Access to medical care is limited in most of Canada, and the population often endures lengthy waiting times to see a physician. The use of new and varied health care providers has been suggested as a means to alleviate the shortage of physicians. This paper reviews the history and role of the Physician Assistant (PA), both in Canada and internationally, and outlines the clinical competencies currently held by this provider to fill the role of a physician extender in our country. PAs' experiences are reported in the Canadian Forces (CF), where they have been employed for many years, and in Manitoba, where they are used as surgical assistants. The potential for the PA to be incorporated into our provincial health care systems will be considered in light of common barriers to Health Human Resources (HHR) strategic implementation.
Abbreviations: PTSD, post traumatic stress disorder; SUDs, substance abuse disorders; FEP, first episode psychosis; HPA, hypothalamic pituitary adrenal IntroductionIncreasing attention, both in research circles and therapeutic environments, is being given to the association between and potential efficacy of co-treatment for addiction and post-traumatic stress disorder (PTSD).1 Recent studies indicate a high prevalence of PTSD clients among clients receiving treatment for substance abuse disorders (SUDs) 2,3 while not addressing physiological similarities. Additionally, strong associations between cannabis and other substance abuse and first episode psychosis (FEP) have been reported. 4,5 Similarities in behaviors and reported symptomatology among people with SUD, PTSD and FEP either in combinations or for single entity diagnosis are clinically significant. As well, associations between addiction and other affective and schizoid disorders including bipolar affective disorder and schizophrenia are strong and well reported.6 This further complicates effective assessment, treatment and ongoing management of clients with SUD. In particular, conclusions easily drawn for SUD clients along any stage of the disorder who experience an FEP can lead to potential misdiagnosis as a concurrent disorder, rather than a potential complication of SUD. At this stage the client is confronted with all the ramifications, of two (versus one), long term chronic diseases. Symptomatology following FEP is remarkably similar to that reported both in bipolar affective disorder with depression and suicidal ideation/behavior, as well as in PTSD, such as "living in permanent fear of the next one (psychotic episode)" and attendant avoidance and social withdrawal.7 Among other commonalities, all three conditions include a relationship with stress and its biopsychological implications. Abnormal basal cortisol levels and reactivity are implicated in SUD, PTSD and FEP as a result of hypothalamic-pituitary-adrenal (HPA) axis dysfunction. [8][9][10] This finding and an understanding of potential mechanisms implicated within each entity are explored to further illuminate associated risk factors, as well as a clinical pathway among and co-existence of these conditions. Finally, the possibility of an FEP resulting as a discrete experience from SUD, rather than an additional disorder, is discussed. Discussion Substance use disorderTo manage the complexities surrounding these three entities, this paper will speak only to substance dependence as that component of SUD and addiction discussed herein. According to the DSM IV TR, substance dependence is a maladaptive pattern of use that is characterized by three or more of the following:i. tolerance of the substance ii. Withdrawal symptoms when the substance is reduced or ceased iii. Using more than was planned or for a longer period than was planned iv. Unsuccessful efforts to reduce or control use v. Significant time spent obtaining, using, or recovering from use vi. Interference with important social, occu...
The underlying neuroscience of substance use disorder is becoming well elaborated. Nonetheless, some of the more subtle symptomatology is not well matched with underlying organic processes identified to date. The ability to explain mental phenomena with underlying brain processes is a strong part of the literature and valuable to those caring for persons. This article draws on current knowledge of the fundamentals of substance use disorder and expands on current literature surrounding axonal demyelination to suggest a likely mechanism for thought disorders commonly experienced by persons in recovery. Viewing demyelination and conduction through an analogue lens is more likely to represent the physics involved more accurately than an ‘on or off’ signalling model as associated with action potentials. Additionally, this approach is thought to better enunciate the underlying physiology behind the mental features characteristic to the disorder.
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