Psychiatr Serv current issue

[Taking Issue] Contented but Not Better: Problems With Satisfaction

Norquist, G. S. — 2009-06-29

[This Month's Highlights] July 2009: This Month's Highlights

2009-06-29

[Columns] Law & Psychiatry: Congress Restores the Americans With Disabilities Act to Its Original Intent

Petrila, J. — 2009-06-29

The Americans With Disabilities Act (ADA) was created to prohibit discrimination based on disability. Although many individuals filed claims alleging discrimination in the workplace based on disability, the federal courts, led by the U.S. Supreme Court, adopted an increasingly constricted interpretation of key provisions of the ADA. As a result, many individuals with serious impairments were found by the courts to not be disabled. In 2008 Congress overturned these court decisions by enacting the ADA Amendments Act. These amendments overrule several decisions by the United States Supreme Court that narrowed the applicability of the ADA, and they restore the ADA to its original intent.

[Columns] Alcohol & Drug Abuse: What Is "Women-Focused" Treatment for Substance Use Disorders?

Greenfield, S. F., Grella, C. E. — 2009-06-29

Over the past three decades research has highlighted gender differences in substance use disorders and substance abuse treatment participation. Programs devoted to addressing women's treatment needs, broadly encompassed in the term "women-focused treatment," have multiplied. This column examines the rationale for women-focused treatment and describes some of its components. The authors cite the need to evaluate women-focused treatment by developing validated measures of the processes embodied in such treatment and by conducting empirically sound research on clinical outcomes, treatment effectiveness, cost-effectiveness, and the optimal means of providing services to women with substance use disorders.

[Articles] A National Action Plan for Workforce Development in Behavioral Health

2009-06-29

Across all sectors of the behavioral health field there has been growing concern about a workforce crisis. Difficulties encompass the recruitment and retention of staff and the delivery of accessible and effective training in both initial, preservice training and continuing education settings. Concern about the crisis led to a multiphased, cross-sector collaboration known as the Annapolis Coalition on the Behavioral Health Workforce. With support from the Substance Abuse and Mental Health Services Administration, this public-private partnership crafted An Action Plan for Behavioral Health Workforce Development. Created with input from a dozen expert panels, the action plan outlines seven core strategic goals that are relevant to all sectors of the behavioral health field: expand the role of consumers and their families in the workforce, expand the role of communities in promoting behavioral health and wellness, use systematic recruitment and retention strategies, improve training and education, foster leadership development, enhance infrastructure to support workforce development, and implement a national research and evaluation agenda. Detailed implementation tables identify the action steps for diverse groups and organizations to take in order to achieve these goals. The action plan serves as a call to action and is being used to guide workforce initiatives across the nation.

[Articles] Bipolar Disorder Center for Pennsylvanians: Implementing an Effectiveness Trial to Improve Treatment for At-Risk Patients

2009-06-29

OBJECTIVE: Adolescents, elderly persons, African Americans, and rural residents with bipolar disorder are less likely than their middle-aged, white, urban counterparts to be diagnosed, receive adequate treatment, remain in treatment once identified, and have positive outcomes. The Bipolar Disorder Center for Pennsylvanians (BDCP) study was designed to address these disparities. This report highlights the methods used to recruit, screen, and enroll a cohort of difficult-to-recruit individuals with bipolar disorder. METHODS: Study sites included three specialty clinics for bipolar disorder in a university setting and a rural behavioral health clinic. Study operations were standardized, and all study personnel were trained in study procedures. Several strategies were used for recruitment. RESULTS: It was possible to introduce the identical assessment and screening protocol in settings regardless of whether they had a history of implementing research protocols. This protocol was also able to be used across the age spectrum, in urban and rural areas, and in a racially diverse cohort of participants. Across the four sites 515 individuals with bipolar disorder were enrolled as a result of these methods (69 African Americans and 446 non-African Americans). Although clinical characteristics at study entry did not differ appreciably between African Americans and non-African Americans, the pathways into treatment differed significantly. CONCLUSIONS: Rigorous recruitment and assessment procedures can be successfully introduced in different settings and with different patient cohorts, thus facilitating access to high-quality treatment for individuals who frequently do not receive appropriate care for bipolar disorder.

[Articles] Dropout From Outpatient Mental Health Care in the United States

2009-06-29

OBJECTIVE: Although mental health treatment dropout is common, patterns and predictors of dropout are poorly understood. This study explored patterns and predictors of mental health treatment dropout in a nationally representative sample. METHODS: Data were from the National Comorbidity Survey Replication, a nationally representative household survey. Respondents who had received mental health treatment in the 12 months before the interview (N=1,664) were asked about dropout, which was defined as quitting treatment before the provider wanted them to stop. Cross-tabulation and discrete-time survival analyses were used to identify predictors. RESULTS: Approximately one-fifth (22%) of patients quit treatment prematurely. The highest dropout rate was from treatment received in the general medical sector (32%), and the lowest was from treatment received by psychiatrists (15%). Dropout rates were intermediate from treatment in the human services sector (20%) and among patients seen by nonpsychiatrist mental health professionals (19%). Over 70% of all dropout occurred after the first or second visits. Mental health insurance was associated with low odds of dropout (odds ratio=.6, 95% confidence interval=.4–.9). Psychiatric comorbidity was associated with a trend toward dropout. Several patient characteristics differentially predicted dropout across treatment sectors and in early and later phases of treatment. CONCLUSIONS: Roughly one-fifth of adults in mental health treatment dropped out before completing the recommended course of treatment. Dropout was most common in the general medical sector and varied by patient characteristics across treatment sectors. Interventions focused on high-risk patients and sectors that have higher dropout rates will likely be required to reduce the large proportion of patients who prematurely terminate treatment.

[Articles] The REACT Study: Cost-Effectiveness Analysis of Assertive Community Treatment in North London

2009-06-29

OBJECTIVE: Assertive community treatment (ACT) is a key component of mental health care, but recent information on its cost-effectiveness is limited. This article provides a cost-effectiveness analysis of assertive community treatment and usual care from community mental health teams (CMHTs) in the United Kingdom. METHODS: Participants who had difficulties engaging with community services were randomly assigned to ACT (N=127) or continued usual care from CMHTs (N= 124). Costs were measured at baseline and 18 months later and compared between the two groups. In the analysis, cost data were linked to information on satisfaction, which had been shown to be significantly higher with ACT. RESULTS: Total follow-up costs over 18 months were higher for the ACT group by £4,031 ($6,369), but this was not statistically significant (95% confidence interval of -£2,592 to £10,690 [-$4,095 to $16,890]). A one-unit improvement in satisfaction was associated with extra costs in the ACT group of £473 ($747). CONCLUSIONS: The costs of ACT were not significantly different from usual care. ACT did, however, result in greater levels of client satisfaction and engagement with services and as such may be the preferred community treatment option for patients with long-term serious mental health problems.

[Articles] VA Intensive Mental Health Case Management in Urban and Rural Areas: Veteran Characteristics and Service Delivery

Mohamed, S., Neale, M., Rosenheck, R. A. — 2009-06-29

OBJECTIVE: The availability of mental health services in rural areas—particularly intensive services such as assertive community treatment (ACT)—has been of increasing concern and was the focus of this study. In recent decades the U.S. Department of Veterans Affairs (VA) has developed a national network of ACT-like programs called mental health intensive case management (MHICM), which have served veterans from diverse locations across the country, including urban and rural areas. METHODS: This study used rural-urban commuting area codes and national VA administrative data to compare characteristics of veterans and patterns of MHICM service delivery among veterans with mental illness living in large urban, large rural, small rural, and isolated rural communities. RESULTS: Among veterans enrolled in MHICM from FY 2000 to FY 2005 (N=5,221), 84% (N=4,373) resided in urban areas, 8% (N=421) in large cities, 6% (N=291) in small rural towns, and 3% (N=136) in isolated rural areas. MHICM participants who lived in rural areas had clinical problems broadly similar to those in urban areas, although more rural veterans were unemployed, disabled, received VA disability compensation, and had a payee or fiduciary. MHICM clients in smaller or isolated rural areas received slightly less frequent and less intensive contacts and less recovery-oriented services than those in large urban locations. CONCLUSIONS: These data highlight the need for intensive case management services in rural areas and note some challenges in providing them at the intensity and frequency observed in urban areas where travel distances and times are shorter.

[Articles] Scope of Agency Control: Assertive Community Treatment Teams' Supervision of Consumers

Moser, L. L., Bond, G. R. — 2009-06-29

OBJECTIVE: Assertive community treatment teams have been criticized as being inherently coercive; however, base rates of control practices used by teams have not been well documented. The purpose of this study was to assess the rates at which different forms of agency control, such as involuntary outpatient commitment, representative payeeship, intensive medication monitoring, and agency-supervised housing, were used by assertive community treatment teams. Also examined were program, practitioner, and consumer correlates of agency control practices. METHODS: A statewide survey was conducted of 23 assertive community treatment teams serving consumers with severe mental illness. Data were collected on both team attributes and practitioner attributes. RESULTS: Extent of agency control was highly variable across sites. Intensive medication monitoring and representative payeeship were the most frequently used agency control practices. The strongest predictor of agency control was having a higher percentage of consumers on the caseload who were diagnosed as having a schizophrenia-spectrum disorder. Fidelity to the assertive community treatment model was not associated with agency control. However, lower quality of basic clinical services (for example, assessment and treatment planning) was associated with greater use of agency-supervised housing. Pessimistic practitioner attitudes were not significantly associated with agency control, but practitioner education was negatively associated with both representative payeeship and intensive medication monitoring. CONCLUSIONS: Assertive community treatment teams differed widely in their scope of agency control, and this variation was not associated with fidelity to the model. Consumer characteristics, such as a schizophrenia spectrum disorder and active substance use, were most closely associated with agency control.

[Articles] Prescriber Fidelity to a Medication Management Evidence-Based Practice in the Treatment of Schizophrenia

2009-06-29

OBJECTIVE: Medication Management Approaches in Psychiatry (MedMAP) is an evidence-based practice developed to guide the management and monitoring of psychotropic medications for individuals with schizophrenia. This article reports prescriber fidelity to MedMAP principles in a public mental health service system. METHODS: This three-year longitudinal intervention study implemented MedMAP in six community mental health centers in Kentucky. Nine psychiatrists and five advanced practice psychiatric nurses with prescriptive authority participated in the study. Prescribers were trained in the use of MedMAP about one month before implementation, and MedMAP principles were reinforced throughout the study. Four posttraining assessments were conducted at each site at approximately four-month intervals over a period of 30 months. An 18-item scale was used to assess baseline and posttraining prescriber fidelity over a period of 30 months in 900 randomly selected medical records. RESULTS: Average fidelity scores improved significantly over baseline at each of the four postimplementation fidelity assessments. Training effects were most evident at the second posttraining fidelity assessment, but effects persisted over the course of the study. There was considerable variability in scores across items both at baseline and subsequently. Posttraining improvement was greatest in patient education, documentation of illness and medication history, and simplification of medication regimen. CONCLUSIONS: Implementation and monitoring of MedMAP were feasible in these community mental health settings. Additional implementation projects are crucial for advancing evidence-based practice in clinical settings.

[Articles] Evaluation of an Outpatient Intervention for Women With Severe Depression and a History of Childhood Trauma

2009-06-29

OBJECTIVE: The study examined the effectiveness of a three-month structured outpatient intervention developed for women with severe depression and childhood trauma that used brief psychodynamic psychotherapy by comparing it to standard treatment recommended in clinical guidelines issued by the Chilean Ministry of Health. METHODS: Eighty-seven women who sought treatment from a public health service in Curicó, Chile, and who had severe depression and a history of childhood traumatic experiences were randomly assigned to receive either the intervention (N=44) or standard treatment (N=43). The participants were assessed at baseline and at three months (completion of the intervention) and six months with use of the Hamilton Depression Scale (Ham-D); Lambert's Outcome Questionnaire (OQ-45.2), which rates psychiatric symptoms, interpersonal relationships, and social role functioning; and the Post-traumatic Stress Treatment Outcome scale (PTO 8), which assesses symptoms of posttraumatic stress disorder. An intent-to-treat design was used with multiple analyses of variance. RESULTS: At three months significant differences were found in favor of the intervention group in Ham-D scores (p<.001) and OQ-45.2 scores (p<.05). At six months a significantly greater proportion of the intervention group had indicators of remission as measured by the OQ-45.2 (39% versus 14%, p<.05) and by the Ham-D (22% versus 5%, p<.05). Scores on the PTO 8 indicated significant improvements in posttraumatic stress disorder symptoms at six months, although there were no significant differences between the groups. CONCLUSIONS: An outpatient intervention that screened for and focused on childhood traumas and that helped patients understand current psychosocial difficulties as a repetition of past traumas was effective in reducing psychiatric symptoms and improving interpersonal relationships and social role functioning among women with severe depression and a history of childhood trauma.

[Articles] Help Seeking and Perceived Need for Mental Health Care Among Individuals in Canada With Suicidal Behaviors

2009-06-29

OBJECTIVE: This study examined and compared help seeking, perceived need, satisfaction with health professionals, and barriers to care in three groups: individuals with a mental disorder without suicidal behaviors, those with suicidal ideation with or without a mental disorder, and those with a suicide attempt with or without a mental disorder in the past year. METHODS: Data came from the Canadian Community Health Survey Cycle 1.2. The sample consisted of 36,984 persons aged 15 years and older (response rate=77%). A total of 4,872 had a mental disorder without suicidal behaviors, 1,234 had suicidal ideation, and 230 had attempted suicide. Multiple logistic regressions were used to examine differences between the three groups after adjusting for sociodemographic factors and the number of mental disorders. RESULTS: Individuals with suicidal ideation and those with suicide attempts were significantly more likely than those with a mental disorder but no suicidal behaviors to seek help and to perceive a need for care in the past year. However, 48% of individuals reporting suicidal ideation and 24% of individuals reporting a suicide attempt did not seek help and did not perceive a need for help in the past year. Significant differences existed between individuals in the three groups in terms of satisfaction with the care they received and barriers to receiving care in the past year. CONCLUSIONS: Although suicidal ideation and suicide attempts represent a significant source of evaluated need associated with help seeking and perceived need over and above the presence and severity of mental disorders, a significant proportion of individuals with suicidal behaviors did not receive care and did not perceive a need for care. Future research should be directed toward finding better ways to identify these individuals and address barriers to their care and other factors that may interfere with their receiving help.

[Articles] Children's Beliefs About Causes of Childhood Depression and ADHD: A Study of Stigmatization

Coleman, D., Walker, J. S., Lee, J., Friesen, B. J., Squire, P. N. — 2009-06-29

OBJECTIVE: Children's causal attributions about childhood mental health problems were examined in a national sample for prevalence; relative stigmatization; variation by age, race and ethnicity, and gender; and self-report of a diagnosis of depression or attention-deficit hyperactivity disorder (ADHD). METHODS: A national sample of 1,091 children were randomly assigned to read vignettes about a peer with depression, ADHD, or asthma and respond to an online survey. Causal attributions and social distance were assessed, and correlations were examined. Logistic regression models for each causal item tested main effects and interaction terms for conditions, demographic characteristics, and self-reported diagnosis. RESULTS: The beliefs that parenting, substance abuse, and low effort caused the condition were all strongly intercorrelated and were moderately correlated with social distance. The depression condition was the strongest predictor of endorsement of the most stigmatizing causal beliefs. Stigmatizing causal beliefs were evident for ADHD, but with more modest effects. Children who reported a diagnosis were more likely to endorse parenting and substance abuse as causes (attenuated for ADHD). Modest to moderate effects were found for variation in causal beliefs across ethnic groups. CONCLUSIONS: This study demonstrated a consistent presence of stigmatization in children's beliefs about the causes of childhood mental health problems. Low effort, parenting, and substance abuse together tapped a moralistic and blaming view of mental health problems. The results reinforce the need to address stigmatization of mental disorders and the relative stigmatization of different causal beliefs. The findings of variation by ethnicity and diagnosis can inform and target antistigmatization efforts.

[Articles] How Many Nursing Home Residents Live With a Mental Illness?

Bagchi, A. D., Verdier, J. M., Simon, S. E. — 2009-06-29

OBJECTIVE: A number of data sets can be used to estimate the size of the nursing home population that has mental illness; however, estimates vary because of differences in methods of data collection. This study sought to compare estimates from three nationally representative data sets of the number of nursing home residents who have a mental illness, determine which data set provides the best national-level estimate, and identify the types of policy and monitoring questions that can best be answered with each. METHODS: The study compared estimates of the number of nursing home residents who had either a primary or any diagnosed mental illness from the National Nursing Home Survey (NNHS), the Minimum Data Set (MDS), and the Medicaid Analytic eXtract (MAX) files. RESULTS: The NNHS produced the most valid national-level estimates of residents with a mental illness—nearly 102,000 with a primary diagnosis in 2004 (6.8% of residents), of which about 23,000 were under age 65 and 79,000 were aged 65 and older. However, data from the NNHS cannot be broken down to the state level; therefore, state- and facility-level estimates would have to be generated with the MDS or MAX data sets. CONCLUSIONS: Policy makers and program managers need to be aware of the strengths and limitations of the data they use in order to make informed decisions. Users of the NNHS, MDS, and MAX data sets should be aware of the differences in recorded diagnoses among the three, especially the relatively limited diagnoses in the MAX and imprecise diagnoses in the MDS.

[Articles] Trends in Mental Health Admissions to Nursing Homes, 1999-2005

Fullerton, C. A., McGuire, T. G., Feng, Z., Mor, V., Grabowski, D. C. — 2009-06-29

OBJECTIVE: The study examined 1999–2005 data on first-time nursing home admissions of individuals with mental illness, dementia, or both to identify trends and characteristics. METHODS: The Minimum Data Set was used to estimate the number and percentage of persons newly admitted to nursing homes who had mental illness (schizophrenia, bipolar disorder, depression, or an anxiety disorder), dementia, or both from 1999 to 2005. Data from 2005 were used to compare demographic characteristics and comorbid conditions of the three groups and treatments received. RESULTS: The number of individuals admitted with mental illness increased from 168,721 in 1999 to 187,478 in 2005. The 2005 number is more than 50% higher than the number admitted with dementia only (118,290 in 2005). The increase was driven by growth in admissions of persons with depression—from 128,566 to 154,262 in 2005. Persons admitted with depression had higher rates of comorbid conditions than those admitted with dementia or with neither dementia nor mental illness. They also had high rates of antidepressant treatment and high rates of receipt of training in skills required to return to the community. CONCLUSIONS: Current trends show that the proportion of nursing home admissions with mental illness, in particular depression, has overtaken the proportion with dementia. These changes may be related to increased recognition of depression, availability of alternatives to nursing homes for persons with dementia, and increased specialization among nursing homes in the care of postacute, rehabilitation residents. In light of these trends, it is critical to ensure that nursing homes have resources to adequately treat residents with mental illness to facilitate community reintegration.

[Open Forum] Improving Psychiatric Services Through Mystery Shopping

Lazarus, A. — 2009-06-29

Pseudo-patients, or "mystery shoppers," have been widely used in the medical setting to detect and correct deficiencies in the delivery of health care services. Persons pretending to be patients have found discrepancies between the service promised and the service delivered, leading to positive changes, such as reduced waiting times, increased retention of patients within medical practices, better explanations of procedures and proposed treatments, and improved encounters with office staff, physicians, and other health care providers. Mystery shopping in the field of mental health, however, remains an untapped strategy to improve service delivery, especially in public-sector programs. Competition among health care providers will likely encourage patients to comparison-shop for treatment, and psychiatric facilities should consider mystery shopping as an innovative method to improve the mental health care consumer's experience.

[Brief Reports] Revised Cost Estimates of Medicaid Recipients With Serious Mental Illness and HIV-AIDS

Rothbard, A. B., Miller, K., Lee, S., Blank, M. — 2009-06-29

OBJECTIVE: The aim of this brief report is to provide accurate 1996 baseline cost estimates for persons with co-occurring HIV and serious mental illness by revising original figures previously reported by the authors. METHODS: Data were examined for 23,729 adults who were enrolled in Medicaid in 1996. A comparison of utilization and cost of services was done for four groups: serious mental illness and HIV-AIDS, serious mental illness only, HIV-AIDS only, and neither condition. RESULTS: In 1996 persons with both illnesses had the highest annual medical and behavioral health treatment expenditures at $20,038 per person, followed by persons with only HIV-AIDS at $14,714. The cost of care for the HIV-AIDS population, regardless of the presence of serious mental illness, averaged $16,253 per person. CONCLUSIONS: Although the absolute costs found in this study were much higher than those reported in the authors' previous study, both studies showed that those with co-occurring illnesses had the highest cost.

[Brief Reports] Health and Social Characteristics of Homeless Adults in Manhattan Who Were Chronically or Not Chronically Unsheltered

Levitt, A. J., Culhane, D. P., DeGenova, J., O'Quinn, P., Bainbridge, J. — 2009-06-29

OBJECTIVE: This study compared health and social characteristics of two groups of homeless adults in Manhattan—those who were chronically unsheltered and those who were not. METHODS: Outreach workers conducted brief, structured interviews with 1,093 unsheltered homeless adults. Respondents were later categorized as being chronically unsheltered on the basis of New York City criteria (sleeping without shelter at least nine of the previous 24 months). RESULTS: The sample had high rates of substance abuse (65%), serious medical issues (42%), and repeated trauma (51%) and low rates of medical insurance (47%) and income entitlements (26%) entitlements. Sixty-seven percent were chronically unsheltered, and these respondents had significantly higher rates on several measures, including military service, incarceration, and mental illness. CONCLUSIONS: The sick and aged nature of this population suggests that more aggressive efforts are needed to enroll unsheltered homeless people in income and health benefits and to create adequate housing opportunities with appropriate support services.

[Brief Reports] Aging Fathers of Adult Children With Schizophrenia: The Toll of Caregiving on Their Mental and Physical Health

Ghosh, S., Greenberg, J. — 2009-06-29

OBJECTIVE: The primary purpose of this study was to compare the physical and psychological well-being of caregiving fathers of an adult son or daughter with schizophrenia with a comparison group of fathers who do not have children with schizophrenia. METHODS: Data for the caregiving fathers (N=95) were drawn from a study of families of adults with schizophrenia; the comparison group of fathers (N=95) was drawn from the Wisconsin Longitudinal Study (WLS). Samples were matched on sociodemographic variables and analyzed with independent-samples t tests. RESULTS: Fathers of adults with schizophrenia experienced higher levels of depression, poorer perceived health, lower levels of psychological well-being, and less marital satisfaction compared with their age-matched peers in the WLS. CONCLUSIONS: This study found hidden personal costs of caregiving among fathers of adults with schizophrenia; strategies are needed for supporting these fathers.

[Brief Reports] Burnout Among Psychiatrists in Milan: A Multicenter Survey

2009-06-29

OBJECTIVES: This study evaluated the prevalence of job burnout and estimated psychiatric morbidity and job satisfaction among psychiatrists in Milan. Also investigated were the contributions of personal and environmental factors to burnout. METHODS: Data were gathered via a cross-sectional, descriptive, multicenter survey. All psychiatrists working in departments of psychiatry within the Italian Public Health System in Milan were invited to participate, and an overall response rate of 70% (N=81) was achieved. The Maslach Burnout Inventory, the 12-item General Health Questionnaire, a job satisfaction measure, and a study-specific questionnaire were used in the assessments. RESULTS: Psychiatrists showed high levels of emotional exhaustion and depersonalization. Main sources of stress were related to work environment. According to regression models, the variable that most predicted burnout was a low level of job satisfaction. CONCLUSIONS: Data suggested that psychiatrists had higher levels of burnout than other physicians employed in general medical settings and confirmed that job satisfaction could have a protective role.

[Brief Reports] Understanding Community Mental Health Administrators' Perspectives on Dialectical Behavior Therapy Implementation

Herschell, A. D., Kogan, J. N., Celedonia, K. L., Gavin, J. G., Stein, B. D. — 2009-06-29

In this study, key informant interviews were conducted with 13 administrators from nine community-based mental health agencies implementing dialectical behavior therapy in order to assess their perspectives on implementation. Four major themes were identified. They include opinions about dialectical behavior therapy and its fit with existing practices, resource concerns (for example, reimbursement issues, time commitment, and staff training), staff selection for training and staff turnover, and ongoing client referrals. Understanding agency administrators' unique perspectives and addressing their concerns is critical to treatment implementation given administrators' role in determining whether and how a treatment will be implemented. Better understanding of the fit between dialectical behavior therapy and existing service structures, the impact of staff turnover on implementation, and the resources required for implementation are all needed to ensure successful implementation and sustainability.

[Letters] The Need for a "Mental Health Home"

McCreath, J. — 2009-06-29

[Letters] The Need for a "Mental Health Home": Reply

Smith, T. E., Sederer, L. I. — 2009-06-29

[Letters] Documentation of Suicide Risk Assessment in Clinical Records

Miret, M., Nuevo, R., Ayuso-Mateos, J. L. — 2009-06-29

[Letters] A Useful Question

Cowen, J. R. — 2009-06-29

[Book Reviews] Cognitive Dysfunction in Bipolar Disorder: A Guide for Clinicians

Schneider, D. — 2009-06-29

[Book Reviews] Assessment of Feigned Cognitive Impairment: A Neuropsychological Perspective

Harlow, M. C. — 2009-06-29

[Book Reviews] Intervention and Resilience After Mass Trauma

Stoddard, F. J. — 2009-06-29

[Book Reviews] Work, Life and the Mental Health System of Care: A Guide for Professionals Supporting Families of Children With Emotional or Behavioral Disorders

Klaehn, R. L. — 2009-06-29

[Book Reviews] Rethinking Expertise

Bennington-Davis, M. — 2009-06-29

[News & Notes] Annual Government Spending on Substance Abuse and Addiction Nears a Half Trillion Dollars

2009-06-29

[News & Notes] IOM Calls for Stronger Protections Against Conflicts of Interest in Research, Education, and Practice

2009-06-29

[News & Notes] News Briefs

2009-06-29