To describe attrition patterns of opioid use disorder (OUD) patients treated with buprenorphine (BUP) and to assess how clinical, sociodemographic, or BUP medication dosing features are associated with attrition. Patients and Methods: Electronic health records of adults (16+ year-olds) with OUD treated with BUP from 23 different substance use or mental health care programs across 11 US states were examined for one year following BUP initiation in inpatient (IP), intensive outpatient (IOP), or outpatient (OP) settings. Treatment attrition was declared at >37 days following the last recorded visit. Survival analyses and predictive modelling were used. Results: Retention was consistently 2-3 times higher following BUP initiation in OP (n = 2409) than in IP/IOP (n = 2749) settings after 2 (50% vs 25%), 6 (27% vs 9%) and 12 months (14% vs 4%). Retention was higher for females, whites (vs blacks), and those with less severe OUD, better global function, or not using non-psychotropic medications. Comorbid substance use, other psychiatric disorders, and the number of psychotropic medications were variously related to retention depending on the setting in which BUP was initiated. Predictive modelling revealed that a higher global assessment of functioning and a smaller OUD severity based on the Clinical Global Impression -Severity led to longer retentions, a higher initial BUP dose led to higher retention in a few cases, an OP setting of BUP initiation led to longer retentions, and a lower total number of psychotropic and nonpsychotropic medications led to longer retentions. These were the most important parameters in the model, which identified 75.2% of patients who left BUP treatment within three months post-initiation, with a precision of 90.5%. Conclusion: Of all the OUD patients who began BUP, 50-75% left treatment within three months, and most could be accurately identified. This could facilitate patient-centered management to better retain OUD patients in BUP treatment.
Scurvy is often considered to be a historical disease that once affected sailors, and so its modern-day prevalence is underestimated. Scurvy can present in various ways, such as with mucocutaneous and/or hematological symptoms in classic scurvy or with isolated psychiatric symptoms in neuropsychiatric scurvy. We describe two patient presentations of scurvy with borderline-low vitamin C levels and neuropsychiatric symptoms. Patient 1 presented with an exacerbation of major depressive symptoms and classic physical symptoms of scurvy, while Patient 2 presented with new-onset psychotic symptoms and no physical symptoms. Both patients had significant improvement of symptoms with vitamin C supplementation. We also conducted a literature search of MED-LINE via PubMed, identifying 16 cases of patients who met criteria for a scurvy diagnosis and presented with psychiatric symptoms that responded to vitamin C supplementation. The cases and literature review revealed that patients with scurvy can have variable psychiatric symptoms with or without the presence of mucocutaneous signs. Therefore, to optimize detection of suspected cases, diagnostic guidelines for scurvy should include psychiatric symptoms in addition to classic signs. Patients with acute psychiatric symptoms and a history of malnutrition should be screened for hypovitaminosis C. An empirical trial of vitamin C supplementation may also be of value in some cases when borderline-low vitamin C levels are found in suspected neuropsychiatric scurvy.
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Psychiatr Ann
. 2023;53(6):282–288.]
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