Psychiatric Services Columns

Public-Academic Partnerships: Early Intervention for Psychotic Disorders in a Community Mental Health Center [Columns]

Fri, 30 Oct 2009 05:01:27 PDT

Early intervention may improve long-term outcomes for psychotic illnesses. Early-intervention services in other countries have focused on reducing the duration of untreated illness and adapting interventions for younger patients. This column describes the process of building such a service, called specialized treatment early in psychosis (STEP), at the Connecticut Mental Health Center. This effort is rooted in a long-standing collaborative relationship between the Connecticut Department of Mental Health and Addiction Services and Yale. The authors describe the critical contribution of such partnerships in evaluating the cost-effectiveness of early intervention in a "real-world" U.S. setting.

Best Practices: An Emerging Best Practice Model for Perinatal Depression Care [Columns]

Fri, 30 Oct 2009 05:01:27 PDT

Perinatal depression is a significant health problem, especially among inner-city women. The authors explored the feasibility of an innovative model that integrated depression screening and treatment within an agency for maternal-child health. The team conducted depression screening with the Edinburgh Postnatal Depression Scale; they confirmed the primary diagnosis with the PRIME-MD instrument for 29 women with positive screens. Most participants had moderate or severe major depressive disorder. Women contended with multiple treatment barriers. Colocated depression care was highly acceptable and enabled evidence-based care delivery for at-risk mothers.

Best Practices: Community-Based Postpartum Depression Screening: Results From the CARE Study [Columns]

Horowitz, J. A., Murphy, C. A., Gregory, K. E., Wojcik, J. — Fri, 30 Oct 2009 05:01:27 PDT

This column describes findings and best-practice recommendations from CARE (Communicating and Relating Effectively), a prospective randomized study in which 5,169 mothers were screened for postpartum depression. The prevalence rate was 13%. Results support use of the Edinburgh Postnatal Depression Screening Scale and a diagnostic assessment for those who screen positive. Of the 674 mothers with positive screens, 26% were not asked about their emotional state by clinicians. Screening must be linked to treatment options via referral and follow-up. Best-practice strategies for implementing screening include educating clinicians and postpartum women.

Law & Psychiatry: Mental Retardation and the Death Penalty: After Atkins [Columns]

Appelbaum, P. S. — Thu, 01 Oct 2009 05:01:57 PDT

In Atkins v. Virginia the U.S. Supreme Court declared execution of persons with mental retardation to constitute cruel and unusual punishment, and thus to be unconstitutional under the Eighth Amendment. However, the Court left all considerations regarding how to implement the decision explicitly to the states. Since Atkins was decided in 2002, legislatures, courts, and mental health experts have struggled with its implementation, highlighting the complexities that can arise when the courts base legal rules on clinical findings. This column reviews the Atkins case and considers the challenges associated with a clinical determination that can have life-or-death consequences for capital defendants.

Case Studies in Public-Sector Leadership: Implementing a Metabolic Initiative in a Community Mental Health Clinic [Columns]

Dragatsi, D., Deakins, S. M. — Thu, 01 Oct 2009 05:01:57 PDT

Public-Academic Partnerships: The Beck Initiative: A Partnership to Implement Cognitive Therapy in a Community Behavioral Health System [Columns]

Stirman, S. W., Buchhofer, R., McLaulin, J. B., Evans, A. C., Beck, A. T. — Thu, 01 Oct 2009 05:01:57 PDT

The Beck Initiative is a partnership between researchers and clinicians at a large university and an urban behavioral health managed care system. Both partners share a commitment to ensuring that consumers in the community have access to competently delivered, individualized, evidence-based mental health care and that the providers who serve them have the support they need to deliver high-quality evidence-based treatments. Central features of the program are individualized training and consultation in cognitive therapy for each provider agency and policies to promote the sustainability of the initiative and its continuing evolution to meet the needs of providers and consumers.

Personal Accounts: Jack and the Clubhouse Road to Recovery [Columns]

Grillo, J. — Thu, 01 Oct 2009 05:01:57 PDT

Best Practices: Improving Quality of Care for Patients With First-Episode Psychosis [Columns]

Addington, D. — Tue, 01 Sep 2009 05:01:25 PDT

The principles of early intervention and evidence-based care have been applied to the task of improving outcome for first-episode schizophrenia. Significant progress has been achieved through clinical innovation, research, advocacy, and policy changes. Canada has seen the implementation of such services in a number of jurisdictions, and there is a need to develop tools and strategies for quality assurance and quality improvement. The use of tools such as clinical practice guidelines, program fidelity scales, and performance measures, standards, and benchmarks is well established for quality assurance and quality improvement. These tools are available for other areas of mental health care and are being developed for application to treatment services for early psychosis. This column illustrates some of the tools available for quality improvement and the challenges in their application. Development and application of such tools are required to move first-episode psychosis treatment from innovation to best practice and standard care.

Datapoints: Psychotropic Drug Prescriptions by Medical Specialty [Columns]

Mark, T. L., Levit, K. R., Buck, J. A. — Tue, 01 Sep 2009 05:01:25 PDT

State Mental Health Policy: Implementation of Computerized Medication Prescribing Algorithms in a Community Mental Health System [Columns]

Milner, K. K., Healy, D., Barry, K. L., Blow, F. C., Irmiter, C., De Chavez, P. — Fri, 31 Jul 2009 05:01:19 PDT

This column describes a Michigan initiative to implement medication prescribing algorithms for schizophrenia, bipolar disorder, and major depression. The algorithms were incorporated into the electronic medical records system of a four-county community mental health system. Guideline adherence of 30 providers who treated nearly 3,000 patients was measured at mid- and endpoints of the first year. They were adherent for about a third of their patients in the first six months (32%) and more than half in the second (52%). Scores on scales measuring providers' perceptions of algorithm ease of use and usefulness were in the midrange at both time points.

Personal Accounts: Severe Mental Illness and Psychotherapy [Columns]

Kunkle, B. A. — Fri, 31 Jul 2009 05:01:19 PDT