Hyponatremia associated with levamisole-adulterated cocaine use in emergency department patients

An increasing percentage of US cocaine has been adulterated with levamisole, an immunomodulator associated with agranulocytosis. We describe 3 emergency department patients with hyponatremia and cocaine use. Despite extensive evaluation, the cause of the hyponatremia was not elucidated but resolved during hospitalization. Because hyponatremia has not previously been associated with cocaine, we sought to uncover a plausible explanation that might be contributing to this new finding. Levamisole was detected in all 3 patients. Although we are unable to confirm causality, we propose that levamisole-adulterated cocaine may have contributed to the hyponatremia described in these patients.     

Risk Assessment: A Reflection on the Principles of Tools to Help Manage Risk of Violence in Mental Health

The proposition that the vast majority of persons experiencing mental illness will never be violent is complicated by the large body of literature demonstrating a heightened risk of violent behaviour in persons suffering from mental disorder. In an era in which resources and individual judgement appear to dictate treatment, the question arises as to why structured clinical judgement is not utilized more in front-line assessment of risk for violence in those with mental and personality disorders? Our review of the literature on mental disorder and violence, risk assessment and risk management led to the contention that front-line mental health professionals can employ structured clinical judgement underpinned by the principles of risk assessment tools, such as the HCR-20. Ongoing resource development, education and availability of expertise should aid the development of more uniform approaches to violence risk management and therapeutic amelioration of the likelihood for violence in persons affected by mental illness.     

Developmental changes in group climate in two types of group therapy for binge-eating disorder: A growth curve analysis

Abstract

The development of group climate across 16 sessions of group psychodynamic–interpersonal psychotherapy (GPIP) and group cognitive–behavioral therapy (GCBT) for 65 female treatment completers with binge-eating disorder (BED) was assessed. Engaged scale growth for GPIP patients varied across sessions and was best represented by a cubic growth curve. This suggested that GPIP progressed in definable phases that reflected a rupture and repair sequence of engaged group climate. For patients receiving GCBT, engaged, avoiding, and conflict scale growth was gradual and consistent (i.e., linear), indicating an increase in positive group climate across sessions. This likely reflected patients taking greater responsibility for treatment as suggested by the CBT model. Linear growth in engaged climate mediated the relationship between attachment anxiety and outcome in GPIP. A consistent increase in engaged group climate through the rupture and repair phase may be a necessary condition for successful treatment of BED patients with high attachment anxiety who receive GPIP.

Zusammenfassung

Entwicklung von Veränderungen im Gruppenklima bei zwei Arten von Gruppentherapie für Essstörungen: Eine Wachstumskurven-Analyse

Es wurde die Entwicklung des Gruppenklimaklimas über 16 Sitzungen bei psychodynamisch - interpersoneller Gruppentherapie (psychodynamic-interpersonal psychotherapy [GPIP]) und kognitiv-verhaltensmässiger Gruppentherapie (group cognitive-behavioral therapy [GCBT]) eingeschätzt. An der Untersuchung nahmen 65 Frauen mit Essanfallstörungen, die die Behandlung auch zu Ende geführt haben, teil. Der Zuwachs der Engagement-Skala variierte für GPIP-Patienten und ließ sich am besten mit Hilfe einer kubischen Wachstumskurve wiedergeben. Das legt für das engagierte Gruppenklima das Fortschreiten vom GPIP-Patienten mit einer Phasensequenz von Einbrüchen und ihrer Wiederherstellung nahe. Für GCBT-Patienten war der Anstieg der Skalen für engagiertes, vermeidendes und konflikthaftes Gruppenklima graduell und konsistent (d. h. linear) und wies insgesamt auf einen kontinuierlichen Anstieg des positiven Gruppenklimas über die Sitzungen hin. Das spiegelt wahrscheinlich die größere Verantwortung der Patienten für die Behandlung, wie sie nach dem CBT-Modell angenommen wird, wider. Ein linearer Anstieg des engagierten Gruppenklimas, über die Phasen von Einbrüchen und Wiederherstellung hinweg, könnte eine notwendige Bedingung für eine erfolgreiche Behandlung von Essanfallstörungs-Patienten mit hoher Bindungsangst unter der GPIP Bedingung sein.

Résumé

Changements du climat dans le groupe dans deux types de thérapies de groupe pour le binge-eating?: une analyse par courbe de croissance

Le développement du climat dans le groupe était évalué à travers 16 séances de psychothérapie de groupe psychodynamique–interpersonnelle (GCBT) et de thérapie de groupe cognitivo–comportementale (GCBT) pour 65 femmes avec un trouble de binge–eating (BED) ayant terminé le traitement. La croissance sur l’échelle d'engagement des patients en GPIP variait à travers les séances et était le mieux représentée par une courbe de croissance cubique. Ceci suggère que la GPIP progressait par phases définies reflétant une séquence de rupture et de réparation du climat d'engagement du groupe. Pour les patients en GCBT, la croissance des échelles d'engagement, d’évitement et de conflit était graduel et consistant (linéaire), indiquant une augmentation du climat de groupe positif à travers les séances. Ceci pourrait refléter une plus grande prise de responsabilité par les patients pour leur traitement, comme suggéré par le modèle CBT. La croissance linéaire du climat engagé était médiatrice de la relation entre l'anxiété d'attachement et l'issue en GPIP. Une augmentation consistante du climat d'engagement dans le groupe dans la phase de rupture et de réparation pourrait être une condition nécessaire pour un traitement réussi de patients BED avec une haute anxiété d'attachement qui bénéficient d'une GPIP.

Resumen

Cambios en el clima grupal en dos tipos de terapia para la bulimia: análisis de la curva de crecimiento

Se evaluó el desarrollo del clima grupal a lo largo de 16 sesiones de una psicoterapia grupal psicodinámica-interpersonal (GPIP) y de otra grupal cognitivo-comportamental (GCBT) de sesenta y cinco mujeres que completaron su tratamiento para desorden bulímico (BED). El crecimiento de la escala comprometida para pacientes GPIP varió a través de las sesiones y se lo representó mejor por medio de una curva de crecimiento cúbico. Esto sugiere que la GPIP progresó en fases definibles que reflejaron una secuencia de ruptura y reparación del clima comprometido grupal. Para los pacientes que recibieron GCBT, el crecimiento en las escalas comprometida, evitativa y conflictiva fue gradual y consistente (esto es, lineal), lo que indica un aumento en el clima positivo grupal a lo largo de las sesiones. Probablemente, esto fue reflejo de que los pacientes tomaron su tratamiento con mayor responsabilidad, según lo sugiere el modelo CBT. Un crecimiento lineal en el clima comprometido medió entre la ansiedad de apego y el resultado en GPIP. Un aumento consistente en el clima grupal comprometido a través de las fases de ruptura y reparación puede ser una condición necesaria para un tratamiento exitoso con GPIP de pacientes BED con gran ansiedad de apego.

Resumo

Mudanças no ambiente de grupo em dois tipos de terapia de grupo para a perturbação de ingestão alimentar compulsiva: uma análise da curva de crescimento

Foi avaliado o desenvolvimento de atmosfera de grupo durante 16 sessões de psicoterapia interpessoal psicodinâmica de grupo (PIPG) e terapia cognitivo-comportamental de grupo (TCCG) no tratamento de 65 mulheres que completaram o tratamento para a perturbação de ingestão alimentar compulsiva (PIAC). O aumento na escala do envolvimento em pacientes com PIPG variou ao longo das sessões e era melhor descrito por uma curva de crescimento cúbica. Isto sugere que a PIPG progrediu em fases definidas que reflectem a ruptura e restauram a sequência da atmosfera de envolvimento do grupo. Para os pacientes que receberam TCCG, a elevação nas escalas de envolvimento, evitamento e conflito foi gradual e consistente (i.e. linear), indicando um aumento positivo no ambiente do grupo ao longo das sessões. Isto parece reflectir que os pacientes tomam maiores responsabilidades no tratamento tal como é sugerido no modelo cognitivo-comportamental. O crescimento linear no envolvimento mediava a relação entre a vinculação ansiosa e o resultado da PIPG. Um aumento consistente no envolvimento do ambiente de grupo ao longo da ruptura e fase de reconciliação poderá ser necessário para o sucesso no tratamento de pacientes com BED, com elevada vinculação ansiosa, que recebem PIPG.

Sommario

Cambiamenti nel clima di gruppo in due tipi di terapia di gruppo per il binge-eating disorder: un'analisi della curva crescente

E’ stato valutato lo sviluppo del clima di gruppo mediante 16 sedute di psicoterapia di gruppo psicodinamico-interpersonale (GPIP) e di terapia di gruppo cognitivo-comportamentale (GCBT) per 65 donne con binge-eating disorder (BED) che hanno terminato il trattamento.

La crescita nelle scale impiegate per i pazienti GPIP è variata tra le sedute ed è stata al meglio rappresentata da una curva di crescita cubica. Ciò ha suggerito che il GPIP è progredito in fasi determinabili che hanno riflettuto una sequenza di rottura e riparazione del clima di gruppo instaurato.

Per i pazienti che hanno ricevuto la GCBT, la crescita nelle scale di adesione, evitamento e conflitto è stata graduale e consistente (lineare), indicando un incremento nel positivo clima di gruppo attraverso le sedute. Ciò probabilmente ha rispecchiato i pazienti che hanno assunto la maggiore responsabilità per il trattamento, come suggerito dal modello CBT.

La crescita lineare nel clima instaurato ha mediato la relazione tra ansia d'attaccamento ed esito nel GPIP. Un incremento consistente nel clima di gruppo instaurato attraverso la fase di rottura e riparazione potrebbe essere una condizione necessaria per un trattamento di successo dei pazienti con BED con alta ansia d'attaccamento che ricevono GPIP.

     

Health care providers’ support of patients’ autonomy,phosphate medication adherence,race and gender in end stage renal disease

This study was designed to assess dialysis subjects’ perceived autonomy support association with phosphate binder medication adherence, race and gender. A multi-site cross-sectional study was conducted among 377 dialysis subjects. The Health Care Climate (HCC) Questionnaire assessed subjects’ perception of their providers’ autonomy support for phosphate binder use, and adherence was assessed by the self-reported Morisky Medication Adherence Scale. Serum phosphorus was obtained from the medical record. Regression models were used to examine independent factors of medication adherence, serum phosphorus, and differences by race and gender. Non-white HCC scores were consistently lower compared with white subjects’ scores. No differences were observed by gender. Reported phosphate binder adherence was associated with HCC score, and also with phosphorus control. No significant association was found between HCC score and serum phosphorus. Autonomy support, especially in non-white end stage renal disease subjects, may be an appropriate target for culturally informed strategies to optimize mineral bone health.     

Correlates of psychosocial well-being among overweight adolescents: the role of the family

An ethnically diverse sample of at-risk-for-overweight and overweight youths (body mass index greater than the 85th percentile for age and gender; n = 667 male participants, and n = 684 female participants) completed a school-based survey measuring family variables (connectedness, mealtime environment, and weight commentary), psychosocial well-being (depressed mood, body satisfaction, and self-esteem), and unhealthy weight-control behaviors; all measures were assessed concurrently. Hierarchical linear regression analyses revealed that measures of general family connectedness, priority of family meals, and positive mealtime environment were significantly positively associated with psychological well-being and inversely associated with depressive symptoms and unhealthy weight-control behaviors. Familial weight commentary (i.e., weight-based teasing and parental encouragement to diet) was associated with many indicators of poor psychological health. The authors conclude that greater psychosocial well-being and fewer unhealthy weight-control behaviors are associated with making family time at meals a priority, creating a positive mealtime atmosphere, and refraining from weight commentary.