January 2006: This Month's Highlights
Mental Health in General Medical Settings
Three papers in this issue are related to the interface between psychiatry and general medical care. In the lead article, Jürgen Unützer, M.D., M.P.H., and coauthors discuss a background report prepared to support the deliberations and recommendations of the Subcommittee on Mental Health Interface With General Medicine, one of 15 subcommittees of the President's Commission on Mental Health. This paper is the first in a series of papers to be published in Psychiatric Services that will examine the goals established by the Commission and their implementation. The authors of this first article present recommendations for achieving high-quality care for common mental disorders at the interface of general medicine and mental health and for overcoming barriers and facilitating use of evidence-based quality improvement models (page 37). One of the key issues from the Commission's report—recovery—is highlighted in an Open Forum piece by Sandra G. Resnick, Ph.D., and Robert A. Rosenheck, M.D., who discuss parallels between the recovery movement and the positive psychology movement (page 120). In another article, Lisa S. Meredith, Ph.D., and associates report on their study of factors associated with the successful implementation, maintenance, and spread of quality improvement efforts for the treatment of depression in primary care. The study was based on data from the Institute for Healthcare Improvement's Breakthrough Series for Depression. The authors found that, despite evidence of substantial challenges, the implementation and maintenance of these measures had been broadly successful (page 48).
Mood disorders
In addition to the above-mentioned paper by Meredith and associates on improving the quality of depression care, this month's issue includes a report on factors related to treatment adherence among veterans with bipolar disorder. The authors—Martha Sajatovic, M.D., and colleagues—conducted a cross-sectional analysis of patient characteristics, features of the patient-provider relationship, and barriers to care as they related to self-reported treatment adherence in this veteran sample. They found that individuals with bipolar disorder who were adherent to medication differed from those who were not adherent—for example, those who were not adherent were more likely to have a current substance use disorder, and those who were adherent took a greater number of different medications. The results of this study suggest that treatment adherence is a multidimensional entity and includes not only patient characteristics but also factors related to patient-provider interactions (see page 56).
Alcohol and drug abuse
Another important theme of this issue of the journal is alcohol and drug abuse. Li-Tzy Wu, Sc.D., and Chris L. Ringwalt, Dr.P.H., present the results of a study of the use of and perceived need for alcohol treatment services among adolescents who had received mental health services compared with same-aged adolescents who did not receive such services. The study data were drawn from the 2000 and 2001 National Household Surveys on Drug Abuse (see page 84). Susan E. Stockdale, Ph.D., and her coauthors discuss their study of the level of transient and persistent need for alcohol, drug, and mental health services and unmet need over time among respondents to the Health Care for Communities (HCC) household telephone survey (page 93). In addition, in the Innovations: Alcohol & Drug Abuse column, Robert F. Forman, Ph.D., examines the availability of controlled substances on the Internet and the challenges this poses for individuals who are trying to overcome addiction (page 31). Two additional articles on the drug and alcohol abuse theme also examine the important issue of trauma. Lisa R. Cohen, Ph.D., and Denise A. Hien, Ph.D., assessed the effect of cognitive-behavioral therapy on a range of problems associated with complex trauma in a sample of women with comorbid substance use disorders and posttraumatic stress disorder (page 100). Finally, Quyen Q. Tiet, Ph.D., and colleagues present their study of rates of sexual and physical abuse and suicide attempts among male and female patients of the Department of Veterans Affairs system who sought treatment for substance abuse or other psychiatric disorders. The study also addressed associations between sexual and physical abuse and recent suicide attempts among men (page 107).
Briefly Noted …
• A report on the 2005 Institute on Psychiatric Services highlights current issues in public-sector psychiatry (page 12).
• The Law & Psychiatry column editor reviews the column's 25-year history (page 18).
• The Innovations: Child & Adolescent Psychiatry column describes a transition program for pediatric inpatients that was underway in New Orleans pre-Hurricane Katrina (page 31).
