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Objective A well-established association exists between academic performance and levels of depression and anxiety among medical students. However, the effects of positive psychological factors on symptoms of depression and anxiety and academic performance have not been adequately studied. This study explores the relationship between the above variables and identifies positive psychological factors that can promote medical student wellbeing. Methods Medical students were surveyed at four time points during their first two years of medical education using Qualtrics. The surveys used a five-point Likert scale to assess students' levels of loneliness, religiosity, engaged living, life fulfillment, resilience, psychological wellbeing, and symptoms of depression and anxiety. Academic performance was measured using students' Comprehensive Basic Science Examination scores. Linear mixed effect models with maximum likelihood estimation were used to investigate the relationship between positive psychological factors and scores on depression and anxiety as well as the relationship between demographic and psychological factors and exam scores. Results Seventy-two students completed the study. A significant positive correlation was observed between loneliness and symptoms of depression and anxiety, while the same symptoms had significant negative correlations with engaged living. None of the positive psychological factors were significantly predictive of exam scores. Conclusion Our findings suggest that medical students who develop meaningful relationships and live engaged lives are less likely to develop symptoms of depression and anxiety. Our study lays the groundwork for future research focusing on identifying and implementing pre-clinical curriculum changes aiming to improve medical students' mental health.
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BACKGROUND: This study investigates the association between Methamphetamine (MA) intoxication and suicidal ideation/behavior in patients presenting to emergency departments. Amidst rising MA use and co-use with opioids, this "twin epidemic" has manifested in increasing admissions for MA intoxication, often accompanied by psychiatric symptoms that can escalate to suicidal behaviors. METHOD: This retrospective study utilized patient records and analyzed data from 629 patients admitted to a Texas emergency department in 2020, with MA intoxication confirmed via urine tests and patient interviews. The suicidal tendencies were assessed using the Columbia-Suicide Severity Scale. The 629 patients were divided into three groups for analysis: Group I (n = 188), MA positive with suicidal ideation (SI) (MA + SI+); Group II (n = 202), MA-positive without SI (MA + SI-); and Group III (n = 239), MA-negative with SI (MA- SI+). Multiple regression analysis was used to elicit clinical features predicting patients presenting to the emergency department with acute MA intoxication. RESULTS: Results reveal that approximately half of patients with acute MA intoxication reported suicidal thoughts, indicating a significant association between MA use and suicidal tendencies. Females exhibited higher rates of suicidal thoughts, behavior, and subsequent medical attention compared to males. Sociodemographic characteristics and clinical features differed among MA-positive patients with and without SI. Multivariable regression analysis identified factors influencing MA use, including cannabis use, male gender, agitation, and an inverse association with alcohol use. Notably, the severity and potential lethality of suicidal behavior in MA-intoxicated patients paralleled those observed in psychiatric patients without MA use. CONCLUSION: These results underscore the urgent need for targeted interventions to address the complex interplay between MA use and suicidal risks in the emergency department setting, as well as broader public health strategies to combat the increasing prevalence of MA use.
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Servicio de Urgencia en Hospital , Metanfetamina , Ideación Suicida , Humanos , Masculino , Femenino , Metanfetamina/efectos adversos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Adulto , Estudios Retrospectivos , Persona de Mediana Edad , Adulto Joven , Trastornos Relacionados con Anfetaminas/epidemiologíaRESUMEN
Rates of youth depression and suicide are rising worldwide and represent public health crises. The present study examined the relationship between trauma history and symptoms of depression, suicidal ideation, and anxiety among suicidal and depressed youth. A diverse group of 1000 8-20-year-olds enrolled in the statewide Texas Youth Depression and Suicide Research Network (TX-YDSRN) reported their trauma history (Traumatic Events Screening Inventory for Children) and symptoms of depression (Patient Health Questionnaire for adolescents; PHQ-A), anxiety (Generalized Anxiety Disorder scale; GAD-7), and suicidality (Concise Health Risk Tracking scale; CHRT-SR). Nearly half of the sample reported exposure to multiple categories of traumatic experiences. Number of trauma exposure categories significantly predicted PHQ-A and GAD-7 scores. Exposure to interpersonal trauma and to sexual trauma were significantly associated with PHQ-A, GAD-7, and CHRT-SR scores. The number of trauma exposure categories was associated with increased levels of anxiety and depression; however, only exposure to interpersonal or sexual trauma was associated with more suicidality. Clinicians should assess trauma exposure in patients seeking psychiatric care, especially for interpersonal and sexual trauma, which may be predictive of increased risk for suicidality in depressed youth. Future work should disentangle the effects of specific trauma types from multiple trauma exposure.
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Depresión , Suicidio , Niño , Humanos , Adolescente , Depresión/epidemiología , Depresión/psicología , Salud Mental , Texas/epidemiología , Psicometría , Suicidio/psicología , Ideación SuicidaRESUMEN
BACKGROUND: American youth are seriously impacted by depression and suicide. The Texas Youth Depression and Suicide Research Network (TX-YDSRN) Participant Registry Study was initiated in 2020 to develop predictive models for treatment outcomes in youth with depression and/or suicidality. This report presents the study rationale, design and baseline characteristics of the first 1000 participants. METHODS: TX-YDSRN consists of the Network Hub (coordinating center), 12 medical school "Nodes" (manage/implement study), each with 1-5 primary care, inpatient, and/or outpatient Sub-Sites (recruitment, data collection). Participants are 8-20-year-olds who receive treatment or screen positive for depression and/or suicidality. Baseline data include mood and suicidality symptoms, associated comorbidities, treatment history, services used, and social determinants of health. Subsequent assessments occur every two months for 24 months. RESULTS: Among 1000 participants, 68.7 % were 12-17 years, 24.6 % were ≥ 18 years, and 6.7 % were < 12. Overall, 36.8 % were non-Hispanic Caucasian, 73.4 % were female, and 79.9 % had a primary depressive disorder. Nearly half of the sample reported ≥1 suicide attempt, with rates similar in youth 12-17 years old (49.9 %) and those 18 years and older (45.5 %); 29.9 % of children <12 reported at least one suicide attempt. Depression and anxiety scores were in the moderate-severe range for all age groups (Patient Health Questionnaire for Adolescents [PHQ-A]: 12.9 ± 6.4; Generalized Anxiety Disorder [GAD-7]: 11.3 ± 5.9). LIMITATIONS: The sample includes youth who are receiving depression care at enrollment and may not be representative of non-diagnosed, non-treatment seeking youth. CONCLUSIONS: The TX-YDSRN is one of the largest prospective longitudinal cohort registries designed to develop predictive models for outcome trajectories based on disorder heterogeneity, social determinants of health, and treatment availability.
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Atención a la Salud , Depresión , Niño , Humanos , Adolescente , Femenino , Masculino , Depresión/terapia , Texas/epidemiología , Estudios Prospectivos , Sistema de RegistrosRESUMEN
This meta-analysis examined the efficacy of positive psychology interventions (PPIs) in treating depression in 11 articles. PubMed, Web of Science, and Clinical Key were used to identify papers published from 2010 to 2020 that utilized PPIs. Key terms were "positive psychology" and "treatment of depression." Studies on adults with (a) depressive symptoms or (b) diagnosed clinical depression were included. A random-effects model was used to compare PPIs and control groups on post- vs. pre-intervention differences in depression scores. Data analysis examined Beck Depression Inventory-II (BDI-II), Center for Epidemiologic Studies Depression Scale (CES-D), and Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16) scores. Findings show PPIs are effective in treating depressive symptoms, with significant improvements in depression scores when compared to control groups in all but one study. This was true for both post- vs. pre-intervention (pooled Cohen's d = -0.44 (-0.77, -0.11)) and follow-up- vs. pre-intervention analyses (pooled Cohen's d = -0.46 (-1.02, 0.09)). PPIs can improve the accessibility and affordability of depression treatments.
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In February 2020, the governing bodies of the United States Medical Licensing Examination (USMLE) announced the decision to change Step 1 score reporting from a three-digit system to pass/fail designation. Previous studies theorized that Step 2 Clinical Knowledge (CK) will become the numerical standard by which residency directors can quickly sort through program applicants. The goal of this study is to review prior research and identify significant factors associated with Step 2 CK outcomes. A systematic literature search on PubMed, Web of Science, Scopus, and ERIC that included articles published between 2005 and 2015 was conducted using the keywords "USMLE," "Step 2 CK," "score," "success," and "predictors." After screening the initial search yield of 3,239 articles, 52 articles were included for this review. Positively correlated factors included Step 1 score, clinical block grades, Comprehensive Clinical Science Self-Assessment (CCSSA), Comprehensive Clinical Science Examination (CCSE), and volunteerism. Factors such as clerkship sequence and pass/fail grading failed to correlate with Step 2 CK. Medical College Admission Test (MCAT) score (p < 0.01) and undergraduate grade point average (GPA) (p = 0.01) positively correlated, while age displayed a negative correlation. Additionally, females typically scored higher on Step 2 CK than their male peers. The study findings suggest that continuous learning and academic success throughout medical school positively influence eventual Step 2 CK scoring. Performance on USMLE practice examinations, Step 1, and clinical evaluations serve as positive predictors for Step 2 CK scores. Interestingly, changing answers and spending more time on each question during the examination were associated with higher scores.
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The goal of the psychiatric assessment of asylum seekers is to evaluate the asylum seeker's mental health and credibility. The shortage of mental health providers trained in this particular type of evaluation makes in-person evaluation not always feasible. Telephonic interview has been occasionally utilized to fill this void. The validity of such evaluations in assessing credibility has yet to be fully established. In the case of telephonic interviews, evaluators are limited with no access to facial or body language cues that can indicate deception or honesty. We will present a case of a client evaluated via telephone that was deemed credible and eventually released to pursue asylum in the US. Assessment of credibility relied solely on cues obtained from the client's narrative, reported symptoms, and their style of interaction with the evaluator. We will highlight the findings from the client's interview that supported credibility in the case and discuss the challenges of assessing asylum seeker's credibility via telephonic interview. Telephonic evaluation of credibility can be considered a valid method despite major challenges, but psychiatric evaluators should be aware of the limitations of telephonic evaluations given the high possibility of secondary gains and deception.
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BACKGROUND: Antipsychotic drug use in children has doubled from 2001 to 2007 with concomitant increase in obesity. Second-generation antipsychotic (SGA) medication use is associated with weight gain, metabolic derangements, and blood sugar and lipid abnormalities in children. The American Psychiatric Association and the American Diabetes Association have recommended metabolic monitoring guidelines for patients using SGA. STUDY QUESTION: The study objective was to investigate and compare metabolic monitoring for SGA medications in psychiatry (PSY), and pediatrics and family medicine [primary care providers (PCP)] outpatient clinics of a university medical center. STUDY DESIGN: This is a retrospective study of 149 charts of patients newly prescribed with SGA, ages 5-18 years, from their initial visit in the outpatient clinics. MEASURES AND OUTCOMES: Compliance with recommended metabolic monitoring was evaluated for initial and subsequent clinic visits. Parameters included body mass index, waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile. RESULTS: Of the 149 charts, 110 patients were in PSY and 39 in PCP. The parameter most regularly monitored was body mass index (baseline: PSY 88.3%, PCP 97.4%; 12 weeks: PSY 86.4%, PCP 85.0%; and 24 weeks: PSY 91.8%, PCP 100%). Fasting plasma glucose (baseline: PSY 18.9%, PCP 25.6% and 12 weeks: PSY 8.6%, PCP 10.0%) and fasting lipid profile (baseline: PSY 12.7%, PCP 25.6% and 12 weeks: PSY 7.0%, PCP 10.0%) had low completions rates. No difference was seen in metabolic monitoring by sex or ethnic group. CONCLUSIONS: Metabolic monitoring rate of child and adolescent patients on SGAs was low overall. No statistically significant differences were seen between psychiatry and PCP except a significantly higher rate of fasting plasma glucose level monitoring at baseline among PCP. Limitations to the study include the small sample size obtained for the period investigated and insufficient documentation in some electronic charts. Extending the period studied may increase the statistical significance of the data.
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Antipsicóticos/efectos adversos , Monitoreo de Drogas/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricos , Trastornos Mentales/tratamiento farmacológico , Obesidad Infantil/diagnóstico , Adolescente , Atención Ambulatoria/normas , Atención Ambulatoria/estadística & datos numéricos , Glucemia/análisis , Índice de Masa Corporal , Niño , Preescolar , Monitoreo de Drogas/normas , Femenino , Humanos , Lípidos/sangre , Masculino , Anamnesis/normas , Anamnesis/estadística & datos numéricos , Uso Fuera de lo Indicado , Obesidad Infantil/sangre , Obesidad Infantil/inducido químicamente , Obesidad Infantil/metabolismo , Atención Primaria de Salud/normas , Atención Primaria de Salud/estadística & datos numéricos , Psiquiatría/normas , Psiquiatría/estadística & datos numéricos , Estudios Retrospectivos , Aumento de Peso/efectos de los fármacosRESUMEN
Immigration and asylum-seeking are issues that have recently. warranted increased attention and significance. In the aftermath of terrorist attacks, people are more wary of asylum seekers who are usually held in detention centers after fleeing persecution and not for criminal or immigration charges. Asylum seekers may raise suspicions due to inconsistent statements and can be held in detention for the duration of the process and/or denied asylum. Inconsistencies may be influenced by psychiatric symptoms, cognitive abilities, the type of past trauma experienced, the questioning style of the interviewer, and are usually unrelated to dishonesty or malingering making psychiatric consult important in many of these evaluations.
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Trastornos de Adaptación/diagnóstico , Entrevista Psicológica , Refugiados/psicología , Trastornos por Estrés Postraumático/diagnóstico , Adulto , Emigración e Inmigración , Femenino , Psiquiatría Forense , Humanos , TexasRESUMEN
Justice-involved youth are at exceedingly high risk of trauma exposure, multisystem involvement, and mental health distress, including depression. Justice-involved youth carry with them both a high symptom burden and a high cost to society. Both could be reduced through evidence-based prevention and treatment strategies. Effective treatment of mental disorders may reduce future justice involvement, whereas lack of treatment increases likelihood of justice involvement into adulthood. Multiple effective programs exist to improve the lives of justice-involved youth and subsequently decrease the cost to society of detaining and adjudicating these youth within the juvenile justice system.
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Trastorno Depresivo/diagnóstico , Delincuencia Juvenil/estadística & datos numéricos , Servicios de Salud Mental , Adolescente , Niño , Protección a la Infancia/psicología , Humanos , Delincuencia Juvenil/psicología , Tamizaje MasivoRESUMEN
OBJECTIVE: Wernicke's encephalopathy is caused by thiamine deficiency and occurs predominantly in alcohol-dependent individuals but also develops in those who are malnourished due to other reasons including medical and psychiatric disorders. This study examined the frequency rate and management of Wernicke's encephalopathy in alcohol-dependent and non-alcohol-dependent patients admitted to a psychiatric hospital. METHODS: Data were retrospectively collected from electronic medical records of psychiatric inpatients admitted to a teaching hospital located in Texas between September 2013 and March 2014. The diagnostic criteria of Caine and colleagues and thiamine dosing strategies were used to identify cases of suboptimal management. RESULTS: A total of 486 charts were reviewed. Nine patients (1.85%) had clinical signs of Wernicke's encephalopathy, and 36 (7%, n = 486) were at a high risk for developing the disorder. None of these patients received adequate doses of parenteral thiamine, and of those who were prescribed thiamine, the majority, including high-risk patients, were prescribed oral thiamine at the traditional dose of 100 mg/d. CONCLUSIONS: The findings suggest that Wernicke's encephalopathy is underdiagnosed and undertreated. Our study also highlights the need for clarifying diagnostic criteria, identifying the risk factors for thiamine deficiency, and improving awareness among physicians about diagnosis, prevention, and adequate treatment of Wernicke's encephalopathy in alcohol-dependent and non-alcohol-dependent patients.
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Enfermos Mentales/estadística & datos numéricos , Encefalopatía de Wernicke/epidemiología , Adulto , Alcoholismo/complicaciones , Alcoholismo/epidemiología , Manejo de la Enfermedad , Femenino , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos , Encefalopatía de Wernicke/complicaciones , Encefalopatía de Wernicke/terapiaRESUMEN
OBJECTIVE: The study collected data on the attitudes of residents toward religion and spirituality in their practice after taking part in a 3-year curriculum on spirituality during their residency. METHODS: This is a descriptive, single-site study with psychiatry residents as subjects. A questionnaire was given to the residents at the end of their third year of residency (N = 12). RESULTS: The responses heavily endorsed the religiousness/spirituality curriculum to be helpful and meaningful. Residents consider addressing spiritual and religious needs of patients to be important (76.9%) and appropriate. For majority of the residents (69.2%), there is strong agreement in the management of addictions having spiritual dimensions. Residents also strongly agreed that treatment of suffering, depression, guilt, and complicated grief may require attention to spiritual concerns (92-100%). CONCLUSION: Regardless of cultural or religious background, the residents endorsed the curriculum as a worthwhile experience and increased their appreciation of the place of spirituality in the holistic care of patients with psychiatric conditions.
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Actitud del Personal de Salud , Curriculum , Internado y Residencia/métodos , Psiquiatría/educación , Espiritualidad , Adulto , Femenino , Humanos , India , Masculino , Persona de Mediana Edad , Nigeria , Pakistán , Sierra Leona , España , Encuestas y Cuestionarios , Emiratos Árabes Unidos , Estados UnidosRESUMEN
This is a case of a 22-year-old Hispanic male with a history of bipolar disorder and methamphetamine dependence who was admitted after presenting with suicidal ideations by slashing his throat with a machete. The patient had been smoking and inhaling "processed" pyrethroid for about eight weeks as an inexpensive methamphetamine substitute. He reported experiencing a "rush" similar to methamphetamine after using pyrethroid from liquid insecticide that had been heated (electrocuted) or sprayed on hot metal sheets until it crystallized. The patient presented with no significant physical markings or findings but claimed to have his suicidal ideations precipitated by concerns of ill effects of pyrethroid on his health. He also had positive urine drug screen for methamphetamine, which he admitted to using on the day of admission. We conclude that it is important for physicians to maintain a high level of suspicion for alternate and uncommon substances of abuse as well as risks for suicidal tendencies in these patients.