Community psychiatry tracks for residents: a review of four programs.

Many psychiatry residency graduates end up practicing at least in part in community settings. However, declining funding and other issues prevent many residency programs from offering robust community psychiatry training to all of their residents. Accordingly, some residency programs have developed Community Psychiatry Tracks, with the goal of developing future leaders in public sector psychiatry. We cataloged US psychiatry residency programs offering Community Psychiatry Tracks by reviewing the literature and surveying training directors and members of the American Association of Community Psychiatrists. Authors from each of the four programs found to be actively offering such tracks describe their track curricula, from which we elucidated common and variable elements as well as strengths and weaknesses and then make recommendations for other programs wishing to start a track. A Community Psychiatry Track preliminarily appears to be a well-received way to offer enhanced Community Psychiatry training to interested residents, to recruit medical students to residency programs, to offer opportunities for collaboration between residents and faculty members, and to expand opportunities for scholarly work by residents.

Implications of co-occurring alcohol abuse for role impairment, health problems, treatment seeking, and early course of alcohol dependence.

This article explores the nosological and clinical implications of co-occurring alcohol abuse and alcohol dependence and examines the hierarchical relationship between these diagnostic categories in the DSM-IV. Among 2,307 alcohol-dependent participants in the 2003 US National Survey on Drug Use and Health, 1,646 (68.1%) additionally met the criteria for alcohol abuse. In multivariate analyses, alcohol-dependent participants with alcohol abuse reported an earlier age of first alcoholic drink compared to those without alcohol abuse. They also reported a higher prevalence of health problems, non-alcohol drug use, impairment, treatment seeking, and early remission. The two groups had different symptom profiles. Revisions to future DSM editions are proposed to better capture these differences.

A randomized, open-label, controlled trial of gabapentin and phenobarbital in the treatment of alcohol withdrawal.

Gabapentin was compared with phenobarbital for the treatment of alcohol withdrawal in a randomized, open-label, controlled trial in 27 inpatients. There were no significant differences in the proportion of treatment completers between treatment groups or the proportion of patients in each group requiring rescue medication for breakthrough signs and symptoms of alcohol withdrawal. There were no significant treatment differences in withdrawal symptoms or psychological distress, nor were there serious adverse events. These findings suggest that gabapentin may be as effective as phenobarbital in the treatment of alcohol withdrawal. Given gabapentin's favorable pharmacokinetic profile, further study of its effectiveness in treating alcohol withdrawal is warranted.