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July 2014
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Psychiatric Services

A Journal of the American Psychiatric Association Editor: Howard H. Goldman, M.D., Ph.D.
Articles  |  July 1, 2014
CBT Helpful for Medication-Resistant Psychosis

Patients with schizophrenia often continue to experience disabling positive symptoms, despite adequate trials of medication. In these situations, patients may be prescribed an adjunctive medication, but a more effective choice may be cognitive-behavioral therapy (CBT). This review of 16 published articles from 12 randomized controlled trials found that CBT was associated with robust improvements in the positive symptoms of psychotic disorders. In addition, the improvements were sustained at follow-up, the authors reported.

Articles  |  July 1, 2014
Medicare Policies and Depression Treatment: Are They Misaligned?

Semistructured interviews with nurses working for home health care agencies in five states raise serious questions about the deleterious effects of Medicare policies and procedures on depression care. The agencies have strong incentives to limit nursing time in a given payment episode and to increase volume, making it difficult to provide high-quality depression care for homebound patients. Some nurses felt forced to “abandon” many patients with depression. The authors call for incremental policy changes in several key areas.

Columns  |  July 1, 2014
Teach Us to Collaborate: Changes Needed in Residency Training?

Psychiatrists of the future will be called upon to lead teams of clinicians in increasingly complex medical care systems, but will they be prepared for those roles? The authors of this column asked alumni of the Columbia University Public Psychiatry Fellowship (PPF) to identify important skills and knowledge that were not stressed in general residency education. “Silos are rampant in our work,” complained one respondent, reflecting a common concern that not enough time was spent teaching residents to collaborate.

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