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This Month's Highlights   |    
October 2008: This Month's Highlights
Psychiatric Services 2008; doi: 10.1176/appi.ps.59.10.1089
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Several articles in this month's issue report research on medication use, including six on antidepressants and antipsychotics. A meta-analysis of data from 27 randomly controlled trials demonstrated the overall benefits of the newer antidepressants in continuation- and maintenance-phase treatment of major depression, although trials comparing the newer drugs to each other are needed (page 1121). An analysis of data from two national epidemiological surveys found a significantly lower rate of antidepressant use among black respondents with depressive or anxiety disorders than among white respondents with these disorders (14.6% and 32.4%). An unexpected finding was the association of antidepressant use and common medical conditions related to vascular disease—use that was independent of the presence of psychiatric illness (page 1131). A study of nearly 4,000 veterans with both major depression and diabetes found that half (51%) were treated with antidepressants, and two-thirds of this group (62%) received treatment that was consistent with current guidelines (page 1139). Analyses of 2002—2005 Medicaid claims data for 1.2 million Florida children showed that rapid increases in antipsychotic use stopped in the spring of 2004, shortly after black-box warnings about metabolic effects were required for antipsychotics and about the same time that warnings in regard to suicidal thoughts were required for pediatric antidepressant prescriptions (page 1162). Implementation of Medicare's new Part D drug benefit decreased out-of-pocket costs for antidepressants and antipsychotics among elderly persons, thus improving access (page 1191). Veterans taking antipsychotics were more likely to experience decreased adherence when their dosing frequency was changed to more than once a day (page 1207).

A growing number of psychotropic agents—mood stabilizers (including anticonvulsants), antipsychotics, and antidepressants—are being used to treat bipolar disorder, both alone and in combination. A study of nearly 1,500 Medicaid beneficiaries in California who had bipolar disorder found a shift between 2001 and 2004 toward greater use of antipsychotics; mood stabilizer monotherapy declined and antipsychotic monotherapy increased; racial-ethnic disparities in medication use were also noted (page 1169). A study of nearly 7,500 patients with newly diagnosed bipolar disorder who were enrolled in a national health plan showed that a third were started on polytherapy and a third were still receiving polytherapy at one year; 37% were not taking any psychotropic at one year (page 1175). Of 10,636 privately insured adults with posttraumatic stress disorder (PTSD), 60% were being treated with psychotropic medication; three-quarters of this group received antidepressants, and a similar proportion received anxiolytics or sedative-hypnotics (page 1184).

California's public mental health system has been engaged in a process of planning and change since 2004, when a 1% tax on annual personal income over $1 million was imposed and the funds earmarked for system change. As of May 2008 all 58 county- and city-operated mental health agencies had submitted plans to reorient services toward recovery and consumer and family preferences. State guidelines mandate creation of full-service partnerships (FSPs), which are rooted in the assertive community treatment and wraparound models. Cheryl Cashin, Ph.D., and colleagues conducted a qualitative content analysis of a sample of 12 such plans, from agencies that represented 62% of the state's population. The authors found that state guidelines were successful in generating remarkable consistency across counties in the creation of FSPs. However, the authors found a wide array of strategies for achieving transformation, reflecting not only the diversity of the 12 counties but also the lack of clear policy and guidance on evidence-based practices (page 1107). The article is the 11th in a series of reports addressing the goals that were established by the President's New Freedom Commission on Mental Health. The series is supported by a contract with the Substance Abuse and Mental Health Services Administration.

• A survey in Australia indicated that youths and their parents differed from clinicians in their beliefs about the helpfulness of interventions for early psychosis (page 1115).

• Should the law allow people with mental illness to act as their own attorney? The Law & Psychiatry column looks at past and recent court decisions (page 1096).




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