ABSTRACT
The social determinants of health (SDOH) are a complex web of factors that influence the health of individuals throughout their lifetime. There are many drivers of health inequities within the SDOH, such as socioeconomic status, education, employment, gender, and race/ethnicity. It is possible that mental illness may develop when these factors negatively affect health. However, current research primarily focuses on SDOH in cisgender individuals leaving a scientific gap in transgender individuals who require unique considerations when providing comprehensive medical care. We present the case of a 20-year-old transgender female who was admitted for suicidal attempts during a methamphetamine overdose, and who had been struggling with mental illness and suicidal gestures since she was a young teenager. The significance of our findings is discussed in the context of the substantial lack of current research on SDOH in transgender individuals to underscore the need for clinical awareness and promote future research.
ABSTRACT
Alcohol use disorder (AUD) continues to be a threat to public health due to the associated morbidity, mortality, and social and economic impacts. AUD accounts for greater than 85,000 deaths annually in the United States and greater than 1500 deaths annually in New Jersey (NJ). Despite these associated burdens, the treatment of AUD remains unequal among the population, and it is important to identify the factors influencing the disparity in defined population groups such as NJ to drive the appropriate intervention. Data were retrieved from the 2018 Treatment Episode Data Set-Discharges (TEDS-D) of the United States Substance Abuse and Mental Health Services Administration (SAMHSA). Logistic regression analysis was used to predict the odds of receiving treatment based on socioeconomic factors and the type of treatment received. Compared to Asian or Pacific Islanders in NJ, the American Indian [odds ratio, OR=2.12, 95% confidence interval, CI: 1.95-2.31] has the greatest odds of receiving treatment for AUD, followed by the Black or African American [OR=1.70, 95% CI: 1.65-1.75], the Alaska Native [OR=1.67, 95% CI: 1.42-1.96], and then the White [OR=1.31, 95% CI: 1.12-1.52]. Those who are retired or on disability [OR=0.88, 95% CI: 0.82-0.94] have lower odds of receiving treatment than those on salary or wages. Those with AUD in NJ have a lower odd of receiving detoxification treatment in a 24-h hospital inpatient setting [OR=0.88, 95% CI 0.82-0.95] and a higher odd of receiving detoxification treatment in a 24-h service, free-standing residential setting when compared to the treatment received in a rehabilitation/hospital (other than detoxification) setting. This study shows that disparity exists in relation to the type of treatment received and the setting of treatment for AUD in NJ in addition to disparity based on the sociodemographic factors.
ABSTRACT
Neutropenia is an adverse effect of various pharmacological therapies, including antipsychotics. Among the second-generation antipsychotic (SGA) medications, clozapine is most notable for neutropenic adverse effect. Risperidone, another SGA drug, is linked mainly with metabolic adverse effects, but rarely, blood dyscrasia adverse reactions have been reported. Hence, we report the case of a 56-year-old African American woman who developed severe neutropenia following two weeks of oral risperidone treatment. Her neutrophil levels returned to normal limits following discontinuation of risperidone and switching to haloperidol.
ABSTRACT
Background Depression and prescription opioid use have a bi-directional relationship. Depression commonly co-occurs with chronic noncancer pain and is known to be associated with opioid use. Studies have found an increased risk of depression only in patients with opioid dependence. Other studies have found an increased risk of opioid misuse in depressed patients. In addition, chronic pain conditions can lead to depression without the use of opioids. Methods We used the National Health and Nutrition Examination Survey (NHANES) data collected over seven survey cycles spanning 14 years: 2005/2006-2017/2018. Included in our study were participants ≥18 years who completed the patient health (PHQ-9) questionnaire. Persons with documented use of opioids were considered to have chronic use of opioids. Relevant data files were merged, and analytical weights computed in keeping with the survey analytical guidelines. Prevalence measures are reported as proportions. Associations were assessed using the Chi-square test. Binary logistic regression was used to assess the trend in the prevalence of opioid use. We used STATA-16 for data analysis and p-values <0.05 were considered statistically significant. Results A total of 36,459 participants met the inclusion criteria. The prevalence of depression was 7.7% (95% CI: 7.3-8.2). The prevalence of any narcotic use was 6.0%. Among depressed individuals, Blacks: OR 0.71 (95% CI: 0.54-0.93) and Hispanics: OR 0.48 (95% CI: 0.34-0.67) were less likely to be on narcotics compared to non-Hispanic Whites. The prevalence of opioid use was stable over the first 12 years, followed by a significant drop in the last two years. Conclusion Beyond the risk for opioid misuse, and opioid use disorder, depression should also be considered when prescribing opioids. It is therefore important to implement a training to screen for depression in patients receiving opioids for pain management.
