Repeated use of IV ketamine infusion for depression and suicidality is not practical for some of patients. Thus, the objective of this report is to describe the current and forthcoming trials investigating Intranasal (IN) ketamine. We conducted a search of PubMed and clinical trials. Gov. There is one published, randomized, double-blind trial and five clinical trials in clinicaltrials.gov: two completed, two recruiting, and one withdrawn. IN ketamine is potentially a promising and practical alternative to IV infusion. Data is still limited, however the results of these ongoing studies could provide helpful clinical guidance regarding efficacy and adverse effects.

The paper deals with a review of “Mental Pain in Israeli Adult Childhood Cancer Survivors and Its Effects on their Quality of Life” by H. Raz, N. Tabak, Y. Alkalay, & S. Kreitler (1). The review focuses on theoretical and therapeutic implications of the findings. The major theoretical elaboration of the findings focuses on the construct of mental pain. This seems advisable both because there are several apparently similar concepts which presumably render mental pain superfluous and because mental pain was found to characterize pediatric cancer survivors who otherwise were found to be well adjusted as adults. The new redefinition of mental pain focuses on the components of low self-image and low meaningfulness of life. The constructs of mental pain in the past and of tolerance of mental pain were found to be less useful in this context. The new redefinition points to two new venues of interventions for reducing mental pain: enhancing self-image and increasing meaningfulness of life. The two kinds of interventions, which are based on elaborating meanings, are briefly described.

Using the Fragile Families and Child Wellbeing Study, we examine the association between parental major depressive and generalized anxiety disorders and child behavior problems across family types: married, cohabiting, involved nonresident father, and noninvolved nonresident father. Among 3-year-olds in all families, maternal anxiety/depression is associated with increased odds of anxious/depressed, attention deficit, and oppositional defiant disorders (N = 2,120). Paternal anxiety/depression has no significant association with these problem behaviors; father’s illness, however, exacerbates anxious/depressed behaviors in young children if both parents are ill and he is co resident. The findings underscore the importance of maternal mental health for child well-being and suggest that a negative interaction between parent illnesses is most likely when parents and children share the same disorder.

Background: It is well-recognized that behavioral health problems are under detected and undertreated in primary care. Medical settings have been identified as likely settings to detect and address these problems, but any such efforts would require a strategic approach based on needs in the treated population. Obstetric settings are being encouraged to detect and address behavioral health needs. Methods: An EMR-based approach for developing an initial estimate of the portion in need, and the range of conditions present, was developed for the obstetric setting. A list was developed of behavioral health diagnoses and prescriptions that could be queried using the electronic medical record (EMR). For diagnoses, the ICD-9 set of "mental disorder" diagnoses (codes 290-319) was used. For prescriptions, a list of behavioral health medications published by NIMH was used, augmented with the behavioral health medications noted in a recent "Top 200" prescription list published by Verispan, a commercial firm. Results: Of this cohort of 3,290 women beginning pregnancy care in a one-year time span, this EMR query indicated that 394 (12.0%) had a behavioral health need; 5.2% were prescribed a medication alone, 3.1% had a diagnosis alone, and 3.6% had both. This is likely an underestimate, but the efficient EMR method serves as a helpful starting place for determining behavioral health needs to be addressed. Conclusions: These data indicate that screening for these conditions will likely yield modest, but steady, numbers of patients with behavioral health needs that could be integrated with obstetric care. Readily available data regarding most common diagnoses and most frequently prescribed drugs can be used to develop an initial estimate of the burden of behavioral health need in obstetrics. Other primary care settings could readily replicate this approach as an initial step for addressing behavioral health burden in primary care.

Introduction: Doctors in primary care are responsible for diagnosing and managing patients with headache, but frequently lack confidence in doing so. We aimed to compare Family Practitioners’ (FPs) diagnosis of headaches to classification based on a symptom questionnaire, and to describe how classification links to other important clinical features. Methods: This was an observational study of patients attending primary care doctors for headache. Main outcome measures: Patients completed a questionnaire including the Headache Impact Test, the Migraine Disability Assessment Score, the Hospital Anxiety and Depression Scale, the Illness Perceptions Questionnaire, a satisfaction scale, a service use inventory and a symptom questionnaire rated by two Practitioners with Special Interest (PSIs) in Headache. Results: 255 patients completed questionnaires. There was low agreement between FP diagnosis and classification using the symptom questionnaire. FPs frequently did not use the diagnosis migraine, when patient reported symptoms which justified this. FPs did not classify patients with =15 days of headache separately as chronic daily headache (CDH), and this could be because the classification system used does not have that code. Patients classified as CDH using the symptom questionnaire reported more disability, more symptoms of anxiety and depression (HADS), more service use, and less satisfaction with FP care. Conclusion: Patients, who present with headache in primary care, tend to receive non-specific diagnoses. Having a system that would allow separate classification of people with headache of = 15 days a month might help FPs to explore and address associated features with patients in terms of disability, psychological co-morbidity and cost, and improve satisfaction with care.

Introduction: Doctors in primary care are responsible for diagnosing and managing patients with headache, but frequently lack confidence in doing so. We aimed to compare Family Practitioners’ (FPs) diagnosis of headaches to classification based on a symptom questionnaire, and to describe how classification links to other important clinical features. Methods: This was an observational study of patients attending primary care doctors for headache. Main outcome measures: Patients completed a questionnaire including the Headache Impact Test, the Migraine Disability Assessment Score, the Hospital Anxiety and Depression Scale, the Illness Perceptions Questionnaire, a satisfaction scale, a service use inventory and a symptom questionnaire rated by two Practitioners with Special Interest (PSIs) in Headache. Results: 255 patients completed questionnaires. There was low agreement between FP diagnosis and classification using the symptom questionnaire. FPs frequently did not use the diagnosis migraine, when patient reported symptoms which justified this. FPs did not classify patients with =15 days of headache separately as chronic daily headache (CDH), and this could be because the classification system used does not have that code. Patients classified as CDH using the symptom questionnaire reported more disability, more symptoms of anxiety and depression (HADS), more service use, and less satisfaction with FP care. Conclusion: Patients, who present with headache in primary care, tend to receive non-specific diagnoses. Having a system that would allow separate classification of people with headache of = 15 days a month might help FPs to explore and address associated features with patients in terms of disability, psychological co-morbidity and cost, and improve satisfaction with care.