The Natural History of Initial Antipsychotic Treatment Among Men Admitted to a State Prison.

Objective: This study examined the natural history of antipsychotic medication treatment for men with a psychotic disorder who entered the North Carolina prison system in 2016-2017.

Methods: The authors used prison records to identify individuals with a psychotic illness who were prescribed an index antipsychotic medication on prison entry (N=245). Data were analyzed to determine persistence of antipsychotic therapy and potential associations with treatment discontinuation.

Effect of Clozapine on Time Assigned to Restrictive Housing in a State Prison Population.

This study examined the effect of clozapine on time assigned to restrictive housing (RH; i.e., solitary confinement), disciplinary infractions, and assaults on custody staff among patients treated within the North Carolina prison system.

A Legal Right to Clozapine Therapy for Incarcerated Individuals With Treatment-Resistant Schizophrenia.

People with serious mental illnesses increasingly are being treated in jails and prisons, and during incarceration are afforded a constitutional right to medical care. This right pertains to both general medical and mental illnesses and both acute and chronic conditions. However, incarcerated patients with treatment-resistant schizophrenia (TRS) often are not offered clozapine, the only medication for this debilitating illness approved by the U.

Effect of Enhanced Primary Care for People with Serious Mental Illness on Service Use and Screening.

Background: Strategies are needed to better address the physical health needs of people with serious mental illness (SMI). Enhanced primary care for people with SMI has the potential to improve care of people with SMI, but evidence is lacking.

Objective: To examine the effect of a novel enhanced primary care model for people with SMI on service use and screening.

The Effects of an Enhanced Primary Care Model for Patients with Serious Mental Illness on Emergency Department Utilization.

Patients with Serious Mental Illness (SMI) have high rates of emergency department visits and high premature mortality rates, often due to poor primary care. A model of enhanced primary care services integrated in a behavioral health location is being implemented and studied at the UNC WakeBrook Primary Care Center (UNCWPC). This research was conducted as a retrospective cohort study.

Behavioral Health Services in North Carolina's State Prison System: Challenges and Opportunities.

There has been a dramatic increase in the number of individuals incarcerated in the United States during the past several decades. Providing behavioral health care services to incarcerated people within North Carolina's prison system presents several challenges, and progress is being made to deliver care that is consistent with accepted community standards.

Clozapine Reduces Self-Injurious Behavior in a State Prison Population.

Self-injurious behavior (SIB) is a common, disruptive, and costly occurrence in U.S. prisons.

A Model of Enhanced Primary Care for Patients with Severe Mental Illness.

Life expectancy and other outcomes for patients with serious mental illness (SMI) are unacceptably poor, largely due to a high prevalence of poorly controlled chronic diseases, high rates of tobacco use, and low rates of preventive care services. Since many of these illnesses are effectively treated in primary care settings, integrating primary care with behavioral health care is necessary to narrow health disparities for patients with SMI.

Acute Crisis Care for Patients with Mental Health Crises: Initial Assessment of an Innovative Prehospital Alternative Destination Program in North Carolina.

Objective: Emergency Departments (ED) are overburdened with patients experiencing acute mental health crises. Pre-hospital transport by Emergency Medical Services (EMS) to community mental health and substance abuse treatment facilities could reduce ED utilization and costs. Our objective was to describe characteristics, treatment, and outcomes of acute mental health crises patients who were transported by EMS to an acute crisis unit at WakeBrook, a North Carolina community mental health center.

Preventing and De-escalating Aggressive Behavior Among Adult Psychiatric Patients: A Systematic Review of the Evidence.

Objective: The project goal was to compare the effectiveness of strategies to prevent and de-escalate aggressive behaviors among psychiatric patients in acute care settings, including interventions for reducing use of seclusion and restraint.

Methods: Relevant databases were systematically reviewed for comparative studies of violence prevention and de-escalation strategies involving adult psychiatric patients in acute care settings. Studies (trials and cohort studies) were required to report on aggression or seclusion or restraint outcomes.

Reducing Length of Acute Inpatient Hospitalization Using a Residential Step Down Model for Patients with Serious Mental Illness.

Psychiatric inpatient bed numbers have been markedly reduced in recent decades often resulting in long emergency department wait times for acutely ill psychiatric patients. The authors describe a model utilizing short-term residential treatment to substitute for acute inpatient care when the barrier to discharge for patients with serious mental illness (SMI) is finding appropriate community placement. Thirty-eight patients (community hospital (n = 30) and a state hospital (n = 8)) were included.

Cardiometabolic Assessment, Diagnosis, and Treatment of Chronic Medical Illnesses During an Inpatient Psychiatric Hospitalization: Colocated Medical Care Versus Treatment as Usual.

Background: Reverse colocation care models reduce lifestyle risk factors, emergency department visits, and readmissions. Persons with serious mental illness have higher than average rates of cardiovascular disease-related morbidity and mortality, with second-generation antipsychotics (SGAs) conferring added related risks. Little is written about reverse colocated medical care (RCL) in inpatient psychiatric settings.

Use of antipsychotic medications in pediatric and young adult populations: future research needs.

The use of antipsychotics, particularly second generation antipsychotics, among children and adolescents has increased markedly during the past 20 years. Existing evidence gaps make this practice controversial and hinder treatment decision-making. This article describes and prioritizes future research needs regarding antipsychotic treatment in youth, focusing on within-class and between-class drug comparisons with regard to key population subgroups, efficacy and effectiveness outcomes, and adverse event outcomes.

A naturalistic comparison of the long-term metabolic adverse effects of clozapine versus other antipsychotics for patients with psychotic illnesses.

Objective: Clozapine, an evidence-based treatment of refractory schizophrenia, is associated with increased weight gain and metabolic dysregulation compared with most antipsychotics in short-term clinical trials. However, there are limited data describing comparative long-term metabolic risks. In this report, we examined whether short-term differences persist with long-term exposure to clozapine.

Examining the relationship between adjunctive psychotherapy use and antipsychotic persistence and hospitalization.

This study assessed whether the addition of adjunctive psychotherapy to antipsychotic pharmacotherapy improved antipsychotic persistence and reduced the risk of hospitalization among patients with schizophrenia using 2001-2003 Medicaid claims data from four states: Illinois, Kansas, Minnesota, and North Carolina. New antipsychotic users aged 18 or older were included. Our study showed that adjunctive psychotherapy use was associated with increased antipsychotic persistence during the first two months of treatment but was not associated with risk of hospitalization.

A+KIDS, a web-based antipsychotic registry for North Carolina youths: an alternative to prior authorization.

Objective: The rise in use of antipsychotics among U.S. children is well documented.