Implementation Strategies for Collaborative Primary Care-Mental Health Models.

Implementation strategies for collaborative primary care-mental health models.

Curr Opin Psychiatry. 2013 Jul 22;
Franx G, Dixon L, Wensing M, Pincus H

Extensive research exists that collaborative primary care-mental health models can improve care and outcomes for patients. These programs are currently being implemented throughout the United States and beyond. The purpose of this study is to review the literature and to generate an overview of strategies currently used to implement such models in daily practice.Six overlapping strategies to implement collaborative primary care-mental health models were described in 18 selected studies. We identified interactive educational strategies, quality improvement change processes, technological support tools, stakeholder engagement in the design and execution of implementation plans, organizational changes in terms of expanding the task of nurses and financial strategies such as additional collaboration fees and pay for performance incentives.Considering the overwhelming evidence about the effectiveness of primary care-mental health models, there is a lack of good studies focusing on their implementation strategies. In practice, these strategies are multifaceted and locally defined, as a result of intensive and required stakeholder engagement. Although many barriers still exist, the implementation of collaborative models could have a chance to succeed in the United States, where new service delivery and payment models, such as the Patient-Centered Medical Home, the Health Home and the Accountable Care Organization, are being promoted. HubMed – addiction

Dysfunctional parental styles perceived during childhood in outpatients with substance use disorders.

Psychiatry Res. 2013 Jul 20;
Icick R, Lauer S, Romo L, Dupuy G, Lépine JP, Vorspan F

People who suffer from substance use disorders (SUDs) frequently report to have undergone childhood adversity that is often associated with father or mother dysfunction, or both. Yet that issue has been barely addressed in opiate dependent patients. Therefore we sought to evaluate parent-specific dysfunctional styles perceived during childhood in a clinical sample from an outpatient addiction treatment program using the Measure Of Parental Styles (MOPS) questionnaire. DSM-IV diagnoses of substance use disorders and history of suicide attempts, family structure and changes of caregiver during childhood were obtained from 159 consecutive outpatients, along with their perception of parental bonding with the MOPS, in which mother and father scores are separate. Mother neglect dimension was significantly correlated with an earlier age at onset of several substances’ use, the number of prior hospitalizations and of lifetime suicide attempts. Most of these associations remained significant in multivariate models. This was the first assessment of a representative sample of outpatients with SUDs by the MOPS questionnaire. Given its excellent acceptance and its association with several key correlates of SUDs, it should be used to design specific interventions targeted at attachment and familial management as well as in research models on gene×environment interactions. HubMed – addiction

Prenatal and gestational cocaine exposure: Effects on the oxytocin system and social behavior with implications for addiction.

Pharmacol Biochem Behav. 2013 Jul 20;
Williams SK, Johns JM

Drug abuse during pregnancy is a major public health concern, with negative consequences throughout development. Prenatal cocaine exposure (PCE) in rats produces social behavior deficits with corresponding changes in neuroendocrine and monoaminergic signaling. The relevance of parental care in social behavior maturity cannot be ignored, and gestational exposure to cocaine severely disrupts parental care, thus impacting the early environment of the offspring. Oxytocin (Oxt) is critical in regulating social behaviors and central levels are disrupted following acute and chronic cocaine (CC) treatment in postpartum rat dams, coincident with deficits in maternal care. We will discuss studies aimed to determine the relative contribution of PCE and CC-induced deficits in maternal care to social behaviors and Oxt signaling across development. PCE results in decreased social (including parental) behaviors in adolescence and adulthood. PCE is also associated with increased aggression in adults. Rearing by CC-exposed mothers synergistically increases the behavioral effects of PCE. Rearing by CC-exposed mothers, but not PCE, disrupts Oxt levels and mRNA in regions relevant to social behavior, but does not affect receptors in postpartum adult offspring. Preliminary work indicates PCE/CC rearing has dynamic effects on Oxt levels and receptors in neonatal rat pups, suggesting very early regulation of Oxt signaling. This work highlights how the interactive role of Oxt signaling and behavioral context throughout development can be derailed by drug abuse during pregnancy. The relevance of disrupted Oxt to intergenerational transmission of addiction is briefly discussed. HubMed – addiction

The influence of orexins on ethanol-induced behavioral sensitization in male mice.

Neurosci Lett. 2013 Jul 20;
de Macedo GC, Kawakami SE, Vignoli T, Sinigaglia-Coimbra R, Suchecki D

Recent evidence indicates the involvement of orexin in reward circuitry and drug addiction. In the present study we evaluated the role of orexin in ethanol-induced behavioral sensitization. In the first experiment, Swiss male mice received seven administrations of saline or ethanol (2.2g/kg, i.p., chronic), every other day. On the last day of treatment, half of saline-treated mice received a saline injection (saline) whereas the other half received 2.2g/kg of ethanol (i.p., acute). Behavioral sensitization was assessed by locomotor activity tests and after the last one, immunoreactivity for orexin and Fos (ORX+Fos-ir) was assessed in the lateral hypothalamic area. Chronic ethanol treatment produced behavioral sensitization and a trend for greater ORX+Fos-IR. In the second experiment, mice were treated as in Experiment 1 and type 1 orexin receptor antagonist, SB334867 (20mg/kg), was administered before the ethanol challenge. SB334867 successfully blocked the expression of sensitization in mice chronically treated with EtOH. These results indicate that orexin plays a role in ethanol-induced behavioral sensitization. HubMed – addiction

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