Psychiatric Services Current Issue

This Month’s Highlights

Wed, 01 May 2013 00:00:00 GMT

Listening to and Involving Consumers in Research

Van Tosh L. — Wed, 01 May 2013 00:00:00 GMT

We are at an important juncture in the health care field, with a growing emphasis on patient-centered care that is driven by patients’ preferences. Patients are increasingly asked to give their opinions in satisfaction surveys. They are regularly invited to test new products and provide feedback to researchers—information that is then used to inform broader decisions that have an impact on patients’ health and well-being. Consumers are invited to describe their treatment preferences and experiences on user-friendly, Web-based platforms, such as the one developed by Patricia Deegan, to facilitate shared decision making with treatment providers.

Assertive Community Treatment in Veterans Affairs Settings: Impact on Adherence to Antipsychotic Medication

Valenstein M, McCarthy JF, Ganoczy D, et al. — Wed, 01 May 2013 00:00:00 GMT

Objectives

Assertive community treatment (ACT) programs may improve patients’ outcomes, in part by increasing adherence to antipsychotic medication. This study assessed the association between ACT enrollment and subsequent antipsychotic adherence.

Methods

The authors identified a national sample of 763 Veterans Affairs (VA) patients with schizophrenia who were newly enrolled in ACT in fiscal years 2001 to 2004 and had valid antipsychotic medication possession ratios (MPRs) for five sequential six-month periods, the first occurring before ACT enrollment. Propensity scores were used to match ACT patients 1:1 with eligible veterans who did not initiate ACT. Logistic regression analyses and generalized estimating equations (GEE) were used to assess the association between ACT enrollment and subsequent antipsychotic adherence. Antipsychotic adherence was compared among ACT enrollees with high, partial, or no participation in ACT services.

Results

Before the index date, there was no significant difference in rates of good adherence (MPR ≥.8) among subsequent ACT enrollees (72%) and patients in the control group (70%). However, in each of the four periods after enrollment, ACT enrollees were more likely to have MPRs ≥.8. In GEE analyses, ACT enrollment was associated with 2.3 greater odds of MPRs ≥.8 (95% confidence interval=1.9–2.7). Among ACT enrollees, higher levels of participation were associated with MPRs ≥.8.

Conclusions

In this large, national study, ACT enrollment was associated with higher levels of antipsychotic adherence among VA patients with schizophrenia. This association persisted over time and was greatest among those with higher levels of ACT use.

Correlation Between Levels of Conflict and Containment on Acute Psychiatric Wards: The City-128 Study

Bowers L, Stewart D, Papadopoulos C, et al. — Wed, 01 May 2013 00:00:00 GMT

Objective

Attainment of safe, calm inpatient psychiatric wards that are conducive to positive therapeutic care is crucial. On such wards, rates of coerced medication, seclusion, manual restraint and other types of containment are comparatively low, and, usually, rates of conflict—for example, aggression, substance use, and absconding—are also low. Sometimes, however, wards maintain low rates of containment even when conflict rates are high. This study investigated wards with the counterintuitive combination of low containment and high conflict or high containment and low conflict.

Methods

The authors conducted a secondary analysis of cross-sectional data collected from 136 acute psychiatric wards across England in 2004–2005. The wards were categorized into four groups on the basis of median splits of containment and conflict rates: high conflict and high containment, high conflict and low containment, low conflict and low containment, and low conflict and high containment. Features significantly associated with these ward types were identified.

Results

Among the variables significantly associated with the various typologies, some—for example, environmental quality—were changeable, and others—such as social deprivation of the area served—were fixed. High-conflict, low-containment wards had higher rates of male staff and lower-quality environments than other wards. Low-conflict, high-containment wards had higher numbers of beds. High-conflict, high-containment wards utilized more temporary staff as well as more unqualified staff. No overall differences were associated with low-conflict, low-containment wards.

Conclusions

Wards can make positive changes to achieve a low-containment, nonpunitive culture, even when rates of patient conflict are high.

Differences in Diffusion of FDA Antidepressant Risk Warnings Across Racial-Ethnic Groups

DePetris A, Cook BL. — Wed, 01 May 2013 00:00:00 GMT

Objective

Numerous articles have identified that medical technologies diffuse more rapidly among non-Latino whites compared with other racial-ethnic groups. However, whether health risk warnings also diffuse differentially across racial-ethnic minority groups is uncertain. This study assessed racial-ethnic variation in children’s antidepressant use before and after the 2004 black-box warning concerning risks of antidepressants for youths.

Methods

Data consisted of responses for white, black, and Latino youths ages five through 17 from the 2002–2008 Medical Expenditure Panel Survey (N=44,422). The dependent variable was any antidepressant use in the prior year. Independent variables were race-ethnicity, year, psychological impairment, income, insurance status, region, and parents’ education level. Logistic regression models were used to assess antidepressant use conditional on race-ethnicity, time, interaction between race-ethnicity and time, need, socioeconomic status, and Institute of Medicine–concordant estimates of disparities in predicted antidepressant use before and after the warning.

Results

The warnings affected antidepressant use differentially for whites, blacks, and Latinos. Usage rates among whites decreased from 3.3 to 2.1 percentage points between prewarning and postwarning, whereas usage rates remained steady among Latinos and increased among blacks. Findings were significant in multiple regression analyses, in which predictions were adjusted for need.

Conclusions

The findings indicate that health safety information on antidepressant usage among children diffused faster among whites than nonwhites, suggesting the need to improve infrastructure for delivering important health messages to racial-ethnic minority populations.

Essential Evidence-Based Components of First-Episode Psychosis Services

Addington D, McKenzie E, Norman R, et al. — Wed, 01 May 2013 00:00:00 GMT

Objective

The purpose of this study was to identify essential evidence-based components of first-episode psychosis services.

Methods

The study was conducted in two stages. In the first stage a systematic review of both peer-reviewed and gray literature (January 1980 to April 2010) was conducted. Databases searched included MEDLINE, PsycINFO, and EMBASE. In the second stage, a consensus-building technique, the Delphi, was used with an international panel of experts. The panelists were presented the evidence-based components identified in the review, together with the level of supporting evidence for each component. They rated the importance of each component on a 5-point scale. A score of 5 was required to determine that a component was essential.

Results

The review identified 1,020 citations; abstracts were reviewed for relevance. A total of 280 peer-reviewed articles met criteria for relevance. Two researchers independently reviewed these articles and identified 75 unique service components. Each component was assigned a level of supporting evidence. Twenty-seven experts completed the first Delphi round, of whom 23 participated in the second. Consensus was achieved in two rounds, with 32 components rated as essential.

Conclusions

The two-step process yielded a manageable list of 32 evidence-based components of first-episode psychosis services. Given the proliferation of such services and the absence of an evidence-based fidelity scale, this list can form a foundation for developing a fidelity scale for such services. It may also be helpful to funders and providers as a summary of essential services.

Family Involvement, Medication Adherence, and Depression Outcomes Among Patients in Veterans Affairs Primary Care

Bolkan CR, Bonner LM, Campbell DG, et al. — Wed, 01 May 2013 00:00:00 GMT

Objective

Family involvement and social support are associated with recovery from mental disorders. This project explored how family involvement in health care and social support among depressed veterans in primary care related to medication adherence and depression outcomes.

Methods

During a longitudinal telephone survey, 761 Veterans Affairs (VA) primary care patients (mean age=60 years) with probable major depression were asked about depression symptoms, self-reported health, medication adherence, social support, family involvement with care, and satisfaction with clinicians’ efforts to involve the patients’ families in their care. Follow-up interviews at seven and 18 months assessed depression severity and medication adherence.

Results

Most participants lived with others (71%) and reported moderately high social support. Most participants (62%) reported being very likely to discuss treatment of a major medical condition with family, but 64% reported that VA providers had not involved the participants’ family in their care within the prior six months. In multivariate regression analyses, lower depression severity and better medication adherence over time were significantly linked to higher satisfaction with limited efforts by clinicians to involve families in care. Neither social support nor the extent of family involvement by itself was associated with outcomes.

Conclusions

The results suggested a link between patient satisfaction with family involvement by clinicians and clinical outcomes among depressed veterans. In addition, clinician responsiveness to patient wishes may be more important than the amount of family involvement per se. Further research is needed to clarify when and how clinicians should involve a patient’s family in depression treatment in primary care.

Forensic and Nonforensic Clients in Assertive Community Treatment: A Longitudinal Study

Beach C, Dykema L, Appelbaum PS, et al. — Wed, 01 May 2013 00:00:00 GMT

Objective

This study compared rates of arrest and incarceration, psychiatric hospitalization, homelessness, and discharge from assertive community treatment (ACT) programs for forensic and nonforensic clients in New York State and explored associated risk factors.

Methods

Data were extracted from the New York State Office of Mental Health’s Web-based outcome reporting system. ACT clients admitted between July 1, 2003, and June 30, 2007 (N=4,756), were divided into three groups by their forensic status at enrollment: recent (involvement in the past six months), remote (forensic involvement was more than six months prior), and no history. Client characteristics as of ACT enrollment and outcomes at one, two, and three years were compared over time.

Results

Clients with forensic histories had a significantly higher ongoing risk of arrest or incarceration, and those with recent criminal justice involvement had a higher risk of homelessness and early discharge from ACT. Psychiatric hospitalization rates did not differ significantly across groups. Rates of all adverse outcomes were highest in the first year for all ACT clients, especially for those with a recent forensic history, and rates of psychiatric hospitalization, homelessness, and discharge declined over time for all clients. For all ACT clients, homelessness and problematic substance abuse at enrollment were significant risk factors for arrest or incarceration and for homelessness on three-year follow-up.

Conclusions

Clients with recent forensic histories were vulnerable to an array of adverse outcomes, particularly during their first year of ACT. This finding highlights the need for additional strategies to improve forensic and other outcomes for this high-risk population.

Leverage, the Treatment Relationship, and Treatment Participation

McNiel DE, Gormley B, Binder RL. — Wed, 01 May 2013 00:00:00 GMT

Objective

Although many psychiatric patients experience various forms of pressure or leverage to participate in community treatment, the association between such experiences and treatment participation is controversial. This study evaluated the hypothesis that aspects of the treatment relationship, such as the working alliance, psychological reactance, and perceived coercion, could be important in understanding treatment adherence and satisfaction in a group of patients at risk of experiencing leverage.

Methods

A total of 198 outpatients at two community mental health centers completed structured interviews including measures of the treatment relationship, treatment participation, experience of leverage, and clinical functioning. Regression analyses were used to assess associations between the treatment relationship and treatment adherence and satisfaction while concomitantly considering experiences of leverage, demographic characteristics, and clinical functioning.

Results

Approximately four in ten participants reported experiencing some form of leverage to adhere to treatment during the previous six months, such as pressures related to the criminal justice system, money, housing, and outpatient commitment. Patients who perceived greater coercion to participate in treatment were more likely to report taking their medications as prescribed. Higher satisfaction with treatment was associated with lower perceived coercion, a better working alliance, and lower levels of psychological reactance.

Conclusions

Benefits in medication adherence associated with interventions that patients perceive as coercive may come at a cost of decreased satisfaction with treatment. Aspects of the treatment relationship hold promise for individualizing treatment planning in a way that addresses satisfaction as well as adherence.

Service Users’ Perceptions About Their Hospital Admission Elicited by Service User–Researchers or by Clinicians

O'Donoghue B, Roche E, Ranieri VF, et al. — Wed, 01 May 2013 00:00:00 GMT

Objective

Service users may express positive, ambivalent, or negative views of their hospital admission. The objective of this study was to determine whether the background of the interviewer—service user–researcher or clinician—influences the information elicited. The primary outcome was the level of perceived coercion on admission, and secondary outcomes were perceived pressures on admission, procedural justice, perceived necessity for admission, satisfaction with services, and willingness to consent to participate in the study.

Methods

Participants voluntarily and involuntarily admitted to three hospitals in Ireland were randomly allocated to be interviewed at hospital discharge by either a service user–researcher or a clinician. Interviewers used the MacArthur Admission Experience Survey and the Client Satisfaction Questionnaire.

Results

A total of 161 participants were interviewed. No differences by interviewer status or by admission status (involuntary or voluntary) were found in levels of perceived coercion, perceived pressures, procedural justice, perceived necessity, or satisfaction with services. Service users were more likely to decline to participate if their consent was sought by a service user–researcher (24% versus 8%, p=.003).

Conclusions

Most interviewees gave positive accounts of their admission regardless of interviewer status. The findings indicate that clinicians and researchers can be more confident that service users’ positive accounts of admissions are not attributable to a response bias. Researchers can also feel more confident in directly comparing the results of studies undertaken by clinicians and by service user–researchers.

The Utility of Patients’ Self-Perceptions of Violence Risk: Consider Asking the Person Who May Know Best

Skeem JL, Manchak SM, Lidz CW, et al. — Wed, 01 May 2013 00:00:00 GMT

Objective

The authors compared the predictive accuracy of two risk assessment methods that are feasible to use in routine clinical settings: brief risk assessment tools and patients’ self-perceptions of risk.

Methods

In 2002–2003, clinical interviewers met with 86 high-risk inpatients with co-occurring mental and substance use disorders (excluding schizophrenia) to carefully elicit the patients’ global rating of their risk of behaving violently and to complete two brief risk assessment tools—the Clinically Feasible Iterative Classification Tree (ICT-CF) and the Modified Screening Tool (MST). Two months after discharge, patients were reinterviewed in the community to assess their involvement in violence.

Results

Patients’ self-perceptions of risk performed quite well in predicting serious violence (area under the curve [AUC]=.74, sensitivity=50%), particularly compared with the ICT-CF (AUC=.59, sensitivity=40%) and the MST (AUC=.66, sensitivity=30%). Self-perceived risk also added significant incremental utility to these tools in predicting violence.

Conclusions

Patients’ self-perceptions hold promise as a method for improving risk assessment in routine clinical settings. Assuming it replicates and generalizes beyond the research context, this finding encourages a shift away from unaided clinical judgment toward a feasible method of risk assessment built on patient collaboration.

Trends in the Prevalence of Tobacco Use in the United States, 1991–1992 to 2004–2005

Secades-Villa R, Olfson M, Okuda M, et al. — Wed, 01 May 2013 00:00:00 GMT

Objective

This study examined changes in the prevalence of daily tobacco use in the United States between 1991–1992 and 2004–2005 by sociodemographic characteristics and psychiatric disorders.

Methods

Secondary analyses were performed using data from the National Longitudinal Alcohol Epidemiologic Survey, conducted in 1991–1992 (N=41,612), and wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions, conducted in 2004–2005 (N=34,653).

Results

Although the overall prevalence of past-year daily tobacco use decreased significantly, the reduction was not uniform across all segments of the population. In both surveys, past-year daily tobacco use was higher among respondents with a drug use disorder, an alcohol use disorder, and major depressive disorder and among individuals from socioeconomically disadvantaged groups. Declines in use were slower among individuals with a lifetime alcohol use disorder or major depressive disorder. The prevalence of past-year daily tobacco use did not decrease among Native Americans.

Conclusions

Individuals with substance use disorders or major depressive disorder and Native Americans reported higher rates of past-year daily tobacco use than the general population. These findings suggest the need to emphasize specific interventions for these groups.

Case Studies in Public-Sector Leadership: Addressing the Problem of Appointment Nonadherence With a Plan for a Walk-In Clinic

Runnels P. — Wed, 01 May 2013 00:00:00 GMT

Introduction by the column editors: This column is based on the use of an electronic mailing list (e-list) to generate a collaborative problem-solving process. Dr. Runnels asked e-list members of the American Association of Community Psychiatrists for suggestions regarding the establishment of a walk-in program for patients who regularly miss scheduled appointments. Readers are invited to submit suggestions for e-list discussions of management problems to column editors Jules M. Ranz, M.D., at jmr1@columbia.edu, or Susan M. Deakins, M.D., at smd3@columbia.edu.

Research and Services Partnerships: The Practice Research Network: A Successful Collaboration in Maryland

Sundeen SJ, Goldman HH, Nieberding DJ, et al. — Wed, 01 May 2013 00:00:00 GMT

The Practice Research Network (PRN) in Maryland, funded by a grant from the National Institute of Mental Health, extends the historically close collaborative relationship between the Department of Psychiatry at the University of Maryland and the Maryland Mental Hygiene Administration. The PRN focuses on the relationship between university-based investigators and participants in the public mental health system by using local mental health authorities (Core Service Agencies) as the point of contact. PRN staff serve as liaisons to foster partnerships between university researchers and practitioners. The PRN has identified a broader range of research participants by establishing contacts with provider agencies and stakeholder groups. It has addressed concerns about research participation by meeting with consumer and family groups and arranging for investigators to present research projects to stakeholders. This approach to developing a statewide network in support of mental health research can serve as a model for other state and university partnerships.

Evergreen: Creating a Child and Youth Mental Health Framework for Canada

Kutcher S, McLuckie A. — Wed, 01 May 2013 00:00:00 GMT

Mental disorders affect many young Canadians, and most do not access care, partly because of lack of health policy–driven programs and services. Recognizing this policy need, the Child and Youth Advisory Committee of the Mental Health Commission of Canada created Evergreen: A Child and Youth Mental Health Framework for Canada. Evergreen was designed as a framework to guide development, implementation, and review of child and youth mental health policies, plans, and services across Canada. This Open Forum report describes the framework and the innovative features used to create Evergreen, including the advisory committee structure, application of qualitative research methods and tools, informed public input, and use of online collaborative writing technologies.

A Case and Care Management Program to Reduce Use of Acute Care by Clients With Substance Use Disorders

Kirk TA, Jr., Di Leo P, Rehmer P, et al. — Wed, 01 May 2013 00:00:00 GMT

Objective

The authors describe outcomes of a targeted case and care management program for persons with addictions utilizing a high level of acute services in Connecticut’s system of care.

Methods

Administrative and cost data were analyzed from five consecutive years (2004–2008) (N=165,305 clients).

Results

In the year after enrollment, acute care episodes fell by 56% compared with the year before enrollment, with a 19% increase in engagement in nonacute care services. Paid units of acute care fell by 62%; paid units of nonacute care increased by 63%. Costs of care were approximately 46% lower in the year after enrollment.

Conclusions

Findings suggest that outcomes can be improved while costs and acute care demands can be reduced through combined use of care management to identify high users and case management to engage them in lower levels of care. The system was able to reallocate acute care resources to nonacute services and serve additional clients.

A Collaborative Care Approach to Depression Treatment for Asian Americans

Ratzliff AH, Ni K, Chan Y, et al. — Wed, 01 May 2013 00:00:00 GMT

Objective

This study examined effectiveness of collaborative care for depression among Asians treated either at a community health center that focuses on Asians (culturally sensitive clinic) or at general community health centers and among a matched population of whites treated at the same general community clinics.

Methods

For 345 participants in a statewide collaborative care program, use of psychotropic medications, primary care visits with depression care managers, and depression severity (as measured with the nine-item Patient Health Questionnaire) were tracked at baseline and 16 weeks.

Results

After adjustment for differences in baseline demographic characteristics, all three groups had similar treatment process and depression outcomes. Asian patients served at the culturally sensitive clinic (N=129) were less likely than Asians (N=72) and whites (N=144) treated in general community health clinics to be prescribed psychotropic medications.

Conclusions

Collaborative care for depression showed similar response rates among all three groups.

A Review of School Mental Health Programs in SAMHSA’s National Registry of Evidence-Based Programs and Practices

George M, Taylor L, Schmidt SC, et al. — Wed, 01 May 2013 00:00:00 GMT

Objective

School programs provided by the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-Based Programs and Practices (NREPP) were reviewed to describe program characteristics, costs, and ratings of research and dissemination.

Methods

Data were gathered from the NREPP to identify mental health programs adaptable for schools. Program costs and quality and dissemination ratings were examined as a function of program characteristics.

Results

School mental health programs constituted 32% of the registry, with 44% providing only materials at cost and 46% providing universal mental health promotion rather than intensive supports. Readiness for dissemination was poorer for programs providing only intensive supports, and quality of research increased as total costs of program implementation increased.

Conclusions

Mechanisms for tracking mental health promotion and treatment can be effective in disseminating information about evidence-based school programming. Assessing program transportability is necessary for decision making to match programs with the needs of particular schools and communities.

A Novel Intervention for Treatment of Suicidal Individuals

Alonzo D, Stanley B. — Wed, 01 May 2013 00:00:00 GMT

The Problem-Solving and Comprehensive Contact Intervention (PS-CCI) is a novel, manual-based intervention for adults presenting to the emergency department for treatment of suicidal ideation, attempts, or both. The purpose of the intervention, developed in 2008, is to facilitate individuals’ transition into outpatient care in order to improve their engagement in outpatient treatment and thereby reduce their risk of future suicidal behavior. Preliminary testing of the intervention occurred between 2008 and 2010.

Rural or Remote Psychiatric Rehabilitation (rPSR)

Rudnick A, Copen J. — Wed, 01 May 2013 00:00:00 GMT

Psychiatric rehabilitation has been developed, studied, and implemented primarily if not exclusively in urban settings, where formal and funded services are much more available than in rural and remote communities. This partly explains the well-known urban drift of many people with schizophrenia, resulting in their uprooting themselves from their original rural or remote communities. Such relocations can adversely affect recovery by disconnecting people who have disabling mental illnesses from people they know and love. Alternatively families sometimes move to urban settings with relatives who have mental illness, which may disrupt considerably more people’s lives. And some people with longstanding psychiatric disability have no choice (due to financial or other reasons) but to remain in their remote communities, whereas others simply choose to stay. Hence, rural or remote psychiatric rehabilitation (rPSR) would be a valuable addition to the mental health services system.

Effects of Point-of-Choice Prompts on Stair Usage in a Psychiatric Setting

Gorczynski PF, Faulkner GE, Cohn TA, et al. — Wed, 01 May 2013 00:00:00 GMT

To the Editor: Psychiatric settings and services have been described as potentially obesogenic because they provide opportunities for increased calorie intake and reduced energy expenditure (1). To supplement traditional weight-loss interventions that mainly target individual behavioral change and to address the higher prevalence of obesity among psychiatric inpatients, ecologically framed interventions are required. For example, in one uncontrolled study, changing how meals were served in a psychiatric ward led to significant weight loss (2).

The Need for Appropriate Use of Involuntary Commitment

Geller JL. — Wed, 01 May 2013 00:00:00 GMT

To the Editor: In an article in the February issue, McGarvey and colleagues (1) reported the results of a study of factors that play a role in decisions to initiate involuntary commitment among emergency evaluators employed by community service boards in Virginia. The authors conclude, “The findings provide a sound empirical basis for the claim that investing in a continuum of crisis stabilization and other intensive outpatient services would reduce the need for involuntary interventions.” But the article does not provide data to support this conclusion.

The Need for Appropriate Use of Involuntary Commitment: In Reply

McGarvey EL, Wanchek TN, Bonnie RJ. — Wed, 01 May 2013 00:00:00 GMT

In Reply: Dr. Geller does not deny that an expanded array of well-provided intensive community services might divert individuals in crisis from involuntary hospital admissions to voluntary community services. At the same time, we do not deny that effective use of involuntary interventions is an essential component of a well-designed services system. Indeed, liberalized commitment criteria and expanded authority to use mandatory outpatient treatment were included in the comprehensive reform package adopted in Virginia in the wake of the Virginia Tech tragedy.

Training Mental Health Professionals to Treat Tobacco Dependence

Mandel-Ricci J, Bresnahan M, Sacks R, et al. — Wed, 01 May 2013 00:00:00 GMT

To the Editor: Compared with the general population, individuals with serious mental illness are heavier smokers and have higher levels of nicotine dependence and higher relapse rates after quitting (1). Smoking rates among adults in New York City declined 31% between 2002 (21.5%) and 2011 (14.8%) (2); yet rates among persons with serious mental illness remain high. A 2010 New York City Department of Health and Mental Hygiene (DOHMH) survey of supportive housing program clients, including many with mental illness, found that 66% smoked (DOHMH, unpublished data, 2010). Evidence suggests that training health care professionals on smoking cessation has an impact on patient behavior (3). Thus the Communities Putting Prevention to Work initiative of the Centers for Disease Control and Prevention (4), which was implemented by DOHMH, focused on integrating tobacco dependence treatment into behavioral health services by implementing a train-the-trainer program for clinical and lay staff serving adults with serious mental illness.

Ben Behind His Voices: One Family’s Journey From the Chaos of Schizophrenia to Hope

Raymond KY. — Wed, 01 May 2013 00:00:00 GMT

Serious mental illness disrupts the lives of people with the illness and their families. Ben Behind His Voices, by Randye Kaye, presents a view of a family’s odyssey while dealing with schizophrenia.

Comprehensive Care of Schizophrenia: A Textbook of Clinical Management, 2nd edition

Frese FJ. — Wed, 01 May 2013 00:00:00 GMT

The editors of this volume, Dr. Jeffrey Lieberman and Dr. Robin Murray, are two of the world’s preeminent psychiatric researchers. Dr. Lieberman is the chairman of psychiatry at Columbia University as well as the president-elect of the American Psychiatric Association. Dr. Murray is a professor of psychiatry at the Institute of Psychiatry at the University of London. He is also a member of the Royal Society and has been knighted by the Queen of England.

Emotion Regulation in Psychotherapy: A Practitioner’s Guide

DeGrush E. — Wed, 01 May 2013 00:00:00 GMT

Robert Leahy, Dennis Tirch, and Lisa Napolitano are veterans in the field of therapy. Together they draw from the realms of cognitive therapy, cognitive-behavioral therapy, mindfulness practice, and compassion-based therapy. Their collective effort, Emotion Regulation in Psychotherapy, is a helpful manual for a wide variety of therapists in a wide variety of fields. Techniques to treat patients through emotion regulation can be applied to all levels of therapeutic interventions, from crisis stabilization to inpatient treatment to outpatient treatment maintenance. Any level or type of provider could use these techniques; they are equally useful to psychologists, social workers, physicians, nurse practitioners, and other health care providers.

Modern Community Mental Health: An Interdisciplinary Approach

Geller JL. — Wed, 01 May 2013 00:00:00 GMT

The book Modern Community Mental Health is an ambitious project. The editors inform the reader that they present 37 original chapters by an interdisciplinary cohort of leaders in the field of mental health to provide the “best knowledge within a realistic format to inform a current model of community mental health practices.” How did they do?

Resilience: The Science of Mastering Life’s Greatest Challenges

Ragins M. — Wed, 01 May 2013 00:00:00 GMT

The book Resilience is pleasant, informative, and useful. The authors have built upon their extensive interviews with prisoners of war, survivors of severe trauma, and highly trained special operation forces to identify ten factors of resilience. These are coping strategies, not inborn traits, that can be enhanced and used by any of us. Some are likely to be familiar to us, some less so, and some are unique frameworks for bringing things into better focus. These are the ten factors: maintain an optimistic but realistic outlook; confront your fears; rely on your own inner moral compass; draw on faith, religion, and spirituality; seek and accept social support—and give of yourself; identify and imitate sturdy role models; commit to good health and train to be physically fit; challenge and develop your mind and stay mentally sharp; show flexibility in response to crises and learn to problem solve; and find meaning and purpose in your life and opportunities for growth.

The Wisdom of Psychopaths: What Saints, Spies, and Serial Killers Can Teach Us About Success

Kellogg RE. — Wed, 01 May 2013 00:00:00 GMT

This book draws positive comparisons between the attributes of antisocial psychopaths, the serial killer profile, and the “functional psychopaths” among professions such as surgeons, high-powered executives, and politicians. The key shared characteristics between the serial killer profile and the successful professionals are ruthlessness, charm, focus, mental toughness, fearlessness, mindfulness, and action—dubbed the “Seven Deadly Wins.” The author makes the case for the evolutionary aspects of the nonviolent psychopathic profile in the modern world as an effective adaptive strategy leading to success and “getting what you want.” The author suggests that the difference between the violent and predatory psychopath and the functional psychopath is how the psychopathic characteristics are “dialed up” and in what context.

CIHS Updates Integrated Care Framework

Wed, 01 May 2013 00:00:00 GMT

Integration of primary care and behavioral health care is essential for improving health and lowering costs. Provisions in the Affordable Care Act are adding momentum to integration initiatives that have been implemented in recent years. However, the term “integration” is used inconsistently and applied to a wide variety of care models. Without an agreed-upon framework to classify integrated care settings more precisely, meaningful discussion and informed comparisons cannot move forward. The Center for Integrated Health Solutions (CIHS) has recently proposed a standard framework for classifying care settings according to their level of integration.

Kaiser Foundation Marks Third Anniversary of ACA

Wed, 01 May 2013 00:00:00 GMT

To mark the three-year anniversary of the Affordable Care Act (ACA), which was signed into law on March 23, 2010, the Kaiser Family Foundation has released an issue brief that summarizes tangible benefits and policy changes already “on the ground,” even though the date for full implementation of most ACA provisions is January 1, 2014. The issue brief summarizes changes that have already been made in in the areas of private insurance and health exchanges, Medicaid coverage, access to primary and preventive care, Medicare, and beneficiaries dually eligible for Medicaid and Medicare. Each summary is accompanied by links to other Kaiser resources that provide more detailed information.

News Briefs

Wed, 01 May 2013 00:00:00 GMT

Call for applications for the 2013 Psychiatric Services Achievement Awards: Innovative programs that deliver services to people with mental illness or mental disabilities, that have overcome obstacles, and that can serve as models for other programs are invited to enter the 2013 Psychiatric Services Achievement Awards competition. Two Gold Achievement Award winners will be chosen—an academically or institutionally sponsored program and a community-based program. The Awards Committee may also choose Silver and Bronze Award winners. The application deadline is May 16. More information about the awards, including links to descriptions of last year's winning programs and the application form, can be found on APA's Web site at www.psych.org/achievementawards.