American Psychiatric Foundation

IntroductionSexually transmitted infections are of great public health importance. The screening of these infections not being part of the routine healthcare package for PLWHIV means most of the infected individuals who are asymptomatic end up being undetected. This study aims to determine the seroprevalence of syphilis, chlamydia, and HBV among PLWHIV in Meme division. Additionally, it aimed to assess the factors associated with STI transmission.MethodsA hospital-based cross-sectional design was adopted that recruited a total of 364 PLWHIV from the urban and rural communities in Meme division from December 2024 to April 2025. About 4 mL of blood was collected and placed in a sodium citrated tube. The sample was used for ABO blood grouping, syphilis, hepatitis B, and chlamydia screening using serological assays. The data was analysed using SPSS version 25. Fisher’s exact test was used to determine the difference in proportions and logistic regression model was used to determine risk factors associated with STI transmission. p-values <0.05 were considered as statistically significant.ResultsThe overall seroprevalence of syphilis, HBV and chlamydia infection among PLWHIV from rural areas was 30/150 (20%) [95% CI 0.139–0.273], 13/150 (8.7%) [95% CI 0.047–0.143] and 6/150 (4.0%) [95% CI 0.014–0.085] while in urban area the seroprevalence was 41/214 (19.2%) [95% CI 0.141–0.250], 33/214 (15.4%) [95% CI 0.108–0.209] and 5/214 (2.3%) [95% CI 0.007–0.053] respectively. A couple of the individuals were infected with at least more than one STI. Multivariate analysis shows that females had a lower odd to STI infection (AOR = 0.468, 95% CI 0.252–0.867, p < 0.016), having multiple sexual partners had a lower odd to STI (AOR = 0.346, 95% CI 0.160–0.748, p < 0.007), bathing before and after sexual intercourse recorded a lower odd to STI (AOR = 0.458, 95% CI 0.272–0.772, p < 0.003) as well as those who reported having sex 1–3 times a week also had a lesser odd to STI (AOR = 0.526, 95% CI 0.296–0.935, p < 0.029).ConclusionSexually transmitted infection was high among PLWHIV in Meme division with individuals from rural communities having the highest prevalence of infections. The most dominant of these infections was syphilis followed by HBV and lastly Chlamydia.

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Replication research is essential for the advancement of any scientific field. In this paper, we argue that prevention science will be better positioned to help improve public health if (a) more replications are conducted; (b) those replications are systematic, thoughtful, and conducted with full knowledge of the trials that have preceded them; and (c) state-of-the art techniques are used to summarize the body of evidence on the effects of the interventions. Under real-world demands it is often not feasible to wait for multiple replications to accumulate before making decisions about intervention adoption. To help individuals and agencies make better decisions about intervention utility, we outline strategies that can be used to help understand the likely direction, size, and range of intervention effects as suggested by the current knowledge base. We also suggest structural changes that could increase the amount and quality of replication research, such as the provision of incentives and a more vigorous pursuit of prospective research registers. Finally, we discuss methods for integrating replications into the roll-out of a program and suggest that strong partnerships with local decision makers are a key component of success in replication research. Our hope is that this paper can highlight the importance of replication and stimulate more discussion of the important elements of the replication process. We are confident that, armed with more and better replications and state-of-the-art review methods, prevention science will be in a better position to positively impact public health.

Beginning January 1, 2006, the Medicare Part D prescription drug benefit shifted drug coverage from Medicaid to the new Medicare Part D program for patients who were eligible for both Medicare and Medicaid benefits ("dual-eligibles"). These patients were randomly assigned to a private Part D plan and came under specific formulary and utilization management procedures of the plan in which they were enrolled. To examine the relationship between physician-reported medication switches, discontinuations, and other access problems and suicidal ideation or behavior among "dual-eligible" psychiatric patients. Data were collected in 3 cross-sectional cycles in 2006 (January-April, May-August, and September-December) as part of the National Study of Medicaid and Medicare Psychopharmacologic Treatment Access and Continuity using through-the-mail, practice-based survey research methods. Data from the third cycle, representing all events since January 1, 2006, were used for these analyses. A national sample of psychiatrists randomly selected from the AMA Masterfile provided clinically detailed data on 1 systematically selected, dual-eligible psychiatric patient (N = 908). Propensity score analyses adjusted for patient sociodemographics, treatment setting, diagnoses, and psychiatric symptom severity. Patients who experienced medication switches, discontinuations, and other access problems had 3 times the rate of suicidal ideation or behavior compared with patients with no access problems (22.0% vs 7.4%, P < .0001). Mean odds ratios and excess probabilities were highest for patients who were clinically stable but were required to switch medications (31.8%; mean OR = 4.87, mean P = 8.92(-5), excess probability = 0.21). Patients who experienced discontinuations (26.4%; mean OR = 2.13, mean P = 2.12(-2), excess probability = 0.12), other access problems (18.7%; mean OR = 3.01, mean P = 1.03(-5), excess probability = 0.15), and multiple access problems (22.3%; mean OR = 2.88, mean P = 4.10(-5), excess probability = 0.14) also had significantly increased suicidal ideation or behavior. Increased occurrences of suicidal ideation or behavior appear to be associated with disruptions in patient medication access and continuity. Clinicians need to be aware of the possibility of increased suicidality when, for administrative reasons, a clinically stable patient's medication regimen is altered. Dual-eligible psychiatric patients represent a highly vulnerable group with a substantial burden of illness; these findings underscore the need to provide special protections for this population.

Back to table of contents Previous article Next article Annual Meeting HighlightsFull AccessGet Early Look at DSM-V Development ProcessEmily A. Kuhl, PH.DEmily A. KuhlSearch for more papers by this author, PH.DPublished Online:20 Feb 2009https://doi.org/10.1176/pn.44.4.0013A question-and-answer forum and several symposia will highlight recent developments in the revision process for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). All sessions will take place Monday and Tuesday, May 18 and 19.The forum, “DSM-V: Progress in Research and Development,” will provide an opportunity to hear experts from the DSM-V Task Force respond to questions and concerns about the revision process.“Outreach and dissemination are vital components of DSM-V development,” said Darrel Regier, M.D., M.P.H., vice chair of the DSM-V Task Force and executive director of the American Psychiatric Institute for Research and Education (APIRE).“The overarching goal for the members of the DSM-V Task Force and work groups is to produce a manual that not only adheres to the scientific base but is meaningful and useful to clinicians and their patients. Feedback from those in the psychiatric community and from researchers and health care providers at large helps inform their decision-making process. It is both our responsibility and our pleasure to make DSM-V an inclusive endeavor.”Two of the three symposia will address issues that apply to all diagnoses.“ Public Health Aspects of Diagnosis and Classification of Mental Disorders: A DSM-V Research Agenda” will feature five presentations on public health, consumer, and primary care implications of the classification of psychiatric disorders. This symposium will review points raised at the DSM-V public health planning conference—one in a series of 13 conferences funded by the National Institutes of Health to provide the research base for DSM-V revisions.The second symposium, “Evolution of the DSM-V Conceptual Framework: Development, Dimensions, Disability, Spectra, and Gender/Culture,” will underscore cross-cutting issues facing all members of the diagnostic work groups, such as how to consider gender-specific and age-specific features of disorders.The remaining symposium, “In or Out? A Discussion About Gender Identity Diagnoses and the DSM,” will focus on diagnostic issues specific to gender identity disorder, particularly the issues of having gender identity disorder listed in DSM-V and the implications of removing it. Several leaders in the transgender community will speak at this symposium.William Narrow, M.D., M.P.H., DSM-V research director and associate director of APA's Division of Research, said that the focus on both specific disorders and broader issues in the development of DSM-V is a noteworthy feature of this year's sessions.“There are certainly specific disorders that have attracted a fair amount of attention, and it is important that we address the issues around these disorders, as we are doing this year with gender identity disorder,” he said. “But it is also important for our members to understand the overarching issues being tackled in the revision, which could affect all disorders. The incorporation of dimensional assessments, improvements in the assessment of disability, and having a more developmentally sensitive approach to diagnosis should make DSM-V a much more effective tool for improved patient care.”APIRE invites questions and comments for the forum, which can submitted either by e-mail at [email protected] (with “DSM-V Forum Question” in the subject line) or online at<www.dsmv.org>.DSM Track ScheduleSpeakers in the sessions below will give updates on the development of DSM-V. In the first session listed below, annual meeting attendees will have an opportunity to ask questions of the experts working on the diagnostic manual. All sessions will be held in the Moscone Center.MONDAY, MAY 18Noon-1:30 p.m.DSM-V: Progress in Research and DevelopmentRoom 102, Gateway Level2 p.m.-5 p.m.Evolution of the DSM-V Conceptual Framework: Development, Dimensions, Disability, Spectra, and Gender/CultureRoom 132-133, Exhibit Level NorthIn or Out? A Discussion About Gender Identity Diagnoses and the DSMRoom 121, Exhibit Level NorthTUESDAY, MAY 192 p.m.-5 p.m.Public Health Aspects of Diagnosis and Classification of Mental Disorders: A DSM-V Research Agenda Room 301, Esplanade Level ▪Emily A. Kuhl, Ph.D., is a science writer in APA's Division of Research and the American Psychiatric Institute for Research and Education. ISSUES NewArchived

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessExpert Appointments Key Step on Road to DSM-VEmily Kuhl, PH.D.Emily KuhlSearch for more papers by this author, PH.D.Published Online:19 Sep 2008https://doi.org/10.1176/pn.43.18.0017Development of DSM-V is officially under way as appointments to the DSM-V work groups were finalized and made public in May (Psychiatric News, June 6). Formation of the DSM-V Task Force was completed and announced in July 2007. Both the task force and work groups are meeting in person and by telephone conferencing to discuss various aspects of the revision process.The task force is chaired by David Kupfer, M.D., of the University of Pittsburgh and Western Psychiatric Institute and Clinic, with Darrel Regier, M.D., M.P.H., director of APA's Division of Research and executive director of the American Psychiatric Institute for Research and Education (APIRE), serving as vice chair. Task force members include chairs of each of the 13 work groups and representatives from APA and the National Institutes of Health, including Wilson Compton, M.D., M.P.E.; Javier Escobar, M.D.; Steven Hyman, M.D.; Helena Kraemer, Ph.D.; Daniel Mamah, M.D.; James McNulty, A.B., Sc.B.; Howard Moss, M.D.; William Narrow, M.D., M.P.H.; Roger Peele, M.D.; Maritza Rubio-Stipec, Sc.D.; Philip Wang, M.D.; William Womack, M.D.; and Kimberly Yonkers, M.D.The work groups were developed to assure a comprehensive review of the diagnostic categories in DSM-IV. These groups include 132 national and international scientific researchers and clinicians with expertise in psychiatry, psycholog y, neuroscience, biology, genetics, statistics, epidemiology, public health, nursing, pediatrics, and social work.These are the names of the 13 work groups and their respective chairs:ADHD and Disruptive Behavior Disorders; Xavier Castellanos, M.D.Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders; Katharine Phillips, M.D.Disorders in Childhood and Adolescence; Daniel Pine, M.D.Eating Disorders; Timothy Walsh, M.D.Mood Disorders; Jan Fawcett, M.D.Neurocognitive Disorders; Dilip Jeste, M.D.Neurodevelopmental Disorders; Susan Swedo, M.D. (not pictured)Personality and Personality Disorders; Andrew Skodol, M.D.Psychotic Disorders; William Carpenter Jr., M.D.Sexual and Gender Identity Disorders; Kenneth Zucker, Ph.D.Sleep-Wake Disorders; Charles Reynolds III, M.D.Somatic Distress Disorders; Joel Dimsdale, M.D.Substance-Related Disorders; Charles O'Brien, M.D., Ph.D., and Thomas Crowley, M.D. (not pictured)A listing of all work group members is posted on APA's Web site at<www.dsmv.org>.In addition to work group formation, four DSM-V study groups have been convened with designated chairs to examine cross-cutting issues, including topics on lifespan and developmental aspects (Susan Schultz, M.D.), diagnostic spectra (Steven Hyman, M.D.), gender and cross-cultural expression (Kimberly Yonkers, M.D.), and psychiatric/general medical interface (Lawson Wulsin, M.D.). A fifth group focused on assessing impairment is now being formed (Jane Paulsen, M.D.).The work groups and study groups are developing specific research questions and hypotheses based on reviews of existing literature, findings from the 13 DSM research planning conferences, and work from published research-agenda “white papers.” Plans for secondary data analyses to address these questions are being implemented.Kupfer said members are cognizant of the medical, social, and political implications of their decision making.“We are quite impressed with the activities of both the work and study groups in terms of the procedures and strategies that they are developing in making recommendations that are both empirically valid and clinician friendly,” he said. “We are confident that these steps will ensure sound decision making for both scientists and practitioners who will use DSM-V.”One result of member activities already noticeable is reflected in the titles of the work groups. Given the scope of work to be covered, five of the groups enacted name changes to better reflect the content and breadth of their discussions. Subsequently, Externalizing Disorders was renamed ADHD and Disruptive Behavior Disorders; Somatoform Disorders was renamed Somatic Distress Disorders; Sleep Disorders was renamed Sleep-Wake Disorders; Delirium, Dementia, Amnestic and Other Cognitive Disorders was renamed Neurocognitive Disorders; and Anxiety Disorders was renamed Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders.The task force has met five times, with the most recent meeting taking place April 21 and 22. Most work groups have met in person twice and hold conference calls once or twice a month. Each study group has had six to 10 conference calls since April 2007.There are 35 in-person work group meetings scheduled to take place between now and November 2009. The next in-person meeting of the DSM-V Task Force will be October 26 and 27.Publication of DSM-V is slated for May 2012. ▪Emily A. Kuhl, Ph.D., is a science writer in APA's Division of Research and the American Psychiatric Institute for Research and Education. ISSUES NewArchived

Back to table of contents Previous article Next article APA InstituteFull Access'Conversations' Event Comes to InstituteCarla DanielsCarla DanielsPublished Online:5 Sep 2008https://doi.org/10.1176/pn.43.17.0024The American Psychiatric Foundation's first "Conversations" event at the Institute on Psychiatric Services last year in New Orleans was such a success that it is hosting a similar event at this year's institute in Chicago. The institute will be held from October 5 to 8.Terrie Williams is the co-founder of the Stay Strong Foundation, whose mission is to promote the well-being of youth and support their educational and professional development through programs and events.Credit: Damaso ReyesUnlike the special event at the 2007 institute—which featured New Orleans musicians who performed and shared their experiences in the aftermath of Hurricane Katrina—this year's event will follow the format of the popular "Conversations" event held each year at APA's annual meeting. That format features an interview by a psychiatrist with a well-known person who has gone public with his or her experiences with mental illness.The person who will be interviewed this year at the institute is Terrie Williams, president of the Terrie Williams Agency for public relations and communications. Through the years, her agency has handled such clients as Miles Davis, Eddie Murphy, Time Warner, and HBO, but she is also well known for her work as an author, lecturer, executive coach, social worker, and community activist, especially for youth and people with depression."Conversations" will be held on Saturday, October 4, from 7:30 p.m. to 9 p.m. in the Red Lacquer Room on the 4th floor of the Palmer House Hilton. Williams will be interviewed by the immediate past president of the American Psychiatric Foundation, Altha Stewart, M.D.Williams, who was diagnosed with depression in 2004, is the author of the recently published book Black Pain: It Just Looks Like We're Not Hurting.Black Pain identifies the emotional pain that deeply affects the black experience as the root of lashing out through desperate acts of crime, violence, drug and alcohol abuse, eating disorders, workaholism, and addiction to shopping, gambling, and sex. In Black Pain, Williams not only shares her personal experiences with depression, but also provides insights from mental health professionals to offer solutions.In addition to the interview, the event will include a poster session by the foundation's Helping Hands Grant recipients. The Helping Hands Grant program is intended to raise awareness of mental illness and the importance of early recognition and builds interest among medical students in entering psychiatry and working in underserved communities.The "Conversations" event is supported by AstraZeneca.▪Carla Daniels is the marketing and communications manager for the American Psychiatric Foundation. ISSUES NewArchived

Objective: This study compared patients with schizophrenia whose antipsychotic medications were switched to manage treatment-resistant positive psychotic symptoms with those for whom another antipsychotic was added. Psychiatrists' characteristics and perceptions of effectiveness of the medication change on clinical outcomes were also reported. Methods: Psychiatrists participating in a nationally representative mailed survey (N = 209) reported on the clinical features, management, and response to the change in antipsychotic medication (added versus switched) of one adult patient with treatment-refractory schizophrenia under their care for at least one year. Results: Thirty-three percent of patients were treated with an added antipsychotic medication. Compared with patients whose antipsychotic medications were switched, those with an added antipsychotic medication were more likely to be female, to have received care from the same psychiatrist for more than two years, and to have been recently prescribed an antidepressant. Compared with psychiatrists who switched antipsychotic prescriptions, those who added an antipsychotic reported that the change was less likely to reduce positive symptoms, improve functioning, and prevent hospitalization. Psychiatrists who added rather than switched antipsychotics reported more frequent attendance at educational programs sponsored by a pharmaceutical company. Conclusions: Consistent with other lines of research and practice guideline recommendations, psychiatrists perceive antipsychotic polypharmacy to be a generally ineffective strategy for treatment-resistant positive psychotic symptoms. In light of these findings, efforts to identify and implement more effective evidence-based pharmacologic approaches should be undertaken. (Reprinted with permission by Psychiatric Services 2007; 58:983–990)