
Psychiatr Serv 56:395, April 2005
© 2005 American Psychiatric Association
April 2005: This Month's Highlights
Special Section on the Global Assessment of Functioning
Findings on the utility of the Global Assessment of Functioning (GAF) continue to be mixed. As testimony to the ongoing research interest in this assessment scale, seven papers on the GAF were recently submitted, independently, to Psychiatric Services, and they have been compiled as a special section in this issue. First, two articles by Greg A. Greenberg, Ph.D., and Robert A. Rosenheck, M.D., report on a study of the reliability and validity of the GAF in a Department of Veterans Affairs setting (see page 420 and page 427). Similar lines of investigation were undertaken in two studies conducted in Sweden, reported by Per Söderberg, M.Sc., Stefan Tungström, M.Sc., and Bengt-Åke Armelius, Ph.D., who assessed the utility of the scale in routine clinical practice (page 434 and page 439). An article by Gary M. Burlingame, Ph.D., and his coauthors reviews one state hospital's approach to outcome assessment that included the GAF (page 444), and an accompanying State Mental Health Policy column covers some of the more pragmatic aspects of implementing such an approach in that particular hospital (page 411). In another study, by Cornelis L. Mulder, M.D., and colleagues, GAF score was one of the variables used in assessing level-of-care decisions in a mobile psychiatric emergency service (page 452). Finally, Karen J. Shedlack, M.D., and her coauthors, in a brief report, outline the limitations of the GAF in evaluating persons who have both mental retardation and mental illness, comparing the scale with the Aberrant Behavior Checklist (ABC) (page 484). Together these papers make a substantial contribution to the growing evidence of the advantages as well as the disadvantages of the GAF.
The Physical Health of Persons With Mental Illness
Four articles in this issue of the journal examine the general medical care of persons with mental illnesses. In light of growing evidence of consistently higher morbidity and mortality rates among persons with severe and persistent mental illness, Pamela J. Salsberry, Ph.D., R.N., and her coauthors studied patterns of use of general medical services in a Medicaid population of persons with severe and persistent mental illness (see page 458). Continuing the theme of disparities in general medical care between persons with mental illness and the general population, Alan S. Rubin, M.D., and colleagues present the results of their study of the effects of collaboration between an internist and psychiatrists on the costs and processes of care among psychiatric inpatients (page 463). Their aim was to determine whether such collaboration would improve the care of this traditionally underserved population. Nicholas P. Emptage, M.A., and his coauthors report the results of their study on depression and comorbid pain and associated outcomes in a nationally representative sample of older persons (page 468). Finally, Marcia L. Verduin, M.D., and colleagues present the results of their study of use of health services by patients with bipolar disorder and substance use disorders, either alone or co-occurring, in a Department of Veterans Affairs medical center (page 475).
Opinions on "Surreptitious Prescribing"
Nonadherence to treatment continues to be one of psychiatry's greatest challenges. To improve adherence and thus improve the care of patients, clinicians and patients' family members sometimes resort to hiding medications in food or drink, a practice referred to as surreptitious prescribing. In an Open Forum discussion in this month's issue, Peter Whitty, M.B., M.R.C.Psych., and Pat Devitt, M.B., M.R.C.Psych., present the advantages and disadvantages of this practice in the context of community psychiatric services as well as related legal and ethical considerations. These authors offer guidelines for clinicians who may be considering giving their patients medications surreptitiously (see page 481). In a related Taking Issue piece, Laurie Ahern and Laura Van Tosh express their opposition to surreptitious prescribing, which they describe as "coercive and forced treatment at its most sinister" (see page 383).
Briefly Noted ...
A study was conducted to assess the effects on adherence and symptoms of depression of a community pharmacy-based coaching program, including a take-home videotape, in the Netherlands (see page 487).
In the Personal Accounts column, a psychiatrist tells the story of the mental illness of his paternal grandmother, whom he never knew (see page 416).
The Rehab Rounds column describes a psychiatric rehabilitation program for patients with schizophrenia at a hospital in China (see page 401).
Related Articles:
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The Irreversible Damage Caused by Surreptitious Prescribing
- Laurie Ahern and Laura Van Tosh
Psychiatr Serv 2005 56: 383.
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Rehab Rounds: Psychiatric Rehabilitation in a Chinese Psychiatric Hospital
- Yong-zhen Weng, Ying-qiang Xiang, and Robert Paul Liberman
Psychiatr Serv 2005 56: 401-403.
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State Mental Health Policy: Implementing a Multisource Outcome Assessment Protocol in a State Psychiatric Hospital: A Case Study
- Dallas Earnshaw, Frank Rees, Todd W. Dunn, Gary M. Burlingame, and Steven Chen
Psychiatr Serv 2005 56: 411-413.
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Personal Accounts: Bringing Grandma Home
- Gary J. Maier
Psychiatr Serv 2005 56: 416-417.
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Special Section on the GAF: Using the GAF as a National Mental Health Outcome Measure in the Department of Veterans Affairs
- Greg A. Greenberg and Robert A. Rosenheck
Psychiatr Serv 2005 56: 420-426.
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Special Section on the GAF: Continuity of Care and Clinical Outcomes in a National Health System
- Greg A. Greenberg and Robert A. Rosenheck
Psychiatr Serv 2005 56: 427-433.
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Special Section on the GAF: Reliability of Global Assessment of Functioning Ratings Made by Clinical Psychiatric Staff
- Per Söderberg, Stefan Tungström, and Bengt Åke Armelius
Psychiatr Serv 2005 56: 434-438.
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Special Section on the GAF: Relationship Between the Global Assessment of Functioning and Other DSM Axes in Routine Clinical Work
- Stefan Tungström, Per Söderberg, and Bengt-Åke Armelius
Psychiatr Serv 2005 56: 439-443.
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Special Section on the GAF: Selection of Outcome Assessment Instruments for Inpatients With Severe and Persistent Mental Illness
- Gary M. Burlingame, Todd W. Dunn, Steven Chen, August Lehman, Reid Axman, Dallas Earnshaw, and Frank M. Rees
Psychiatr Serv 2005 56: 444-451.
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Special Section on the GAF: Determinants of Indicated Versus Actual Level of Care in Psychiatric Emergency Services
- Cornelis L. Mulder, Gerrit T. Koopmans, and John S. Lyons
Psychiatr Serv 2005 56: 452-457.
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Use of General Medical Services Among Medicaid Patients With Severe and Persistent Mental Illness
- Pamela J. Salsberry, Esther Chipps, and Carol Kennedy
Psychiatr Serv 2005 56: 458-462.
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Effects on Processes and Costs of Care Associated With the Addition of an Internist to an Inpatient Psychiatry Team
- Alan S. Rubin, Benjamin Littenberg, Robert Ross, Susan Wehry, and Marilee Jones
Psychiatr Serv 2005 56: 463-467.
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Depression and Comorbid Pain as Predictors of Disability, Employment, Insurance Status, and Health Care Costs
- Nicholas P. Emptage, Roland Sturm, and Rebecca L. Robinson
Psychiatr Serv 2005 56: 468-474.
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Health Service Use Among Persons With Comorbid Bipolar and Substance Use Disorders
- Marcia L. Verduin, Rickey E. Carter, Kathleen T. Brady, Hugh Myrick, and Mary Ann Timmerman
Psychiatr Serv 2005 56: 475-480.
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Surreptitious Prescribing in Psychiatric Practice
- Peter Whitty and Pat Devitt
Psychiatr Serv 2005 56: 481-483.
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Brief Reports: A Comparison of the Aberrant Behavior Checklist and the GAF Among Adults With Mental Retardation and Mental Illness
- Karen J. Shedlack, John Hennen, Christine Magee, and Daniel M. Cheron
Psychiatr Serv 2005 56: 484-486.
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A Pharmacy-Based Coaching Program to Improve Adherence to Antidepressant Treatment Among Primary Care Patients
- Oscar Hugo Brook, Hein van Hout, Wim Stalman, Hugo Nieuwenhuyse, Bram Bakker, Eibert Heerdink, and Marten de Haan
Psychiatr Serv 2005 56: 487-489.
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