ABSTRACT
: Topiramate is an anticonvulsant medication with increasingly strong evidence, supporting its use for treating alcohol use disorder (AUD) based on clinical trials. These clinical cases summarize the initiation and titration of topiramate in AUD treatment. The core issues of patient selection, consideration of comorbid psychiatric and medical conditions, side-effect profile, safety and effectiveness are reviewed. Addiction physicians should take a leading role in using topiramate to treat AUDs, working with patients to balance the benefits of topiramate with the risk.
Subject(s)
Alcoholism/drug therapy , Central Nervous System Agents/pharmacology , Topiramate/pharmacology , Central Nervous System Agents/administration & dosage , Central Nervous System Agents/adverse effects , Female , Humans , Male , Middle Aged , Topiramate/administration & dosage , Topiramate/adverse effectsSubject(s)
Anxiety , Depression , Exposure to Violence/psychology , Psychotherapy/methods , Refugees/psychology , Selective Serotonin Reuptake Inhibitors/administration & dosage , Stress Disorders, Post-Traumatic , Syncope , Adult , Anxiety/diagnosis , Anxiety/therapy , Depression/diagnosis , Depression/psychology , Female , Humans , Medically Unexplained Symptoms , Pain/etiology , Pain/psychology , Psychotherapeutic Processes , Refugee Camps , Resilience, Psychological , Self-Management/methods , Social Support , Stress Disorders, Post-Traumatic/complications , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/psychology , Syncope/etiology , Syncope/psychology , SyriaSubject(s)
Attention Deficit Disorder with Hyperactivity/therapy , Autistic Disorder/therapy , Mental Health Services , Psychiatry/education , Referral and Consultation , Relief Work , Stress Disorders, Post-Traumatic/therapy , Telemedicine/methods , Adolescent , Aggression/psychology , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/psychology , Autistic Disorder/psychology , Cognitive Behavioral Therapy , Delivery of Health Care , Global Health , Humans , Male , Organization and Administration , Refugees/psychology , Selective Serotonin Reuptake Inhibitors/therapeutic use , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/psychology , Syria , United StatesABSTRACT
BACKGROUND: Store-and-forward (S&F) telemedicine is thought to be most applicable in humanitarian settings. Unlike other kinds of telemental health (TMH), S&F requires engagement and active participation from healthcare providers in submitting text or audio-video clinical material for consultations. To implement such consultative systems there is a need to gauge providers' attitudes towards this technology. MATERIALS AND METHODS: An electronic survey was sent to Syrian healthcare providers (physicians and nonphysicians) who are affiliated with humanitarian nongovernmental organizations managing Syrians affected by war. After a description of what TMH and S&F are, participants were asked about their attitudes towards such services. RESULTS: Fifty-two providers responded to the electronic survey. Only results from providers inside Syria (n = 30) are presented. The majority of respondents had no experience with TMH. Half of the providers believed that mental healthcare can be provided through S&F and that there would be a benefit from such services. Respondents reported that cultural (68%), financial (84%), and technical (80%) barriers do exist for such services. When asked, providers believed that patients would agree to be audiotaped (58%) for the purpose of S&F compared with being videotaped (15%) (p = 0.007). CONCLUSIONS: Electronic surveys of healthcare workers in humanitarian settings are feasible. Providers in the Syrian humanitarian setting have little experience in TMH; however, they are open to using an S&F service while acknowledging cultural, financial, and technical barriers to the implementation.
Subject(s)
Attitude of Health Personnel , Emergency Services, Psychiatric/organization & administration , Health Personnel/psychology , Remote Consultation/organization & administration , Telemedicine/organization & administration , Adult , Altruism , Female , Humans , Male , Middle Aged , Surveys and Questionnaires , SyriaABSTRACT
BACKGROUND: Given the scarcity of mental health resources available for refugees in areas of conflict, it is imperative to investigate interventions that would be accepted by the refugees. MATERIALS AND METHODS: In this study we surveyed 354 Syrian refugees using the HADStress screening tool and asked about their openness to referral to psychiatry and telepsychiatry. RESULTS: Of the surveyed sample, 41.8% had scores on HADStress that correlate to posttraumatic stress disorder. However, only 34% of the whole sample reported a perceived need to see a psychiatrist, and of those only 45% were open to telepsychiatry. CONCLUSIONS: Women, those who were bilingual, and those with positive HADStress status were less likely to accept telepsychiatry; however, this finding did not reach statistical significance. This study reports a partial acceptance of Syrian refugees for telepsychiatric services despite the high prevalence of psychological stress.
Subject(s)
Patient Acceptance of Health Care , Refugees/psychology , Stress, Psychological/diagnosis , Stress, Psychological/therapy , Telemedicine , Adult , Connecticut , Female , Health Services Accessibility , Health Services Needs and Demand , Humans , Male , Pilot Projects , Referral and Consultation , Surveys and Questionnaires , Syria/ethnologyABSTRACT
OBJECTIVE: The aim of this report is to study the impact of a pilot educational event on psychiatry residents' attitudes towards suicidal patients, understanding of their family members' experience, and intended management of patients who died by suicide. METHODS: A panel of suicide loss survivors spoke to psychiatry residents during an educational event. Psychiatry residents who attended the event were asked to complete a survey after the event. RESULTS: About a third of residents (29.4 %) reported encountering a patient suicide during training. Overall, psychiatry residents subjectively felt the program had a positive impact on their understanding of suicide loss and on their attitudes towards suicide and towards engagement with family members of patients who died by suicide. CONCLUSIONS: The data collected in this study suggest that educational programs focused on patient suicide from the surviving families' perspective may have a positive impact on the attitudes and future practice of residents.
