ABSTRACT
First responders are regularly confronted with exposure to traumatic events, including potentially life-threatening situations as well as the grave injuries and deaths of colleagues and civilians. Evidence indicates that the prevalence of posttraumatic stress disorder (PTSD) is substantially higher among first responders than the general population. This article provides information about the outpatient trauma services at McLean Hospital's LEADER (Law Enforcement, Active Duty, Emergency Responder) program to assist clinicians who encounter these first responders in their practices or who are specifically interested in working with this patient population. We begin by synthesizing the literature on the prevalence of PTSD in first responders following work-related exposure to traumatic stress, and by addressing the occupation-specific risk factors and the third-variable risk factors that may contribute to potentiated risk. We then discuss assessment strategies and treatment options used in our program, which is tailored for individuals who are dealing with mental health issues stemming from occupation-specific traumatic-stress exposure. We also address the unique challenges of treating traumatized first responders with more complex issues such as traumatic stress exposure across the lifespan and safety issues, including acute suicidality. We conclude by discussing notable gaps in the literature, including the need to investigate why and how women present with different PTSD symptoms than men and how these differences need to be taken into account in determining appropriate treatment for women.
Subject(s)
Emergency Responders , Occupational Stress , Psychotherapy/methods , Stress Disorders, Post-Traumatic , Emergency Responders/psychology , Emergency Responders/statistics & numerical data , Humans , Occupational Stress/diagnosis , Occupational Stress/epidemiology , Occupational Stress/etiology , Occupational Stress/therapy , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/therapySubject(s)
Bipolar Disorder/drug therapy , Depressive Disorder/drug therapy , Naltrexone/therapeutic use , Narcotic Antagonists/therapeutic use , Adolescent , Adult , Aged , Bipolar Disorder/diagnosis , Bipolar Disorder/epidemiology , Depressive Disorder/diagnosis , Depressive Disorder/epidemiology , Double-Blind Method , Humans , Middle Aged , Young AdultSubject(s)
Antidepressive Agents/therapeutic use , Bipolar Disorder/drug therapy , S-Adenosylmethionine/therapeutic use , Administration, Oral , Adolescent , Adult , Aged , Antidepressive Agents/administration & dosage , Double-Blind Method , Humans , Middle Aged , S-Adenosylmethionine/administration & dosage , Treatment Outcome , Young AdultABSTRACT
Most of the knowledge of racial/ethnic disparities in mental health treatment utilization comes from studies examining outpatient services, and less is known about these disparities in inpatient services. This empirical gap may limit our understanding of these disparities since inpatient treatment is the most intensive form of specialty mental health care for patients with psychological disorders. We conducted a systematic chart review of 129 Asian American and 198 White American psychiatric inpatients to examine patterns of inpatient psychiatric treatment utilization. Demographic and clinical data were extracted from admission and discharge records during a two-year timeframe. Patterns of diagnoses revealed that Asian American patients utilized inpatient services for more severe psychiatric diagnoses compared to White American patients. Despite this, there were no racial/ethnic differences in levels of functional impairment at admission, and there were no racial/ethnic differences in length of treatment stay. For Asian American patients, level of psychosocial functioning at admission predicted length of stay. A better understanding of patterns of inpatient treatment use is needed to meet the clinical needs of Asian Americans with psychiatric disorders.
ABSTRACT
OBJECTIVE: This study aimed to test the effects of omega-3 fatty acids (O3FA), given as fish oil capsules, with and without oral cytidine (CYT), a pyrimidine with reported preclinical and clinical antidepressant-like effects, in patients with bipolar disorder (BD). METHODS: A total of 45 outpatients with diagnosed BD (type I) according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition - Text Revision, were recruited for this 4-month, randomized, double-blind, placebo-controlled, add-on study. Treatment groups were (1) oral CYT + O3FA, (2) placebo + O3FA, and (3) placebo + placebo control. O3FA was given 2 g twice a day and CYT was administered as 1 g twice a day. RESULTS: There was no statistically significant difference among the groups in the primary outcome: study retention. Clinical measures improved in all treatment groups, and there were no significant differences between groups, including change in probability of symptoms of depression or mania, change in positive ratings of depression or mania, or change in Global Assessment of Functioning scores. Neither CYT + O3FA nor placebo + O3FA treatment was superior to placebo treatment. Rather, there was a statistically nonsignificant trend for both groups treated with O3FA to do worse than the placebo group. CONCLUSIONS: Despite preclinical studies suggesting that the effect of O3FA might be augmented with pyrimidines, add-on CYT did not substantially improve mood symptoms in BD. In addition, although a power analysis indicated that the sample size would be adequate to see beneficial effects similar to those previously reported, O3FA treatment by itself was not superior to placebo for BD.
