Disaster Preparedness in the Emergency Department Using In Situ Simulation.

High influxes of patients during disasters have led to increased incidence of medical errors in emergency departments (EDs), ultimately leading to poor patient outcomes. Nearly 30% of errors committed in EDs are due to deficiencies in knowledge and skills, and between 60% and 70% of errors occur due in part from communication breakdowns. The goal of this project was to examine whether in situ simulation will increase health care providers' knowledge of how to perform during a disaster, improve competency in skills related to those actions, and to improve communication regarding the special circumstances inherent to a disaster in the ED.

How can we use depression severity to guide treatment selection when measures of depression categorize patients differently?

Objective: Treatment guidelines for depression suggest that severity should be taken into account when initiating treatment. If clinicians are to consider illness severity in selecting among treatment options for depression, then it is important to have reliable, valid, and clinically useful methods of distinguishing between levels of depression severity. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared 3 self-report scales that assess the DSM-IV criteria for major depressive disorder on the basis of how these scales distribute patients into severity categories.

Does DSM-IV already capture the dimensional nature of personality disorders?

Objective: Personality disorder research favors a dimensional representation of the personality disorders over categorical classification, and this is one of the central justifications for changing the diagnostic approach in DSM-5. However, recent research has suggested that the most important loss of information in a categorical system is the failure to account for subthreshold levels of pathology. DSM-IV can be considered to already accommodate a quasi-dimensional system insofar as individuals who do not meet the threshold for diagnosis can be noted to have traits of the disorder.

Underrecognition of clinically significant side effects in depressed outpatients.

Objective: The presence of medication side effects is one of the most frequent reasons depressed patients discontinue medication, and premature discontinuation of medication is associated with poorer outcome in the treatment of depression. Despite the clinical importance of detecting side effects, few studies have examined the adequacy of their detection and documentation by clinicians. We are not aware of any studies comparing psychiatrists' clinical assessments to a standardized side effects checklist in depressed patients receiving ongoing treatment in clinical practice.

A clinically useful anxiety outcome scale.

Objective: Standardized scales are increasingly being recommended to measure outcome when treating psychiatric disorders in routine clinical practice. If the standard of care is to change and scales are to be incorporated into clinical practice, then it will be necessary to develop measures that are feasible to use as well as have good psychometric properties. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we describe the reliability and validity of the Clinically Useful Anxiety Outcome Scale (CUXOS).

Psychiatrists' and nonpsychiatrist physicians' reported use of the DSM-IV criteria for major depressive disorder.

Objective: Several studies of nonpsychiatrist physicians suggest that there are deficits in the knowledge and application of the diagnostic criteria for major depressive disorder (MDD). This research raises questions about the clinical utility of the MDD criteria. The goal of the present study was to determine psychiatrists' reported use of the DSM-IV criteria for MDD to diagnose depression and to compare their use to the use by nonpsychiatrist physicians.

The frequency of personality disorders in psychiatric patients.

Community-based epidemiological studies of psychiatric disorders provide important information about the public health burden of these problems; however, because seeking treatment is related to a number of clinical and demographic factors, studies of the frequency and correlates of psychiatric disorders in the general population should be replicated in clinical populations to provide the practicing clinician with information that might have more direct clinical utility. Diagnosing co-occuring personality disorders in psychiatric patients with an Axis I disorder is clinically important because of their association with the duration, recurrence, and outcome of Axis I disorders. This article reviews clinical epidemiological studies of personality disorders and finds that in studies using semi-structured diagnostic interviews, approximately half of the patients interviewed have a personality disorder.

Remission in depressed outpatients: more than just symptom resolution?

Objective: In treatment studies of depression remission is defined according to scores on symptom severity scales. Normalization of functioning has often been mentioned as an important component of the definition of remission, though it is not used to identify remitted patients in studies of treatment efficacy. Conceptually, the return of normal functioning should be as fundamental to the concept of remission as is symptom resolution because the presence of both symptoms and impaired functioning are core constructs in the diagnosis of mental disorders.

The prevalence of DSM-IV personality disorders in psychiatric outpatients.

Objective: The largest clinical epidemiological surveys of personality disorders have been based on unstructured clinical evaluations. However, several recent studies have questioned the accuracy and thoroughness of clinical diagnostic interviews; consequently, clinical epidemiological studies, like community-based studies, should be based on standardized evaluations. The Rhode Island Methods to Improve Diagnostic Assessment and Services project is one of the largest clinical epidemiological studies to use semistructured interviews to assess a wide range of psychiatric disorders conducted in general clinical outpatient practice.

Using a self-report depression scale to identify remission in depressed outpatients.

Objective: Some have suggested that standardized rating scales be used in clinical practice to monitor the course of treatment; however, the time demands of clinical practice make it difficult to use such measures. This study derived a cutoff on a self-report depression questionnaire corresponding to the most widely used definition of remission (a score < or =7 on the 17-item Hamilton Depression Rating Scale).

Method: Two hundred sixty-seven depressed outpatients were rated on the Hamilton depression scale and completed the Clinically Useful Depression Outcome Scale (CUDOS).

Which factors influence psychiatrists' selection of antidepressants?

Objective: There is little empirical evidence to guide clinicians in choosing among the diverse array of antidepressants available. In the absence of replicated empirical research guiding the selection of antidepressants, it is of interest to examine what factors psychiatrists consider when prescribing antidepressants.

Method: For 1,137 depressed patients who received a new antidepressant prescription, the treating psychiatrist completed a 43-item questionnaire listing factors that might have influenced the choice of antidepressant medication.

Defining remission on the Montgomery-Asberg depression rating scale.

Objective: In antidepressant efficacy trials, it is common to define treatment remission as a score below a cutoff on symptom severity measures. No consensus has emerged regarding an appropriate cutoff for defining remission on the Montgomery-Asberg Depression Rating Scale (MADRS). The goal of the present study was to establish an empirically based cutoff on the MADRS for defining remission.

The effectiveness of switching antidepressants during remission: a case series of depressed patients who experienced intolerable side effects.

Background: It is unknown whether depressed patients who have experienced intolerable side effects to one antidepressant can safely and effectively be switched to a second antidepressant while the depressive disorder is in remission. The present study sought to determine the viability of such a strategy.

Methods: All subjects were psychiatric outpatients who were treated in an open-label manner according to standard clinical practice.

Delayed puberty.

Normal puberty is a time of life and a process of development that results in full adult maturity of growth, sexual development, and psychosocial achievement. Delayed puberty describes the clinical condition in which the pubertal events start late (usually > +2.5 SD later than the mean) or are attenuated in progression.