Monday, October 11, 2004

Involuntary Outpatient Commitment, Community Treatment Orders, and Assisted Outpatient Treatment: What’s in the Data?
Article in the September Canadian Journal of Psychiatry - "Involuntary outpatient commitment (OPC) is a legal intervention designed to benefit persons with serious mental illness (SMI) who need ongoing psychiatric care and support to prevent relapse, hospital readmissions, homelessness, or incarceration but have difficulty following through with community-based treatment. Virtually all states in the US permit some form of OPC. Forty states and the District of Columbia have explicit OPC statutes, while several states are currently considering enacting or modifying existing OPC legislation (1–4). OPC has been enacted or is being considered in several other countries, including Israel, Canada, the UK, Australia, and New Zealand (5–11). OPC is also referred to as assisted outpatient treatment, community treatment orders (CTOs), and mandated outpatient treatment. In this paper, we refer to it generically as OPC. We discuss the empirical evidence for the effects of OPC on treatment outcomes. "  
  

Hospitalization in the First Year of Treatment for Schizophrenia
Article in the September Canadian Journal of Psychiatry - "Over the past decade, interest has increased in designing services to optimize care during the early stages of psychotic disorders. In designing these services, it will be important to study such service indicators as hospitalization rates and to investigate factors that may influence these indicators. The province of Nova Scotia is an advantageous setting in which to carry out such studies. Available administrative databases contain all inpatient admissions and outpatient psychiatric contacts. As do all Canadian provinces and territories, Nova Scotia provides universal access to health care. A prototype Early Psychosis Program, designed to enhance prompt assessment and optimize treatment, has been operating in the province since late 1995. The program has focused on education about the signs and symptoms of early psychosis while also providing expert clinical care for a self-selected convenience sample of first-episode patients. This study measured hospitalization rates during the first year of treatment for schizophrenia in Nova Scotia and identified factors that might influence those rates."  
  

Research Designs Need Not Exclude Suicide Risk
Psychiatric News story - "In routine clinical trials of new medications, patients with a history of suicidal behavior are typically excluded, so that the specific effect of drugs on suicidality is not known. Research on interventions for suicidal behavior is dogged by ethical problems: how to design a study that rigorously tests the effectiveness of treatment, but that adequately protects subjects at high risk of killing themselves. Yet it is possible to design a randomized, controlled trial that minimizes the risk of morbidity and mortality for suicidal patients while providing valuable data on effectiveness of interventions, according to Maria A. Oquendo, M.D., and colleagues, in a report in the August American Journal of Psychiatry."  
  

'Switching' Risks Minimal In Bipolar Treatment
Psychiatric News story - "Antidepressants can be both safe and effective in the treatment of bipolar depression, without risk of "switching" patients to mania. Antidepressants are effective in the treatment of bipolar depression and are safe when used for short-term treatment. That is the conclusion of new research whose findings do not support a risk of "switching" patients to mania. A wide-ranging review of data from randomized controlled trials of antidepressants in bipolar patients also found that selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are more prudent choices for first-line therapy than tricyclics. The data were reported in the September American Journal of Psychiatry..."  
  

Many in Assisted Living Have Mental Health Problems
HealthDayNews story at Yahoo - "Rates of mental health problems among elderly assisted living residents are higher than expected, says an Indiana University study in the October issue of the Journal of the American Geriatrics Society. Two-thirds of the 2,100 assisted living residents in the study showed signs of mental health problems. Half of them had dementia and a quarter of them showed signs of depression. More than half took psychotropic medications such as antipsychotics, sedatives or antidepressants..."