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This column is the ninth in a series exploring drug-drug interactions (DDIs) with a special emphasis on psychiatric medications. The first 3 columns in this DDI series discussed why patients being treated with psychiatric medications are at increased risk for taking multiple medications and thus experiencing DDIs, how to recognize such DDIs, strategies for avoiding and/or minimizing adverse outcomes from such DDIs, and pharmacokinetic considerations concerning DDIs in psychiatric practice. The fourth and fifth columns in this series presented a pair of parallel tables, one of which outlined the primary, known mechanism(s) of action of all commonly used psychiatric medications and one of which summarized major types of pharmaco-dynamic DDIs based on mechanism of action. Clinicians can use these 2 tables together to predict pharmacodynamically mediated DDIs. The sixth column discussed key pharmacodynamic interactions involving ethanol, opioids, and monoamine oxidase inhibitors. The seventh and eighth columns prprincipally dependent on CYP enzyme-mediated oxidative metabolism as a necessary step in their clearance from the body. The latter 2 tables inform prescribers as to which drugs they may prefer to use to avoid CYP enzyme-mediated DDIs. The overall goal of this series of columns is to present a simple way of conceptualizing neuropsychiatric medications in terms of their pharmacodynamics and pharmacokinetics to allow prescribers to take these facts into consideration when they need to use ≥2 drugs in combination to optimally treat a patient.Young adults with chronic mood and anxiety disorders may receive a range of services in pediatric care (eg, psychiatry, therapy) and within the school system (eg, individualized education plans). Such services rely on the involvement of parents or guardians to support youth (eg, attending appointments, administering medications). However, in college, young adults are often on their own and need to assume responsibility for scheduling appointments, obtaining and taking medications, and seeking out additional services (eg, accommodations). Unfortunately, many young adults may not have developed the skills needed to navigate campus and health care systems effectively, which can often lead to dire consequences. Adding to these difficulties are the high rates of depression and suicidal ideation observed in today's college students. Many students need intermediate levels of care to stay in school successfully, although not all have the maturity and skills to navigate health care without a transition plan. To address the needs of young adults transitioning out of pediatric mental health care, we developed a brief group intervention delivered to young adults and their parents during the 6 months before college or transition to living independently in the community. The transition group program structured sessions focused on scaffolding knowledge about one's own skills (and deficits) related to independent living, successful transition to college or community, and ability to independently manage a chronic mental health disorder. All young adults and parents reported that they would recommend or strongly recommend the group to a friend, and the majority found the group to be acceptable with regard to length and frequency. For both young adults and parents, the future outlook also improved from pregroup to postgroup.OBJECTIVE Because of the heterogeneity of obsessive-compulsive disorders (OCDs) and their co-occurrence with anxiety disorders, we investigated the prevalence, severity, and correlations between obsessive and compulsive symptoms reported by patients diagnosed with OCD or generalized anxiety disorder (GAD). METHODS A retrospective study was conducted in 2 groups of patients 76 patients diagnosed with OCD [F42 according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10)], and 186 patients diagnosed with GAD (F41.1 according to ICD-10), who had presented for therapy at the day ward. The Symptom Questionnaire "O," based on the Symptom Checklist 90-Revised (SCL-90-R) questionnaire, was used to assess obsessive, compulsive, and anxiety symptoms. The analysis took into account the impact of sex and the presence or absence of cognitive dysfunction (as assessed using the Bender Benton Visual Retention and Bender-Gestalt tests) on the associations beingon. Obsessive-compulsive symptoms observed in patients with GAD may show a different structure than obsessive-compulsive symptoms in patients with OCD. The results of this study suggest that compulsions are more specific for the diagnosis of OCD than obsessions. Compulsions, such as counting related to the need for order and symmetry, may be associated with some cognitive dysfunctions and male sex, a finding that requires further research.OBJECTIVE A lack of resources and cultural stigma associated with mental health treatment necessitate the development of innovative and economical individualized treatments. This study evaluated the efficacy of delivering computer-based cognitive behavioral therapy (e-CBT) presented through Microsoft PowerPoint and delivered via email in the treatment of generalized anxiety disorder (GAD) to Iranian patients, as a means of overcoming treatment barriers. METHODS Participants (N=80) of Iranian descent were recruited through announcements on psychology websites, Iranian organization websites, weblogs, and in flyers. Participants were randomly assigned to either an e-CBT or a control group. The e-CBT group received 12 weekly modules and homework assignments through email, presented using PowerPoint. The control group received no treatment (individuals in the control group were able to pursue another treatment, but would then be excluded from the study although they could continue with the program). All emails were sent by an attending or resident psychiatrist, who also provided feedback on weekly homework via email. The Beck Anxiety Inventory was used to measure levels of anxiety before study onset and changes in levels of anxiety upon completion of the program at 12 weeks, and at 6-month and 1-year follow-up in both groups. RESULTS Beck Anxiety Inventory scores were significantly reduced in the group who received PowerPoint e-CBT modules delivered via email, compared with the control group, following 12 weeks of treatment, and the reductions were maintained at both follow-up points. CONCLUSIONS Delivery of PowerPoint e-CBT modules via email was found to be a viable method for delivering CBT to individuals with GAD and a simple method for overcoming language, cultural, and travel barriers to accessing mental health resources. Disodium hydrogen orthophosphate This simplified approach to the individualization and delivery of treatment modules has the potential to improve access to CBT as a treatment option throughout the world.

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