viewed as a patient safety imperative. In the context of decreasing inpatient length of stay (LOS) and known child psychiatry human resource challenges, we investigated time to aftercare for adolescents following psychiatric hospitalization. Method: We conducted a population-based cohort study of adolescents aged 15 to 19 years with psychiatric discharge between April 1, 2002, and March 1, 2004, in Ontario, using encrypted identifiers across health administrative databases to determine time to first psychiatric aftercare with a primary care physician (PCP) or a psychiatrist within 395 days of discharge. Results: Among the 7111 adolescents discharged in the study period, 24% had aftercare with a PCP or a psychiatrist within 7 days and 49% within 30 days. High socioeconomic status (adjusted hazard ratio [AHR] 1.31; 95% CI 1.21 to 1.43, P < 0.001) and psychotic disorders (AHR 1.24; 95% CI 1.12 to 1.36, P < 0.001) were associated with greater likelihood of aftercare. Youth in the northern part of the province (AHR 0.48; 95% CI 0.32 to 0.71, P < 0.001), rural areas (AHR 0.82; 95% CI 0.76 to 0.89, P < 0.001), and with self-harm or suicide attempts (AHR 0.58; 95% CI 0.53 to 0.64, P < 0.001) and substance use disorders (AHR 0.50; 95% CI 0.44 to 0.56, P < 0.001) were less likely to receive aftercare. Conclusions: Hospitalization is our most intensive, intrusive, and expensive psychiatric treatment setting, yet in our cohort of formerly hospitalized adolescents fewer than 50% received psychiatry-related aftercare in the month postdischarge. Innovations are necessary to address geographic inequities and improve timely access to mental health aftercare for all youth. HubMed – addiction
?CCT, an antagonist selective for ?(1) gaba(a) receptors, reverses diazepam withdrawal-induced anxiety in rats.
Filed under: Addiction Rehab
Brain Res Bull. 2012 Nov 10;
Divljakovi? J, Mili? M, Namjoshi OA, Tiruveedhula VV, Timi? T, Cook JM, Savi? MM
The abrupt discontinuation of prolonged benzodiazepine treatment elicits a withdrawal syndrome with increased anxiety as a major symptom. The neural mechanisms underlying benzodiazepine physical dependence are still insufficiently understood. Flumazenil, the non-selective antagonist of the benzodiazepine binding site of GABA(A) receptors was capable of preventing and reversing the increased anxiety during benzodiazepine withdrawal in animals and humans in some, but not all studies. On the other hand, a number of data suggest that GABA(A) receptors containing ?(1) subunits are critically involved in processes developing during prolonged use of benzodiazepines, such are tolerance to sedative effects, liability to physical dependence and addiction. Hence, we investigated in the elevated plus maze the level of anxiety 24h following 21 days of diazepam treatment and the influence of flumazenil or a preferential ?1-subunit selective antagonist ?CCt on diazepam withdrawal syndrome in rats. Abrupt cessation of protracted once-daily intraperitoneal administration of 2mg/kg diazepam induced a withdrawal syndrome, measured by increased anxiety-like behavior in the elevated plus maze 24h after treatment cessation. Acute challenge with either flumazenil (10mg/kg) or ?CCt (1.25, 5 and 20mg/kg) alleviated the diazepam withdrawal-induced anxiety. Moreover, both antagonists induced an anxiolytic-like response close, though not identical, to that seen with acute administration of diazepam. These findings imply that the mechanism by which antagonism at GABA(A) receptors may reverse the withdrawal-induced anxiety involves the ?(1) subunit and prompt further studies aimed at linking the changes in behavior with possible adaptive changes in subunit expression and function of GABA(A) receptors.
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Effect of GBR12909 on affective behavior: Distinguishing motivational behavior from antidepressant-like and addiction-like behavior using the runway model of intracranial self-stimulation.
Filed under: Addiction Rehab
Behav Brain Res. 2012 Nov 10;
Esumi S, Sagara H, Nakamoto A, Kawasaki Y, Gomita Y, Sendo T
Rationale: It was recently demonstrated that the priming stimulation effect (PSE) in the runway model of intracranial self-stimulation (ICSS) can be used as a model system to study the motivational effects of drugs. However, the characteristics of this novel experimental model have not been fully clarified. Objective: To elucidate the involvement of dopamine uptake inhibition in motivated behavior and the difference in experimental characteristics between closely related experimental models, we investigated the effects of the dopamine uptake inhibitor GBR12909 in the runway ICSS model, in the forced swimming test (FST), and on conditioned place preference (CPP). In addition, the role of dopamine receptor signaling in the runway model was evaluated using dopamine receptor agonists and antagonists. Results: GBR12909 dose-dependently increased running speed on the runway and decreased immobility time in the FST without affecting the time spent in the drug-associated compartment in CPP tests. The effect of GBR12909 in the runway model was inhibited by pre-treatment with the dopamine receptor antagonists haloperidol and raclopride. The dopamine receptor agonists SKF38393 and quinpirole dose-dependently decreased running speed. Conclusions: These results demonstrate that GBR12909 displays motivation-enhancing and antidepressant-like effects without place conditioning effects. In addition, the mechanisms of PSE enhancement in the runway ICSS model are different from those underlying closely associated experimental models and are mediated by increases in dopamine signaling.
HubMed – addiction
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