Loneliness in the United States: A 2018 National Panel Survey of Demographic, Structural, Cognitive, and Behavioral Characteristics.

Purpose: To inform health behavior intervention design, we sought to quantify loneliness and its correlates, including social media use, among adults in the United States.

Design: Cross-sectional research panel questionnaire.

Setting: Responses were gathered from individuals in all 50 states surveyed via Internet from February 2018 to March 2018.

Psychotherapy and psychopharmacology utilization following repetitive transcranial magnetic stimulation (rTMS) in patients with major depressive disorder.

Lifetime prevalence of major depressive disorder (MDD) among a sample of adults in the United States has been reported as over 16%. Repetitive transcranial magnetic stimulation (rTMS) has become a treatment option for a subset of treatment-refractory patients with MDD. In a population of 159 commercial health plan individuals, we used claims data to compare utilization of antidepressants, antipsychotics, and psychotherapy during the one-year time period prior to rTMS initiation to the one-year time period starting 60 days after rTMS initiation.

Navigating a Managed Care Peer Review: Guidance for Clinicians Using Applied Behavior Analysis in the Treatment of Children on the Autism Spectrum.

As autism rates increase, providers of applied behavioral analysis (ABA) services are more frequently engaging with managed care companies to discuss the medical necessity of treatment. In an effort to maximize the efficiency and effectiveness of these reviews, we draw upon our experience as peer reviewers for a managed care company to guide ABA providers in discussions with managed care on behalf of their patients. In this article, we first provide an overview of the managed care peer review process.

The new, confusing CPT codes: tips for documenting and billing to get paid what you deserve.

As of January 1, 2013, psychiatrists should be billing for services by using Evaluation and Management Current Procedural Terminology (CPT) codes for any encounter related to medical services. Because detailed information about these CPT codes became available only toward the end of 2012, clinicians had little time to be trained in their use, resulting in widespread confusion about when and how to use these codes for reimbursement. The authors describe strategies that psychiatrists can use to ensure appropriate reimbursement for patient care, such as how to code the initial psychiatric evaluation, acute or chronic conditions, medical decision-making complexity, psychotherapy, counseling, coordination of care, and crisis care.

Optimizing managed care peer reviews: turning a "Doc to Doc" talk into better advocacy for psychiatric inpatients.

Clinicians often resent behavioral health managed care peer reviews. However, such reviews need not be onerous. This Open Forum, written by managed care physician reviewers, attempts to help attending psychiatrists, specifically those on inpatient units, achieve more satisfying outcomes for patients by adhering to a few basic principles.

Testimonials, narratives, stories, and drawings: child refugees as witnesses.

An estimated 80% of the world's war victims are women and children, a significant proportion of whom suffer from social and psychiatric sequelae of traumatic experiences. Various treatments for psychiatric symptoms related to trauma among refugees have been studied. This article summarizes the literature on therapies involving the creation of stories, such as narrative therapy and testimonial therapies, and other storytelling techniques described on the World Wide Web in the absence of an academic literature.

Asylum grant rates following medical evaluations of maltreatment among political asylum applicants in the United States.

Although many individuals applying for political asylum allege maltreatment and sometimes torture in their countries of origin, the utility of medical evaluations in asylum adjudication has not been documented. This study compares the asylum grant rate among US asylum seekers who received medical evaluations from Physicians for Human Rights (PHR), with rates among asylum seekers who did not receive PHR evaluations. Retrospective analysis was carried out on all asylum cases referred to PHR between 2000 and 2004 for medical evaluations for which adjudication outcome was available.

Testimonial psychotherapy for adolescent refugees: a case series.

Adolescent refugees are a traumatized, vulnerable group of arrivals to America who lack experience with or interest in psychiatric care. Testimonial psychotherapy's unique focus on transcribing personal, traumatic events for the altruistic purpose of education and advocacy make it an acceptable interaction by which to bridge the cultural gap that prevents young refugees from seeking psychiatric care. The theoretical basis for testimony is discussed.

Review of child and adolescent refugee mental health.

Objective: To review stressful experiences and stress reactions among child and adolescent refugees, as well as interventions and ethical considerations in research and clinical work, within the framework of the chronological experiences of child refugees; namely, the phases of preflight, flight, and resettlement. Highlighted are special refugee populations such as unaccompanied minors, asylum seekers, and former child soldiers. Pertinent medical findings are summarized.

Implementing a randomized clinical trial on a pediatric psychiatric inpatient unit at a children's hospital: the case of clonidine for post-traumatic stress.

Randomized clinical trials (RCTs) of psychotropic medications are uncommon among child and adolescent populations, and even rarer on pediatric, psychiatric inpatient units. We mention some of these studies, and then discuss the advantages and challenges of conducting a RCT among youngsters on an inpatient psychiatric unit in a pediatric hospital, using as an example our ongoing study of clonidine for intrusive symptoms of post-traumatic stress. Our purpose is to alert potential investigators to the obstacles they may encounter while implementing a RCT, while also pointing the way to potential resources.