Psychiatric Disease Preceding Intracranial Tumor Diagnosis: Investigating the Association.

Objective: Here, we examine rates of intracranial tumor diagnoses in patients with and without comorbid psychiatric diagnoses to better understand how psychiatric disease may alter risk profiles for brain tumor diagnosis.

Methods: We used a longitudinal version of the California Office of Statewide Health Planning and Development (OSHPD) database, which includes all inpatient admissions in California from 1995 to 2010. We examined patients with confirmed hospital admissions from 1997 to 2004.

Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs.

Objective: The assessment and remediation of boundary-challenged healthcare professionals is enhanced through examination of individual risk factors. We assessed three such factors--attachment style, childhood trauma and maladaptive beliefs--in 100 attendees (mostly physicians) of a CME professional boundaries course. We propose a theoretical model which draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations.

Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs.

Objective: The assessment and remediation of boundary-challenged health care professionals is enhanced through examination of individual risk factors. We assessed three such factors - attachment style, childhood trauma and maladaptive beliefs - in 100 attendees (mostly physicians) of a continuing medical education (CME) professional boundaries course. We propose a theoretical model that draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations.

Incarceration among adults who are in the public mental health system: rates, risk factors, and short-term outcomes.

Objective: Incarceration of people with mental illness has become a major social, clinical, and economic concern, with an estimated 2.1 million incarcerations in 2007. Prior studies have primarily focused on mental illness rates among incarcerated persons.

Predisposing, enabling, and need factors associated with high service use in a public mental health system.

The purpose of this study was twofold: (1) To investigate the individual- and system-level characteristics associated with high utilization of acute mental health services according to a widely-used theory of service use-Andersen's Behavioral Model of Health Service Use -in individuals enrolled in a large, public-funded mental health system; and (2) To document service utilization by high use consumers prior to a transformation of the service delivery system. We analyzed data from 10,128 individuals receiving care in a large public mental health system from fiscal years 2000-2004. Subjects with information in the database for the index year (fiscal year 2000-2001) and all of the following 3 years were included in this study.

Increased Framingham 10-year risk of coronary heart disease in middle-aged and older patients with psychotic symptoms.

Objective: The Framingham 10-risk of coronary heart disease (CHD) has been a widely studied estimate of cardiovascular risk in the general population. However, few studies have compared the relative risk of developing CHD in antipsychotic-treated patients with different psychiatric disorders, especially in older patients with psychotic symptoms. In this study, we compared the 10-year risk of developing CHD among middle-aged and older patients with psychotic symptoms to that in the general population.

A randomized study comparing the treatment environment in alternative and hospital-based acute psychiatric care.

Objective: Programs that offer alternatives to hospital-based acute psychiatric care have reported promising results of lower costs, equivalent or superior outcomes, and greater patient satisfaction. This study supplements previous research that compared the outcomes, satisfaction, and cost of hospital-based care and one such alternative program, short-term acute residential treatment (START), with an analysis of patient and staff perceptions of the treatment environments.

Methods: Patients who participated were all veterans and were randomly assigned to receive treatment in a hospital psychiatric unit (N=45) or in START (N=48).

Association of posttraumatic stress disorder with increased prevalence of metabolic syndrome.

Objective: Few studies have compared prevalence rates of metabolic abnormalities in antipsychotic-treated patients with different psychiatric disorders, including posttraumatic stress disorder (PTSD). In this study, we examined components of metabolic syndrome among middle-aged and older patients with psychiatric disorders.

Method: In the study, 203 outpatients older than 40 years and with psychotic symptoms that needed antipsychotic treatment were enrolled.

Psychotropic medication nonadherence among United States Latinos: a comprehensive literature review.

Objective: Psychotropic medication nonadherence is a major public health problem, but few studies have focused on Latinos. The authors systematically reviewed the literature on rates of and factors influencing antipsychotic, antidepressant, and mood stabilizer nonadherence among U.S.

Physical and mental health-related quality of life among older people with schizophrenia.

Objective: Since the time of Kraeplin, schizophrenia has been thought of as a disorder with progressive deterioration in functioning. An important aspect of functioning is both physical and mental health-related quality of life (HRQoL). The objective of this study was to examine the relationship of age to both mental and physical aspects of HRQoL in individuals with schizophrenia as compared to normal comparison subjects (NCs).

Initiation and use of public mental health services by persons with severe mental illness and limited english proficiency.

Objective: Few studies have examined the effect of limited English proficiency on use of mental health services by persons with mental illness from ethnic minority groups who are uninsured or publicly insured. This study examined how indigent or publicly insured Latino and Asian adults with limited English proficiency initially accessed the public mental health system and how their use of services changed over time compared with English-proficient peers.

Methods: Data from San Diego County for fiscal years 2000-2005 were used to examine point of first contact and use of inpatient, emergency, and outpatient services in the 18 subsequent months among 9,243 clients with a psychiatric diagnosis of schizophrenia, bipolar disorder, or major depression.

A longitudinal study of the use of mental health services by persons with serious mental illness: do Spanish-speaking Latinos differ from English-speaking Latinos and Caucasians?

Objective: Reports of mental health care use by Latinos compared to Caucasians have been mixed. To the authors' knowledge, no large-scale studies have examined the effects of language on mental health service use for Latinos who prefer Spanish compared to Latinos who prefer English and to Caucasians. Language is the most frequently used proxy measure of acculturation.

Antipsychotic polypharmacy trends among Medicaid beneficiaries with schizophrenia in San Diego County, 1999-2004.

Objective: This study examined trends and costs of second-generation antipsychotic polypharmacy among Medicaid beneficiaries with schizophrenia in San Diego County.

Methods: Medicaid data were used to identify 15,962 persons with schizophrenia receiving antipsychotic medications between 1999 and 2004. The yearly proportion of beneficiaries receiving second-generation antipsychotic polypharmacy, duration of polypharmacy, inpatient admissions, and pharmaceutical costs were examined.

Unmet needs for services for older adults with mental illness: comparison of views of different stakeholder groups.

Objective: The authors assessed the need for mental health services among older adults in San Diego County, California, by determining what needs were not being addressed by existing services, what services were necessary to address these needs, and how much consensus there was among different stakeholders with respect to the problems and solutions related to service delivery.

Methods: Semistructured interviews were conducted with 23 health care and social service providers and administrators, 16 services consumers and other older adults (55 years of age and older), and 19 caregivers/family members and patient/client advocates. This was followed by four focus groups comprised of 18 providers and administrators, six focus groups comprised of 50 consumers and other older adults, and five focus groups comprised of 39 caregivers (family members and advocates).

Building blocks of successful aging: a focus group study of older adults' perceived contributors to successful aging.

Objective: The purpose of this study was to solicit the opinions of older adults about factors related to successful aging using focus group methods.

Methods: Twelve focus groups were conducted with an average of six individuals per group. Participants included 72 community-dwelling older adults (age range: 60-99 years) recruited primarily from retirement communities in San Diego County, California.

Multimedia educational aids for improving consumer knowledge about illness management and treatment decisions: a review of randomized controlled trials.

Psychiatric practice is becoming increasingly more complex in terms of the available treatment options, use of new technologies for assessments, and a need for psychiatric patients and their caregivers to be familiar with general medical procedures. This trend will only intensify in the years to come. Routine methods of providing information relevant to clinical decision making about healthcare evaluations or management are often suboptimal.

Diagnostic variability for schizophrenia and major depression in a large public mental health care system dataset.

Administrative datasets can provide information about mental health treatment in real world settings; however, an important limitation in using these datasets is the uncertainty regarding psychiatric diagnosis. To better understand the psychiatric diagnoses, we investigated the diagnostic variability of schizophrenia and major depression in a large public mental health system. Using schizophrenia and major depression as the two comparison diagnoses, we compared the variability of diagnoses assigned to patients with one recorded diagnosis of schizophrenia or major depression.

Costs of community-based public mental health services for older adults: variations related to age and diagnosis.

Background: Several studies have examined service use among older adults although, to our knowledge, none has examined costs from a systems perspective. This study examined use and costs of mental health services among older adults in San Diego County in order to determine how expenditures and modes of service varied by age cohort and psychiatric diagnosis.

Methods: Utilization data from San Diego County Adult and Older Adult Mental Health Services (AOAMHS) were used to identify older adults (age > or = 60) receiving services in the community during fiscal year 2003-2004.

Schizophrenia in late life: emerging issues.

Schizophrenia in late life is emerging as a major public health concern worldwide. We discuss several areas of research and clinical care that are particularly pertinent to older persons with schizophrenia, including the public health challenge and the cost of care. We then discuss clinical issues relevant to late-life schizophrenia (course of illness and cognition), medical care and comorbidity in older psychiatric patients (general and illness-related), and treatment concerns related to the use of atypical antipsychotics in older persons with psychosis (efficacy and side effects).

Use of Primary Care and by Middle Aged and Older Persons with Schizophrenia.

INTRODUCTION: Comorbid medical conditions and receipt of primary medical care are important aspects of healthcare for older persons with schizophrenia. This study describes the prevalence of comorbid medical conditions and the factors associated with the use of primary care treatment in a group of middle-aged and older persons with schizophrenia. METHODS: Using baseline data from an ongoing study of functional skills training (N= 236), we determined the self-reported prevalence of 8 common medical conditions.

Differences in clinical features and mental health service use in bipolar disorder across the lifespan.

Objective: Because of the scarcity of research in geriatric bipolar disorder, the authors examined the prevalence, clinical features, and service use of persons with bipolar disorder among older adults treated in a large public mental health system.

Methods: From San Diego County's Adult and Older-Adult Mental Health Services database (N=34,970, fiscal year 2002-2003), the authors selected patients with bipolar disorder, divided them into three age-groups (young: age 18-39, middle-aged: age 40-59, and elderly: age 60+) and compared them on demographic, clinical, and mental health service use characteristics.

Results: The authors identified 2,903 patients who received services for bipolar disorder at least once during the fiscal year, accounting for a slightly lower proportion of diagnosis among elderly patients (7.

Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system.

Objective: The authors examined the prevalence of and risk factors for homelessness among all patients treated for serious mental illnesses in a large public mental health system in a 1-year period. The use of public mental health services among homeless persons was also examined.

Method: The study included 10,340 persons treated for schizophrenia, bipolar disorder, or major depression in the San Diego County Adult Mental Health Services over a 1-year period (1999-2000).

Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia.

Objective: The authors' goal was to evaluate the relationship between adherence to treatment with antipsychotic medication and health expenditures. A secondary objective was to identify risk factors predictive of nonadherence.

Method: Data included Medicaid eligibility and claims data from 1998 to 2000 for San Diego County, Calif.