Objective-To perform a pilot study to examine a range of cognitive flexibility tasks early in cocaine withdrawal.Background-Previous neuropsychological investigations of cocaine withdrawal have conflicted regarding whether impaired cognitive flexibility occurs. However, most studies have examined patients later in withdrawal. Anxiety and yohimbine-induced panic are greatest early in withdrawal, and both anxiety and increased noradrenergic tone can impair cognitive flexibility.

Upregulated noradrenergic activity occurs early in cocaine withdrawal. Our previous work revealed impaired cognitive flexibility in acute cocaine withdrawal, a cognitive domain that appears to be modulated by noradrenergic activity. Therefore, we wished to determine the effect of beta-adrenergic antagonists on cognitive performance in acute cocaine withdrawal. Eleven subjects acutely withdrawing from cocaine were tested in this pilot study on tasks of cognitive flexibility as well as word fluency, attention, verbal memory, and spatial memory, off and on propranolol in a double-blinded manner. Propranolol significantly benefited certain aspects of cognitive flexibility in acute cocaine withdrawal, and improved some measures of verbal fluency and verbal recall. Cocaine withdrawal treatment is characterized by high failure rates. Further research is needed to determine the role this finding of a reversible cognitive impairment in cocaine withdrawal has in treatment.

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Within inpatient psychiatric settings exists evidence of a significant risk of violent incidents and incidents of deliberate self-harm. One of the most hidden and preventable mental health problems is the fact that approximately 1,500 suicides take place annually in inpatient hospital facilities throughout the United States. This article focuses on the advantages and disadvantages of risk and suicide assessment procedures while attempting to answer the following questions: What degree of risk currently exists on inpatient psychiatric facilities for harm to self and others? What can be done within the physical environment to protect the psychiatric patient? We discuss a combined risk and quality proactive approach to risk reduction through a safety equation integrating patient assessment, physical environment, program safety, and patient component to formalize a systems approach to the at-risk patient. [Brief Treatment and Crisis Intervention 5:121-141 (2005)]

Persons with obsessive-compulsive disorder (OCD) in singular presentation may experience profound threats to self-esteem; activities of daily living; marital, family, social relationships; and occupational functioning. OCD is present in a number of comorbid conditions, the most risky of which elevate suicide risk. This paper examines the prevalence, assessment methods, clinical features, and treatment approaches to OCD, and depression, substance abuse, or psychotic episodes in comorbid presentation, where threats to the functioning and survival of the individual as well as complications in clinical treatment may arise because of the interplay of symptoms of OCD, substance abuse, brief psychotic episodes, and depression. Case illustrations are used to demonstrate effects of comorbidity and considerations in treatment planning. This article closes by calling for longitudinal research on the causes, consequences, and efficacy of integrated treatment of OCD, depression, substance abuse, and suicidality. [Brief Treatment and Crisis Intervention 3:145-167 (2003)]