Psychoeducation for Inpatients With First-Episode Psychosis: Results From a Survey of Psychiatry Trainees in New York City.

OBJECTIVE: In this study, the authors aimed to characterize psychoeducation provided to inpatients with first-episode psychosis (FEP) and their families. METHODS: Psychiatrists were surveyed about how they provide psychoeducation to this population. RESULTS: In total, 60 psychiatry trainees at nine New York City hospitals responded to the survey invitation. Almost all reported that they provide psychoeducation. Most (81% for patients, 84% for families) reported that psychoeducation content and delivery method were not uniform. The most frequently used delivery method was unstructured conversation (98%), followed by handouts (25% for patients, 26% for families). Responses from a national sample (N=167) revealed similar trends. CONCLUSIONS: Most respondents provided some form of psychoeducation to hospitalized patients with FEP and their families. Few utilized a standardized method, and less than one-third incorporated supplemental materials. Inpatient psychoeducation for this population was largely informal, and patients and their families were not receiving consistent content and quality of information.

Ameliorative response to detoxification, psychotherapy, and medical management in patients maintained on opioids for pain.

BACKGROUND AND OBJECTIVES: The prevalence of opioid-induced hyperalgesia (OIH) among patients maintained on opioids for chronic non-malignant pain has not been estimated. As a contribution toward establishing its prevalence, we report a case series of opioid maintained patients whose pain tolerance was measured by the cold pressor test at baseline. METHODS: A case series of 117 patients who had undergone detoxification was reviewed retrospectively. Most patients (n = 108) and selected non-addicted support persons who accompanied them (controls; n = 37) had cold pressor time (CPT) assessments at baseline. Twenty patients had a repeat CPT after 1 month. RESULTS: When 61 patients completed one month abstinent reported pain was improved (51%), unchanged (46%), or worse (3%). Baseline CPT was 48 sec for patients and 102 sec for controls, suggesting that opioid maintained patients were more pain sensitive than opioid naïve controls. CPT increased for 90% of 1-month completers, suggesting improved pain tolerance. Ameliorative response to detoxification, psychotherapy, and medical management, as defined as the absence of worsening pain with removal of opioids, was 97% in this population. CONCLUSION: The difference in CPT between opioid maintained patients and controls, and the response to detoxification, psychotherapy and medical management suggest the possibility that the prevalence of OIH may be high. SCIENTIFIC SIGNIFICANCE: This study adds to the growing evidence that chronic opioid treatment contributes little to the management of chronic pain and in fact appears to frequently make it worse. (Am J Addict 2017;26:738-743).

Alpha-2 receptor agonists for the treatment of posttraumatic stress disorder.

Clonidine and guanfacine are alpha-2 receptor agonists that decrease sympathetic outflow from the central nervous system. Posttraumatic stress disorder (PTSD) is an anxiety disorder that is theorized to be related to a hyperactive sympathetic nervous system. Currently, the only US Food and Drug Administration (FDA)-approved medications for PTSD are the selective serotonin reuptake inhibitors (SSRIs) sertraline and paroxetine. Sometimes use of the SSRIs may not lead to full remission and symptoms of hyperarousal often persist. This article specifically reviews the literature on alpha-2 receptor agonist use for the treatment of PTSD and concludes that while the evidence base is limited, these agents might be considered useful when SSRIs fail to treat symptoms of agitation and hyperarousal in patients with PTSD.