Showing papers by "Robert A. Rosenheck published in 2019"
TL;DR: This is the first longitudinal multivariable analysis of predictors of injurious violence in a large cohort of patients with schizophrenia followed over 18 months and revealed simultaneous strong effects of baseline injurious Violence and recent violent victimization on future injurious violent behavior.
Abstract: Objective:Violent behavior is infrequent among individuals with schizophrenia but is clinically important. The purpose of this study was to provide data on the correlates of violence, which may all...
48 citations
TL;DR: This article examined the association of current and past Opiate Use Disorder (OUD) with measures of HRQOL and employment in a nationally representative sample of adults using DSM-5 criteria.
44 citations
TL;DR: Veterans and non-veterans experience similar risk of OUD, similar correlates and adverse HRQOL impacts suggesting that similar treatment approaches may be effective for both groups.
Abstract: BACKGROUND AND OBJECTIVES Amidst a surging national crisis of opioid use, concern has been expressed about its impact on veterans, but no study has presented a population-based comparison of opioid use disorder (OUD) among veterans and non-veterans. We analyzed national epidemiologic data to compare rates, correlates and impacts of the opioid crisis on male veterans and non-veterans. METHODS Restricted data from 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) were used to compare veteran and non-veteran men on rates of OUD, as well as correlates of OUD including socio-demographic characteristics, psychiatric and substance use co-morbidities, and reductions in health-related quality of life (HRQOL). RESULTS About 2.0% of veterans and 2.7% of non-veterans, estimated at 418,000 and 2.5 million men, respectively, met criteria for life-time OUD. In both groups, OUD was associated with younger age, lower income levels, and fewer years of education. OUD was associated minority race among veterans, but with non-Hispanic white race among non-veterans. Both veteran and non-veteran adults with OUD were at least five times more likely than their peers to have both psychiatric and substance use co-morbidities (p < .001) and they experienced strongly reduced HRQOL scores (Cohen's d = -.50 to -.93). DISCUSSION AND CONCLUSION Veterans and non-veterans experience similar risk of OUD, similar correlates and adverse HRQOL impacts suggesting that similar treatment approaches may be effective for both groups. SCIENTIFIC SIGNIFICANCE Our findings highlight comparable vulnerability of veterans to non-veterans in both the risk of OUD and adverse effects on HRQOL. (Am J Addict 2018;XX:1-9).
43 citations
TL;DR: Entry into supported housing with linked primary care services was not associated with improvements in physical HRQOL and improvement in other medical outcome measures was not specifically associated with improved housing status.
Abstract: The permanent supported housing model is known to improve housing outcomes, but there has been sparse research on the effects of supported housing on physical health. Various organizations including the National Academy of Sciences have called for research in this area. This observational multi-site outcome study examined changes in physical health among chronically homeless adults participating in a comprehensive supported housing program and the associations between changes in physical health, housing status, and trust in primary care providers. Data are presented from an observational outcome study analyzed with mixed linear modeling and regression analyses. A total of 756 chronically homeless adults across 11 sites were assessed every 3 months for 1 year. The Collaborative Initiative to End Chronic Homelessness provided adults who were chronically homeless with permanent housing and supportive primary healthcare and mental health services. Days housed, physical health-related quality of life (HRQOL) measured by the Short Form-12 health survey, number of medical conditions, number of treated medical conditions, and number of preventive medical procedures received. Participants showed reduced number of medical problems and receipt of more preventive procedures over time, but there was no statistically significant change in physical HRQOL. Changes in housing were not significantly associated with changes in any physical health outcomes. Over time, participants’ trust in primary care providers was positively associated with increased numbers of reported medical problems and preventive procedures received but not with physical HRQOL. Entry into supported housing with linked primary care services was not associated with improvements in physical HRQOL. Improvement in other medical outcome measures was not specifically associated with improved housing status.
35 citations
TL;DR: Most adults with opioid use disorder remain untreated, much less received outpatient treatment to address their addiction, and interventions are needed to improve access to and motivation for care among these vulnerable adults.
Abstract: Objectives:The study examined rates, patterns, and correlates of drug treatment services use among adults with opioid use disorder compared with adults with other drug use disorders.Methods:Data we...
29 citations
TL;DR: Between-class polypharmacy is the most common pattern and in over 50% of instances may be justified by augmentation strategies or considerations of psychiatric multimorbidity, especially those occurring with psychiatric co-morbididities.
28 citations
Boston University1, University of Minnesota2, University of California, Los Angeles3, Dartmouth College4, The Feinstein Institute for Medical Research5, University of North Carolina at Chapel Hill6, Harvard University7, Oregon Health & Science University8, Long Island Jewish Medical Center9, University of Calgary10, Yale University11
TL;DR: The results indicate that the NAVIGATE program can be implemented with good fidelity to the treatment model in a diverse array of community mental health care settings serving persons with a first episode psychosis.
23 citations
TL;DR: It is hoped that this trial provides a foundation for planning a large-scale multi-site RCT to establish the efficacy of recovery-oriented interventions such as CTI-TS in Latin America.
Abstract: Several Latin American countries have made remarkable strides towards offering community mental health care for people with psychoses. Nonetheless, mental health clinics generally have a very limited outreach in the community, tending to have weaker links to primary health care; rarely engaging patients in providing care; and usually not providing recovery-oriented services. This paper describes a pilot randomized controlled trial (RCT) of Critical Time Intervention-Task Shifting (CTI-TS) aimed at addressing such limitations. The pilot RCT was conducted in Santiago (Chile) and Rio de Janeiro (Brazil). We included 110 people with psychosis in the study, who were recruited at the time of entry into community mental health clinics. Trial participants were randomly divided into CTI-TS intervention and usual care. Those allocated to the intervention group received usual care and, in addition, CTI-TS services over a 9-month period. Primary outcomes include quality of life (WHO Quality of Life Scale - Brief Version) and unmet needs (Camberwell Assessment of Needs) at the 18-month follow-up. Primary outcomes at 18 months will be analyzed by Generalized Estimating Equations (GEE), with observations clustered within sites. We will use three-level multilevel models to examine time trends on the primary outcomes. Similar procedures will be used for analyzing secondary outcomes. Our hope is that this trial provides a foundation for planning a large-scale multi-site RCT to establish the efficacy of recovery-oriented interventions such as CTI-TS in Latin America.
23 citations
TL;DR: In office-based medical practices in the US, diagnoses for opioid use disorder (OUD) and buprenorphine prescriptions for adults with OUD increased from 0.14% and 56.1%, respectively, in 2006-10 to 0.38% and 73.6% in 2011-15.
Abstract: BACKGROUND AND AIMS Opioid use disorder (OUD) remains a serious public health issue, and treating adults with OUD is a major priority in the United States. Little is known about trends in the diagnosis of OUD and in buprenorphine prescribing by physicians in office-based medical practices. We sought to characterize OUD diagnoses and buprenorphine prescribing among adults with OUD in the United States between 2006 and 2015. DESIGN AND SETTINGS We used a repeated cross-sectional design, based on data from the 2006-15 National Ambulatory Medical Care Surveys that surveyed nationally representative samples of office-based out-patient physician visits. PARTICIPANTS Adult patients aged 18 years or older with a diagnosis of OUD (n = 1034 unweighted) were included. MEASUREMENTS Buprenorphine prescribing was defined by whether visits involved buprenorphine or buprenorphine-naloxone, or not. We also examined other covariates (e.g. age, gender, race and psychiatric comorbidities). FINDINGS We observed an almost tripling of the diagnosis of OUD from 0.14% in 2006-10 to 0.38% in 2011-15 in office-based medical practices (P < 0.001). Among adults diagnosed with OUD, buprenorphine prescribing increased from 56.1% in 2006-10 to 73.6% in 2011-15 (P = 0.126). Adults with OUD were less likely to receive buprenorphine prescriptions if they were Hispanic [adjusted odds ratio (aOR) = 0.26; 95% confidence interval (CI) = 0.11, 0.60], had Medicaid insurance (aOR = 0.27; 95% CI = 0.10, 0.74) or were diagnosed with other psychiatric disorders (aOR = 0.45; 95% CI = 0.25, 0.83) or substance use disorders (aOR = 0.19; 95% CI = 0.09, 0.41). CONCLUSIONS In office-based medical practices in the United States, diagnoses for opioid use disorder and buprenorphine prescriptions for adults with opioid use disorder increased from 0.14 and 56.1%, respectively, in 2006-10 to 0.38 and 73.6% in 2011-15.
22 citations
TL;DR: Clinical changes in patient symptoms and quality of life were not significantly associated with changes in family caregiver burden, likely reflecting that small clinical changes in chronically ill adults are insufficient to affect long established experiences of burden.
Abstract: The longitudinal association of changes in clinical status among adults with schizophrenia and changes in family caregiver burden has not been demonstrated. Using data from the NIMH-funded CATIE schizophrenia trial (n = 446 family caregivers), we examined the association of changes in patient symptoms and quality of life with changes in measures of family caregiver burden. Clinical changes in patient symptoms and quality of life were not significantly associated with changes in family caregiver burden. The weak association likely reflects that small clinical changes in chronically ill adults are insufficient to affect long established experiences of burden.
19 citations
TL;DR: Results indicate that hospital use may be decreased by reducing the duration of untreated psychosis and prior hospitalizations, minimizing residual symptoms, preventing substance misuse, and facilitating adherence to medication taking.
Abstract: Objective:Despite treatment advances in other domains, inpatient psychiatric hospitalization rates for individuals with first-episode psychosis remain high. Even with early intervention services, a...
TL;DR: Connecticut experienced a more-than doubling of opioid-involved overdose deaths, largely driven by fentanyl and polysubstance use, which should be considered in efforts toward reducing opioid-related overdose incidents.
TL;DR: New psychotropic medications are commonly initiated without any psychiatric diagnosis, especially by non-psychiatrist physicians, and non-Psychiatrists should document relevant diagnoses more vigilantly to prevent potentially inappropriate use or misuse.
Abstract: Objectives To estimate rates and national trends of initiation of new psychotropic medications without a psychiatric diagnosis and to identify demographic and clinical correlates independently associated with such use among US adults in outpatient settings. Data source Data were gathered from the 2006-2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based U.S. outpatient care. The sample was limited to adults aged 18 or older who received a new psychotropic drug prescription (n = 8618 unweighted). Study design Using a repeated cross-sectional design with survey sampling techniques, we estimated prescription initiation rates and national trends. Multivariable-adjusted logistic regression analysis was used to identify correlates independently associated with initiation of new psychotropic prescriptions without a psychiatric diagnosis. Data collection/extraction methods Data were publicly available, and we extracted them from the Centers for Disease Control and Prevention website. Principal findings Altogether, at 60.4% of visits at which a new psychotropic prescription was initiated, no psychiatric diagnosis was recorded for the visit. Overall, the rate increased from 59.1% in 2006-2007 to 67.7% in 2008-2009 and then decreased to 52.0% in 2014-2015. Visits to psychiatrists were associated with very low odds of having no psychiatric diagnosis when compared to primary care visits (OR = 0.02; 95% CI, 0.01-0.04). Visits to non-psychiatric specialists showed 6.90 times greater odds of not having a psychiatric diagnosis when compared to primary care visits (95% CI, 5.38-8.86). Conclusion New psychotropic medications are commonly initiated without any psychiatric diagnosis, especially by non-psychiatrist physicians. Non-psychiatrists should document relevant diagnoses more vigilantly to prevent potentially inappropriate use or misuse.
TL;DR: PTSD patients with higher levels of multimorbidity were younger, had greater likelihood of recent homelessness, substance use disorder, and diverse medical diagnoses, along with increased mental health and medical service use and greater psychotropic medication use.
Abstract: Over 30% of veterans treated for psychiatric disorders in the Veterans Health Administration (VHA) are diagnosed with Post-Traumatic Stress Disorder (PTSD), with most receiving treatment for war-zone stress they experienced decades previously. We examined psychiatric multimorbidity among these patients and consider its implications for treatment and research. Using national VHA data from Fiscal Year 2012 on all veterans diagnosed with PTSD, we compared those with PTSD only to those with one, two, and three or more concurrent (non-substance use) psychiatric disorders. Comparisons of these four groups on sociodemographic characteristics, medical and substance use co-morbidities, health service use, and psychotropic prescription fills were conducted using bi-variate and ordinal logistic regression methods. Of 638,451 veterans diagnosed with PTSD in FY2012, only 29.8% had PTSD alone; 36.7% had one concurrent psychiatric diagnosis, 21.3% had two, and 12.2% had three or more. Anxiety disorder and major depressive disorder were the most common concurrent diagnoses. Veterans with higher levels of multimorbidity were younger, had greater likelihood of recent homelessness, substance use disorder, and diverse medical diagnoses, along with increased mental health and medical service use and greater psychotropic medication use. Psychiatric multimorbidity is highly prevalent among VHA patients diagnosed with PTSD, and may represent an underappreciated and poorly understood clinical complication that poses unique challenges to effective treatment. Clinical attention and both epidemiological and interventional research on multimorbidity in PTSD patients are needed in order to better understand and treat this common but understudied phenomenon.
TL;DR: The pattern of increasing PLEs predominates in predicting emergent mental disorder, particularly psychosis, along with minority status, trauma, and family divorce, suggesting potential targets for preventive intervention.
Abstract: Background Psychotic-like experiences (PLEs) may be important antecedents of psychosis and other mental disorders. Objective To investigate distinct longitudinal trajectories of the frequency of PLEs and their relationship to subsequent development of mental disorders. Methods A longitudinal study of self-reported PLEs and concurrent traumatic experiences was conducted among 6,198 adolescents through annual classroom assessments over 3 years (2014-2016) using the Community Assessment of Psychic Experiences and the Trauma History Questionnaire. Diagnoses of mental disorders were based on the Mini-International Neuropsychiatric Interview in the final year. Growth mixture modeling was used to identify distinct growth trajectories in the frequency of PLEs. Logistic regression was then used to explore relationships between different PLE trajectories and emergence of psychiatric disorders, taking account of sociodemographic characteristics and childhood antecedents. Results Two different PLE trajectories were identified, one characterized by stable low levels of PLE frequency and the other by progressively increasing PLE frequency. Transition to mental disorder occurred in 3.39% of the increasing-frequency group and 1.28% of the stable low-level group. The increasing-frequency group had a significantly higher risk of transition to any psychiatric disorder (OR = 2.7; 95% CI, 1.56-4.66), to a psychotic disorder (OR = 22.14; 95% CI, 2.30-213.25), and to a nonpsychotic psychiatric disorder (OR = 2.28; 95% CI, 1.27-4.10). Besides increasing PLEs (OR = 3.33; 95% CI, 1.55-7.19), other risk factors for any psychiatric disorder included childhood trauma (OR = 1.17; 95% CI, 1.01-1.36), family divorce (OR = 2.86; 95% CI, 1.24-6.61), and minority ethnicity (OR = 2.91; 95% CI, 1.18-7.20). Conclusions The pattern of increasing PLEs predominates in predicting emergent mental disorder, particularly psychosis, along with minority status, trauma, and family divorce, suggesting potential targets for preventive intervention.
TL;DR: In this paper, the authors examined the interrelation of recovery-oriented care and the de-stigmatization of mental illness, but no studies examined the impact of these interventions on mental health patients.
Abstract: Background: Although mental health advocates and providers have promoted both recovery-oriented care and the de-stigmatization of mental illness, no studies have examined the interrelation of these...
TL;DR: Electroconvulsive therapy use appears to be substantially higher in China than in the United States and is associated with indicators of higher rather than lower functioning as reflected by independent associations with youth, employment, and fewer past hospitalizations.
Abstract: Objective Recent studies have expressed concern about the infrequent and declining use of electroconvulsive therapy (ECT) in the United States. However, it is not known whether the US experience reflects changing global practice or one that varies between countries. This observational study examined use of ECT in the largest psychiatric hospital in China's third largest city over a 4-year period, 2014 to 2017. Methods Unduplicated electronic medical records concerning all inpatients with psychiatric diagnoses were examined. Electroconvulsive therapy utilization rates, correlates of ECT use, and its association with readmission within the 6 months following discharge were evaluated using bivariate and multivariate logistic regression analyses. Results Of 13,831 hospitalized patients, 2460 (17.8%) received ECT. Logistic regression analysis showed ECT utilization was independently associated with being female, younger age, being employed, nonlocal residence, involuntary admission, having no health insurance, longer length of stay, and the diagnoses of bipolar disorder and major depressive disorder. Use of ECT has increased since 2014 but was not significantly related to readmission 6 months after discharge. Conclusions Electroconvulsive therapy use appears to be substantially higher in China than in the United States and is associated with indicators of higher rather than lower functioning as reflected by independent associations with youth, employment, and fewer past hospitalizations, but also with behavioral noncompliance as reflected by involuntary admission, and has increased in recent years. Understanding United States-China discrepancies may further international understanding of the diverse roles of ECT in psychiatric practice.
TL;DR: Associative stigma was lower in China than in the US, possibly reflecting the cultural dominance of respect for educated professionals over stigma towards people with serious mental illness.
Abstract: “Associative stigma” is the negative stereotyping of mental health service providers who treat people with serious mental illness. The Clinician Associative Stigma Scale (CASS) has been validated in a US sample but not in other nations, e.g., in China which has been found to have substantially higher levels of stigma towards people with mental illness than the US. The 19-item CASS was translated into Chinese and administrated to 665 mental health professionals working in psychiatric hospitals in Southern China. Confirmatory factor analysis (CFA) was used to compare the factor structure with that found in the US sample. Socio-demographic correlates of CASS scores and comparison with US data were conducted using regression models and t test. CFA showed a good model fit (GFI = 0.911 and RMSEA = 0.068) for the four factors found in the US study: (1) discomfort with disclosing about working with serious mental illness, (2) stereotypes about professionals’ own poor mental health, (3) stereotypes about unpleasantness of working with people with serious mental illness, and (4) stereotypes about lack of treatment effectiveness. Total CASS score and subscales concerning stereotypes about providers’ mental health and about unpleasantness of working with such patients were significantly lower in China than in the US (both P < 0.001), but stereotypes concerning professional ineffectiveness were higher in China. Associative stigma was lower in China than in the US, possibly reflecting the cultural dominance of respect for educated professionals over stigma towards people with serious mental illness.
TL;DR: Polysubstance use, conceptualized within the multimorbidity perspective, is associated with increased severity of PTSD symptoms among veterans with dual diagnoses requiring complex interventions, the evaluation of which will require innovative trial designs.
Abstract: Objective: A distinct group of patients has recently been described who experience polysubstance use disorder characterized by use of multiple addictive substances. This study examines baseline cha...
TL;DR: In this longitudinal study, violent behavior assessed at admission and as a change measure after discharge, along with suicidal ideation and alcohol use, were associated with suicide attempts.
Abstract: OBJECTIVE There has been increasing concern about the high risk of suicide among US veterans, especially those with posttraumatic stress disorder (PTSD). Among those at greatest risk are veterans recently discharged from inpatient or specialized intensive treatment programs, but little is known about clinical correlates of suicide attempts among such veterans and this information that might facilitate prevention efforts. METHODS National program evaluation data were obtained at program entry and 4 months after discharge from 30,384 veterans from 57 sites (fiscal years 1993-2011) who were discharged from specialized intensive PTSD programs nationally in the Veterans Health Administration. Rates of attempted suicide were 10.6% in the 4 months prior to admission and 3.4% in the 4 months following discharge. Bivariate analyses and multivariable logistic regression were used to identify baseline characteristics, especially PTSD symptoms, associated with suicide attempts prior to admission and after discharge. Further analyses examined the association of changes in symptoms and other outcomes with reported post-discharge suicide attempts. RESULTS Suicide attempts both prior to admission and after discharge were associated with psychiatric and substance abuse comorbidity and especially suicidal ideation and violent behavior. Clinical changes independently associated with post-discharge suicide attempts included increased suicidal thoughts (β = 0.96, P < .001), violent behavior (β = 0.49, P < .001), and alcohol use (β = 0.56, P < .001). CONCLUSIONS In this longitudinal study, violent behavior assessed at admission and as a change measure after discharge, along with suicidal ideation and alcohol use, were associated with suicide attempts. Additional therapeutic attention to violent behavior and alcohol use, quite likely reflecting underlying impulsivity, may help reduce the risk of suicide attempts.
TL;DR: Medical comorbidities and service use accounted for most, but not all, of the increased risk of medical hospitalizations associated with mental illness.
TL;DR: Policy, funding, and strategy development initiatives are suggested to promote the implementation and dissemination of BITs in U.S. healthcare systems to better understand these phenomena.
Abstract: Behavioral intervention technologies (BITs) are online programs or mobile applications that deliver behavioral health interventions for self-care. The dissemination and implementation of such programs in U.S. healthcare systems has not been widely undertaken. To better understand these phenomena, we explored perspectives on BIT deployment in the Veterans Health Administration. Interviews from 20 providers, administrators, and policy makers were analyzed using qualitative methods. Eight themes were identified including the use of traditional healthcare delivery models, strategies for technology dissemination and implementation, internet infrastructure, leadership, health system structure, regulations, and strategic priorities. This research suggests policy, funding, and strategy development initiatives to promote the implementation and dissemination of BITs.
TL;DR: There has been a five-fold increase in veterans with mental disorders seen by non-specialists over 20 years from 7 to 38%, findings similar to those in non-VA settings.
Abstract: Patients with psychiatric disorders are treated by both mental health specialists and non-specialists. We use national data from the Veterans Health Administration to evaluate changing proportions of patients seen exclusively by non-specialists during the study year (FY 2012) limit as well as differences in socio-demographic, clinical and service use characteristics. There has been a five-fold increase in veterans with mental disorders seen by non-specialists over 20 years from 7 to 38%, findings similar to those in non-VA settings. Veterans treated by mental health specialists were younger, more likely to have been homeless and disabled, and had more severe and more numerous psychiatric diagnoses. There is a need to maintain specialty services and to strengthen non-specialty care through education and research.
TL;DR: Compared to participants in mixed-gender programs, those in women-only programs had longer lengths of stay, higher levels of commitment to therapy, and were more likely to participate in posttreatment outcome assessments following discharge.
Abstract: Although most female veterans treated in specialized intensive Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) programs receive services in settings in which over 95% of participants are men, two programs include only women. Whether outcomes for women with PTSD are superior in women-only programs has not been evaluated. National program evaluation data on 1,357 women veterans from 57 sites were collected at program entry and 4 months after discharge. With adjustment for differences in baseline characteristics, outcomes of women in two women-only programs (n = 469) were compared with those from 55 mixed-gender programs (n = 888), using mixed models with random effect for site. The primary outcome was total PTSD symptom level, with supplementary information on PTSD assessment subscales, substance use, and other outcomes. At program entry, female veterans in women-only programs had lower scores on measures of total PTSD symptoms, p = .013, d = -0.24, and on several subscales. Adjusting for these differences, there were no significant differences between program types in terms of PTSD total score or scores on secondary measures. In women-only programs, veterans had longer lengths of stay and were rated by their clinicians to have a higher level of commitment to therapy at discharge. Thus, women-only programs did not show superior outcomes; however, compared to participants in mixed-gender programs, those in women-only programs had longer lengths of stay, higher levels of commitment to therapy, and were more likely to participate in posttreatment outcome assessments following discharge.
TL;DR: In this article, the authors discuss the efeito do internato em saude mental nas atitudes dos alunos de medicina quanto a portador de transtorno mental (PTM).
Abstract: RESUMO Objetivo Avaliar o efeito do internato em saude mental nas atitudes dos alunos de medicina quanto ao portador de transtorno mental (PTM). Metodos Atitudes foram avaliadas por questionario antes e depois do internato, por meio dos fatores: “aceitacao social de PTM” (F1), “nao acreditar em causas sobrenaturais para doenca mental” (F2), “papeis sociais comuns para PTM” (F3), “acreditar em causas psicossociais para doenca mental” (F4), “intimidade” (F5). Diferencas foram avaliadas por meio de testes t, fatores confundidores por ANOVA e correlacoes entre expectativa de melhora e fatores por Pearson. Resultados 74 de 85 alunos responderam ao questionario. Houve reducao significativa em quatro fatores avaliados (F1, p < 0,001, F2, p = 0,002, F3, p = 0,04, F5, p < 0,001). Uma associacao entre ter um amigo PTM e F3 foi identificada antes do curso (p = 0,04), porem nao apos (p = 0,13). Houve correlacao positiva entre crencas de melhora e atitudes negativas com o F2 antes do curso (p = 0,01), mas nao apos. F5 esteve relacionado com a expectativa de melhora (p < 0,001) apos o curso, indicando melhores atitudes quando melhor expectativa. Observou-se a melhora da expectativa quanto a resposta ao tratamento da esquizofrenia (p = 0,02), transtorno bipolar (p = 0,03) e transtorno de ansiedade (p = 0,03). Conclusoes O internato esteve associado a reducao de atitudes negativas com relacao aos PTMs. O contato direto com o paciente parece ter influencia direta nessa reducao. Acreditamos que, mais importante do que possiveis efeitos de esclarecimento sobre causas do adoecimento, a desconstrucao do mito sobre o louco violento e essencial para a melhora das atitudes. Estudos com populacoes de outras regioes do Brasil e voltadas para avaliacao do medo de violencia sao necessarios para a confirmacao dessa hipotese e do efeito do internato sobre os alunos.
TL;DR: The high risk of homelessness among HIV positive veterans is largely attributable to multi-morbid risk factors common to both HIV and homelessness rather than to an independent effect of HIV, and requires multi-dimensional preventive psychosocial interventions.
Abstract: This study sought to evaluate the risk of homelessness among HIV positive users of Veterans Health Administration (VHA) services. National VHA administrative data from Fiscal Year (FY) 2012...
TL;DR: A synthesis of cost-effectiveness studies to determine whether benefits exceed costs in psychosis concludes only that early intervention ‘might be’ worth its costs.
Abstract: Early intervention in psychosis has generated hope. Cost-effectiveness studies, to determine whether benefits exceed costs, thus far conclude only that early intervention 'might be' worth its costs. It is a testament to the importance of the question: even in the absence of conclusive data, a synthesis should be attempted.Declaration of interestNone.