Treatment adherence with lithium and anticonvulsant medications among patients with bipolar disorder.

Objective: Nonadherence limits the effectiveness of medications among patients with bipolar disorder. This study examined adherence with lithium and anticonvulsant medication among patients with bipolar disorder receiving treatment in Department of Veterans Affairs (VA) settings.

Methods: Patients receiving treatment in the VA for bipolar disorder during federal fiscal year 2003 (FY03) and receiving lithium or anticonvulsant medication were identified (N=44,637) by using the VA's National Psychosis Registry.

Social support among veterans with serious mental illness.

Background: We determined whether patients with serious mental illness were more likely to report low social support than those without serious mental illness.

Method: We conducted a national, cross-sectional study of VA patients in Fiscal Year 1999 who were diagnosed with a serious mental illness, as well as a random sample of VA patients without a diagnosis of serious mental illness (N = 8,547) from the National Psychosis Registry who also completed the VA's Large Health Survey of Veteran Enrollees (LHSV) 9-item questionnaire on social support. Using generalized estimating equations; we assessed patient's likelihood of reporting low social support, while controlling for patient socio-economic and clinical factors.

Veterans Affairs Health System and mental health treatment retention among patients with serious mental illness: evaluating accessibility and availability barriers.

Objective: We examine the impact of two dimensions of access-geographic accessibility and availability-on VA health system and mental health treatment retention among patients with serious mental illness (SMI).

Methods: Among 156,631 patients in the Veterans Affairs (VA) health care system with schizophrenia or bipolar disorder in fiscal year 1998 (FY98), we used Cox proportional hazards regression to model time to first 12-month gap in health system utilization, and in mental health services utilization, by the end of FY02. Geographic accessibility was operationalized as straight-line distance to nearest VA service site or VA psychiatric service site, respectively.

Oral health in Veterans Affairs patients diagnosed with serious mental illness.

Objectives: We evaluated patient and medication treatment factors associated with self-reported oral health status in patients diagnosed with serious mental illness (SMI) in a large, national sample of patients in the Veterans Affairs (VA) health system.

Methods: 4,769 patients (mean age = 55, 7.8 percent women) were included from the VA's 1999 National Psychosis Registry (NPR) for whom the oral health information gathered by the VA's Large Health Survey of Veterans was available.

Long-term antipsychotic polypharmacy in the VA health system: patient characteristics and treatment patterns.

Objective: Although antipsychotic polypharmacy is being prescribed with increasing frequency, few studies have described patient characteristics and treatment patterns associated with long-term use of this treatment strategy.

Methods: By using data from the National Psychosis Registry of the Department of Veterans Affairs, 5,826 patients with schizophrenia or schizoaffective disorder who received long-term antipsychotic polypharmacy (simultaneous treatment with two or more antipsychotics for 90 or more days) during fiscal year 2000 and 39,745 patients who received long-term antipsychotic monotherapy were identified. By using multivariate regression models, patient demographic and clinical characteristics, antipsychotic dosages, and use of antiparkinson and adjunctive psychotropic medications were compared between the two groups.

Access to and satisfaction with care comparing patients with and without serious mental illness.

Objectives: We compared perceived access to and satisfaction with health care between patients diagnosed with serious mental illness (SMI: schizophrenia or bipolar disorder) and among those with no SMI diagnosis.

Method: We conducted a national, cross-sectional study of VA patients in Fiscal Year (FY) 1999 (N = 7,187) who completed the VA's Large Health Survey of Veteran Enrollees (LHSV) section on access and satisfaction and either received a diagnosis of schizophrenia or bipolar disorder, or did not and were randomly selected from the general non-SMI VA patient population (non-SMI group). We compared the probability of perceived poor access and dissatisfaction using multivariable logistic regression adjusting for patient covariates.

Age comparison of treatment adherence with antipsychotic medications among individuals with bipolar disorder.

Background: Few studies have evaluated medication adherence among older vs younger individuals with bipolar disorder (BPD). We compared adherence with antipsychotic medication among older (age 60 and older) and younger individuals using a large case registry (n = 73,964).

Methods: Adherence was evaluated using the medication possession ratio (MPR) for patients receiving antipsychotic medication.

Late-life depression and alcoholism.

The relationship between alcohol use and later-life depression is complex. At-risk and problem drinking elevates the risk of depressive symptoms. The co-occurrence of alcohol use disorders and depression increases the potential for poor mental and physical health outcomes in older adults.

Depression in veterans with Parkinson's disease: frequency, co-morbidity, and healthcare utilization.

Objective: To determine the frequency of depression in Parkinson's disease (PD) in routine clinical care, and to examine its association with co-morbid psychiatric and medical conditions and healthcare utilization.

Methods: Depression diagnoses and healthcare utilization data for all male veterans with PD age 55 or older seen in fiscal year 2002 (n = 41,162) were analyzed using Department of Veterans Affairs (VA) national databases. Frequencies of co-morbid disorders and healthcare utilization were determined for depressed and non-depressed patients; associations with depression were examined using multivariate logistic regression models.

A tailored smoking, alcohol, and depression intervention for head and neck cancer patients.

Background: Smoking, alcohol use, and depression are interrelated and highly prevalent in patients with head and neck cancer, adversely affecting quality of life and survival. Smoking, alcohol, and depression share common treatments, such as cognitive behavioral therapy and antidepressants. Consequently, we developed and tested a tailored smoking, alcohol, and depression intervention for patients with head and neck cancer.

Antipsychotic adherence over time among patients receiving treatment for schizophrenia: a retrospective review.

Objective: Approximately 40% of patients with schizophrenia are poorly adherent to their antipsychotics at any given time. However, little is known about patients' adherence over time, although this has important services implications. We examined antipsychotic adherence over 4 years at the aggregate and the individual level among a large cohort of patients.

Using the addiction severity index to predict mental and medical health service utilization.

This study assessed the utility of adding the Addiction Severity Index (ASI) to demographic and clinical diagnostic information for the purpose of predicting subsequent substance use disorder service use, and use of other healthcare services by 260 veterans admitted for outpatient substance use disorder treatment. Data collected included demographics, clinical diagnoses, assessment data from the ASI, as well as measures of six-month health service utilization (e.g.

Recognition of co-occurring medical conditions among patients with serious mental illness.

We determined whether patients with serious mental illness (SMI) were less likely than non-SMI to self-report having a medical condition that was recorded in their medical record. We included all patients from the VA National Psychosis Registry diagnosed with SMI and a random sample of non-SMI patients in fiscal year 1999 who completed the Large Health Survey of Veteran Enrollees (N = 35,837). Among patients with diagnoses for any of 11 conditions recorded in administrative data, we evaluated whether patients reported having that same condition in the survey, using multivariable logistic regression and generalized estimating equations.

Screening psychiatric emergency department patients with major mental illnesses for at-risk drinking.

Objective: This study determined the prevalence of at-risk drinking in a psychiatric emergency service and compared the characteristics and functioning of at-risk drinkers with schizophrenia or bipolar disorder with those of at-risk drinkers with depression or anxiety disorders.

Methods: Adult patients who entered the psychiatric emergency service and met study criteria were surveyed.

Results: A total of 148 participants had schizophrenia or bipolar disorder, and 242 had depression or anxiety.

PRISM-E: comparison of integrated care and enhanced specialty referral in managing at-risk alcohol use.

Objective: This study was part of the Primary Care Research in Substance Abuse and Mental Health for the Elderly study (PRISM-E) and determined the relative effectiveness of two different models of care for reducing at-risk alcohol use among primary care patients aged 65 and older.

Methods: This multisite study was a randomized clinical trial comparing integrated care with enhanced specialty referral for older primary care patients screened and identified to have at-risk drinking.

Results: Before the study, the 560 participants consumed a mean of 17.

What happened to lithium? Antidepressant augmentation in clinical settings.

Objective: Antidepressant augmentation is recommended when patients do not respond to antidepressant monotherapy. However, little is know about antidepressant augmentation in clinical settings and whether these practices reflect the research evidence.

Method: The authors identified 244,859 patients in Veterans Administration mental health settings with a diagnosis of depression and an antidepressant prescription during fiscal year 2002.

Rates and predictors of depression treatment among pregnant women in hospital-affiliated obstetrics practices.

Objective: The purpose of this study was to provide information on rates of depression treatment among pregnant women at risk for depression and among those with clinician-diagnosed current major depressive disorder (MDD) and to examine predictors of depression treatment.

Method: Women seeking prenatal care completed a screening survey (including the Center for Epidemiological Studies-Depression Scale) in several hospital-based obstetrics clinics. Women identified as high risk for depression completed diagnostic interviews (n=276) during pregnancy, consisting of the Structured Clinical Interview for DSM-IV, measures of depression symptom severity (Beck Depression Inventory-II), health functioning (SF-36) and current and past psychiatric treatment.

Psychiatric comorbidity in older adults with bipolar disorder.

Introduction: Comorbidity patterns and correlates among older adults with bipolar disorder (BPD) are not well understood. The aim of this analysis was to examine the prevalence of comorbid PTSD and other anxiety disorders, substance abuse and dementia in a population of 16,330 geriatric patients with BPD in a Veterans Health Administration administrative database.

Methods: Patients were identified from case registry files during Federal Fiscal Year 2001(FY01).

The efficacy of two brief intervention strategies among injured, at-risk drinkers in the emergency department: impact of tailored messaging and brief advice.

Objective: This study used a randomized controlled trial design to compare the effectiveness of four interventions at reducing alcohol consumption, consequences, and heavy episodic drinking among injured, at-risk drinkers in the emergency department (ED).

Method: Injured patients (n=4,476) completed a computerized survey; 575 at- risk drinkers were randomly assigned to one of four intervention conditions: tailored message booklet with brief advice, tailored message booklet only, generic message booklet with brief advice, and generic message booklet only. Regression models using the generalized estimating equation approach were constructed comparing the intervention conditions at baseline, 3-month follow-up, and 12-month follow-up.

Treatment adherence with antipsychotic medications in bipolar disorder.

Objectives: Atypical antipsychotic medications are a relatively new, increasingly prominent component of the treatment armamentarium for bipolar disorder. Information on adherence with antipsychotics among individuals with bipolar disorder in general, and atypical antipsychotics in particular, is currently quite limited. Using data from the VA National Psychosis Registry, we examined adherence with antipsychotic medications among patients with bipolar disorder (n = 73,964).

Long-term combination antipsychotic treatment in VA patients with schizophrenia.

Treatment guidelines consider antipsychotic monotherapy the standard of care for patients with schizophrenia. However, previous studies have reported widely varying, and sometimes high, rates of antipsychotic polypharmacy. We identified 61,257 VA patients with schizophrenia in fiscal year 2000 who had >or=90 non-institutionalized days and one or more fills of antipsychotic medications.

Menopause knowledge and subjective experience among peri- and postmenopausal women with bipolar disorder, schizophrenia and major depression.

This study examined concerns regarding menopause among women with schizophrenia/schizoaffective disorder (N = 30), women with bipolar disorder (N = 25), and women with major depression (N = 36). The three groups were compared regarding knowledge of menopause, expectations of effect of menopause, and menopause-related quality of life. All women had deficits in fund of knowledge regarding menopause.

Outpatient visit chaining among patients with serious mental illness.

Background: To reduce travel burdens, patients may coordinate outpatient services to receive multiple encounters during a single day. Unmeasured visit "chaining" may bias estimates of the impact of accessibility barriers when utilization volume is measured using visit days. No studies have evaluated differential encounter chaining by distance.

Menopause-related quality of life in chronically mentally ill women.

Objective: Menopause is an important life event that has not yet been well characterized among women with severe mental illness. Our goal was to evaluate menopause-related quality of life among severely mentally ill women.

Method: We conducted a cross-sectional assessment of perimenopausal and postmenopausal women, ages 45-55, diagnosed with schizophrenia/schizoaffective disorder, bipolar disorder, or major depression, who were receiving inpatient or outpatient psychiatric care.