Treatment considerations for HIV-infected individuals with severe mental illness.

There has been a general recognition of a syndemic that includes HIV/AIDS and serve mental illnesses including schizophrenia, major depression, bipolar disorder, post-traumatic stress disorder, and others. The pathophysiology and direction of effects between severe mental illness and HIV infection is less clear however, and relatively little work has been done on prevention and treatment for people with these complex, co-occurring conditions. Here we present the most recent work that has been published on HIV and mental illness.

Increasing quality of life and reducing HIV burden: the PATH+ intervention.

The heightened risk of persons with serious mental illness (SMI) to contract and transmit human immunodeficiency virus (HIV) is a public health problem. Our objective was test the effectiveness of a community-based advanced practice nurse intervention to promote adherence to HIV and psychiatric treatment regimens call Preventing AIDS Through Health for Positives (PATH+). We enrolled 238 HIV-positive subjects with SMI who were in treatment at community HIV provider agencies from 2004 to 2009.

School-based mental health program evaluation: children's school outcomes and acute mental health service use.

Background: This study examined the impact of school-based mental health programs on children's school outcomes and the utilization of acute mental health services.

Methods: The study sample included 468 Medicaid-enrolled children aged 6 to 17 years who were enrolled 1 of 2 school-based mental health programs (SBMHs) in a metropolitan area sometime during school year 2006-2007. A multilevel analysis examined the relative effects of SBMHs on children's absence, suspension, grade promotion, use of acute mental health services, as well as the association of child and school-level factors on the outcomes of interest.

Tailored treatment for HIV+ persons with mental illness: the intervention cascade.

The public health literature demonstrates disturbingly high HIV risk for persons with a serious mental illness, who are concurrently comorbid for substance abuse. Many HIV positives have not been tested and therefore do not know their status, but for individuals who are triply diagnosed, adherence to HIV treatment results in meaningful reductions in viral loads and CD4 counts. Barriers to treatment compliance are reviewed, low-threshold/low-intensity community-based interventions are discussed, and preliminary evidence is presented for the efficacy of the intervention cascade, defined as an integrated intervention delivered by specially trained nurses who individualize a treatment compliance intervention in real time as an adaptive response to demand characteristics of the individual.

Health-related quality of life: expanding a conceptual framework to include older adults who receive long-term services and supports.

For older adults receiving long-term services and supports (LTSS), health-related quality of life (HRQoL) has emerged as a critical construct to examine because of its focus on components of well-being, which are affected by progressive changes in health status, health care, and social support. HRQoL is a health-focused quality of life (QOL) concept that encompasses aspects of QOL that affect health such as function, physical, and emotional health. Examining existing theoretical constructs and indicators of HRQoL among LTSS recipients led us to posit a revised conceptual framework for studying HRQoL among LTSS recipients.

Korean culture and autism spectrum disorders.

This paper reviews the literature on early child development among Koreans, with a focus on autism spectrum disorders (ASD). The literature review of 951 abstracts in English, 101 abstracts in Korean and 27 full articles published from 1994 to 2011 was performed to understand the presentation of and response to ASD in Korean culture. Based on research to date on the identification, description, and treatment of ASD in Korean populations, we argue that at both conceptual and practical levels, early child development and interventions must be understood within cultural context.

Evaluating the effectiveness of an integrated community continuum of care program for individuals with serious mental illness.

Objective: To evaluate effectiveness of an "Continuum of Care Program" (CCCP) for persons with serious mental health conditions in reducing inpatient use, and building a continuum of integrated care that enhanced employment and residential stability. The program combined components of Assertive Community Treatment with a comprehensive wrap-around program.

Methods: A cohort of 1154 individuals admitted to four outpatient CCCPs between December 2003 and May 31 2004 was identified and followed for 1 year.

Implementing an E-prescribing system in outpatient mental health programs.

This study describes the implementation and evaluation of an electronic prescription ordering system and feedback report in three community-based mental health outpatient agencies and the usefulness of the system in improving psychiatrists' prescribing behavior. Using the e-prescribing system as a data collection tool, feedback on evidence based prescribing practices for patients diagnosed with schizophrenia spectrum disorder or major affective disorder was provided to agency directors and prescribers via a monthly report. The results of the project were that e-prescribing tools can be installed at a reasonable cost with a short start up period.

Exploring the social impact of being a typical peer model for included children with autism spectrum disorder.

This study examined the social impact of being a typical peer model as part of a social skills intervention for children with autism spectrum disorder (ASD). Participants were drawn from a randomized-controlled-treatment trial that examined the effects of targeted interventions on the social networks of 60 elementary-aged children with ASD. Results demonstrated that typical peer models had higher social network centrality, received friendships, friendship quality, and less loneliness than non-peer models.

The interplay of outpatient services and psychiatric hospitalization among Medicaid-enrolled children with autism spectrum disorders.

Objective: To examine whether increased provision of community-based services is associated with decreased psychiatric hospitalizations among children with autism spectrum disorders (ASDs).

Design: Retrospective cohort study using discrete-time logistic regression to examine the association of service use in the preceding 60 days with the risk of hospitalization.

Setting: The Medicaid-reimbursed health care system in the continental United States.

Using psychiatric symptomatology to assess risk for HIV infection in individuals with severe mental illness.

In this study, we use the Colorado Symptom Index, a measure of psychiatric symptomatology, to identify vulnerable subgroups within the severely mentally ill population at elevated risk for HIV infection. Baseline data on 228 HIV positive and 281 HIV negative participants from two clinical trials were used. With years to HIV diagnosis as our primary endpoint, Kaplan-Meier estimates were calculated to find a CSI cut-off score, and a Cox proportional hazards model was used to obtain relative risks of infection for the two CSI categories created by the cut point.

Interaction effect of Medicaid census and nursing home characteristics on quality of psychosocial care for residents.

Background: Numerous studies have identified disparities in nursing home quality of care. Although previous studies have found the overlap among Medicaid census, nursing home characteristics, and negative quality of care outcomes, few studies have examined how the psychosocial well-being of nursing home residents is associated with Medicaid census and other nursing home characteristics.

Purpose: The purpose of this study was to elucidate the intertwined relationships between Medicaid census and other important nursing home factors and its impact on psychosocial care for residents.

Service use and costs for persons experiencing chronic homelessness in Philadelphia: a population-based study.

Objective: This study is the first to examine the distribution of service utilization and costs with a population-based sample that experienced chronic homelessness in sheltered and unsheltered locations in a large U.S. city.

Age of diagnosis among Medicaid-enrolled children with autism, 2001-2004.

Objective: This study examined child- and county-level factors associated with age of diagnosis of autism among Medicaid-enrolled children and the change in age of diagnosis over time.

Methods: National Medicaid claims from 2002 to 2004 were used to identify age of diagnosis and characteristics of children younger than ten years old with a diagnosis of autism (ICD-9 codes 299, 299.0x, or 299.

Certified peer specialist roles and activities: results from a national survey.

Objective: In 2001 Georgia became the first state to allow services provided by certified peer specialists (CPSs) to be reimbursed by Medicaid. Six other states have since followed Georgia's lead, with many others in the process of doing so. This study examined where CPSs work and what they do.

County-level variation in the prevalence of medicaid-enrolled children with autism spectrum disorders.

This study examined how county-level resources are associated with the identification of children with autism spectrum disorders (ASD) in Medicaid. Medicaid claims from 2004 were combined with county-level data. There were 61,891 children diagnosed with ASD in the Medicaid system in 2004.

A systematic review of community-based health interventions on depression for older adults with heart disease.

Purpose: This systematic review examined the effectiveness of community-based heart-health interventions on depression outcomes among homebound elderly (64 years and older) with heart disease.

Design And Methods: A comprehensive literature search and meta analysis was performed to evaluate randomized controlled trials examining outpatient or home-based interventions. Methodological quality was assessed by standard criteria developed by the Cochrane Collaborative Initiative.

Law & psychiatry: Liability issues associated with referrals to self-help groups.

Self-help groups, which are also referred to as mutual aid groups, are widely recognized as an important component of a comprehensive public mental health system that promotes recovery. Nonetheless, some psychiatrists and other providers have expressed concerns about these consumer-run groups and fear potential liability if they make referrals and something harmful occurs. This column reviews potential liability claims that could be made pertaining to referrals to self-help groups.

Effectiveness of a jail-based treatment program for individuals with co-occurring disorders.

Objective: This study examines the effectiveness of a county jail program for individuals with co-occurring disorders (COD) in reducing rates of recidivism and increasing rates of engagement in community-based treatment following discharge.

Methods: Over a period of 30 months, between 2002 and 2004, 261 individuals who screened positive for COD voluntarily entered an in-jail treatment program. The program provided integrated treatment for both mental health and substance abuse by therapists who had attended a state sponsored COD core training curriculum.

Perceived partner adaptation and psychosocial outcomes for newly diagnosed stage I and stage II breast cancer patients.

The current study examines the relationship between a woman's perception of her partner's emotional, behavioral, and intimate adaptation to her breast cancer and her levels of distress, well-being, and social support. Sixty-six women diagnosed with Stage I or II breast cancer within the previous year completed distress, well-being and social support measures and answered open-ended questions describing their partners' adaptation to their cancer. Women whose partners' intimate adaptation is positive had significantly lower distress, and positive emotional and intimate adaptation was related to higher well-being and social support.

Racial/ethnic disparities in the identification of children with autism spectrum disorders.

Objectives: We sought to examine racial and ethnic disparities in the recognition of autism spectrum disorders (ASDs).

Methods: Within a multisite network, 2568 children aged 8 years were identified as meeting surveillance criteria for ASD through abstraction of evaluation records from multiple sources. Through logistic regression with random effects for site, we estimated the association between race/ethnicity and documented ASD, adjusting for gender, IQ, birthweight, and maternal education.