March 2005: This Month's Highlights
Special Focus on Quality of Care
As the management of schizophrenia and other serious psychiatric disorders has expanded beyond simply controlling symptoms, expectations about outcomes for this patient population have increased, and there has been greater emphasis on the quality of care delivered. This issue of Psychiatric Services includes seven articles and three brief reports on various aspects of quality of care. Topics covered include the quality of treatment for patients with schizophrenia (see page 273 and page 283), assessment of quality of life and other outcomes among persons with serious and persistent mental illness (page 292 and page 301), psychiatrists' assessments of their own ability to deliver high-quality care compared with those of other physicians (page 308), a comparison of the use of clozapine in a U.S. state and in a state of Australia (page 320), perceptions of quality of housing among persons with serious mental illness (page 315 and page 350), the association between the waiting time for an initial appointment and the rate of kept appointments at a community mental health center (page 344), and the identification and treatment of substance misuse in an inpatient setting (page 347). This month's contribution to Taking Issue also addresses this important theme in its discussion of measuring the effectiveness of outpatient care (see page 241).
Integrating Physical Activity Into Mental Health Services
In the general population, a strong relationship has been found between physical activity and both physical and mental health. However, researchers have only just begun to examine the impact of physical activity on the mental and physical health of individuals with serious and persistent mental illness. In an article in this issue of the journal, Caroline R. Richardson, M.D., and her coauthors note that physical activity has the potential to improve the quality of life of people with serious mental illness through two routes—by improving physical health and by alleviating psychiatric and social disability. These authors review the evidence for the benefits of physical activity and summarize what is currently known about the epidemiology of physical activity in this patient population. They present an overview of the components of effective physical activity interventions and argue that such interventions should become a routine part of comprehensive psychiatric care for persons with serious mental illness (see page 324). The Frontline Reports column presents companion case reports that describe various individual and group-based programs aimed at promoting physical activity among persons with mental illness, including individuals who have comorbid physical conditions (see page 353).
Diagnosis and Treatment of Insomnia
Insomnia is highly prevalent and is associated with significant personal and socioeconomic burden. However, it is largely underrecognized and is inadequately treated. Ruth M. Benca, M.D., Ph.D., reviewed the literature on insomnia and its treatment for the period 1970 to 2004 to understand why the treatment needs of people with insomnia continue to go unmet. Barriers to the appropriate recognition, diagnosis, and treatment of insomnia include misconceptions about its seriousness, about the advantages of treatment, and about the risks associated with using hypnotic medications to treat insomnia, the author notes. Both pharmacologic and nonpharmacologic therapies have demonstrated benefit, although pharmacologic treatment is of course associated with a greater risk of side effects. Commonly prescribed newer hypnotic medications have shown efficacy for sleep onset but limited efficacy for sleep maintenance; older agents, although effective for sleep maintenance, may produce substantial next-day residual effects. The author notes that treatment options that are currently available do not address the needs of difficult-to-treat patients with chronic insomnia, such as the elderly, and those with comorbid medical and psychiatric conditions (see page 332).
Briefly Noted…
• This month's Clinical Computing column describes the advantages of open-source software and a particular application—SQL Clinic—that can be used to create electronic medical records in mental health care facilities (see page 269).
• An approach to engaging formerly incarcerated clients in clinical training and group treatment that takes clients' "incarceration culture" into account is described in this month's Best Practices column (see page 265).
