Positive screens for psychiatric disorders in primary care: a long-term follow-up of patients who were not in treatment.

Objective: Screening for psychiatric disorders has gained acceptance in some general medical settings, but critics argue about its value. The purpose of this study was to determine the clinical utility of screening by conducting a long-term follow-up of patients who screened positive for psychiatric disorders but who were initially not in treatment.

Methods: A cohort of 519 low-income, adult primary care patients were screened for major depression and bipolar, anxiety, and substance use disorders and reassessed with the Structured Clinical Interview for DSM-IV after a mean of 3.

National trends in psychotropic medication polypharmacy in office-based psychiatry.

Context: Psychotropic medication polypharmacy is common in psychiatric outpatient settings and, in some patient groups, may have increased in recent years.

Objective: To examine patterns and recent trends in psychotropic polypharmacy among visits to office-based psychiatrists.

Design: Annual data from the 1996-2006 cross-sectional National Ambulatory Medical Care Surveys were analyzed to examine patterns and trends in psychotropic polypharmacy within nationally representative samples of 13 079 visits to office-based psychiatrists.

National patterns in antidepressant medication treatment.

Context: Antidepressants have recently become the most commonly prescribed class of medications in the United States.

Objective: To compare sociodemographic and clinical patterns of antidepressant medication treatment in the United States between 1996 and 2005.

Design: Analysis of antidepressant use data from the 1996 (n = 18 993) and 2005 (n = 28 445) Medical Expenditure Panel Surveys.

Mental health treatment received by youths in the year before and after a new diagnosis of bipolar disorder.

Objective: Despite a marked increase in treatment for bipolar disorder among youths, little is known about their pattern of service use. This article describes mental health service use in the year before and after a new clinical diagnosis of bipolar disorder.

Methods: Claims were reviewed between April 1, 2004, and March 31, 2005, for 1,274,726 privately insured youths (17 years and younger) who were eligible for services at least one year before and after a service claim; 2,907 youths had new diagnosis of bipolar disorder during this period.

Broadened use of atypical antipsychotics: safety, effectiveness, and policy challenges.

Atypical antipsychotic medications are increasingly used for a wide range of clinical indications in diverse populations, including privately and publicly insured youth and elderly nursing home residents. These trends heighten policy challenges for payers, patients, and clinicians related to appropriate prescribing and management, patient safety, and clinical effectiveness. For clinicians and patients, balancing risks and benefits is challenging, given the paucity of effective alternative treatments.

Dropout from outpatient mental health care in the United States.

Objective: Although mental health treatment dropout is common, patterns and predictors of dropout are poorly understood. This study explored patterns and predictors of mental health treatment dropout in a nationally representative sample.

Methods: Data were from the National Comorbidity Survey Replication, a nationally representative household survey.

Sudden death and use of stimulant medications in youths.

Objective: The authors sought to determine whether a significant association exists between the use of stimulants and the rare event of sudden unexplained death in children and adolescents.

Method: A matched case-control design was performed. Mortality data from 1985-1996 state vital statistics were used to identify 564 cases of sudden death occurring at ages 7 through 19 years across the United States along with a matched group of 564 young people who died as passengers in motor vehicle traffic accidents.

Screening for generalized anxiety disorder symptoms in the wake of terrorist attacks: a study in primary care.

Little is known about the mental health impact of terrorism beyond posttraumatic stress disorder (PTSD) and depression. The associations between exposure to the September 11, 2001 (9/11) attacks in New York City and generalized anxiety disorder (GAD) symptoms were examined in a sample of 929 primary care patients. After controlling for PTSD, depression, panic and substance use disorders, and pre-9/11 trauma, patients who screened positive (vs.

Antidepressant switching among adherent patients treated for depression.

Objective: This study examined the pharmacologic, clinical, and demographic factors associated with switching antidepressants during the first three months of outpatient treatment for episodes of depression.

Methods: A cohort analysis of outpatients aged 18-75 and treated for a depressive disorder (N=56,521) was performed with PharMetrics administrative data from 2001-2006. Patients commencing antidepressant treatment who continued to receive the initial antidepressant or a second antidepressant for > or = 72 of the first 90 days were selected.

Stimulant dosing for children with ADHD: a medical claims analysis.

Objective: To evaluate stimulant dosing patterns in the community treatment of children with attention-deficit/hyperactivity disorder (ADHD).

Method: Claims data from U.S.

Racial differences in visit duration of outpatient psychiatric visits.

Context: Substantial racial disparities exist in the delivery of some health care services. Whether racial disparities exist in the duration of office visits to psychiatrists is not known.

Objective: To compare the duration of visits to office-based psychiatrists by white and African American patients.

Treatment patterns for schizoaffective disorder and schizophrenia among Medicaid patients.

Objective: This study compared background characteristics, pharmacologic treatment, and service use of adults treated for schizoaffective disorder and adults treated for schizophrenia.

Methods: Medicaid claims data from two states were analyzed with a focus on adults treated for schizoaffective disorder or schizophrenia. Patient groups were compared regarding demographic characteristics, pharmacologic treatment, and health service use during 180 days before and after a claim for either schizophrenia or schizoaffective disorder.

The mental health consequences of disaster-related loss: findings from primary care one year after the 9/11 terrorist attacks.

This study examines the long-term psychiatric consequences, pain interference in daily activities, work loss, and functional impairment associated with 9/11-related loss among low-income, minority primary care patients in New York City. A systematic sample of 929 adult patients completed a survey that included a sociodemographic questionnaire, the PTSD Checklist, the PRIME-MD Patient Health Questionnaire, and the Medical Outcomes Study Short Form-12 (SF-12). Approximately one-quarter of the sample reported knowing someone who was killed in the attacks of 9/11, and these patients were sociodemographically similar to the rest of the sample.

Mental health of college students and their non-college-attending peers: results from the National Epidemiologic Study on Alcohol and Related Conditions.

Context: Although young adulthood is often characterized by rapid intellectual and social development, college-aged individuals are also commonly exposed to circumstances that place them at risk for psychiatric disorders.

Objectives: To assess the 12-month prevalence of psychiatric disorders, sociodemographic correlates, and rates of treatment among individuals attending college and their non-college-attending peers in the United States.

Design, Setting, And Participants: Face-to-face interviews were conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093).

Guideline-consistent antidepressant treatment patterns among veterans with diabetes and major depressive disorder.

Objective: This study estimated guideline-consistent antidepressant treatment of depression among veterans with diabetes and examined its variation by patient-level demographic characteristics, socioeconomic characteristics, access to care, and health status.

Methods: Data were retrospectively analyzed from Veterans Health Administration (VHA) and Medicare claims of VHA clinic users with diabetes and major depressive disorder (N=3,953). Major depression was identified by using ICD-9-CM codes 296.

National trends in psychotherapy by office-based psychiatrists.

Context: In addition to prescribing medications, providing psychotherapy has long been a defining characteristic of the practice of clinical psychiatry. However, there are indications that the role of psychiatrists in providing psychotherapy may have diminished in recent years.

Objective: To examine recent national trends in the provision of psychotherapy by office-based psychiatrists.

Psychiatric disorders in pregnant and postpartum women in the United States.

Context: Psychiatric disorders and substance use during pregnancy are associated with adverse outcomes for mothers and their offspring. Information about the epidemiology of these conditions in this population is lacking.

Objective: To examine sociodemographic correlates, rates of DSM-IV Axis I psychiatric disorders, substance use, and treatment seeking among past-year pregnant and postpartum women in the United States.

Correlates of help-seeking behavior among at-risk adolescents.

This study compared demographic, academic, and clinical characteristics of adolescents at risk for mental health problems who either did or did not request help during a voluntary mental health screening. High school students completed a self-report to identify risk of mental health problems (n=364). Students at risk were administered a clinical interview.