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Frontiers in Psychiatry 2022Scientific and clinical work concerning the etiology of substance use and addiction has come a long way in the past decades. Current theories highlight the notion that...
Scientific and clinical work concerning the etiology of substance use and addiction has come a long way in the past decades. Current theories highlight the notion that addiction is rooted in deficits in neurobiological and psychological reward mechanisms, but also as a coping-oriented effort to contend with, or "self-medicate," negative emotional experiences. As such, contemporary approaches in the dynamic psychotherapy of addiction highlight the compensatory nature of addiction, encouraging clinicians to detect the mental suffering underlying addiction and promote alternative coping behaviors. In this perspective article, the authors advocate for an integrative approach toward understanding and addressing addiction in psychotherapy, acknowledging its biological, psychological and social aspects. We propose that in addition to the regulatory process of self-medication, in which negative emotions are being suppressed, compulsive substance use may also reflect a substitutive function, in which negative emotions are being 'acted-out' through the use of drugs or alcohol. We suggest an integrative clinical approach which addresses these psychological aspects in a sequential manner and discuss consequent benefits for clinicians and patients working with and through addiction.
PubMed: 35222121
DOI: 10.3389/fpsyt.2022.820660 -
Respiratory Care Jun 2018Asthma exacerbation is defined as a progressive increase in symptoms of shortness of breath, cough, or wheezing sufficient to require a change in therapy. After ruling... (Review)
Review
Asthma exacerbation is defined as a progressive increase in symptoms of shortness of breath, cough, or wheezing sufficient to require a change in therapy. After ruling out diagnoses that mimic an asthma exacerbation, therapy should be initiated. Short-acting β agonists and short-acting muscarinic antagonists are effective as bronchodilators for asthma in the acute setting. Systemic corticosteroids to reduce airway inflammation continue to be the mainstay therapy for asthma exacerbations, and, unless there is a contraindication, the oral route is favored. Based on the current evidence, nebulized magnesium should not be routinely used in acute asthma. The evidence favors the use of intravenous magnesium sulfate in selected cases, particularly in severe exacerbations. Methylxanthines have a minimum role as therapy for asthma exacerbations but may be considered in refractory cases of status asthmaticus with careful monitoring of toxicity. Current guidelines recommend the use of helium-oxygen mixtures in patients who do not respond to standard therapies or those with severe disease.
Topics: Acute Disease; Anti-Asthmatic Agents; Asthma; Disease Management; Disease Progression; Drug Therapy, Combination; Humans
PubMed: 29794211
DOI: 10.4187/respcare.05953 -
Comprehensive Psychiatry Apr 2021Two of Europe's most influential psychopathologists at the start of the twentieth century (Eugen Bleuler and Karl Jaspers) pointed out the fact that patients rarely act... (Review)
Review
OBJECTIVES
Two of Europe's most influential psychopathologists at the start of the twentieth century (Eugen Bleuler and Karl Jaspers) pointed out the fact that patients rarely act according to their delusions. This study proposes an investigation of how this issue is addressed in psychopathological literature.
METHODS
This article offers a critical review of psychopathological literature which focuses on the influence of delusional ideation on behaviour.
RESULTS
Phenomenological psychiatry has relied on the paradox pointed out by Bleuler and Jaspers to emphasize disorders of self-experience in psychosis whereas analytical philosophy of delusion has focused on the psychological status of delusion, regarded as belief, certainty, or imagination. The empirical studies conducted during the past three decades - which were devoted to acting on delusion - focused on violent and safety-seeking behaviours. These studies have shown that these behavioural disorders are motivated by an emotional outburst (anger and/or fear) rather than by delusional content.
CONCLUSION
Delusional inconsequentiality can be clarified by conceptual research in phenomenological psychiatry and analytical philosophy, even though its role in the psychopathological processes has not yet been clearly identified or conceptualised. Empirical psychopathology on acting on delusion confirms the delusional inconsequentiality, but only implicitly, by highlighting the role of affectivity (rather than beliefs) in delusional actions. Given the major implications of better understanding this phenomenon, in terms of psychopathology and clinical practices, we suggest considering delusional inconsequentiality as a promising concept which could guide further research in contemporary psychopathology.
Topics: Delusions; Humans; Psychiatry; Psychopathology; Psychotic Disorders; Thinking
PubMed: 33581447
DOI: 10.1016/j.comppsych.2021.152230 -
California Medicine Dec 1956Not all behavior problems develop into juvenile delinquency nor do all juvenile delinquents become adult criminals. Environment is not in itself the only determining...
Not all behavior problems develop into juvenile delinquency nor do all juvenile delinquents become adult criminals. Environment is not in itself the only determining factor in the development of delinquency; rather, environment may offer the opportunity for acting out conflicts in an antisocial way. Conflicts are dealt with by antisocial behavior patterns rather than through various neurotic defense mechanisms. There appears to be a defect in conscience. Parental roles are extremely important in helping the growing child develop those positive aspects of his personality which lead to adult maturity and adult happiness. Included in parental factors are the relationships of both parents to the child, not just in what is conscious and deliberate in the relationship, but in what also can occur unconsciously or without awareness in the relationship.
Topics: Adult; Antisocial Personality Disorder; Child; Humans; Juvenile Delinquency; Parents
PubMed: 13374562
DOI: No ID Found -
The Western Journal of Medicine May 1990Some symptoms seen in adolescents with the disease of chemical dependence are similar to those seen in adults. Because of their age, lack of personality development,...
Some symptoms seen in adolescents with the disease of chemical dependence are similar to those seen in adults. Because of their age, lack of personality development, dependent family role, immaturity, and acting out of age-related behavioral tendencies, however, symptoms specific to this population occur. These may become exacerbated and telescope--intensify and shorten--the progression of the disease. A plan to solve the problem of adolescent chemical dependence must focus on education, demonstration, cooperation, prevention, intervention, habilitation, treatment, and recovery. The phenomenon of denial in a chemically dependent adolescent yields a more complex delusional system that dictates age-specific intervention approaches. Habilitation is necessary for successful adolescent treatment and recovery because what is needed is an initial process of learning, not relearning or rehabilitation. If specific adolescent issues are addressed through comprehensive, multimodality treatment approaches, then treatment and recovery outcomes for chemically dependent adolescents and their families are substantially improved. Primary care physicians must be alert to the possibility of drug use in their young patients and aware of treatment options.
Topics: Adolescent; Child; Denial, Psychological; Female; Humans; Male; Primary Health Care; Psychology, Adolescent; Substance-Related Disorders
PubMed: 2349798
DOI: No ID Found -
Frontiers in Pharmacology 2023Long-acting injectable (LAI) antipsychotics (APs) each have an oral equivalent formulation, while aripiprazole, olanzapine, and ziprasidone each also have a...
Long-acting injectable (LAI) antipsychotics (APs) each have an oral equivalent formulation, while aripiprazole, olanzapine, and ziprasidone each also have a short-acting injectable (SAI) equivalent formulation. Inpatient prescribing patterns of LAIs and their oral/SAI equivalents are less characterized in populations other than Medicaid, Medicare, and Veterans Affairs populations. Mapping out inpatient prescribing patterns remains an important first step to ensure appropriate use of antipsychotics during this critical juncture of patient care prior to discharge. This study determined inpatient prescribing patterns of first- (FGA) and second-generation antipsychotic (SGA) LAIs and their oral/SAI formulations. This was a large retrospective study using the Cerner Health Facts® database. Hospital admissions due to schizophrenia, schizoaffective disorder, or bipolar disorder from 2010 to 2016 were identified. AP utilization was defined as the proportion of inpatient stays during which at least 1 AP was administered to the total number of inpatient visits over the observed period. Descriptive analyses were used to determine prescribing patterns for APs. Chi-square tests were used to determine utilization differences across years. 94,989 encounters were identified. Encounters during which oral/SAI of SGA LAIs were administered were most common (n = 38,621, 41%). Encounters during which FGA LAIs or SGA LAIs were administered were the least common (n = 1,047, 1.1%). Prescribing patterns differed across years ( < 0.05) within the SGA LAI subgroup analysis (N = 6,014). Paliperidone palmitate (63%, N = 3,799) and risperidone (31%, N = 1,859) were the most frequently administered. Paliperidone palmitate utilization increased from 30% to 72% ( < 0.001), while risperidone utilization decreased from 70% to 18% ( < 0.001). Compared with their oral or SAI formulations, LAIs were underutilized from 2010 to 2016. Among SGA LAIs, the prescribing patterns of paliperidone palmitate and risperidone changed significantly.
PubMed: 37284307
DOI: 10.3389/fphar.2023.1140969 -
Frontiers in Psychiatry 2022The goal of this paper is to try and close the gap between the ways in which pathological and normal personality, including their development, are conceptualized. To... (Review)
Review
The goal of this paper is to try and close the gap between the ways in which pathological and normal personality, including their development, are conceptualized. To this end, attention is drawn to parallels that exist between the ways self-function is conceptualized in contemporary personality psychology and in recent iterations of the major psychiatric nosologies, particularly ICD-11. Conceptualizations in both normal and abnormal personality see a fundamental dichotomy between and (vs autonomous). Evidence is reviewed supporting a basic dichotomy between two categories of personality pathology that can be subsumed under the labels "Acting Out" and "Anxious-Inhibited." It is suggested that fundamental to the personality pathology subsumed under "Acting Out" is a deficient interdependent self, while a defective self-identity is proposed to underlie the personality pathology subsumed under "Anxious-Inhibited."
PubMed: 36339855
DOI: 10.3389/fpsyt.2022.1023236 -
The American Journal of Managed Care Nov 2022To describe the uptake and out-of-pocket (OOP) costs of Basaglar, the first long-acting insulin biosimilar, in a commercially insured population in the United States.
OBJECTIVES
To describe the uptake and out-of-pocket (OOP) costs of Basaglar, the first long-acting insulin biosimilar, in a commercially insured population in the United States.
STUDY DESIGN
Retrospective analysis of commercial pharmacy claims and pharmacy co-payment offsets.
METHODS
We assessed Basaglar uptake by examining trends in the composition of the long-acting insulin market in the United States from 2014 to 2018. As patient demographics and plan type may be important determinants of biosimilar uptake, we also assessed characteristics of all long-acting insulin users by drug. We examined Basaglar OOP costs by assessing mean OOP costs per claim for users of Basaglar and other long-acting insulins, overall and by plan type, and the number and source of co-payment offsets for Basaglar and other insulin glargine products from Basaglar market entry through 2018. We used multivariate linear models to examine the relationship between Basaglar OOP expenditures and insurer-negotiated amounts, overall and by plan type.
RESULTS
Basaglar experienced a rapid uptake. However, there was no evidence that Basaglar users had lower OOP costs than reference product (Lantus) users.
CONCLUSIONS
Given our results and the approval of the first interchangeable biosimilar, we recommend the empirical evaluation of biosimilar cost savings to patients and insurers prior to promoting their automatic substitution.
Topics: Humans; United States; Insulin Glargine; Biosimilar Pharmaceuticals; Insulin, Long-Acting; Hypoglycemic Agents; Retrospective Studies; Insulin
PubMed: 36374658
DOI: 10.37765/ajmc.2022.89265 -
Family Relations Apr 2022Our study investigates how changes in family contexts were associated with child behaviors during Ohio's COVID-19 shutdown of early 2020.
OBJECTIVE
Our study investigates how changes in family contexts were associated with child behaviors during Ohio's COVID-19 shutdown of early 2020.
BACKGROUND
The COVID-19 pandemic caused major economic and social changes for families. Rapid research was conducted to assess these changes and their potential impacts on child behaviors.
METHOD
Using a diverse sample of families with children aged birth to 9 years ( = 559), we describe key economic changes and parent-reported stressors experienced during Ohio's shutdown period. Then, we use regression models to examine how these family conditions were associated with child emotional distress and changes in sleep routines.
RESULTS
When parents experienced more total COVID-19 pandemic-related stressors, they also reported that their children exhibited more anxious and withdrawn, fearful, acting out, and COVID-19 pandemic-related behaviors ( < 0.01).
CONCLUSION
Families and children living at home in Ohio experienced significant stress during the shutdown. These findings can be used to inform future studies of the social and economic consequences of the COVID-19 pandemic for parents and children.
IMPLICATIONS
Families and children have experienced multiple stressors during the COVID-19 pandemic. Researchers and practitioners should continue to monitor and support families and children to mitigate potential lasting consequences.
PubMed: 35600938
DOI: 10.1111/fare.12655