Objective: Excessive calorie intake constitutes a global public health concern, due to its associated range of untoward outcomes. Impulsivity and compulsivity have been linked to dietary intake. However, nothing is known about dietary intake and body-focused repetitive behaviors, despite their classification as obsessive-compulsive related conditions, and high co-morbidity with impulsive and compulsive conditions.Methods: One hundred and ninety six adults with trichotillomania or skin picking disorder were recruited. Dietary intake over the preceding year was quantified using the Dietary Fat and Free Sugar Short questionnaire. Relationships between dietary fat/sugar intake and behaviors were evaluated using regression modeling.Results: Sugar intake was significantly related to higher trans-diagnostic compulsivity (p = 0.011) and higher non-planning impulsivity (p = 0.013) In terms of saturated fat intake, there was no significant relationship to the explanatory variables. A combination high fat/high sugar diet was significantly associated with higher motor impulsivity (p = 0.005).Conclusions: Past-year nutrition appears to be significantly associated with trans-diagnostic impulsivity and compulsivity. The role of poor nutrition in these disorders and related conditions, and its link with impulsivity and compulsivity, requires longitudinal research attention; and clinical work should address not only psychiatric symptoms but also impact of lifestyle of overall health.

Summary This study examined post-traumatic stress disorder (PTSD) symptoms in 13 049 survivors of suspected or confirmed COVID-19, from the UK general population, as a function of severity and hospital admission status. Compared with mild COVID-19, significantly elevated rates of PTSD symptoms were identified in those requiring medical support at home (effect size 0.178 s.d., P = 0.0316), those requiring hospital admission without ventilation (effect size 0.234 s.d., P = 0.0064) and those requiring hospital admission with ventilator support (effect size 0.454 s.d., P < 0.001). Intrusive images were the most prominent elevated symptom. Adequate psychiatric provision for such individuals will be of paramount importance.

BACKGROUND Firearm ownership is extremely common in parts of the United States. Yet little research has examined whether it is associated with impulsive symptoms and traits. METHODS Adults age 18 to 29 who gamble at least occasionally were recruited in 2 cities in the United States using media advertisements for an exploratory study examining general mental health, impulse control disorders, impulsive personality, and aspects of cognition (decision-making, response inhibition, and flexible responding). The participants were grouped as firearm owners and non-firearm owners; these 2 groups were compared on the above measures. RESULTS For this study, 149 young adults took part, of whom 33 (22.1%) endorsed owning ≥1 firearm. Firearm ownership was significantly associated with male gender and elevated risk of gambling disorder, but not with other measures of impulsivity. CONCLUSIONS The link between firearm ownership and disordered gambling merits further research and may have policy implications, such as in terms of screening for guns in gambling arenas, including casinos. Further research is needed to explore potential associations between gun ownership and impulsivity in cohorts with other demographic characteristics, including longitudinally.

BACKGROUND:We compared injury incidence and mechanisms among youth, high school (HS), and National Collegiate Athletic Association (NCAA) boys' and men's lacrosse athletes for the 2014-2015 to 2016-2017 lacrosse seasons.METHODS:Multiple injury surveillance systems were used to capture 21 youth boys', 22 HS boys', and 20 NCAA men's lacrosse team-seasons of data during the 2014-2015 to 2016-2017 seasons. Athletic trainers reported game and practice injuries and athlete exposures (AEs). Injuries included those occurring during a game and/or practice and requiring evaluation from an athletic trainer and/or physician. Injury counts, rates per 1000 AEs, and injury rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated.RESULTS:The injury rate in youth was higher than those reported in HS (10.3 vs 5.3 per 1000 AEs; IRR = 2.0; 95% CI: 1.6-2.4) and the NCAA (10.3 vs 4.7 per 1000 AEs; IRR = 2.2; 95% CI: 1.9-2.5). When considering time loss injuries only (restricted participation of >= 24 hours), the injury rate in youth was lower than those reported in HS (2.0 vs 2.9 per 1000 AEs; IRR = 0.7; 95% CI: 0.5-0.95) and the NCAA (2.0 vs 3.3 per 1000 AEs; IRR = 0.6; 95% CI: 0.4-0.8). The concussion rate in youth was higher than those in HS (0.7 vs 0.3 per 1000 AEs; IRR = 2.4, 95% CI: 1.1-5.2) and the NCAA (0.7 vs 0.3 per 1000 AEs; IRR = 2.1, 95% CI: 1.2-3.7). Injuries at the youth, HS, and NCAA levels were most commonly associated with stick contact, inflammatory conditions (including bursitis, tendonitis, and other unspecified inflammation), and noncontact mechanisms, respectively.CONCLUSIONS:Although the time loss injury rate was lowest in youth boys' lacrosse, the concussion rate was the highest. Injury prevention approaches should be specific to the mechanisms associated with each level of play (eg, equipment skill development in youth).

BACKGROUND:Prior data indicate high rates of problematic gambling in some racial-ethnic minority groups, yet research into mechanisms contributing to these associations is scant. The aim of the present study was to examine whether impulsivity and compulsivity differ across racial-ethnic groups in recreational gamblers. METHODS:Young adult non-treatment seeking recreational gamblers were recruited from the general community. Presence of mental health diagnoses (including gambling disorder) was exclusionary. Participants completed clinical interviews, questionnaires, and cognitive tasks germane to impulsivity and compulsivity. RESULTS:202 recreational gamblers (63.5% males) had mean (standard deviation) age 23.8 (2.7) years and identified using the following racial-ethnic identities: Caucasian (N = 145), African-American (N = 41), and Asian (N = 16). Groups did not differ on age, gender, education, or impulsivity measures. Compared to the Caucasian group, the African-American group reported significantly higher endorsement of sub-syndromal disordered gambling, higher compulsivity scores, and exhibited decision-making decrements on the Gambling Task. The Asian and Caucasian groups did not differ on any measure. CONCLUSIONS:This study suggests that young adult African-American recreational gamblers may experience greater levels of subsyndromal gambling compared to other racial-ethnic groups, and this appears linked with aspects of compulsivity. Future work should evaluate gambling longitudinally to better understand nuanced presentations across different groups, including in other age groups.

CONTEXT:Recent injury-surveillance data for collegiate-level cross-country athletes are limited.OBJECTIVE:To describe the epidemiology of National Collegiate Athletic Association (NCAA) men's and women's cross-country injuries during the 2009-2010 through 2013-2014 academic years.DESIGN:Descriptive epidemiology study.SETTING:Aggregate injury and exposure data collected from 25 men's and 22 women's cross-country programs, providing 47 and 43 seasons of data, respectively.PATIENTS OR OTHER PARTICIPANTS:Collegiate student-athletes participating in men's and women's cross-country during the 2009-2010 through 2013-2014 academic years.MAIN OUTCOME MEASURE(S):Injury rates; injury rate ratios (RRs); injury proportions by body site, diagnosis, and apparatus; and injury proportion ratios were reported with 95% confidence intervals (CIs).RESULTS:The Injury Surveillance Program captured 216 injuries from men's cross-country and 260 injuries from women's cross-country, leading to injury rates of 4.66/1000 athlete-exposures (AEs) for men (95% CI = 4.04, 5.28) and 5.85/1000 AEs for women (95% CI = 5.14, 6.56). The injury rate in women's cross-country was 1.25 times that of men's cross-country (95% CI = 1.05, 1.50). Most injuries affected the lower extremity (men = 90.3%, women = 81.9%). The hip/groin-injury rate in women (0.65/1000 AEs) was higher than that in men (0.15/1000 AEs; RR = 4.32; 95% CI = 1.89, 9.85). The ankle-injury rate in men (0.60/1000 AEs) was higher than that in women (0.29/1000 AEs; RR = 2.07; 95% CI = 1.07, 3.99). Common diagnoses were strains (men = 19.9%, women = 20.4%) and inflammation (men = 18.1%, women = 23.8%). The majority of injuries were classified as overuse (men = 57.6%, women = 53.3%).CONCLUSIONS:Consistent with prior research, injury distributions varied between male and female athletes, and the injury rate among females was higher. Understanding the epidemiology of these cross-country injuries may be important for developing appropriate preventive interventions.

Clemens W. Janssen, PhD; Christopher A. Lowry, PhD; Matthias R. Mehl, PhD; John J. B. Allen, PhD; Kimberly L. Kelly, MPA; Danielle E. Gartner, BA; Angelica Medrano, BA; Tommy K. Begay, PhD; Kelly Rentscher, MA; Joshua J. White, BS; Andrew Fridman, BS; Levi J. Roberts, BA; Megan L. Robbins, PhD; Kay-u Hanusch, MSc; Steven P. Cole, PhD; Charles L. Raison, MD

In this chapter, we discuss indications, pre-electroconvulsive therapy (ECT) evaluations, concurrent use of ECT and psychotropic medications, right unilateral ultra-brief pulse wave ECT, methods of ECT administration, adverse reactions, methods of management for those who fail to respond to the index ECT treatment, continuation of ECT, and maintenance of ECT. The primary focus is for those psychiatrists who refer their patients to an ECT specialist. A brief summary for the newly emerging right unilateral ultra-brief pulse wave ECT has been incorporated.

BACKGROUND:Stealing is a fairly common behaviour among young adults. Understanding the potential associations and characteristics of individuals who steal may help educational institutions, health services and young people themselves resolve difficulties before the behaviour impacts on their academic performance and health.AIMS:We aim to test the hypothesis that desires to steal among students would be associated with worse academic achievements and higher rates of mood and impulse control disorders.METHODS:One thousand eight hundred and five students completed the College Student Computer User Survey online and were included in this analysis at a large Midwestern United States University. Responders were grouped according to self-reported stealing urges and behaviours and were compared on measures of psychosocial function, mental health disorders and impulsivity.RESULTS:Urges to steal were associated with worse depressive symptoms, higher levels of perceived stress and a number of psychiatric disorders including bipolar disorder and multiple disorders of impulse control (kleptomania, compulsive sexual behaviour, skin picking, trichotillomania and compulsive buying). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE AND/OR FUTURE RESEARCH: These following data indicate that stealing for many college students may be considered within a spectrum of impulsive behaviours. • Illegal behaviours among students point to mental health difficulties among them. • Our findings may provide clinicians, researchers and health professionals with a clearer picture of a range of impulsive behaviours among college students and promote treatment for this group. • Our findings could also inform preventative approaches to impulsive problems in young adults.

What is known and objectivesObstetrics services are a high-throughput and high-risk environment poised for pharmacist involvement, but determining how to ideally allocate services is difficult. There is recent interest in the development of tools for service prioritization, but none are specifically targeted to obstetrics. Therefore, the aim of this study was (i) to conduct a practice audit surveying the demographics of patients attending obstetrics wards at a high-capacity maternity hospital; and (ii) to evaluate a triage tool developed to prioritize pharmacy services.MethodsA retrospective case review of women discharged after birth admissions was undertaken at a hospital in National Health Service (NHS) Scotland during June 2014. Demographic and admission data were collected, as well as pharmacist interventions and missed opportunities in patient care on post-natal wards. A pharmacy triage tool was developed and retrospectively applied to each case to ascertain a risk category that would trigger and target pharmacist review. Interventions/opportunities were classified as either clinical (medication related) or administrative (potential for error development).Results and discussionOne hundred and seventy-five cases were reviewed with a median age of 29years old. Eighty-six patients (491%) were retrospectively classified with elevated risk using the triage tool. A total of 117 charts (669%) were identified with missed opportunities for pharmacist intervention, which was significantly greater among patients classified as higher risk (756 vs. 584%, P=0017). Compared to low-risk patients, patients with a higher-risk classification had lower rates of administrative missed opportunities (554 vs. 808%, P=0015), but numerically higher rates of clinical (262 vs. 96%, p=NS) and mixed clinical/administrative (185 vs. 96%, p=NS) missed opportunities, although this failed to reach statistical significance.What is new and conclusionEvaluation of a triage tool for obstetric services demonstrated potential for prioritizing higher-risk patients for pharmacist review and addressing opportunities for clinical improvements.

This chapter considers special issues in treatment—those issues that present in clinical practice but which are often difficult to address. It includes a section on treatment-resistant cases, including a definition of “treatment resistance,” and key steps that should be undertaken when a patient’s symptoms have not improved sufficiently despite first-line interventions; important issues in treatment resistance discussed here include confirming original diagnoses, not missing differential diagnoses and potential medical contributions, detailed clarification of treatments actually received in the past (including compliance), and what to try next. The next section focuses on treatment issues in children and adolescents, summarizing conditions in which medications should be considered, along with guidelines about treatment regimes since these can differ considerably from those used in adult patients. There is a section on alternative treatments—options that are not “first line” or not so supported by a clear evidence base, but which can be helpful as additional strategies in some cases due to (in many cases) negligible downsides to trying them. Finally, the chapter has sections on inpatient and residential treatments, and neurosurgical interventions.

Pathological gambling ( PG ) is a relatively common and often disabling psychiatric condition characterized by intrusive urges to engage in deleterious gambling behaviour. Although common and financially devastating to individuals and families, there currently exist no formally approved pharmacotherapeutic interventions for this disorder. This review seeks to examine the history of medication treatments for PG . A systematic review of the 18 double‐blind, placebo‐controlled pharmacotherapy studies conducted for the treatment of pathological gambling was conducted. Study outcome and the mean dose of medication administered was documented in an effort to determine a preferred medication choice in this population. A variety of medication classes have been examined in the treatment of PG with varying results. Antidepressants, atypical antipsychotics and mood stabilizers have demonstrated mixed results in controlled clinical trials. Although limited information is available, opioid antagonists and glutamatergic agents have demonstrated efficacious outcomes, especially for individuals with PG suffering from intense urges to engage in the behaviour. Given that several studies have demonstrated their efficacy in treating the symptoms associated with PG , opioid antagonists should be considered the first line treatment for PG at this time. Most published studies, however, have employed relatively small sample sizes, are of limited duration and involve possibly non‐representative clinical groups (e.g. those without co‐occurring psychiatric disorders). Response measures have varied across studies. Heterogeneity of PG treatment samples may also complicate identification of effective treatments. Identification of factors related to treatment response will help inform future studies and advance treatment strategies for PG .