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On May 7th 2008, our annual Motherisk Update was devoted to reproductive mental health, which is a part of life for many women of child bearing age. Presentations were delivered by experts in the fields of psychiatry, maternal/fetal pharmacology and obstetrics. Our goal was to improve patient care for a population that is particularly vulnerable to misinformation and the stigma that surrounds mental illness. The topics presented, included the prevalence of depression and other psychiatric illnesses during pregnancy and postpartum, the adverse consequences of untreated psychiatric illnesses in pregnancy and postpartum and the treatment of substance abuse which is often a comorbidity in these women. We also provided information on the risk/safety of drugs used for the treatment of these conditions in pregnancy and breastfeeding,including concerns regarding neonatal withdrawal in infants who were exposed to antidepressants during pregnancy.
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PMID:Proceedings from Motherisk Update 2008. Introduction: reproductive mental health. 1915 21

On May 7th 2008, our annual Motherisk Update was devoted to reproductive mental health, which is a part of life for many women of childbearing age. Presentations were delivered by experts int he fields of psychiatry, maternal/fetal pharmacology and obstetrics. Our goal was to improve patient care for a population that is particularly vulnerable to misinformation and the stigma that surrounds mental illness. The topics presented, included the prevalence of depression and other psychiatric illnesses during pregnancy and postpartum, the adverse consequences of untreated psychiatric illnesses in pregnancy and postpartum and the treatment of substance abuse which is often a comorbidity in these women. We also provided information on the risk/safety of drugs used for the treatment of these conditions in pregnancy and breastfeeding,including concerns regarding neonatal withdrawal in infants who were exposed to antidepressants during pregnancy.
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PMID:Introduction: reproductive mental health--Motherisk update 2008. 1916 41

Women are under-represented in opioid dependency treatment, yet national statistics indicate that, as the non-medical use of prescription pain relievers rises, more women will require this treatment. Important considerations for the treatment of opioid-dependency in women include high rates of psychiatric illness, concerns regarding substance abuse and treatment in pregnancy, high rates of history of trauma, relationship dynamics that put women at risk for sexually transmitted diseases, and social factors such as lower economic status and responsibilities as care givers. Traditional approaches to opioid-dependency treatment, such as methadone maintenance programs (MMPs), have not consistently addressed these needs and do not provide flexible care and anonymity. Recent data suggest that, in comparison to MMPs, a greater percentage of women are entering office-based treatment. Yet it is unclear whether physicians' offices will be equipped to adequately handle women's treatment needs. Nonetheless office-based treatment may provide a solution for women concerned about anonymity, stigma, and the requirement of daily visits to a MMP.
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PMID:Women and opioid dependence treatment: office-based versus opioid treatment program-based care? 1926 7

A retrospective, longitudinal analysis of case management and medical charts was used to evaluate utilization of support group, mental health, and substance abuse treatment services among HIV-positive women in New York City. Analyses of 4134 case management and supportive service transactions revealed that 70% utilized support groups over the two-year study period. In contrast, only 35% utilized mental health services (therapy) and of those identified as using substances, only 48% utilized substance abuse treatment services. Considering the high prevalence of mental illness (63%, n=29) and substance use (54%, n=25) in the sample, the low utilization rates highlight unmet needs for service. Significant differences were found in utilization of mental health and substance abuse treatment services, with those who received services at a medical model agency (integrated care) being more likely to receive both types of treatment. In contrast, participants attending support groups in non-medical model agencies (77.8%, n=7) were significantly more likely to be retained in group (i.e., attend 11 or more sessions) than those at medical model agencies (39.1%, n=9). Based on the higher utilization rates of support groups among seropositive women, perhaps these groups could be a vehicle for establishing rapport between mental health professionals and group members to bridge the utilization gap and reduce the stigma associated with therapy and substance abuse treatment services. These findings both taut the success and highlight weaknesses regarding accessing mental health and substance abuse care, and support group retention. Sharing of information regarding recruitment and retention efforts between agencies of different modalities would be beneficial and also could identify service niches that capitalize on their subsequent strengths.
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PMID:Case manager-reported utilization of support group, substance use and mental health services among HIV-positive women in New York City. 1950 74

HIV-positive MSM may report high-risk behaviors-including drug use and intentional unprotected anal sex-as a means of coping. We recruited a diverse sample of HIV-positive men (n = 66) at gay community events. One third of these men self-identified as barebackers. Barebackers were more likely to report drug use and sex under the influence of drugs (i.e., PnP). Beyond this, those who identified as barebackers also tended to report greater stigma, gay-related stress, self-blame-related coping, and substance abuse coping. Providers must attend to issues of stress and coping to engage men who may not respond to traditional risk reduction efforts.
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PMID:Stress and coping among HIV-positive barebackers. 1953 21

Male-to-female (MTF) transgender women experience a host of psychosocial issues such as discrimination, stigmatization, and marginalization. These challenges often limit economic opportunities, affect mental health, and may place members of this population at an increased risk for HIV infection. This report presents a review of the literature that focuses on risk factors for HIV infection specific to the MTF population. Factors including needle sharing and substance abuse, high-risk sexual behaviors, commercial sex work, health care access, lack of knowledge regarding HIV transmission, violence, stigma and discrimination, and mental health issues have been identified in the literature as risk factors for the acquisition of HIV infection by members of this population. Implications for care provided to MTF transgender persons are presented, and suggestions for future research are identified.
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PMID:HIV infection risk factors among male-to-female transgender persons: a review of the literature. 1973 95

Despite the high prevalence of problem drinking among Americans, primary care physicians often fail to address this major health threat. In addition, once alcohol use disorders are identified, patients often fail to receive coordinated medical and substance abuse treatment. This article reviews four types of barriers as well as potential facilitators to improving the prevention and management of problem drinking. First, primary care physicians are poorly trained about the clinical relevance of addressing alcohol problems in their daily patient care. Second, primary care physicians are concerned about the stigma and health insurance problems encountered by patients diagnosed with alcohol use disorders. Third, primary care practices have limited organizational and financial support to identify and address alcohol problems. Fourth, primary care and alcohol treatment settings communicate and collaborate poorly in delivering patient care. Opportunities to overcome these challenges are discussed and must be initiated to reduce the myriad of adverse outcomes resulting from problem drinking.
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PMID:Gaps in addressing problem drinking: overcoming primary care and alcohol treatment deficiencies. 1978 74

Drug use and HIV/AIDS remain serious public health issues in the US. The intersection of the twin epidemics of HIV and drug/alcohol use, results in difficult medical management issues for the healthcare providers who work in the HIV prevention and treatment fields. Access to care and treatment, medication adherence to multiple therapeutic regimens and concomitant drug-drug interactions of prescribed treatments are difficult barriers for drug users to overcome without directed interventions. Injection drug users are frequently disenfranchised from medical care and suffer stigma and discrimination creating additional barriers to care and treatment for their substance use disorders as well as HIV infection. Controlling the transmission of HIV will require access to care and treatment of individuals who abuse illicit drugs and alcohol. Improving health outcomes (e.g. access to and adherence to antiretroviral therapy) among HIV-infected substance users will also require access to evidenced-based pharmacological therapies for the treatment of drug abuse and dependence. The current review presents an overview of issues regarding the use of medication-assisted treatments for substance abuse and dependence among HIV-infected individuals, providing medical management paradigms for their care and treatment.
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PMID:Medication-assisted treatment and HIV/AIDS: aspects in treating HIV-infected drug users. 1991 Jul 88

Common and pernicious adult psychiatric disorders consequent to burn injury include post-traumatic stress disorder (PTSD), major depressive disorder (MDD), and new-onset substance abuse disorder. Diagnosing and treating these disorders is complicated by the complex psychosocial issues associated with burns including grief, pain, role impairment, disfigurement, dysfunction, stigma, as well as financial and legal issues. Additionally, pre-morbid psychiatric and neurological illnesses are risk factors for burns, adding to the challenge of diagnosis and treatment. This article will focus on the diagnosis and treatment of PTSD and MDD consequent to burn trauma, as these are the major psychiatric outcomes, addressing the attendant psychosocial problems as threads in this post-trauma tapestry.
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PMID:Treatments for common psychiatric conditions among adults during acute, rehabilitation, and reintegration phases. 1991 9

Tobacco use exerts a huge toll on persons with mental illnesses and substance abuse disorders, accounting for 200,000 of the annual 443,000 annual tobacco-related deaths in the United States. Persons with chronic mental illness die 25 years earlier than the general population does, and smoking is the major contributor to that premature mortality. This population consumes 44% of all cigarettes, reflecting very high prevalence rates plus heavy smoking by users. The pattern reflects a combination of biological, psychosocial, cultural, and tobacco industry-related factors. Although provider and patient perspectives are changing, smoking has been a historically accepted part of behavioral health settings. Additional harm results from the economic burden imposed by purchasing cigarettes and enduring the stigma attached to smoking. Tailored treatment for this population involves standard cessation treatments including counseling, medications, and telephone quitlines. Further progress depends on clinician and patient education, expanded access to treatment, and the resolution of existing knowledge gaps.
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PMID:Confronting a neglected epidemic: tobacco cessation for persons with mental illnesses and substance abuse problems. 2000 18


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