Randy Burke - Academia.edu (original) (raw)

Papers by Randy Burke

Research paper thumbnail of Unrecognized physical illness prompting psychiatric admission

Annals of Clinical Psychiatry Official Journal of the American Academy of Clinical Psychiatrists, Aug 1, 2010

We assessed factors that might contribute to clinicians erroneously attributing medically based c... more We assessed factors that might contribute to clinicians erroneously attributing medically based changes in a patient's mental status to psychiatric illness. Records of 1340 patients admitted to a VA hospital psychiatric unit and 613 to a public hospital psychiatric unit from 2001 to 2007 were reviewed. Cases admitted because of an unrecognized medical disorder underwent further analysis of the preadmission assessment and documented history of mental illness. Of 1340 patients whose records were reviewed, 55 (2.8%) had a medical disorder that caused their symptoms. Compared with patients admitted to medical units, patients inappropriately admitted to psychiatric units had lower rates of completion of medical histories, physical examinations, cognitive assessments, indicated laboratory and/or radiologic studies, and treatment of abnormal vital signs (P < .001 in each case). Among patients admitted to psychiatric units, 85.5% had a history of mental illness vs 30.9% of comparable admissions to medical units (Chi2(1) = 35.85; P < .001). Key assessment procedures are less likely to be performed in patients with mental status changes who are admitted to psychiatric units than in comparable patients admitted to medical units. Symptoms of patients with a history of mental illness are more likely to be attributed to psychiatric illness than are those of patients without such a history.

Research paper thumbnail of What Does �Medical Clearance� for Psychiatry Really Mean?

Journal of Psychosocial Nursing and Mental Health Services, Aug 1, 2010

1. J Psychosoc Nurs Ment Health Serv. 2010 Aug;48(8):2-4. doi: 10.3928/02793695-20100701-06. What... more 1. J Psychosoc Nurs Ment Health Serv. 2010 Aug;48(8):2-4. doi: 10.3928/02793695-20100701-06. What does "medical clearance" for psychiatry really mean? Reeves RR, Perry CL, Burke RS. PMID: 20704125 [PubMed - in process]. Publication Types: Editorial.

Research paper thumbnail of Inappropriate psychiatric admission of elderly patients with unrecognized delirium

Southern Medical Journal, Feb 1, 2010

To explore factors that might contribute to misattribution of mental status changes to psychiatri... more To explore factors that might contribute to misattribution of mental status changes to psychiatric illness when an elderly patient actually has a delirium (mental status changes due to a medical condition). Records of 900 elderly patients referred to a Veterans Affairs psychiatric inpatient unit and 413 to an inpatient psychiatric team at a public hospital from 2001 to 2007 were reviewed. Cases referred because of symptoms secondary to an unrecognized delirium underwent further analysis of preadmission assessments. Comparisons were made to elderly patients with delirium appropriately admitted to medical units. Thirty (2.3%) of the patients referred to psychiatric units were found to have a physical disorder requiring medical intervention within twelve hours. Compared to 30 delirious patients admitted to medical units, those inappropriately referred to psychiatric units had significantly lower rates of adequate medical histories, physical examinations, cognitive assessments, and laboratory/radiological studies. Among patients with delirium referred to psychiatric units, 66.7% had a history of mental illness, versus 26.7% of comparable admissions to medical units (chi (7) = 60.00, P < 0.001). Our findings suggest that elderly patients with delirium admitted to psychiatric units are less likely to undergo complete diagnostic assessments than delirious elderly patients admitted to medical units. Symptoms of delirium appear more likely to be incorrectly attributed to psychiatric illness in patients with a history of mental illness than in patients without such a history. Possible explanations for these findings and suggestions for addressing these issues are offered.

Research paper thumbnail of Characteristics of Psychotic Patients With Foreign Accent Syndrome

The authors describe three patients with foreign accent syndrome during psychotic episodes which ... more The authors describe three patients with foreign accent syndrome during psychotic episodes which resolve with improvement of psychotic symptoms. Psychotic symptoms were worse during the times patients had foreign accents, suggesting a relationship between the presence of the accent and the severity of the psychosis.

Research paper thumbnail of The relation between ethnicity and cognistat performance in males seeking substance use disorder treatment

Neuropsychology Development and Cognition Section a Journal of Clinical and Experimental Neuropsychology, Oct 1, 2005

This study examined the relation between ethnicity and results obtained during standard administr... more This study examined the relation between ethnicity and results obtained during standard administration of the Cognistat, a screening measure of cognitive functioning, in a sample of male veterans seeking substance use disorder treatment (n = 312). Results indicated that screening items for the Naming, Calculation, and Similarities subtests were missed significantly more frequently by African American compared to Caucasian veterans, although the frequency of identification as impaired on the full metric portion of this scales did not differ based on ethnicity. The mean scores on the metric items for these three scales were very similar between groups. Additionally, African American veterans diverted to the Constructional Ability metric items had significantly lower scores on items from that subtest. Logistic regression analyses of impairment identification on the various subtests indicated that ethnicity was a significant (p < .005) predictor beyond the covariates of age and years of education for the Calculation subtest, but only accounted for 4.8% of the variance. Based on the results of the current study, it is recommended that 1) the entire Cognistat be administered regardless of screening item performance to minimize the risk of potential ethnic or cultural based performance bias and 2) a prospective study of potential demographic bias based on comparing Cognistat screening results to a battery of specific neuropsychological assessments of the same constructs be performed to maximize the potential specificity and sensitivity of this assessment for all demographic groups.

Research paper thumbnail of Is it time for carisoprodol to become a controlled substance at the federal level?

Southern Medical Journal, Mar 1, 2008

Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Southern Medical ... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Southern Medical Journal. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed ...

Research paper thumbnail of EEG does not predict response of manic patients to atypical antipsychotics

Clinical EEG and neuroscience, 2011

Research paper thumbnail of Abuse of Medications That Theoretically Are Without Abuse Potential

Southern medical journal, 2015

The potential for abuse of medications that are controlled substances is well known. Abuse of cer... more The potential for abuse of medications that are controlled substances is well known. Abuse of certain noncontrolled prescription drugs and over-the-counter medications also may occur. To some degree, any medication that exerts psychoactive effects may be abused if taken in high enough doses or by means that result in high serum or cerebrospinal fluid levels. Many clinicians may be unaware of the potential for abuse of these medications. This review examines evidence of the possibility of abuse of several common medications that theoretically do not have abuse potential, including cough and cold preparations, antihistamines, anticholinergics, antipsychotics, antidepressants, anticonvulsants, skeletal muscle relaxants, and antiemetics. Means by which such medications may be abused and biochemical and physiological mechanisms fostering their abuse also are discussed.

Research paper thumbnail of Abuse of combinations of gabapentin and quetiapine

The primary care companion for CNS disorders, 2014

Research paper thumbnail of Computer-analyzed quantitative EEG findings in Capgras syndrome

Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists, 2013

Research paper thumbnail of Carisoprodol: update on abuse potential and legal status

Southern medical journal, 2012

Carisoprodol is a centrally acting skeletal muscle relaxant of which meprobamate, a controlled su... more Carisoprodol is a centrally acting skeletal muscle relaxant of which meprobamate, a controlled substance, is the primary active metabolite. The abuse of carisoprodol has increased dramatically in the last several years. A withdrawal syndrome occurs in some patients who abruptly cease carisoprodol intake. The symptoms of this syndrome are similar to those seen with meprobamate withdrawal, suggesting that they may result from withdrawal from meprobamate accumulated with intake of excessive carisoprodol; however, carisoprodol is capable of modulating GABAA function, which may contribute to its abuse potential.There has been considerable debate about whether carisoprodol should be considered a controlled substance. Carisoprodol was removed from the market in Norway on May 1, 2008, but may still be used by specially approved patients. Carisoprodol was classified as a controlled substance in several US states, and effective January 11, 2012, became a schedule IV controlled substance at th...

Research paper thumbnail of Unrecognized physical illness prompting psychiatric admission

Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists, 2010

We assessed factors that might contribute to clinicians erroneously attributing medically based c... more We assessed factors that might contribute to clinicians erroneously attributing medically based changes in a patient's mental status to psychiatric illness. Records of 1340 patients admitted to a VA hospital psychiatric unit and 613 to a public hospital psychiatric unit from 2001 to 2007 were reviewed. Cases admitted because of an unrecognized medical disorder underwent further analysis of the preadmission assessment and documented history of mental illness. Of 1340 patients whose records were reviewed, 55 (2.8%) had a medical disorder that caused their symptoms. Compared with patients admitted to medical units, patients inappropriately admitted to psychiatric units had lower rates of completion of medical histories, physical examinations, cognitive assessments, indicated laboratory and/or radiologic studies, and treatment of abnormal vital signs (P < .001 in each case). Among patients admitted to psychiatric units, 85.5% had a history of mental illness vs 30.9% of comparable...

Research paper thumbnail of Does alexithymia differ in combat veterans of different eras with posttraumatic stress disorder?

Annals of Clinical Psychiatry

Research paper thumbnail of Proactive Tobacco Treatment and Population-Level Cessation

JAMA Internal Medicine, 2014

Current tobacco use treatment approaches require smokers to request treatment or depend on the pr... more Current tobacco use treatment approaches require smokers to request treatment or depend on the provider to initiate smoking cessation care and are therefore reactive. Most smokers do not receive evidence-based treatments for tobacco use that include both behavioral counseling and pharmacotherapy. To assess the effect of a proactive, population-based tobacco cessation care model on use of evidence-based tobacco cessation treatments and on population-level smoking cessation rates (ie, abstinence among all smokers including those who use and do not use treatment) compared with usual care among a diverse population of current smokers. The Veterans Victory Over Tobacco Study, a pragmatic randomized clinical trial involving a population-based registry of current smokers aged 18 to 80 years. A total of 6400 current smokers, identified using the Department of Veterans Affairs (VA) electronic medical record, were randomized prior to contact to evaluate both the reach and effectiveness of the proactive care intervention. Current smokers were randomized to usual care or proactive care. Proactive care combined (1) proactive outreach and (2) offer of choice of smoking cessation services (telephone or in-person). Proactive outreach included mailed invitations followed by telephone outreach to motivate smokers to seek treatment with choice of services. The primary outcome was 6-month prolonged smoking abstinence at 1 year and was assessed by a follow-up survey among all current smokers regardless of interest in quitting or treatment utilization. A total of 5123 participants were included in the primary analysis. The follow-up survey response rate was 66%. The population-level, 6-month prolonged smoking abstinence rate at 1 year was 13.5% for proactive care compared with 10.9% for usual care (P = .02). Logistic regression mixed model analysis showed a significant effect of the proactive care intervention on 6-month prolonged abstinence (odds ratio [OR], 1.27 [95% CI, 1.03-1.57]). In analyses accounting for nonresponse using likelihood-based not-missing-at-random models, the effect of proactive care on 6-month prolonged abstinence persisted (OR, 1.33 [95% CI, 1.17-1.51]). Proactive, population-based tobacco cessation care using proactive outreach to connect smokers to evidence-based telephone or in-person smoking cessation services is effective for increasing long-term population-level cessation rates. clinicaltrials.gov Identifier: NCT00608426.

Research paper thumbnail of Guidance for New Motivational Interviewing Trainers When Training Addiction Professionals: Findings from a Survey of Experienced Trainers

Motivational interviewing : training, research, implementation, practice, 2012

Evidence-based practices, such as motivational interviewing (MI), are not widely used in communit... more Evidence-based practices, such as motivational interviewing (MI), are not widely used in community alcohol and drug treatment settings. Successfully broadening the dissemination of MI will require numerous trainers and supervisors who are equipped to manage common barriers to technology transfer. The aims of the our survey of 36 MI trainers were: 1) to gather opinions about the optimal format, duration, and content for beginning level addiction-focused MI training conducted by novice trainers and 2) to identify the challenges most likely to be encountered during provision of beginning-level MI training and supervision, as well as the most highly recommended strategies for managing those challenges in addiction treatment sites. It is hoped that the findings of this survey will help beginning trainers equip themselves for successful training experiences.

Research paper thumbnail of Houston Flight Standards District Office Employee Directory

Research paper thumbnail of Is It Time for Carisoprodol to Become a Controlled Substance at the Federal Level?

Southern Medical Journal, 2008

Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Southern Medical ... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Southern Medical Journal. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed ...

Research paper thumbnail of Rapid Decline in Cognition After Tick Bites

Southern Medical Journal, 2005

Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Southern Medical ... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Southern Medical Journal. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed ...

Research paper thumbnail of Inappropriate Psychiatric Admission of Elderly Patients with Unrecognized Delirium

Southern Medical Journal, 2010

To explore factors that might contribute to misattribution of mental status changes to psychiatri... more To explore factors that might contribute to misattribution of mental status changes to psychiatric illness when an elderly patient actually has a delirium (mental status changes due to a medical condition). Records of 900 elderly patients referred to a Veterans Affairs psychiatric inpatient unit and 413 to an inpatient psychiatric team at a public hospital from 2001 to 2007 were reviewed. Cases referred because of symptoms secondary to an unrecognized delirium underwent further analysis of preadmission assessments. Comparisons were made to elderly patients with delirium appropriately admitted to medical units. Thirty (2.3%) of the patients referred to psychiatric units were found to have a physical disorder requiring medical intervention within twelve hours. Compared to 30 delirious patients admitted to medical units, those inappropriately referred to psychiatric units had significantly lower rates of adequate medical histories, physical examinations, cognitive assessments, and laboratory/radiological studies. Among patients with delirium referred to psychiatric units, 66.7% had a history of mental illness, versus 26.7% of comparable admissions to medical units (chi (7) = 60.00, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Our findings suggest that elderly patients with delirium admitted to psychiatric units are less likely to undergo complete diagnostic assessments than delirious elderly patients admitted to medical units. Symptoms of delirium appear more likely to be incorrectly attributed to psychiatric illness in patients with a history of mental illness than in patients without such a history. Possible explanations for these findings and suggestions for addressing these issues are offered.

Research paper thumbnail of Effect of anxious affect on drinking self-efficacy in college students

Psychology of Addictive Behaviors, 1997

... Correspondence concerning this article should be addressed to Randy S. Burke, Department of P... more ... Correspondence concerning this article should be addressed to Randy S. Burke, Department of Psychology, Virginia Polytechnic Institute and State University ... Partici-pants who scored in the upper third were considered to be high in dispositional social anxiety (M = 51.76, SD ...

Research paper thumbnail of Unrecognized physical illness prompting psychiatric admission

Annals of Clinical Psychiatry Official Journal of the American Academy of Clinical Psychiatrists, Aug 1, 2010

We assessed factors that might contribute to clinicians erroneously attributing medically based c... more We assessed factors that might contribute to clinicians erroneously attributing medically based changes in a patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s mental status to psychiatric illness. Records of 1340 patients admitted to a VA hospital psychiatric unit and 613 to a public hospital psychiatric unit from 2001 to 2007 were reviewed. Cases admitted because of an unrecognized medical disorder underwent further analysis of the preadmission assessment and documented history of mental illness. Of 1340 patients whose records were reviewed, 55 (2.8%) had a medical disorder that caused their symptoms. Compared with patients admitted to medical units, patients inappropriately admitted to psychiatric units had lower rates of completion of medical histories, physical examinations, cognitive assessments, indicated laboratory and/or radiologic studies, and treatment of abnormal vital signs (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001 in each case). Among patients admitted to psychiatric units, 85.5% had a history of mental illness vs 30.9% of comparable admissions to medical units (Chi2(1) = 35.85; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Key assessment procedures are less likely to be performed in patients with mental status changes who are admitted to psychiatric units than in comparable patients admitted to medical units. Symptoms of patients with a history of mental illness are more likely to be attributed to psychiatric illness than are those of patients without such a history.

Research paper thumbnail of What Does �Medical Clearance� for Psychiatry Really Mean?

Journal of Psychosocial Nursing and Mental Health Services, Aug 1, 2010

1. J Psychosoc Nurs Ment Health Serv. 2010 Aug;48(8):2-4. doi: 10.3928/02793695-20100701-06. What... more 1. J Psychosoc Nurs Ment Health Serv. 2010 Aug;48(8):2-4. doi: 10.3928/02793695-20100701-06. What does "medical clearance" for psychiatry really mean? Reeves RR, Perry CL, Burke RS. PMID: 20704125 [PubMed - in process]. Publication Types: Editorial.

Research paper thumbnail of Inappropriate psychiatric admission of elderly patients with unrecognized delirium

Southern Medical Journal, Feb 1, 2010

To explore factors that might contribute to misattribution of mental status changes to psychiatri... more To explore factors that might contribute to misattribution of mental status changes to psychiatric illness when an elderly patient actually has a delirium (mental status changes due to a medical condition). Records of 900 elderly patients referred to a Veterans Affairs psychiatric inpatient unit and 413 to an inpatient psychiatric team at a public hospital from 2001 to 2007 were reviewed. Cases referred because of symptoms secondary to an unrecognized delirium underwent further analysis of preadmission assessments. Comparisons were made to elderly patients with delirium appropriately admitted to medical units. Thirty (2.3%) of the patients referred to psychiatric units were found to have a physical disorder requiring medical intervention within twelve hours. Compared to 30 delirious patients admitted to medical units, those inappropriately referred to psychiatric units had significantly lower rates of adequate medical histories, physical examinations, cognitive assessments, and laboratory/radiological studies. Among patients with delirium referred to psychiatric units, 66.7% had a history of mental illness, versus 26.7% of comparable admissions to medical units (chi (7) = 60.00, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Our findings suggest that elderly patients with delirium admitted to psychiatric units are less likely to undergo complete diagnostic assessments than delirious elderly patients admitted to medical units. Symptoms of delirium appear more likely to be incorrectly attributed to psychiatric illness in patients with a history of mental illness than in patients without such a history. Possible explanations for these findings and suggestions for addressing these issues are offered.

Research paper thumbnail of Characteristics of Psychotic Patients With Foreign Accent Syndrome

The authors describe three patients with foreign accent syndrome during psychotic episodes which ... more The authors describe three patients with foreign accent syndrome during psychotic episodes which resolve with improvement of psychotic symptoms. Psychotic symptoms were worse during the times patients had foreign accents, suggesting a relationship between the presence of the accent and the severity of the psychosis.

Research paper thumbnail of The relation between ethnicity and cognistat performance in males seeking substance use disorder treatment

Neuropsychology Development and Cognition Section a Journal of Clinical and Experimental Neuropsychology, Oct 1, 2005

This study examined the relation between ethnicity and results obtained during standard administr... more This study examined the relation between ethnicity and results obtained during standard administration of the Cognistat, a screening measure of cognitive functioning, in a sample of male veterans seeking substance use disorder treatment (n = 312). Results indicated that screening items for the Naming, Calculation, and Similarities subtests were missed significantly more frequently by African American compared to Caucasian veterans, although the frequency of identification as impaired on the full metric portion of this scales did not differ based on ethnicity. The mean scores on the metric items for these three scales were very similar between groups. Additionally, African American veterans diverted to the Constructional Ability metric items had significantly lower scores on items from that subtest. Logistic regression analyses of impairment identification on the various subtests indicated that ethnicity was a significant (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .005) predictor beyond the covariates of age and years of education for the Calculation subtest, but only accounted for 4.8% of the variance. Based on the results of the current study, it is recommended that 1) the entire Cognistat be administered regardless of screening item performance to minimize the risk of potential ethnic or cultural based performance bias and 2) a prospective study of potential demographic bias based on comparing Cognistat screening results to a battery of specific neuropsychological assessments of the same constructs be performed to maximize the potential specificity and sensitivity of this assessment for all demographic groups.

Research paper thumbnail of Is it time for carisoprodol to become a controlled substance at the federal level?

Southern Medical Journal, Mar 1, 2008

Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Southern Medical ... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Southern Medical Journal. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed ...

Research paper thumbnail of EEG does not predict response of manic patients to atypical antipsychotics

Clinical EEG and neuroscience, 2011

Research paper thumbnail of Abuse of Medications That Theoretically Are Without Abuse Potential

Southern medical journal, 2015

The potential for abuse of medications that are controlled substances is well known. Abuse of cer... more The potential for abuse of medications that are controlled substances is well known. Abuse of certain noncontrolled prescription drugs and over-the-counter medications also may occur. To some degree, any medication that exerts psychoactive effects may be abused if taken in high enough doses or by means that result in high serum or cerebrospinal fluid levels. Many clinicians may be unaware of the potential for abuse of these medications. This review examines evidence of the possibility of abuse of several common medications that theoretically do not have abuse potential, including cough and cold preparations, antihistamines, anticholinergics, antipsychotics, antidepressants, anticonvulsants, skeletal muscle relaxants, and antiemetics. Means by which such medications may be abused and biochemical and physiological mechanisms fostering their abuse also are discussed.

Research paper thumbnail of Abuse of combinations of gabapentin and quetiapine

The primary care companion for CNS disorders, 2014

Research paper thumbnail of Computer-analyzed quantitative EEG findings in Capgras syndrome

Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists, 2013

Research paper thumbnail of Carisoprodol: update on abuse potential and legal status

Southern medical journal, 2012

Carisoprodol is a centrally acting skeletal muscle relaxant of which meprobamate, a controlled su... more Carisoprodol is a centrally acting skeletal muscle relaxant of which meprobamate, a controlled substance, is the primary active metabolite. The abuse of carisoprodol has increased dramatically in the last several years. A withdrawal syndrome occurs in some patients who abruptly cease carisoprodol intake. The symptoms of this syndrome are similar to those seen with meprobamate withdrawal, suggesting that they may result from withdrawal from meprobamate accumulated with intake of excessive carisoprodol; however, carisoprodol is capable of modulating GABAA function, which may contribute to its abuse potential.There has been considerable debate about whether carisoprodol should be considered a controlled substance. Carisoprodol was removed from the market in Norway on May 1, 2008, but may still be used by specially approved patients. Carisoprodol was classified as a controlled substance in several US states, and effective January 11, 2012, became a schedule IV controlled substance at th...

Research paper thumbnail of Unrecognized physical illness prompting psychiatric admission

Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists, 2010

We assessed factors that might contribute to clinicians erroneously attributing medically based c... more We assessed factors that might contribute to clinicians erroneously attributing medically based changes in a patient's mental status to psychiatric illness. Records of 1340 patients admitted to a VA hospital psychiatric unit and 613 to a public hospital psychiatric unit from 2001 to 2007 were reviewed. Cases admitted because of an unrecognized medical disorder underwent further analysis of the preadmission assessment and documented history of mental illness. Of 1340 patients whose records were reviewed, 55 (2.8%) had a medical disorder that caused their symptoms. Compared with patients admitted to medical units, patients inappropriately admitted to psychiatric units had lower rates of completion of medical histories, physical examinations, cognitive assessments, indicated laboratory and/or radiologic studies, and treatment of abnormal vital signs (P < .001 in each case). Among patients admitted to psychiatric units, 85.5% had a history of mental illness vs 30.9% of comparable...

Research paper thumbnail of Does alexithymia differ in combat veterans of different eras with posttraumatic stress disorder?

Annals of Clinical Psychiatry

Research paper thumbnail of Proactive Tobacco Treatment and Population-Level Cessation

JAMA Internal Medicine, 2014

Current tobacco use treatment approaches require smokers to request treatment or depend on the pr... more Current tobacco use treatment approaches require smokers to request treatment or depend on the provider to initiate smoking cessation care and are therefore reactive. Most smokers do not receive evidence-based treatments for tobacco use that include both behavioral counseling and pharmacotherapy. To assess the effect of a proactive, population-based tobacco cessation care model on use of evidence-based tobacco cessation treatments and on population-level smoking cessation rates (ie, abstinence among all smokers including those who use and do not use treatment) compared with usual care among a diverse population of current smokers. The Veterans Victory Over Tobacco Study, a pragmatic randomized clinical trial involving a population-based registry of current smokers aged 18 to 80 years. A total of 6400 current smokers, identified using the Department of Veterans Affairs (VA) electronic medical record, were randomized prior to contact to evaluate both the reach and effectiveness of the proactive care intervention. Current smokers were randomized to usual care or proactive care. Proactive care combined (1) proactive outreach and (2) offer of choice of smoking cessation services (telephone or in-person). Proactive outreach included mailed invitations followed by telephone outreach to motivate smokers to seek treatment with choice of services. The primary outcome was 6-month prolonged smoking abstinence at 1 year and was assessed by a follow-up survey among all current smokers regardless of interest in quitting or treatment utilization. A total of 5123 participants were included in the primary analysis. The follow-up survey response rate was 66%. The population-level, 6-month prolonged smoking abstinence rate at 1 year was 13.5% for proactive care compared with 10.9% for usual care (P = .02). Logistic regression mixed model analysis showed a significant effect of the proactive care intervention on 6-month prolonged abstinence (odds ratio [OR], 1.27 [95% CI, 1.03-1.57]). In analyses accounting for nonresponse using likelihood-based not-missing-at-random models, the effect of proactive care on 6-month prolonged abstinence persisted (OR, 1.33 [95% CI, 1.17-1.51]). Proactive, population-based tobacco cessation care using proactive outreach to connect smokers to evidence-based telephone or in-person smoking cessation services is effective for increasing long-term population-level cessation rates. clinicaltrials.gov Identifier: NCT00608426.

Research paper thumbnail of Guidance for New Motivational Interviewing Trainers When Training Addiction Professionals: Findings from a Survey of Experienced Trainers

Motivational interviewing : training, research, implementation, practice, 2012

Evidence-based practices, such as motivational interviewing (MI), are not widely used in communit... more Evidence-based practices, such as motivational interviewing (MI), are not widely used in community alcohol and drug treatment settings. Successfully broadening the dissemination of MI will require numerous trainers and supervisors who are equipped to manage common barriers to technology transfer. The aims of the our survey of 36 MI trainers were: 1) to gather opinions about the optimal format, duration, and content for beginning level addiction-focused MI training conducted by novice trainers and 2) to identify the challenges most likely to be encountered during provision of beginning-level MI training and supervision, as well as the most highly recommended strategies for managing those challenges in addiction treatment sites. It is hoped that the findings of this survey will help beginning trainers equip themselves for successful training experiences.

Research paper thumbnail of Houston Flight Standards District Office Employee Directory

Research paper thumbnail of Is It Time for Carisoprodol to Become a Controlled Substance at the Federal Level?

Southern Medical Journal, 2008

Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Southern Medical ... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Southern Medical Journal. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed ...

Research paper thumbnail of Rapid Decline in Cognition After Tick Bites

Southern Medical Journal, 2005

Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Southern Medical ... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Southern Medical Journal. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed ...

Research paper thumbnail of Inappropriate Psychiatric Admission of Elderly Patients with Unrecognized Delirium

Southern Medical Journal, 2010

To explore factors that might contribute to misattribution of mental status changes to psychiatri... more To explore factors that might contribute to misattribution of mental status changes to psychiatric illness when an elderly patient actually has a delirium (mental status changes due to a medical condition). Records of 900 elderly patients referred to a Veterans Affairs psychiatric inpatient unit and 413 to an inpatient psychiatric team at a public hospital from 2001 to 2007 were reviewed. Cases referred because of symptoms secondary to an unrecognized delirium underwent further analysis of preadmission assessments. Comparisons were made to elderly patients with delirium appropriately admitted to medical units. Thirty (2.3%) of the patients referred to psychiatric units were found to have a physical disorder requiring medical intervention within twelve hours. Compared to 30 delirious patients admitted to medical units, those inappropriately referred to psychiatric units had significantly lower rates of adequate medical histories, physical examinations, cognitive assessments, and laboratory/radiological studies. Among patients with delirium referred to psychiatric units, 66.7% had a history of mental illness, versus 26.7% of comparable admissions to medical units (chi (7) = 60.00, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Our findings suggest that elderly patients with delirium admitted to psychiatric units are less likely to undergo complete diagnostic assessments than delirious elderly patients admitted to medical units. Symptoms of delirium appear more likely to be incorrectly attributed to psychiatric illness in patients with a history of mental illness than in patients without such a history. Possible explanations for these findings and suggestions for addressing these issues are offered.

Research paper thumbnail of Effect of anxious affect on drinking self-efficacy in college students

Psychology of Addictive Behaviors, 1997

... Correspondence concerning this article should be addressed to Randy S. Burke, Department of P... more ... Correspondence concerning this article should be addressed to Randy S. Burke, Department of Psychology, Virginia Polytechnic Institute and State University ... Partici-pants who scored in the upper third were considered to be high in dispositional social anxiety (M = 51.76, SD ...