PurposeTo systematically review articles reporting on depression, anxiety, and burnout among U.S. and Canadian medical students.MethodMedline and PubMed were searched to identify peer-reviewed English-language studies published between January 1980 and May 2005 reporting on depression, anxie

http://www.medical-mastermind-community.com/uploads/63-Systematic_Review_of_Depression_Anxiety_and.9.pdf

Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students.

In this study, burnout was common among resident physicians and was associated with self-reported suboptimal patient care practices.

Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program

Substance abuse treatment entry, retention, and outcome in women: a review of the literature.

The goal of medical education is to graduate knowledgeable, skillful, and professional physicians. The medical school curriculum has been developed to accomplish these ambitions; however, some aspects of training may have unintended negative effects on medical students' mental and emotional health that can undermine these values. Studies suggest that mental health worsens after students begin medical school and remains poor throughout training. On a personal level, this distress can contribute to substance abuse, broken relationships, suicide, and attrition from the profession. On a professional level, studies suggest that student distress contributes to cynicism and subsequently may affect students' care of patients, relationship with faculty, and ultimately the culture of the medical profession. In this article, we review the manifestations and causes of student distress, its potential adverse personal and professional consequences, and proposed institutional approaches to decrease student distress.

Medical Student Distress: Causes, Consequences, and Proposed Solutions

Opioid receptors have been targeted for the treatment of pain and related disorders for thousands of years and remain the most widely used analgesics in the clinic. Mu (μ), kappa (κ), and delta (δ) opioid receptors represent the originally classified receptor subtypes, with opioid receptor like-1 (ORL1) being the least characterized. All four receptors are G-protein coupled and activate inhibitory G proteins. These receptors form homo- and heterodimeric complexes and signal to kinase cascades and scaffold a variety of proteins.The authors discuss classic mechanisms and developments in understanding opioid tolerance and opioid receptor signaling and highlight advances in opioid molecular pharmacology, behavioral pharmacology, and human genetics. The authors put into context how opioid receptor signaling leads to the modulation of behavior with the potential for therapeutic intervention. Finally, the authors conclude there is a continued need for more translational work on opioid receptors in vivo.

Molecular mechanisms of opioid receptor-dependent signaling and behavior.

Objective. —To estimate the prevalence of substance use among US physicians. Design. —A mailed, anonymous, self-report survey that assessed use of 13 substances and permitted comparison with results of the National Household Survey on Drug Abuse. Rates of physician substance use were weighted to provide national prevalence estimates. Participants. —A national sample of 9600 physicians, stratified by specialty and career stage, and randomly selected from the American Medical Association master file. The response rate after three mailings was 59%. Demographic characteristics of respondents closely reflected those of the US physician population. Main Outcome Measures. —Subjects' self-reported use of 13 substances in their lifetime, the past year, and the past month; reasons for use; self-admitted substance abuse or dependence; and whether treatment was received. For controlled prescription substances, respondents were asked to report only use "not prescribed by another physician for a legitimate medical or psychiatric condition." Results. —Physicians were less likely to have used cigarettes and illicit substances, such as marijuana, cocaine, and heroin, in the past year than their age and gender counterparts in the National Household Survey on Drug Abuse. They were more likely to have used alcohol and two types of prescription medications—minor opiates and benzodiazepine tranquilizers. Prescription substances were used primarily for self-treatment, whereas illicit substances and alcohol were used primarily for recreation. Current daily use of illicit or controlled substances was rare. Conclusions. —Although physicians were as likely to have experimented with illicit substances in their lifetime as their age and gender peers in society, they were far less likely to be current users of illicit substances. The higher prevalence of alcohol use among respondents may be more a characteristic of their socioeconomic class than of their profession. A unique concern for physicians, however, is their high rate of self-treatment with controlled medications—a practice that could increase their risk of drug abuse or dependence. Uniform national guidelines are needed to sensitize medical students and physicians to the dangers of self-treatment with controlled prescription substances. (JAMA. 1992;267:2333-2339)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=396891&pdfFileName=jama_267_17_029.pdf

Prevalence of substance use among US physicians.

Senior students at 23 regionally distributed medical schools received an anonymous questionnaire designed to examine current and prior use of tobacco, alcohol, and nine other drugs. The overall response rate was 67% (N = 2046). Substance use prevalence rates during the 30 days preceding the survey included alcohol, 87.5%; marijuana, 10.0%; cigarettes, 10.0%; cocaine, 2.8%; tranquilizers, 2.3%; opiates other than heroin, 1.1%; psychedelics other than LSD (lysergic acid diethylamide), 0.6%; amphetamines, 0.3%; barbiturates, 0.2%; LSD, 0.1%; and heroin, 0.0%. Compared with national, age-related comparison groups, senior medical students reported less use of all substances during the past 30 days and the past 12 months, except for alcohol, tranquilizers, and psychedelics other than LSD. Substantial new drug use after entry into medical school was reported only for tranquilizers. Seven students (0.2%) admitted to current dependence on a substance other than tobacco, four of these implicating marijuana. Thirty-three students (1.6%) believed that they currently needed help for substance abuse. Only 25.7% were aware of any policy on substance abuse at their own school.

Substance use among senior medical students. A survey of 23 medical schools.

OBJECTIVE\nTo estimate the prevalence of substance use among US physicians.\n\n\nDESIGN\nA mailed, anonymous, self-report survey that assessed use of 13 substances and permitted comparison with results of the National Household Survey on Drug Abuse. Rates of physician substance use were weighted to provide national prevalence estimates.\n\n\nPARTICIPANTS\nA national sample of 9600 physicians, stratified by specialty and career stage, and randomly selected from the American Medical Association master file. The response rate after three mailings was 59%. Demographic characteristics of respondents closely reflected those of the US physician population.\n\n\nMAIN OUTCOME MEASURES\nSubjects' self-reported use of 13 substances in their lifetime, the past year, and the past month; reasons for use; self-admitted substance abuse or dependence; and whether treatment was received. For controlled prescription substances, respondents were asked to report only use \"not prescribed by another physician for a legitimate medical or psychiatric condition.\"\n\n\nRESULTS\nPhysicians were less likely to have used cigarettes and illicit substances, such as marijuana, cocaine, and heroin, in the past year than their age and gender counterparts in the National Household Survey on Drug Abuse. They were more likely to have used alcohol and two types of prescription medications--minor opiates and benzodiazepine tranquilizers. Prescription substances were used primarily for self-treatment, whereas illicit substances and alcohol were used primarily for recreation. Current daily use of illicit or controlled substances was rare.\n\n\nCONCLUSIONS\nAlthough physicians were as likely to have experimented with illicit substances in their lifetime as their age and gender peers in society, they were far less likely to be current users of illicit substances. The higher prevalence of alcohol use among respondents may be more a characteristic of their socioeconomic class than of their profession. A unique concern for physicians, however, is their high rate of self-treatment with controlled medications--a practice that could increase their risk of drug abuse or dependence. Uniform national guidelines are needed to sensitize medical students and physicians to the dangers of self-treatment with controlled prescription substances.

Prevalence of substance use among U.S. physicians

Self-reported past year use of alcohol, tobacco, marijuana, cocaine, and two controlled prescription substances (opiates, benzodiazepines); and self-reported lifetime substance abuse or dependence was estimated and compared for 12 specialties among 5,426 physicians participating in an anonymous mailed survey. Logistic regression models controlled for demographic and other characteristics that might explain observed specialty differences. Emergency medicine physicians used more illicit drugs. Psychiatrists used more benzodiazepines. Comparatively, pediatricians had overall low rates of use, as did surgeons, except for tobacco smoking. Anesthesiologists had higher use only for major opiates. Self-reported substance abuse and dependence were at highest levels among psychiatrists and emergency physicians, and lowest among surgeons. With evidence from studies such as this one, a specialty can organize prevention programs to address patterns of substance use specific to that specialty, the specialty characteristics of its members, and their unique practice environments that may contribute risk of substance abuse and dependence.

Physician Substance Use by Medical Specialty

A national survey was conducted to determine patterns of drug use among 3000 American resident physicians. Sixty percent (1785) of the residents surveyed responded. This report evaluates the prevalence of drug use among the respondents, when they initiated drug use, and their reasons for current use. Substance use rates are compared with other studies of resident physicians and with a sample of their nonphysician age peers surveyed the same year. Heavy substance use patterns were not observed among resident physicians. They had significantly lower rates of use for most psychoactive substances than their peers in the general population but did report higher rates of past-month use of alcohol and benzodiazepines. A sizable minority began using benzodiazepines and prescription opiates during their residency years—the stage in physicians' training when they first receive prescribing privileges. Current users of benzodiazepines and opiates used these drugs primarily for self-treatment rather than recreation. These two substances are often associated with impairment at later stages in the physician's career. (JAMA. 1991;265:2069-2073)

Patrick H. Hughes

Papers

Prevalence of substance use among US physicians.

Substance use among senior medical students. A survey of 23 medical schools.

Prevalence of substance use among U.S. physicians

Physician Substance Use by Medical Specialty

Resident physician substance use in the United States.