ABSTRACT
Twenty-two veterans with posttraumatic stress disorder (PTSD) were assessed for trauma-related nightmares and nonnightmare distressed awakenings (NNDA) before and after treatment with the alpha-1 adrenoreceptor antagonist prazosin at an average bedtime dose of 9.6 mg/day. Ratings combining frequency and intensity dimensions of trauma-related nightmares decreased from 3.6 to 2.2, NNDA from 5.2 to 2.1, and sleep difficulty from 7.2 to 4.1 per week. These results suggest that increased brain adrenergic activity may contribute to the pathophysiology of both trauma-related nightmares and NNDA in PTSD.
Subject(s)
Adrenergic alpha-Antagonists/therapeutic use , Dreams/drug effects , Prazosin/therapeutic use , Stress Disorders, Post-Traumatic/physiopathology , Veterans/psychology , Adrenergic alpha-Antagonists/administration & dosage , Humans , Prazosin/administration & dosage , Sleep Wake Disorders/drug therapyABSTRACT
The effects of establishing a multidisciplinary mental health primary care team in a Veterans Affairs internal medicine primary care clinic were evaluated. The multidisciplinary team worked in collaboration with primary care providers to evaluate and treat their patients, who had a wide variety of psychiatric disorders, in the primary care clinic. In the first year of operation preliminary outcomes indicated that the rate of referrals to specialty mental health care dropped from 38 percent to 14 percent. The mean number of appointments with the team for evaluation and stabilization was 2.5. These outcomes suggest that a multidisciplinary mental health primary care team can rapidly evaluate and stabilize patients with a wide range of psychiatric disorders, reduce the number of referrals to specialty mental health care, and improve collaborative care.
Subject(s)
Internal Medicine/organization & administration , Mental Disorders/therapy , Mental Health Services/organization & administration , Outcome and Process Assessment, Health Care , Outpatient Clinics, Hospital/organization & administration , Patient Care Team/organization & administration , Primary Health Care/organization & administration , Adult , Hospitals, Veterans , Humans , Mental Disorders/diagnosis , Middle Aged , United States , United States Department of Veterans Affairs , WorkforceABSTRACT
OBJECTIVE: Valproic acid is frequently not recommended for patients with hepatic dysfunction. The authors evaluated the association between hepatitis C and alanine aminotransferase (ALT) values during valproic acid treatment. METHOD: ALT changes in 564 individuals beginning valproic acid treatment were examined. Changes among those with positive hepatitis C status were compared with changes among patients with positive hepatitis C status who were taking other psychotropic agents. RESULTS: ALT elevations with valproic acid were significantly greater among patients with positive hepatitis C status than those with negative or unknown status. Among patients with positive hepatitis C status, ALT increases did not differ significantly between valproic acid and other medications. CONCLUSIONS: Use of valproic acid may be possible for some patients with hepatitis C. ALT increases in seropositive patients may be partially related to chronic hepatitis infection. However, ALT levels should be closely monitored in all hepatitis C patients taking valproic acid.
