Objective
We sought to characterize diagnostic and treatment factors associated with receiving a prescription for benzodiazepines at discharge from a psychiatric inpatient unit. We hypothesized that engaging in individual behavioral interventions while on the unit would decrease the likelihood of receiving a benzodiazepine prescription at discharge.
Method
This is an observational study utilizing medical chart review (n = 1007) over 37 months (2008–2011). Descriptive statistics characterized patient demographics and diagnostic/prescription frequency. Multivariate regression was used to assess factors associated with receiving a benzodiazepine prescription at discharge.
Results
The sample was 61% female with mean age = 40.5 (S.D. = 13.6). Most frequent diagnoses were depression (54.7%) and bipolar disorder (18.6%). Thirty eight percent of participants engaged in an individual behavioral intervention. Benzodiazepines were prescribed in 36% of discharges. Contrary to our hypothesis, individual behavioral interventions did not influence discharge benzodiazepine prescriptions. However, several other factors did, including having a substance use disorder (OR = 0.40). Male sex (OR = 0.56), Black race (OR = 0.40), and age (OR = 1.03) were non-clinical factors with strong prescribing influence.
Conclusion
Benzodiazepines are frequently prescribed at discharge. Our results indicate strong racial and sex biases when prescribing benzodiazepines, even after controlling for diagnosis.
A neoliberal medicalized framework shapes society's understanding of distress as a disease or disorder and places the responsibility on individuals to "fix" themselves, situating the problem within a person, rather than in a sociopolitical context. This framework has become increasingly prevalent in Western society and has permeated rape crisis centers (RCCs), which play a vital role supporting sexual violence survivors. The goal of the present study was to explore the impact of a neoliberal medicalized discourse on RCC clinicians' understandings of survivor distress. Interpretative phenomenological analysis was employed. Six RCC clinicians were interviewed. Analysis revealed four master themes: Wielding the Double-Edged Sword of the Medical Model, Navigating the Healing Process with Survivors, Stay in Your Lane: The Role of the RCC, and Understanding and Honoring Survivor Shame. Recommendations for researchers and clinicians working with survivors are provided pertaining to how to (1) critically adopt medical neoliberalism, (2) empower survivors with medication information, and (3) employ alternatives to individual counseling to foster healing. Suggestions for future research are also provided.
Because of increased attention to the issue of trustworthiness of clinical practice guidelines, it may be that both transparency and management of industry associations of guideline development groups (GDGs) have improved. The purpose of the present study was to assess a) the disclosure requirements of GDGs in a cross-section of guidelines for major depression; and, b) the extent and type of conflicts of panel members. Treatment guidelines for major depression were identified and searched for conflict of interest policies and disclosure statements. Multi-modal screens for undeclared conflicts were also conducted. Fourteen guidelines with a total of 172 panel members were included in the analysis. Eleven of the 14 guidelines (78%) had a stated conflict of interest policy or disclosure statement, although the policies varied widely. Most (57%) of the guidelines were developed by panels that had members with industry financial ties to drug companies that manufacture antidepressant medication. However, only a minority of total panel members (18%) had such conflicts of interest. Drug company speakers bureau participation was the most common type of conflict. Although some progress has been made, organizations that develop guidelines should continue to work toward greater transparency and minimization of financial conflicts of interest.
We conclude that, until the relative contribution of patient and surgical (eg, positioning, retractors, hypotension) factors is known, the decision to perform neuraxial blockade in patients with severe symptoms of neuroclaudication or recently progressive symptomatic spinal stenosis should be made cautiously. Avoidance of spinal anesthesia is suggested for any procedure with prolonged lordotic positioning or any position that might cause a compromise of the spinal canal because subarachnoid block may contribute to any deterioration suffered by the patient.
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