Adults with any DSM-IV diagnosed mental illness smoke nearly half of the cigarettes consumed in the U.S. (Lasser et al. 2000). This study compared two smoking cessation interventions for persons with schizophrenia or other serious mental illness because national data suggests that: (1) they smoke at two to three times the rate of the general population; (2) cessation interventions for this population are understudied; (3) most cessation studies exclude persons with serious mental illness; and (4) cessation results in public health care savings and disposable income savings for clients. This study included a large number of persons with serious mental illness (N=181) who were randomly assigned to one of three groups: contingent reinforcement (CR), CR plus nicotine patch (21 mg, CR+NRT) for 16 weeks, and a minimal intervention, self-quit control group. These participants were followed for 36 weeks. CR was accomplished with escalating financial compensation for achieving and maintaining abstinence as verified by expired carbon monoxide (CO). Quit rates, as measured by expired CO, were higher and discordant with saliva cotinine quit rates. Cotinine showed lower quit rates and small differences between intervention and control participants at weeks 20 and 36. There was, however, evidence of reduced smoking and importantly, no evidence of psychiatric exacerbation.

OBJECTIVE: To describe the incidence of pelvic floor dysfunction in transgender women undergoing gender-affirming vaginoplasty and outcomes in a program providing pelvic floor physical therapy (PT). METHODS: We conducted a retrospective, single-institution study on vaginoplasty patients between May 1, 2016, and February 28, 2018; all were referred for pelvic floor PT. We reviewed medical records for baseline demographics, medical comorbidities, prior surgeries, insurance data, attendance at pelvic floor PT, and dilation success at 3 and 12 months. RESULTS: Seventy-two of 77 patients (94%) attended pelvic floor PT at least once. Preoperative pelvic floor PT identified a high incidence of potential problems: 42% had pelvic floor dysfunction, 37% had bowel dysfunction. Of those patients found to have dysfunction preoperatively, the rate of resolution by the first postoperative visit of pelvic floor and bowel dysfunction were 69% and 73%, respectively. There were significantly lower rates of pelvic floor dysfunction postoperatively for those patients who attended pelvic floor PT both preoperatively and postoperatively compared with only postoperatively (28% vs 86%, P=.006). Patients reporting a history of abuse had a significantly higher rate of preoperative pelvic floor muscle dysfunction (91% vs 31%, P<.001). Successful dilation at 3 months in all patients was 89%. CONCLUSION: Pelvic floor physical therapists identify and help patients resolve pelvic floor-related problems before and after surgery. We find strong support for pelvic floor PT for patients undergoing gender-affirming vaginoplasty.

Co-occurring mental health and substance use disorders (COD) are common and frequently under-detected, which may lead to less than optimal treatment for persons in psychosocial rehabilitation settings. A new, relatively brief instrument, the Comprehensive Addictions and Psychological Evaluation (CAAPE) was compared with the Structured Clinical Interview for DSM-IV (SCID). The CAAPE required less time to administer than the SCID, efficiently explored DSM substance use disorder criteria and served as a screen for psychiatric disorders. The CAAPE promises to be a useful screening and diagnostic instrument for persons with co-occurring disorders, especially suited for use in psychosocial rehabilitation.

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A series of four focus groups were conducted with 35 clients with a co-occurring diagnosis of mental illness and substance abuse to obtain their perspectives on treatment. Four content areas emerged. System barriers, such as poor therapeutic environment, difficulties navigating complex systems, and poor integration of services were most frequently mentioned. Factors facilitating recovery included consumer strengths, a positive therapeutic environment, and helpful recovery tools. Consumer challenges refer to obstacles in the client's life including the long-term chronic nature of their illness, self-medication of psychiatric symptoms, and limited personal resources and options. Specific treatment needs, such as treatment from “similar others,” one-on-one counseling, and time management were identified. The results demonstrate that a client-centered approach is preferred. Limited system resources continue to be a barrier. Improved coordination of services and cross-training on co-occurring diagnosis are needed. Consumers recognize the long-term nature of their problems and have strengths for dealing with them.