Smart phones and medical students: Pleasant distraction or dangerous addiction?

Smart phones are central to communication in the current century. We administered a survey to determine the impact of excessive smart phone use on academic performance, interpersonal relationships and mental health in medical students. During the study, 700 medical students from King Edward Medical University, Lahore, Pakistan, were administered a questionnaire which recorded information about demographics, academic performance, interpersonal relationships and psychological problems. Out of 630 respondents, 255(40.5%) were males and 375(59.5%) were females with a mean age of 21.1}1.8 years. Results showed smart phone use during class lectures was associated with significant reduction in academic performance and problems with interpersonal relationships. Medical students bullied via smart phones were likely to bully others. Excessive use of smart phones was associated with students preferring to communicate emotions through texting rather than verbal communication. Various psychological problems were found prevalent in excessive users of smart phones.

A Review of the Pharmacological Management of Chronic Pain in Patients with Heart Failure.

Background: The incidence rates of heart failure (HF) and chronic pain increase with age. In the geriatric population, both disorders often coexist and pose a challenge to clinicians in treating them simultaneously. Methods: We conducted an online literature search for reports of the heart failure effects of pharmacological treatments for chronic pain. Results: Topical pain medications are favored agents because of their efficacy, tolerability, and favorable side-effect profile. Acetaminophen is a preferred oral medication for the treatment of pain in patients with HF. Due to deleterious effects including HF, the long-term use of oral nonsteroidal anti-inflammatory drugs and gabapentinoids are discouraged. Conclusion: Prescribers should thoroughly consider the risk-benefit ratio and individual patient-risk profile before instituting pharmacological treatment for chronic pain in patients with HF.

Psychotherapeutic interventions for chronic pain: Evidence, rationale, and advantages.

BACKGROUND: Long-term use of opioids to treat chronic pain incurs serious risks for the individual-including misuse, abuse, addiction, overdose and death-as well as creating economic, social, and cultural impacts on society as a whole. Chronic pain and substance use disorders are often co-morbid with other medical problems and at the present time, primary care clinicians serve most of this population. Primary care clinicians would benefit from having alternatives to opioids to employ in treating such patients. METHOD: We electronically searched different medical databases for studies evaluating the effect of nonpharmacological treatments for chronic pain. We describe alternative approaches for the treatment of chronic pain and cite studies that provide substantial evidence in favor of the use of these treatments. RESULTS: Cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based programs have well-documented effectiveness for the treatment of chronic nonmalignant pain. Integration of such behavioral health therapies into primary care settings may optimize health resources and improve treatment outcomes. CONCLUSION: Evidence-based psychotherapy for chronic pain has established efficacy and safety and improves quality of life and physical and emotional functioning. Such interventions may be used as an alternative or adjunct to pharmacological management. Chronic opioid use should be reserved for individuals undergoing active cancer treatment, palliative care, or end-of-life care.

Bibliometrics of Fifty Most-Cited Articles on the Mental Health of Immigrants Living in the United States.

The premise of our study was to identify the 50 most frequently cited articles on the mental and behavioral health of immigrant and refugee populations in the USA using the Thomas Reuters' WOS database. Articles were reviewed for inclusion by a panel comprised of two specialist physicians and a political scientist. Citations ranged from 69 to 520. Almost half of all articles (n = 23) focus on Hispanic populations. 32 articles employed a cross-sectional study design. Sample sizes ranged from 8,000,000 to 20. Over half of all (n = 30) articles were published between 2000 and 2012 in 22 journals, covering 38 research areas. The total number of institutional affiliations was 148, averaging at 3 per article. Our recommendations state: diversify sampling in terms of ethnic and racial backgrounds; develop a uniform instrument for immigrant and refugee mental health; and conduct comparative studies to examine the differences in the mental health among diverse communities.

Frequency and correlates of symptoms of anxiety and depression among young caregivers of cancer patients: a pilot study.

OBJECTIVES: To determine the frequency of symptoms of anxiety and depression among the young caregivers of family members with cancer and their correlation with role of gender, age and socio-economic status. RESULTS: A total of 87.8% of caregivers were between 11 and 16 years of age, with 94.6% reported having support from another caregiver. At least 95% of caregivers reported symptoms of anxiety with a higher predisposition among females. Around 73% of caregivers had low monthly incomes followed by (22.9%) middle and (4.1%) high monthly incomes. Care givers belonging to low income groups were more likely to report anxiety and depressive symptoms (70%). Young adults 17-18 years of age reported fewer symptoms of anxiety (10.9%) than their younger counterparts. Reported symptoms of anxiety and depression decreased when the number of care givers increased-2 (67.5%), 3 (16.2%), 4 (5.4%). Increased hospital stay was associated with increased frequency of symptoms, but not beyond 5 weeks.

Mindfulness-based interventions for chronic pain: Evidence and applications.

Chronic pain is estimated to occur in from 5.5% to 33% of the world's adult population (Gureje et al., 1998). Chronic pain is frequently treated with opiates, which has produced an opiate addiction crisis (Dowell et al., 2016). Several non-pharmacological treatment alternatives can help manage chronic pain. There is moderate evidence that mindfulness-based interventions (MBIs) such as meditation, yoga, and stress reduction lower the perception of pain, increase mobility, improve functioning and well-being. By integrating MBIs and other therapeutic interventions in a multi-disciplinary pain management plan, clinicians can improve treatment outcomes and potentially decrease pain-related medication utilization.

Mental health in the Americas: an overview of the treatment gap.

OBJECTIVE: To understand the mental health treatment gap in the Region of the Americas by examining the prevalence of mental health disorders, use of mental health services, and the global burden of disease. METHODS: Data from community-based surveys of mental disorders in Argentina, Brazil, Canada, Chile, Colombia, Guatemala, Mexico, Peru, and the United States were utilized. The World Mental Health Survey published data were used to estimate the treatment gap. For Canada, Chile, and Guatemala, the treatment gap was calculated from data files. The mean, median, and weighted treatment gap, and the 12-month prevalence by severity and category of mental disorder were estimated for the general adult, child-adolescent, and indigenous populations. Disability-adjusted Life Years and Years Lived with Disability were calculated from the Global Burden of Disease study. RESULTS: Mental and substance use disorders accounted for 10.5% of the global burden of disease in the Americas. The 12-month prevalence rate of severe mental disorders ranged from 2% - 10% across studies. The weighted mean treatment gap in the Americas for moderate to severe disorders was 65.7%; North America, 53.2%; Latin America, 74.7%; Mesoamerica, 78.7%; and South America, 73.1%. The treatment gap for severe mental disorders in children and adolescents was over 50%. One-third of the indigenous population in the United States and 80% in Latin America had not received treatment. CONCLUSION: The treatment gap for mental health remains a public health concern. A high proportion of adults, children, and indigenous individuals with serious mental illness remains untreated. The result is an elevated prevalence of mental disorders and global burden of disease.

Mental health in the Americas: an overview of the treatment gap / La salud mental en las Américas: una visión general de la brecha de tratamiento / Saúde mental nas Américas: uma visão geral da lacuna de tratamento

ABSTRACT Objective To understand the mental health treatment gap in the Region of the Americas by examining the prevalence of mental health disorders, use of mental health services, and the global burden of disease. Methods Data from community-based surveys of mental disorders in Argentina, Brazil, Canada, Chile, Colombia, Guatemala, Mexico, Peru, and the United States were utilized. The World Mental Health Survey published data were used to estimate the treatment gap. For Canada, Chile, and Guatemala, the treatment gap was calculated from data files. The mean, median, and weighted treatment gap, and the 12-month prevalence by severity and category of mental disorder were estimated for the general adult, child-adolescent, and indigenous populations. Disability-adjusted Life Years and Years Lived with Disability were calculated from the Global Burden of Disease study. Results Mental and substance use disorders accounted for 10.5% of the global burden of disease in the Americas. The 12-month prevalence rate of severe mental disorders ranged from 2% - 10% across studies. The weighted mean treatment gap in the Americas for moderate to severe disorders was 65.7%; North America, 53.2%; Latin America, 74.7%; Mesoamerica, 78.7%; and South America, 73.1%. The treatment gap for severe mental disorders in children and adolescents was over 50%. One-third of the indigenous population in the United States and 80% in Latin America had not received treatment. Conclusion The treatment gap for mental health remains a public health concern. A high proportion of adults, children, and indigenous individuals with serious mental illness remains untreated. The result is an elevated prevalence of mental disorders and global burden of disease.

RESUMEN Objetivo Comprender la brecha en el tratamiento de la salud mental en la Región de las Américas mediante la revisión de la prevalencia de los trastornos de salud mental, el uso de los servicios de salud mental y la carga mundial de enfermedad. Métodos Se utilizaron datos de encuestas comunitarias de trastornos mentales de Argentina, Brasil, Canadá, Chile, Colombia, Estados Unidos, Guatemala, México y Perú. Se emplearon los datos publicados de la Encuesta Mundial de Salud Mental para estimar la brecha de tratamiento. Para Canadá, Chile y Guatemala, la brecha de tratamiento se calculó a partir de los archivos de datos. Se estimaron la brecha de tratamiento media, media ponderada, y mediana, y la prevalencia de 12 meses por gravedad y categoría de trastorno mental para las poblaciones generales de adultos, niños y adolescentes, e indígenas. Se calcularon los años de vida ajustados por discapacidad y los años vividos con discapacidad a partir del estudio Carga Global de Enfermedad. Resultados Los trastornos mentales y por consumo de sustancias representaron el 10,5% de la carga mundial de enfermedad en las Américas. La tasa de prevalencia de 12 meses de los trastornos mentales severos varió del 2% al 10% en los estudios. La brecha de tratamiento media ponderada en las Américas para los trastornos moderados a graves fue del 65,7%; en América del Norte de 53,2%; en América Latina de 74,7%; en Mesoamérica de 78,7%; y en América del Sur de 73,1%. La brecha de tratamiento para los trastornos mentales graves en niños y adolescentes fue superior al 50%. Un tercio de la población indígena en los Estados Unidos y el 80% en América Latina no recibieron tratamiento. Conclusión La brecha de tratamiento para la salud mental sigue siendo un problema de salud pública. Una gran proporción de adultos, niños y personas indígenas con enfermedades mentales graves continúan sin tratamiento. El resultado implica una prevalencia elevada de trastornos mentales y de la carga mundial de enfermedad.

RESUMO Objetivo Compreender a lacuna de tratamento em saúde mental na Região das Américas examinando a prevalência de transtornos mentais, o uso de serviços de saúde mental e a carga global de doença. Métodos Foram utilizados dados de inquéritos comunitários de transtornos mentais na Argentina, Brasil, Canadá, Chile, Colômbia, Guatemala, México, Peru e Estados Unidos. Os dados publicados na Pesquisa Mundial de Saúde Mental foram utilizados para estimar a lacuna de tratamento. Para o Canadá, Chile e Guatemala, a lacuna de tratamento foi calculada a partir de arquivos de dados. A lacuna de tratamento média, média ponderada e mediana, e a prevalência de 12 meses por gravidade e categoria de transtorno mental foram estimadas para as populações adulta, infantil-adolescente e indígena em geral. Os anos de vida ajustados por incapacidade e os anos de vida com incapacidade foram calculados a partir do estudo Carga Global de Doença. Resultados Os transtornos mentais e de uso de substâncias foram responsáveis por 10,5% da carga global de doença nas Américas. A taxa de prevalência de 12 meses de transtornos mentais graves variou de 2% a 10% entre os estudos. A lacuna de tratamento média ponderada nas Américas para transtornos moderados a graves foi de 65,7%; em América do Norte de 53,2%; em América Latina de 74,7%; em Mesoamérica de 78,7%; e na América do Sul de 73,1%. A lacuna de tratamento para transtornos mentais graves em crianças e adolescentes foi superior a 50%. Um terço da população indígena nos Estados Unidos e 80% na América Latina não recebeu tratamento. Conclusão A lacuna de tratamento para a saúde mental continua sendo uma preocupação de saúde pública. Uma alta proporção de adultos, crianças e indígenas com doença mental grave permanece sem tratamento. O resultado é uma elevada prevalência de transtornos mentais e de carga global de doença.

Aripiprazole-Induced Neutropenia in a Seven Year-Old Male: A Case Report.

Blood dyscrasias are the widely known side effect of the second-generation antipsychotic medications. Aripiprazole rarely causes hematological side effects and it is considered relatively safe. We present the case report of a seven-year-old male who developed acute neutropenia a week after starting aripiprazole. His absolute neutrophil count (ANC) arose spontaneously once the medication was stopped. Clinicians should periodically check ANC in the patients taking aripiprazole as neutropenia could be lethal in extreme cases. To our knowledge, this is the first case report of leukopenia associated with aripiprazole in the child and adolescent population.