General Hospital Psychiatry

Which is more important for outcome: the physician's or the patient's understanding of a health problem? A 2-year follow-up study in primary care

2009-10-05

Abstract: Objective: We sought to examine (1) whether the patients' and the family physicians' (FPs') beliefs about the nature of a health problem predict health outcomes and (2) whether the FPs were aware of their patients' beliefs.Methods: A 2-year follow-up study of 38 FPs and 1131 patients presenting with well-defined physical disease (n=922) or medically unexplained symptoms (MUS) (n=209) according to the FPs was conducted. Before the consultation, patients categorized their health problem as being either physical or both physical and psychological. After the consultation, the FPs judged their patients' understanding of the health problem. Outcome measures were (1) patient satisfaction (seven-item Patient Satisfaction Consultation Questionnaire), (2) self-perceived mental and physical health (component summaries of the Medical Outcome Study's Short Form: SF-36) and (3) health care use extracted from patient registers.Main results: Patients with MUS according to the FPs and patients who believed that the nature of their health problem was both physical and psychological had higher health care use and worse self-rated health than patients in cases where both the FP and the patient had a physical understanding. Patients presenting MUS were more dissatisfied with the consultation than patients with well-defined physical disease.Overall, the FPs' perceptions of their patients' understanding were accurate in 82% of the consultations, but when the patients had a both physical and psychological understanding of their health problem, the FPs were right in only 26% of the consultations.Conclusions: Both FPs' diagnoses and patients' beliefs predict important health outcomes such as patient satisfaction, use of health care and self-rated health.

Patient perspectives on improving the depression referral processes in obstetrics settings: a qualitative study

Heather A. Flynn, Erin Henshaw, Heather O’Mahen, Jane Forman — 2009-08-28

Abstract: Objectives: Although depression screening in obstetrics settings has been recommended, little research exists to guide strategies for screening follow up and depression referral. The purpose of this qualitative study was to inform recommendations for depression screening follow up and referral in obstetrics settings based on responses from a key sample of women about influences on depression treatment use and engagement.Methods: A stratified purposeful sampling based on pregnancy, socioeconomic status and depression severity was used to identify 23 women who completed semistructured interviews that centered on their beliefs about what would prevent or facilitate entry into depression treatment in the context of obstetrical care. We conducted a thematic analysis through an iterative process of expert transcript review, creation of and refining codes and identifying themes.Results: Two broad themes influencing depression treatment usage emerged including practical and psychological factors. Among practical factors, women reported a strong preference for treatment provided in the obstetric clinic or in the home with a desire for a proactive referral process and flexible options for receiving treatment. Psychological factors included differing conceptualizations of depression, knowledge about severity and treatment and issues of stigma.Conclusions: This study suggests that the current standard practice of depression screening and referral to specialty treatment does not match with perceived influences on treatment use among our sample of perinatal women. Recommendations derived from the results for improving follow up with screening and depression referral in obstetrics settings are provided as a platform for further research.

Falling through the net — Black and minority ethnic women and perinatal mental healthcare: health professionals' views

Dawn Edge — 2009-09-25

Abstract: Objectives: The objective of this study was to investigate health professionals' views about perinatal mental healthcare for Black and minority ethnic women.Methods: Qualitative data were collected from a range of healthcare professionals (n=42) via individual interviews and focus groups. Participants were recruited from antenatal community clinics, a large teaching hospital, general practice and a specialist voluntary sector agency in the north of England, UK.Results: Participants reported inadequacies in training and lack of confidence both for identifying the specific needs of Black women and for managing perinatal depression more generally, particularly in women with mild/moderate and ‘subthreshold’ depression. Inadequate perinatal depression management was associated with failure to screen routinely, confusion about professional roles and boundaries, and poorly defined care pathways, which increased women's likelihood of ‘falling through the net,’ thus failing to receive appropriate care and treatment.Conclusions: Suboptimal detection and treatment of perinatal depression among ‘high-risk’ women highlight gaps between UK policy and practice. This applies to women from all ethnic groups. However, evidence suggests that Black women might be particularly vulnerable to deficiencies in provision. Effective management of perinatal depression requires a more robust implementation of existing guidelines, more effective strategies to address the full spectrum of need, improved professional training and a more coordinated multiagency approach.

Current strategies and barriers in integrated health care: a survey of publicly funded providers in Texas

Katherine Sanchez, Sanna Thompson, Laurie Alexander — 2009-12-03

Abstract: Objective: This study aimed to assess the extent to which publicly funded behavioral health and primary care providers in Texas have integrated physical and mental health care, the strategies used in implementation efforts and barriers encountered in integration.Method: A survey of behavioral health and primary care providers in Texas was conducted to examine providers' perceptions of efforts to integrate physical and mental health care in their organizations. Integration strategies utilized, health conditions targeted and barriers to implementation were evaluated. Descriptive analyses were conducted to determine organizations' current integration strategies and perceived clinical, organizational and financial barriers to integration.Results: Out of 382 surveys initially distributed, a final subsample of 84 organizations with complete data was examined, a response rate of 22%. Among this sample of behavioral health and primary care providers, many shared integration practice strategies and endorsed similar barriers to integration.Conclusion: The findings from this study suggest that publicly funded organizations in Texas attempting to integrate physical and mental health care were aware of and employing practice strategies considered essential to the successful treatment of mental health issues in primary care settings. Attention to barriers that still exist, especially regarding workforce and funding issues, will be critical for organizations considering and attempting integration.

The impact of diabetes on depression treatment outcomes

2009-08-28

Abstract: Background: Individuals with diabetes mellitus (DM) are two to four times more likely to be diagnosed with major depressive disorder (MDD). However, few controlled studies have examined the impact of DM on the treatment of MDD. Understanding the effect of DM on depressed patients could provide valuable clinical information toward adjusting current treatment modalities to produce a more effective treatment for depressed patients with DM.Methods: This study was conducted using an evaluable sample of 2876 outpatient participants enrolled in the Sequenced Treatment Alternatives to Relieve Depression study. Sociodemographic and clinical characteristics and treatment characteristics with the selective serotonin reuptake inhibitor (SSRI) citalopram, as well as remission rates for MDD and time to remission, were compared between participants with DM and participants without DM.Results: The odds of remission were lower in participants with DM than in those without DM prior to adjustment [odds ratio (OR)=0.68; 95% confidence interval (95% CI)=(0.49, 0.94); P=.0184]. These differences were no longer present after adjustment [OR=0.92; 95% CI=(0.64, 1.32); P=.6399]. Participants with DM reported fewer side effects than participants without DM despite similar dosing.Conclusions: Depressed patients with DM and depressed patients without DM appear to have similar rates of MDD remission, indicating that a diagnosis of DM per se has no impact on MDD remission. The findings of fewer side effects and psychiatric serious adverse events in participants with DM imply that depressed patients with DM may be excellent candidates for more aggressive SSRI dosing. This lower prevalence of side effects reported by depressed participants with DM warrants further exploration.

Anxiety and depression in patients with self-reported food hypersensitivity

2009-10-05

Abstract: Objective: Self-reported food hypersensitivity (SFH) is common. Psychological factors are assumed to be associated. We assessed anxiety and depression in SFH patients, using both questionnaires and interview.Methods: Consecutive patients (n=130) and randomly selected healthy volunteers (n=75) completed the Hospital Anxiety and Depression Scale (HADS), the neuroticism scale of the Eysenck Personality Questionnaire (EPQ-N) and the General Health Questionnaire (GHQ). Seventy-six of the patients were also interviewed by use of the Mini International Neuropsychiatric Interview and the Montgomery–Aasberg Depression Rating Scale. All patients underwent extensive allergological, gastroenterological and dietary examinations.Results: According to interviews, 57% of patients fulfilled the DSM-IV criteria for at least one psychiatric disorder. Anxiety disorders (34%) and depression (16%) predominated. According to questionnaires, patients scored significantly higher than controls on all psychometric scales except for depression (HADS). We also found an underreporting of depression in HADS compared with interviews (2.5% vs. 16%, P=.001). Food hypersensitivity was rarely confirmed by provocation tests (8%). Eighty-nine percent of the patients had irritable bowel syndrome.Conclusions: Anxiety and depression are common in patients with IBS-like complaints self-attributed to food hypersensitivity. Anxiety disorders predominate. In this setting, depression may be underreported by HADS.

Anxiety and mood disorders in narcolepsy: a case–control study

2009-10-05

Abstract: Introduction: Narcolepsy is a primary sleeping disorder with excessive daytime sleepiness and cataplexy as core symptoms. There is increasing interest in the psychiatric phenotype of narcolepsy. Although many authors suggest an overrepresentation of mood disorders, few systematic studies have been performed and conflicting results have been reported. Anxiety disorders in narcolepsy have only received little attention.Methods: We performed a case–control study in 60 narcolepsy patients and 120 age- and sex-matched controls from a previous population study. The Schedules for Clinical Assessment in Neuropsychiatry were used to assess symptoms and diagnostic classifications of mood and anxiety disorders.Results: Symptoms of mood disorders were reported by about one third of patients. However, the prevalence of formal mood disorder diagnoses — including major depression — was not increased. In contrast, more than half of the narcolepsy patients had anxiety or panic attacks. Thirty-five percent of the patients could be diagnosed with anxiety disorder (odds ratio=15.6), with social phobia being the most important diagnosis. There was no influence of age, sex, duration of illness or medication use on the prevalence of mood or anxiety symptoms and disorders.Discussion: Anxiety disorders, especially panic attacks and social phobias, often affect patients with narcolepsy. Although symptoms of mood disorders are present in many patients, the prevalence of major depression is not increased. Anxiety and mood symptoms could be secondary complications of the chronic symptoms of narcolepsy. Recent studies have shown that narcolepsy is caused by defective hypocretin signaling. As hypocretin neurotransmission is also involved in stress regulation and addiction, this raises the possibility that mood and anxiety symptoms are primary disease phenomena in narcolepsy.

Is the personality characteristic “impulsive sensation seeking” correlated to differences in current smoking between ulcerative colitis and Crohn's disease patients?

2009-10-05

Abstract: Background: Crohn's disease (CD) is associated with smoking, while ulcerative colitis (UC) is largely a disease of nonsmokers. We aimed to test whether the smoking-linked personality characteristic “impulsive sensation seeking” (ImpSS) is correlated to the differences in smoking in inflammatory bowel disease (IBD).Methods: In 185 IBD patients, the General Health Questionnaire and the Zuckerman–Kuhlman Personality Questionnaire (ZKPQ) were administered. The Fagerstrom Test for Nicotine Dependence was used to assess smokers' nicotine dependence.Results: CD patients were twice as likely to be active smokers than UC patients. CD patients presented higher ImpSS scores than UC patients, but the differences became nonsignificant after adjustment for age, gender, education and psychological distress. Multivariate analyses, however, showed that the relationship of ImpSS with current smoking was stronger in CD patients. Moderator analysis showed that the relationship of ImpSS with nicotine dependence was also greater in smokers with CD than in those with UC. No other ZKPQ subscale was correlated to disease type, current smoking or nicotine dependence.Conclusion: ImpSS is associated with current smoking and nicotine dependence in IBD, and these associations are stronger in CD. These findings might be relevant to more effective interventions aiming at smoking cessation in CD patients.

Type D personality among noncardiovascular patient populations: a systematic review

Floortje Mols, Johan Denollet — 2009-10-26

Abstract: Objective: This article reviews all available literature concerning the implications of Type D personality (the conjoint effects of negative affectivity and social inhibition) among patients with noncardiovascular conditions.Methods: Published papers were included if they studied Type D personality among noncardiovascular patient populations. Twelve articles met our inclusion criteria and were subjected to a methodological quality checklist (e.g., sample size, response rate, Type D measurement).Results: The methodological quality of the selected studies was quite good. The noncardiovascular patient populations included chronic pain, asthma, tinnitus, sleep apnea, primary care patients, vulvovaginal candidiasis, mild traumatic brain injury, vertigo, melanoma and diabetic foot syndrome. Type D personality was associated with an increased number or severity of reported health complaints, heightened the perception of negative emotions (e.g., depression and anxiety), had an adverse effect on health-related behaviors, was associated with poor adherence to treatment and significantly reduced effort to perform during diagnostic testing.Conclusion: Type D is a vulnerability factor that not only affects people with cardiovascular conditions but also those with other medical conditions. Type D was associated with poor physical and mental health status and poor self-management of the disease. Consequently, including Type D in future studies seems warranted.

Psychological well-being in persons receiving HIV-related mental health services: the role of personal meaning in a stress and coping model

2009-10-21

Abstract: Objective: This investigation examined the association of personal meaning to psychological well-being in adults living with HIV/AIDS receiving mental health services. Personal meaning refers to a framework for delineating the purposes and goals that make life worth living and for evaluating the degree to which these purposes and goals are being fulfilled. Personal meaning was hypothesized to be positively associated with psychological well-being and to contribute independently to the variance in psychological well-being over and above social support, dispositional optimism and coping behavior.Method: With the use of a cross-sectional design, a set of self-report measures were completed by 132 adults living with HIV disease at the time of their initial mental health services evaluation. Data were analyzed using correlation and regression techniques.Results: Personal meaning was positively associated with psychological well-being, although it did not contribute significantly to the variance in well-being over and above social support, optimism and coping behavior in a multifactorial regression model. Post hoc analysis showed partial mediation by optimism of the association between personal meaning and well-being.Conclusions: Personal meaning should be considered along with other psychological and behavioral coping factors in understanding and intervening clinically with individuals living with HIV disease and co-occurring psychiatric concerns.

Early detection of patients at risk for anxiety, depression and apathy after stroke

2009-11-13

Abstract: Background and purpose: The aim of this study was to identify clinical factors in the acute stage that can predict anxiety, depression and apathy at 4 months after stroke.Methods: One hundred four consecutive stroke patients in a stroke unit were assessed within the first 2 weeks and after 4 months. Assessments included anxiety and depression symptoms on the Hospital Anxiety and Depression Scale (HADS) [HADS Anxiety subscale (HADS-A) ≥8 and HADS Depression subscale (HADS-D) ≥8], physical impairment, functional disability, somatic comorbidity upon admission, assessment of apathy (score ≥34 on the Apathy Evaluation Scale) and a psychiatric Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of anxiety disorder (anxiety) or depression (depression) on follow-up. Logistic regression analysis was used to identify factors associated with anxiety, depression and apathy.Results: Anxiety and depression at 4 months were significantly associated with HADS-A scores of ≥8 upon admission [odds ratio (OR)=4.4; 95% confidence interval (95% CI)=1.7–11.9; P=.003 and OR=2.9; 95% CI=1.0–7.9; P=.043, respectively]. Apathy at 4 months was significantly associated with somatic comorbidity upon admission (OR=3.0; 95% CI=1.0–8.3; P=.036) and had a borderline association with HADS-D scores of ≥8 (OR=8.4; 95% CI=1.0–72.0; P=.051) upon admission.Conclusion: Assessment with HADS within the first 2 weeks of stroke can contribute to the detection of patients at risk for clinically significant anxiety, depression and apathy at 4 months after stroke.

Motivation to change risky drinking and motivation to seek help for alcohol risk drinking among general hospital inpatients with problem drinking and alcohol-related diseases

2009-11-09

Abstract: Objective: The objective of this study was to analyze motivation to change drinking behavior and motivation to seek help in general hospital inpatients with problem drinking and alcohol-related diseases.Method: The sample consisted of 294 general hospital inpatients aged 18–64 years. Inpatients with alcohol-attributable disease were classified according to its alcohol-attributable fraction (AAF; AAF=1, AAF<1 and AAF=0). Baseline differences in alcohol-related variables, demographics and motivation between the AAF groups were analyzed. Furthermore, differences in motivation to change, in motivation to seek help and in the amount of alcohol consumed from baseline to follow-up between the AAF groups were evaluated.Results: During hospital stay, motivation to change was higher among inpatients with alcohol-attributable diseases than among inpatients who had no alcohol-attributable diseases [F(2)=18.40, P<.001]. Motivation to seek help was higher among inpatients with AAF=1 than among inpatients with AAF<1 and AAF=0 [F(2)=21.66, P<.001]. While motivation to change drinking behavior remained stable within 12 months of hospitalization, motivation to seek help decreased. The amount of alcohol consumed decreased in all three AAF groups.Conclusions: Data suggest that hospital stay seems to be a “teachable moment.” Screening for problem drinking and motivation differentiated by AAFs might be a tool for early intervention.

Outcomes following appeal and reversal of civil commitment

Jay H. Moss, Donald A. Redelmeier — 2009-11-19

Abstract: Objective: Psychiatric inpatients may be detained against their will, yet they still retain the right to apply for a hearing to challenge this detention. We tested whether adjudicated decisions over whether to uphold or rescind the detention have implications in subsequent patient morbidity.Methods: Consecutive patients applying to the Consent and Capacity Board in Ontario between January 1, 2004, and March 31, 2007, were identified who had a hearing to challenge their involuntary detention. Population based databases provided information on subsequent deaths, hospitalization for a psychiatric illness, or emergency department visit for any reason.Results: A total of 3498 decisions were rendered for 2321 unique psychiatric patients during the 39 month study period. Almost all patients (90%) had a prior psychiatric admission. Approximately 18% of involuntary detentions were rescinded with subsequent outcomes showing a greater likelihood of emergency department visits within 100 days of discharge in the group whose detention was rescinded compared to the group whose detention was upheld (46% vs. 36%, P=.003).Conclusions: When an involuntary detention is rescinded patients have a high likelihood of subsequent utilization of emergency department services for suicide related symptoms but no large increase in risk of dying.

Substance misuse among older patients in psychiatric emergency service

Benjamin K.P. Woo, Weilu Chen — 2009-09-14

Abstract: Objective: To determine the prevalence of substance misuse among older patients presented to a psychiatric emergency service (PES) on involuntary bases.Method: At the time of initial presentation to the PES, all patients received a comprehensive assessment that included a urine toxicology screening. The screening consisted of six substances: barbiturate, benzodiazepine, cocaine, opiate, phencyclidine and amphetamine. Charts of elderly patients (aged 65 and above) with positive urine toxicology were reviewed to ensure that the results were not due to (1) home medications and (2) medications given in the PES.Results: During the 2-year study period (2006–2007), there were 5914 patients under the age of 65 and 104 patients aged 65 and above. Our findings indicated that 471 (8.0%) and 14 (13.4%) urine toxicology screens were not collected during the PES visits in younger and older patients, respectively (P=.04). The positive urine toxicology rate was 31.5% (1716/5443) and 26.7% (24/90) for younger and older patients, respectively (P=.33).Conclusions: Substance misuse in the older population presenting with psychiatric emergency is prevalent in the PES. Urine toxicology screens, as well as patient or collateral report of substance usages, should be obtained from this group of patients to ensure quality of care delivered at the PES.

Mania complicated with delirium following cessation of long-term lithium therapy

Ching-En Lin, Wei-Chung Mao — 2009-10-21

Abstract: Objective: To highlight the association between the use of lithium and the development of delirium following discontinuation of lithium therapy, a condition that substantially increases the risk of psychogenic events and other medical complications.Method: Physical examination, laboratory studies including measurement of serum calcium and parathyroid hormone levels, measurement of urine osmolalities before and after desmopressin administration and a brain magnetic resonance imaging.Results: A 49-year-old woman with a background history of bipolar disorder taking lithium presented with severe mania complicated with delirium following discontinuation of lithium therapy.Conclusion: Mania in the context of lithium therapy may be complicated with delirium. Therefore, mental status should be closely monitored in patients receiving lithium in order to facilitate early detection and intervention of delirium to prevent further health complications.

Axis I and Axis II psychiatric disorders in patients with fibromyalgia

2009-09-14

Abstract: Objective: To determine the current prevalence of Axis I and Axis II psychiatric disorders in patients with fibromyalgia.Method: The study sample includes 103 patients with fibromyalgia and 83 control subjects. Axis I and Axis II disorders were determined by structured clinical interviews.Results: The rate of any Axis I psychiatric disorder (47.6% vs. 15.7%), major depression (14.6% vs. 4.8%), specific phobia (13.6% vs. 4.8%), any Axis II disorder (31.1% vs. 13.3%), obsessive–compulsive (23.3% vs. 3.6%) and avoidant (10.7% vs. 2.4%) personality disorders were significantly more common in the patient group compared to the control group.Conclusion: Our results suggest that a considerable proportion of patients with fibromyalgia also present with Axis I and Axis II psychopathologies.

Fluoroquinolone-induced suicidal ideation

Elizabeth A. LaSalvia, Gretchen J. Domek, David F. Gitlin — 2009-04-06

Fluoroquinolones are commonly prescribed antibiotics used to treat a variety of infections including respiratory infections, sexually transmitted diseases, urinary tract infections, and skin and soft tissue infections. A wide range of fluoroquinolone-induced CNS side-effects are reported in the literature . In comparison with other systemic antibiotics, adverse CNS events were significantly higher with fluroquinolone use . Studies of fluoroquinolones have noted CNS toxicity occur in approximately 1.0–4.4% of patients , but with serious side-effects occurring in <0.5% of patients . Common side-effects are noted to be headache, dizziness and insomnia. Rare but more serious side-effects reported in the product literature include tremors, restlessness, anxiety, lightheadedness, confusion, hallucinations, paranoia, depression, nightmares, insomnia and suicidal thoughts or acts . Case reports have documented fluoroquinolone-induced psychosis , catatonia , seizures and delirium . Some differences have been noted within the safety profiles of individual fluoroquinolones, with rufloxacin and ofloxacin being more frequently associated with psychiatric symptoms .

Response to Kroenke, Krebs and Bair

Roy D. Altman — 2009-10-21

I read with interest the review by Kroenke, Krebs and Bair of published recommendations for the management of chronic pain. Their paper is timely given the aging of the U.S. population and the increase in chronic pain conditions such as low back pain and osteoarthritis. Chronic pain management is of particular interest to mental health professionals because of the high prevalence of psychiatric disorders among patients with chronic pain . The authors provide a useful overview of opioid analgesics and oral nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with several chronic pain conditions. However, I wish to challenge a few points in their discussion of topical analgesics in general, topical NSAIDs in particular and opioids.

Authors' reply to letter on pharmacotherapy of chronic pain

Kurt Kroenke, Erin E. Krebs, Matthew J. Bair — 2009-10-30

We thank Dr. Altman for his thoughtful reply to our review and we agree with most of his comments. Topical analgesics are not as widely used as oral medications and thus are less familiar to clinicians. The point that NSAIDs have proven effective for musculoskeletal pain whereas lidocaine and capsaicin are indicated for neuropathic pain is also an important clarification. A variety of topical NSAIDs have been used in Europe for years, while their approval and use in the United States has been more limited. As Dr. Altman notes, diclofenac sodium 1% gel is the only topical NSAID approved in the US for the treatment of superficial osteoarthritis, i.e., pain in the hands or knees. Thus, use of topical NSAIDs or any topical analgesic in more deep-seated musculoskeletal conditions such as hip or low back pain cannot be recommended. Also, the effectiveness of topical salicylates and capsaicin in chronic musculoskeletal pain is supported by a few clinical trials, but the evidence is less convincing than for topical NSAIDs . It should be noted that long-term trials of topical NSAIDs are lacking. Only three of 16 randomized trials of diclofenac gel for chronic pain lasted longer than 4 weeks, and the median trial duration was 2 weeks . Thus, evidence for long-term efficacy, adherence and safety is needed. Also, few head-to-head trials of topical analgesics have been conducted.

Musculoskeletal pain and measures of depression: comment on the article by Poleshuck et al

Alberto J. Caban-Martinez — 2009-10-15

I read with great interest the recently published article by Poleshuck et al. on psychosocial stress, anxiety and its association with depression severity among patients with chronic musculoskeletal pain. Among patients with chronic conditions such as musculoskeletal pain, mental health remains an important overall component of general health and I agree with the authors that anxiety and psychosocial distress should be carefully screened and assessed in this patient population. Previous studies have shown that the prevalence of serious psychological distress, frequent anxiety, and depression has been reported to be higher in adults with musculoskeletal pain than in those without musculoskeletal pain . In the study by Poleshuck et al. , depressed patients reported significantly more psychosocial stressors and more severe anxiety and pain disability than the nondepressed counterparts. Nonetheless, items included in the depression scale utilized in the study may have overestimated the difference in the prevalence of depression among those patients with chronic musculoskeletal pain.

Musculoskeletal pain and measures of depression: response to comment on the article by Poleshuck et al

2009-10-15

We appreciate the interest in our work and commend the letter's author for raising the important and complex issue of depression assessment in patients with pain. It is critical to consider the appropriateness of our assessment measures to address the validity of our study findings.

Erratum to “Prevalence and correlates of poor medication adherence amongst psychiatric outpatients in southwestern Nigeria” [General Hospital Psychiatry 31 (2009) 167–174]

2009-12-07

The above article contained an error in Reference 23 in the list of References. The first author's name was listed incorrectly. The reference should have been published as: [23] Ramirez Garcia JL, Chang CL, Young JS, Lopez SR, Jenkins JH. Family support predicts psychiatric medication usage among Mexican American individuals with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2006;41:624–31.

Erratum to “Trauma and mental health in US inner-city populations” [General Hospital Psychiatry 31 (2009) 501–502]

Naomi Breslau — 2009-12-07

The above Editorial contained an error in the first sentence of the second paragraph. The parenthetical text “(≥23 years of age)” should have read “(19–23 years of age)”. The correct sentence is as follows:

Announcement

2010-01-01