Objective-Substance use disorders (SUDs) are common among patients presenting to general psychiatry treatment settings, and thus it is important that all psychiatry residents be well-trained in the screening, diagnosis, and treatment of outpatients with these problems. Nonetheless, there is a relative shortage of trained addiction psychiatry staff to meet residents' educational needs.Methods-The authors describe an addiction psychiatry curriculum within a general psychiatry training program to demonstrate practical approaches to educating general psychiatry residents on the treatment of SUDs.Results-The MGH/McLean adult psychiatry residency training program provides training in addiction psychiatry in multiple treatment settings during the four years of residency. The program uses addiction specialists, non-specialty psychiatrists, and residents and fellows to provide training.Conclusions-Adult psychiatry residencies can provide comprehensive addiction psychiatry training that spans multiple treatment settings and post-graduate years. This can be accomplished by training general staff psychiatrists, senior residents, and fellows to assist core addiction faculty in providing addiction psychiatry education.
A polyclonal antibody against a glutathione S-transferase fusion protein containing the 76 COOH-terminal amino acids of Hex, a divergent homeobox gene, was raised in rabbits. Western blot and immunofluorescence reveal that Hex is a 35-37-kD soluble protein present both in the nucleus and cytoplasm of transfected and nontransfected cultured cells as well as in whole mouse embryo. Confocal microscopy of whole mount immunostained mouse embryos at E7.5 and E8.5 demonstrates that Hex is differentially localized in the cytoplasm and nucleus of definitive endoderm, developing blood islands, and hepatic diverticulum. In particular, in the region of the foregut that gives rise to the liver, Hex expression is nuclear in the endodermal cells of the hepatic diverticulum, whereas expression is primarily cytoplasmic in cells lateral to the liver-forming region. This suggests that nuclear localization of Hex is involved in early hepatic specification and that compartmentalization of Hex protein plays an important role in its function during mouse development. Homeobox gene products are transcription factors containing a conserved 60-amino acid homeodomain that binds DNA in a sequence-specific manner and regulates different aspects of cell differentiation and morphogenesis during animal development (1, 2). The divergent or orphan homeobox gene Hex (3), also known as Prh (4), is expressed in a variety of multipotent hematopoietic progenitor cells and cell lines, suggesting a role in the early stages of hematopoietic cell differentiation. Recently Hex has been implicated as the earliest unequivocal molecular marker of anteroposterior patterning in the mouse embryo (5) and is also believed to play a role in organogenesis on the basis of its expression in the developing liver, thyroid, and lung (6).In general, the expression patterns of homeobox genes, including Hex, have mainly been examined at the mRNA level by use of in situ hybridization or RNase protection assay. However, the expression patterns of homeobox mRNA and their proteins do not always correlate, possibly because of posttranscriptional and/or posttranslational modifications (7,8). For example, maternally derived caudal mRNA is distributed diffusely but its protein is expressed in a gradient fashion only in the posterior area of the Drosophila embryo (9), and Csx/Nkx 2.5 mRNA is readily detectable in National Institutes of Health 3T3 cells but its protein product is undetectable (10). Another level of homeobox gene regulation involves the spatial distribution of its protein product within the cell. The Exd product accumulates only in the cell cytoplasm in early embryos and is later translocated to the nucleus (11, 12). Endogenous rat engrailed homeoproteins are present in the cytosolic and membrane fractions in addition to their nuclear localization in embryonic midbrain/hindbrain (13). Although a considerable amount of information regarding the distribution and expression pattern of Hex is available at the mRNA level in vertebrate development (3,5,6,14,15), nothing is...
BACKGROUND Mood disorders and substance use disorders (SUDs) co-occur at a high rate. Individuals with co-occurring mood and substance use disorders are less likely to complete treatment. Of those who receive treatment, many do not receive adequate care that addresses both disorders. Integrated Group Therapy (IGT) is an evidence-based psychosocial treatment that treats both mood disorders and SUDs, stressing the similarities and relationship between the two disorders. Although IGT is an effective treatment for individuals with mood and substance use disorders, it is not widely available, and for those who do receive IGT, there is no in-the-moment support. OBJECTIVE A mobile version of IGT would increase access and provide in-the-moment support for individuals when they need it. The aim of this study is to use exploratory, qualitative user-centered design methodology to interview and observe end users and clinicians who treat individuals with mood disorders and SUDs to inform the design of the mobile app. METHODS Qualitative interviews were conducted with 5 patient participants who were currently receiving treatment for a co-occurring mood and substance use disorder, and 5 clinicians with experience treating patients with mood disorders and/or substance use disorders. All participants completed a short survey to assess demographic information and technology use. Additionally, observations were conducted at 3 IGT inpatient and outpatient groups to triangulate findings across methods. Interviews were audio-recorded and transcribed. Transcripts and field notes were analyzed using thematic analysis using NVivo for Mac (version 11). RESULTS Patient participants were predominately male (3/5, 60%), age 45-64 (4/5, 80%), unemployed or disabled (3/5, 60%), and white (5/5, 100%). The majority of clinicians were female (4/5, 80%), age 26-44 (5/5, 100%), and white (4/5, 80%). Most patients (4/5, 80%) and clinicians (5/5, 100%) reported feeling comfortable using technology as a treatment tool, and 40% (2/5) of patients indicated that they had experience doing so. Key treatment themes that emerged from the qualitative data included the importance of IGT in helping patients to develop a common language to describe their co-occurring conditions and experiences, visualizing the recovery journey, the importance of independence and freedom to patients throughout treatment, along with varied acceptance and self-perception of one’s recovery journey. With respect to developing a mobile tool, reported patient needs included: in-the-moment support, peer-to-peer support, after-care planning, maintaining structure post-discharge from treatment and opportunities to practice skills. Clinicians corroborated the need for patient peer-to-peer support, help with after-care planning and the opportunity to practice skills. CONCLUSIONS Patients and clinicians were open to the idea of using technology as part of treatment. Several themes emerged to inform the direction of a minimal viable product (MVP) of the app. Next steps include narrowing down to key themes to focus on for the MVP, defining features as relevant to those themes, designing a clickable prototype of the app and conducting iterative feedback sessions with end users.
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