Distress with medication side effects among persons with severe mental illness.

We examined prevalence and perceived distress resulting from self-reported side effects (SEs) attributed to psychotropic medications among individuals with severe mental illness participating in a study of consumer-operated services. We examined gender and racial differences using logistic regression, conducted factor analyses of SEs, and examined correlations between distress and self-reported symptoms. Over 90% reported at least one SE, and nearly two-thirds reported a high level of distress with at least one SE.

What's in a name? Terms preferred by service recipients.

In a large (n = 1,827) multi-site study examining effectiveness of consumer operated service programs as an adjunct to traditional mental health services, we examined individuals' preferred term describing their status as service recipients, and we applied logistic regression to examine whether preference varied by gender, race or diagnosis. Preferred terms were client (39%), patient (22%), consumer (16%), survivor (11%), other (11%) and ex-patient (1%), varying by site. Controlling for site, preferences did not vary by gender, race, or diagnosis.

Impact of splitting risperidone tablets on medication adherence and on clinical outcomes for patients with schizophrenia.

Objective: Tablet splitting is a strategy aimed at reducing the cost of prescriptions. Some clinicians question whether patients with psychosis can understand and follow tablet-splitting instructions. The clinical impact of tablet splitting for individuals with severe mental illness is unknown.

Health monitoring for patients who have schizophrenia. Summary of the Mount Sinai Conference recommendations.

Schizophrenia is associated with several chronic medical illnesses and a reduced life expectancy. This paper summarizes findings and recommendations from "The Mount Sinai Conference," held at the Mount Sinai School of Medicine in New York on October 17-18, 2002, and discusses the implications for improving medical monitoring of patients with schizophrenia who are managed in outpatient settings from the initiation of treatment. The Mount Sinai Conference involved a diverse panel of experts, including specialists on schizophrenia, obesity, diabetes, cardiology, endocrinology, and ophthalmology.

Lipid monitoring in patients with schizophrenia prescribed second-generation antipsychotics.

Objectives: Treatment with second-generation antipsychotic (SGA) medications has been linked with increased rates of the metabolic syndrome (i.e., dyslipidemia, obesity, and hyperglycemia).

Implementing peer-assisted case management to help homeless veterans with mental illness transition to independent housing.

Formerly homeless mentally ill veterans are at an important crossroads when they move from living in an institutional setting such as a shelter or supportive residential facility to independent living. We hypothesized that peer advisors, veterans with severe mental illness who had been homeless previously, graduated from a Healthcare for Homeless Veterans program, and subsequently maintained independent, stable housing could assist other veterans make a successful transition to independent living. Pilot data suggests that participants who received peer advisors were more likely to follow up with assessments than were controls.

Physical health monitoring of patients with schizophrenia.

Objective: Schizophrenia is associated with several chronic physical illnesses and a shorter life expectancy, compared with life expectancy in the general population. One approach to improving the health of patients with schizophrenia is to improve the monitoring of physical health that occurs in psychiatric settings. The authors discuss a consensus panel's recommendations for improving the physical health monitoring of patients with schizophrenia who are treated in outpatient settings.

Weight gain with clozapine compared to first generation antipsychotic medications.

Few studies have examined gender differences in the propensity to gain weight on clozapine. Weight gain increases risk for many medical illnesses and is of particular concern for people with schizophrenia who are more overweight than the general population. Long-stay patients in Connecticut state hospitals were randomly assigned to switch to open-label treatment with clozapine (n = 138) or to continue receiving first generation (conventional) antipsychotic medications (n = 89).

Volume of VA patients with posttraumatic stress disorder in the New York metropolitan area after September 11.

The authors examined data from the Veterans Integrated Service Network of New York and New Jersey to determine whether the number of veterans who were treated for posttraumatic stress disorder (PTSD) increased significantly after the terrorist attacks of September 11, 2001. They analyzed the number of veterans treated for PTSD at Veterans Healthcare Administration facilities in New York and New Jersey from September 1999 through June 2002. The number of veterans treated for PTSD in these facilities after September 11 exceeded projections based on secular trends, and the increase was more pronounced than for other diagnostic groups.

Impact of modifying risk adjustment models on rankings of access to care in the VA mental health report card.

Objective: Using a measure from the Veterans Administration (VA) mental health report card, the authors examined stability of report card rankings under different risk adjustment models. The study determined the impact of adding one variable to a standard VA risk adjustment model for access to care and examined whether veterans who reside in counties with VA facilities are more likely than veterans who reside in counties without VA facilities to use VA mental health services.

Methods: The authors compared the proportion of service users among veterans residing in counties either with or without VA facilities; the data were risk-adjusted by using demographic and geographic variables.

Antipsychotic prescribing practices in the Veterans Healthcare Administration--New York metropolitan region.

Most research literature concerning pharmacological treatments reports results from controlled clinical trials, which provide data critical to assess the efficacy of new treatments in research populations. Fewer studies examine how treatments are adopted in everyday practice settings, where comorbid disorders and environmental issues typically complicate patients' situations. In this study, we examine the evolution of antipsychotic prescribing practices in the New York region of the Veterans Healthcare Administration (VHA) from 1998 to 2000 using administrative data.

Pharmacoeconomics of antipsychotic medications.

Antipsychotic medications play a central role in the treatment of schizophrenia and other psychotic disorders. In the last decade, second-generation antipsychotic agents have been introduced that are more expensive on a cost per daily dose basis than older agents. We review empirical data showing trends in prescribing patterns of first- and second-generation antipsychotic agents in the USA and the cost implications of these trends.