Psychiatric Services (PSYCHIAT SERV)

Publications in this journal

• Article: Experiencing Community: Perspectives of Individuals Diagnosed as Having Serious Mental Illness

  Elizabeth Bromley, Sonya Gabrielian, B.S. Benjamin Brekke, Rohini Pahwa, Kathleen A. Daly, Ph.D. John S. Brekke, Joel T. Braslow
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  ABSTRACT: Objective Community integration is recognized as a crucial component of recovery from serious mental illness. Although the construct of community integration can be measured with structured instruments, little is known about the subjective and experiential meaning of community and community involvement for persons with serious mental illness. Methods In 2010, 30 individuals with serious mental illness treated in two public mental health clinics completed semistructured interviews that elicited the places and people that they associate with the experience of community and the larger meaning of community in their lives. Results Participants described four experiences as integral to their concepts of community: receiving help, minimizing risk, avoiding stigma, and giving back. Participants looked for communities that provide reliable support, and they described the need to manage community contact in order to protect themselves and others from their symptoms and from discrimination. Most participants experienced communities centered on mental health treatment or mentally ill peers as providing opportunities for positive engagement. Conclusions The experience of having a serious mental illness shapes preferences for and perceptions of community in pervasive ways. Participants described community involvement not as a means to move away from illness experiences and identities but as a process that is substantially influenced by them. Mental health communities may help individuals with serious mental illness to both manage their illness and recognize and enjoy a sense of community. The findings indicate the need for further research on the relationship between community integration and outcome in serious mental illness.
  Psychiatric Services 04/2013;
• Article: Does Assertive Community Outreach Improve Social Support? Results From the Lambeth Study of Early-Episode Psychosis

  Raymond Tempier, M.D, F.R.C.P.C, Lloyd Balbuena, M.S, Ph.D, Philippa Garety, F.B.Ps.S, Tom J. Craig, F.R.C.Psych
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  ABSTRACT: Objective: Specialized early intervention by a team providing assertive community treatment (ACT) is beneficial to the recovery, housing, and employment of individuals with schizophrenia, but few studies have examined its effect on social support. This study assessed whether the ACT model of care was related to clinical and social outcomes among patients who had experienced a first episode of psychosis. Methods: The sample was drawn from the Lambeth Early Onset Trial, a study of 144 patients in the United Kingdom who sought treatment for a first episode of psychosis between January 2000 and October 2001 and who were randomly assigned to a specialized early intervention modeled on ACT or standard care. The Positive and Negative Syndrome Scale, the Global Assessment of Functioning, and the Significant Others Scale were administered at six-month and 18-month follow-ups. Results: Data on social support were available at both follow-ups for 57 patients assigned to specialized care and 50 patients assigned to standard care. The two groups were similar in personal characteristics, relationship status, and living arrangements at baseline and at six-month follow-up, but by 18 months, patients in specialized care reported having a higher meanαSD number of significant others in their social networks than did standard care patients (2.40α1.20 and 1.71α1.06, respectively; p=.01). They also achieved superior clinical outcomes at 18 months, and these outcomes were associated with network size. Conclusions: Early intervention by using an ACT model of care may improve clinical results by reestablishing or maintaining bonds between patients and family, friends, and acquaintances. (Psychiatric Services doi: 10.1176/appi.ps.201100132)
  Psychiatric Services 01/2012;
• Article: M. Weissman, Y Neria, MJ. Gameroff, D J. Pilowsky, S. Shea, R. Lantigua, M. Olfson, Screening for Psychiatric Disorders in Primary Care: A Long Term Follow -Up of Untreated Patients. Psychiatric Services. Vol 61(2), 2010 (pp.151-9).

  M. Weissman, Y Neria, MJ. Gameroff, D J. Pilowsky, S. Shea, R. Lantigua, M. Olfson
  Psychiatric Services 01/2010;
• Article: K. Glover, MJ. Gameroff, M. Olfson, Y. Neria. Assault and Mental Disorder: A Cross-sectional Study of Urban Adult Primary Care Patients. Psychiatric Services. Vol 61, 2010 (pp 1018-1023).

  K. Glover, MJ. Gameroff, M. Olfson, Y. Neria
  Psychiatric Services 01/2010;
• Source

  Available from: psychiatryonline.org

  Article: A question of disclosure: reply.

  Howard H Goldman
  Psychiatric Services 09/2008; 59(8):935.
• Source

  Available from: psychiatryonline.org

  Article: A question of disclosure: reply.

  Kenneth Duckworth, Michael J Fitzpatrick
  Psychiatric Services 09/2008; 59(8):935-6.
• Source

  Available from: amykilbourne.com

  Article: Improving medical and psychiatric outcomes among individuals with bipolar disorder: a randomized controlled trial.

  Amy M Kilbourne, Edward P Post, Agnes Nossek, Larry Drill, Susan Cooley, Mark S Bauer
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  ABSTRACT: Comorbid medical conditions, notably cardiovascular disease, occur disproportionately among persons with bipolar disorder; yet the quality and outcomes of medical care for these individuals are suboptimal. This pilot study examined a bipolar disorder medical care model (BCM) and determined whether, compared with usual care, individuals randomly assigned to receive BCM care had improved medical and psychiatric outcomes. Persons with bipolar disorder and cardiovascular disease-related risk factors were recruited from a large Department of Veterans Affairs mental health facility and randomly assigned to receive BCM or usual care. BCM care consisted of four self-management sessions on bipolar disorder symptom control strategies, education and behavioral change related to cardiovascular disease risk factors, and promotion of provider engagement. Primary outcomes were physical and mental health-related quality of life; secondary outcomes included functioning and bipolar symptoms. Fifty-eight persons participated. Twenty-seven received BCM care, and 31 received usual care. The mean+/-SD age was 55+/-8 years, 9% were female, 90% were white, and 10% were African American. Repeated-measures analysis was used, and significant differences were observed between the two groups in change in scores from baseline to six months for the 12-Item Short-Form Health Survey (SF-12) subscale for physical health (t=2.01, df=173, p=.04), indicating that the usual care group experienced a decline in physical health over the study period. Change in SF-12 scores also indicated that compared with the usual care group, the BCM group showed improvements in mental health-related quality of life over the six-month study period; however, this finding was not significant. Compared with usual care, BCM care may have slowed the decline in physical health-related quality of life. Further studies are needed to determine whether BCM care leads to long-term positive changes in physical and mental health-related quality of life and reduced risk of cardiovascular disease among persons with bipolar disorder.
  Psychiatric Services 08/2008; 59(7):760-8.
• Article: Indicators of conformance with guidelines of schizophrenia treatment in mental health services.

  Paola Bollini, Sandro Pampallona, Salvatore Nieddu, Maurizio Bianco, Giuseppe Tibaldi, Carmine Munizza
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  ABSTRACT: The aim of this study was to develop indicators of conformance in clinical practice with guidelines for care in schizophrenia. Recommended guidelines rarely apply to all patients and need to allow for social ability, family context, and phase of the disorder. These indicators were therefore devised for tailoring to patient characteristics and allowing for factors that may justify the lack of adherence to clinical guidelines. A team of senior clinicians and methodologists reviewed three clinical guidelines (from the Schizophrenia Patient Outcomes Research Team, McEvoy and colleagues, and the National Institute for Health and Clinical Excellence) and defined criteria for their operationalization into clinical indicators. For each indicator, the team defined criteria for eligibility (requirements to be met to qualify for evaluation), conformance (criteria to be satisfied to comply with each recommendation), and moderators (factors that could justify the lack of application of a given recommendation). These indicators were tested with a random sample of 807 patients with schizophrenia or schizoaffective disorders in outpatient facilities, long-term residential facilities, and hospital units for acute care in the Piedmont region of Italy. A set of 15 indicators was derived, nine concerning pharmacological treatment and six for general care and psychosocial rehabilitation. Moderators such as patient or family refusal of antipsychotic treatment and the patient's level of disability helped to justify a considerable proportion of nonconformant care. The indicators developed are a simple and useful tool to monitor the conformance of care with recommended practices and to identify areas needing improvement.
  Psychiatric Services 08/2008; 59(7):782-91.
• Article: Privilege in the Federal Courts: should there be a "dangerous patient exception"?

  Paul S Appelbaum
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  ABSTRACT: Although a 1996 U.S. Supreme Court decision affirmed that therapists cannot be compelled to testify in federal proceedings about patients' disclosures, a footnote could be interpreted as creating a "dangerous patient exception" when there is a serious threat of harm. This column describes circuit courts' differing views about whether such an exception exists and the value of an exception. Although the footnote appears to indicate the Supreme Court's inclinations to create an exception to psychiatrist-patient privilege in some cases, opponents have made strong arguments that a dangerous patient exception would inhibit help seeking by those in whose treatment society has the strongest interest -- people who have harmed or are likely to harm others.
  Psychiatric Services 08/2008; 59(7):714-6.
• Article: Dialogues on mixed-methods and mental health services research: anticipating challenges, building solutions.

  Cynthia S Robins, Norma C Ware, Susan dosReis, Cathleen E Willging, Joyce Y Chung, Roberto Lewis-Fernández
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  ABSTRACT: Increasingly, contemporary mental health services research projects aim to combine qualitative and quantitative components. Yet researchers often lack theoretical and practical guidance for undertaking such studies. In September 2006 the authors convened under the auspices of the National Institute of Mental Health at a working conference, "Mixed Methods in Community-Based Mental Health Services Research." This meeting provided the opportunity for participants to share their experiences in conducting mixed-methods research, to critically consider problems they had encountered and their solutions, and to develop guiding principles for others conducting similar research. The authors' discussions, which are described in this article, emphasize that the problems encountered by mixed-methods research teams are rarely simple misunderstandings but often reflect epistemological differences that are overlooked in the study planning phases. Failure to acknowledge these different worldviews may result in significant tensions between members of the study team, use of qualitative methods that are insufficient or inappropriate for a particular research question, or serious conflicts when team members belatedly discover they are interpreting key concepts -- or each other's research techniques -- differently. The authors conclude that ongoing communication is the organizing principle for robust and effective mixed-methods research. Among the recommendations for preventing problems are collaboration between quantitative and qualitative researchers during the study design phase; open acknowledgement of the philosophical approaches brought to the study by various team members; and because not all challenges can be anticipated, a shared willingness to negotiate emerging problems.
  Psychiatric Services 08/2008; 59(7):727-31.
• Article: Self-directed care for adults with serious mental illness: the barriers to progress.

  Vidhya Alakeson
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  ABSTRACT: The President's New Freedom Commission on Mental Health identified self-directed care as one service innovation that could create a more consumer- and family oriented mental health system. Four years later, there are still fewer than 400 consumers in five states accessing self-directed care in the public mental health system. This Open Forum identifies three main barriers to explain this lack of progress: the absence of a strong evidence base to support the effectiveness of self-directed care for serious mental illness, uncertainty over the appropriate scope of self-directed care, and the absence of a sustainable source of funding. The introduction of the 1915(i) provision of the Social Security Act in 2007 appears to partly address the funding barrier to self-directed care. There is also a strong case for a large-scale evaluation of self-directed care for persons with serious mental illness to address the two remaining barriers to progress.
  Psychiatric Services 08/2008; 59(7):792-4.
• Article: Core elements of a public psychiatry fellowship.

  Jules M Ranz, Susan M Deakins, Stephanie M LeMelle, Stephen D Rosenheck, Sara L Kellermann
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  ABSTRACT: As the oldest, largest, and best known program for training psychiatrists to become public-sector leaders, the Columbia University Public Psychiatry Fellowship (PPF) at New York State Psychiatric Institute has frequently been consulted by other departments of psychiatry planning public and community fellowship programs. PPF's faculty has developed seven core elements for such training programs. The fellowship's longevity and the career paths of its graduates suggest that these core elements represent a best-practices model for fellowship training in public-community psychiatry.
  Psychiatric Services 08/2008; 59(7):718-20.
• Article: Sexuality among Chinese mental health consumers in halfway houses of Hong Kong.

  Iris W Y Wong, Winnie W S Mak
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  ABSTRACT: This study examined the sexuality of Chinese mental health consumers in halfway houses by incorporating the perspectives of consumers and staff. A total of 193 consumers and 88 staff from 11 halfway houses in Hong Kong completed surveys about sexual needs, attitudes, and expression. Chi square analyses and t tests examined group differences. Needs related to nine sex-related activities were examined: finding a partner, dating, marriage, procreation, use of sex workers (persons who exchange sex for money), viewing pornography, masturbation, intimate physical contacts, and sexual intercourse. From 14% to 49% of consumers reported needs related to the nine activities. Acceptance of activities was higher among staff, and consumers were more conservative in sexual attitudes. Staff's members' reported level of sexual knowledge and level of comfort in addressing sexual issues were higher than consumers' reports of their own knowledge and comfort. The findings can inform the development of sexuality training programs for staff and consumers in halfway houses.
  Psychiatric Services 08/2008; 59(7):803-7.
• Article: Views of persons with schizophrenia on their own disorder: an Italian participatory study.

  Lorenza Magliano, Andrea Fiorillo, Claudio Malangone, Heidegret Del Vecchio, Mario Maj
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  ABSTRACT: This study explored the views of 241 patients with schizophrenia about their own disorder. Patients' knowledge of their diagnosis, confidence that they will be well again, and perception of limitations in their own life as a result of the disorder were explored in relation to patients' opinions about the social consequences of schizophrenia. Study results were presented to participants, and suggestions were collected regarding how these study results should be used. Seventy-two respondents (30%) reported that a psychiatrist told them that they have schizophrenia. Respondents who were confident that they would be well again had a lower duration of contact with psychiatric services and a less pronounced perception of affective and social difficulties related to schizophrenia. Respondents who did not feel limited in their life by the disorder reported less social distance and more optimism about the usefulness of treatments. Participatory studies may provide ideas for a more constructive interaction between patients and professionals.
  Psychiatric Services 08/2008; 59(7):795-9.