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).