Abstract: Objectives: To determine nationally representative estimates of the prevalence of depressive symptoms and factors associated with treatment among those with moderate to severe symptoms.Methods: A cross-sectional, retrospective analysis of adults age?18 in the 2005–2010 NHANES data who responded to the Patient Health Questionnaire (PHQ-9) was conducted (n=13,320). Depressive symptoms and severity were defined by PHQ-9 scores. Depression treatment was defined as receiving either antidepressants or seeing a mental health professional.
Importance Although substance use disorders (SUDs) are prevalent and associated with adverse consequences, treatment rates remain low. Unlike physical and mental health problems, treatment for SUDs is predominantly provided in a separate specialty sector and more heavily financed by public sources. Medicaid expansion under the Patient Protection and Affordable Care Act has the potential to increase access to treatment for SUDs but only if an infrastructure exists to serve new enrollees
Abstract: Objective: To improve clinic design, trial-and-error is commonly used to discover strategies that lead to improvement. Our goal was to predict the effects of various changes before undertaking them.Method: Systems engineers collaborated with staff at an integrated primary care–mental health care clinic to create a computer simulation that mirrored how the clinic currently operates. We then simulated hypothetical changes to the staffing to understand their effects on percentage of patients seen outside scheduled clinic hours and service completion time.Results: We found that, out of the change options being considered by the clinic, extending daily clinic hours by two and including an additional psychiatrist are likely to result in the greatest incremental decreases in patients seen outside clinic hours and in service time.Conclusion: Simulation in partnership with engineers can be an attractive tool for improving mental health clinics, particularly when changes are costly and thus trial-and-error is not desirable.
Abstract: Objectives: We compare findings from 10 years of experience evaluating physicians referred for fitness-to-practice assessment to determine whether those referred for disruptive behavior are more or less likely to be declared fit for duty than those referred for mental health, substance abuse or sexual misconduct.Method: Deidentified data from 381 physicians evaluated by the Vanderbilt Comprehensive Assessment Program (2001–2012) were analyzed and compared to general physician population data and also to previous reports of physician psychiatric diagnosis found by MEDLINE search.Results: Compared to the physicians referred for disruptive behavior (37.5% of evaluations), each of the other groups was statistically significantly less likely to be assessed as fit for practice [substance use, %: odds ratio (OR)=0.22, 95% confidence interval (CI)=0.10–0.47, P
Importance There have been recent calls for increased access to mental health services, but access may be limited owing to psychiatrist refusal to accept insurance. Objective To describe recent trends in acceptance of insurance by psychiatrists compared with physicians in other specialties. Design, Setting, and Participants We used data from a national survey of office-based physicians in the United States to calculate rates of acceptance of private noncapitated insurance, Medicare, and Medicaid by psychiatrists vs physicians in other specialties and to compare characteristics of psychiatrists who accepted insurance and those who did not
Abstract: Objective: Influenza epidemics can have consequences in terms of morbidity and mortality for the patients. This work assesses influenza outbreaks in order to validate and optimize alert and control measures in a psychiatric hospital.Method: The prospective monitoring of influenza episodes was conducted for 8 years in 19 units of a mental health hospital. Rapid influenza diagnostic tests were used.
Importance Established nosology identifies schizoaffective disorder as a distinct category with boundaries separating it from mood disorders with psychosis and from schizophrenia. Alternative models argue for a single boundary distinguishing mood disorders with psychosis from schizophrenia (kraepelinian dichotomy) or a continuous spectrum from affective to nonaffective psychosis. Objective To identify natural boundaries within psychotic disorders by evaluating associations between symptom course and long-term outcome
Importance In addition to dopaminergic hyperactivity, hypofunction of the N -methyl- d -aspartate receptor (NMDAR) has an important role in the pathophysiology of schizophrenia. Enhancing NMDAR-mediated neurotransmission is considered a novel treatment approach.
Abstract: Objective: To improve clinic design, trial-and-error is commonly used to discover strategies that lead to improvement. Our goal was to predict the effects of various changes before undertaking them.Method: Systems engineers collaborated with staff at an integrated primary care–mental health care clinic to create a computer simulation that mirrored how the clinic currently operates.
Importance Up to 1 million persons die by suicide annually. However, a lack of risk markers makes suicide risk assessment one of the most difficult areas of clinical practice. Objective To assess psychotic symptoms (attenuated or frank) as a clinical marker of risk for suicide attempt