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Objective: This article describes the clinical utility and feasibility of proposed DSM-5 criteria and measures as tested in the DSM-5 Field Trials in Routine Clinical Practice Settings (RCP). Methods: RCP data were collected online for six months (October 2011 to March 2012). Participants included psychiatrists, licensed clinical psychologists, clinical social workers, advanced practice psychiatric-mental health nurses, licensed counselors, and licensed marriage and family therapists. Clinicians received staged, online training and enrolled at least one patient. Patients completed seff-assessments of cross-cutting symptom domains, disability measures, and an evaluation of these measures. Clinicians conducted diagnostic interviews and completed DSM-5 and related assessments and a clinical utility questionnaire. Results: A total of 621 clinicians provided data for 1,269 patients. Large proportions of clinicians reported that the DSM-5 approach was generally very or extremely easy for assessment of both pediatric (51%) and adult (46%) patients and very or extremely useful in routine clinical practice for pediatric (48%) and adult (46%) patients. Clinicians considered the DSM-5 approach to be better (57%) or much better (18%) than that of DSM-IV. Patients, including children age 11 to 17 (47%), parents of children age six to ten (64%), parents of adolescents age 11 to 17 (72%), and adult patients (52%), reported that the cross-cutting measures would help their clinicians better understand their symptoms. Similar patterns in evaluations of feasibility and clinical utility were observed among clinicians from various disciplines. Conclusions: The DSM-5 approach was feasible and clinically useful in a wide range of routine practice settings and favorably received by both clinicians and patients. [ABSTRACT FROM AUTHOR]

The article discusses a study about the challenges to the access and continuity of medication faced by the so-called dual eligible psychiatric patients during the first year of the Medicare Part D prescription drug initiative that was imposed on January 1, 2006 in the U.S. Based on physicians' report, about 43.3 % of patients failed to get access to medication refills or new drugs due to disapproval while 29% ceased taking medications because of drug coverage or copays. The patients also raised concerns on cost sharing under such drug program.

Objective: The gap between evidence-based treatments and routine care has been well established. Findings from the Sequenced Treatments Alternatives to Relieve Depression (STAR*D) emphasized the importance of measurement-based care for the treatment of depression as a key ingredient for achieving response and remission; yet measurement-based care approaches are not commonly used in clinical practice. Methods: The Nine-Item Patient Health Questionnaire (PHQ-9) for monitoring depression severity was introduced in 19 diverse psychiatric practices. During the one-year course of the project the helpfulness and feasibility of implementation of PHQ-9 in these psychiatric practices were studied. The project was modeled after the Institute for Healthcare Improvement Breakthrough Series. Two of the 19 practices dropped out during the course of the project. Results: By the conclusion of the study, all remaining 17 practices had adopted PHQ-9 as a routine part of depression care in their practice. On the basis of responses from 17 psychiatrists from those practices, PHQ-9 scores influenced clinical decision making for 93% of 6,096 patient contacts. With the additional information gained from the PHQ-9 score, one or more treatment changes occurred during 40% of these clinical contacts. Changing the dosage of antidepressant medication and adding another medication were the most common treatment changes recorded by psychiatrists, followed by starting or increasing psychotherapy and by switching or initiating antidepressants. In 3% of the patient contacts, using the PHQ-9 led to additional suicide risk assessment. Conclusions: The study findings suggest that adopting measurement-based care, such as using the PHQ-9, is achievable, even in practices with limited resources. [ABSTRACT FROM AUTHOR]

Two current congressional bills mandate parity for benefits for mental disorders with benefits for medical/surgical conditions in private insurance when mental health benefits are provided; the bills differ in regard to benefit levels and access to out-of-network coverage. This study assessed clinicians' and beneficiaries' participation in managed care networks in the national capital area under the Federal Employees Health Benefits (FEHB) parity program. Approximately one-third of the clinicians studied participated in FEHB net- works, and only 44 percent of FEHB patients received care from network clinicians. Out-of- network mental health benefits are an important policy consideration to ensure access to mental health treatment under parity proposals. [ABSTRACT FROM AUTHOR]

Objective: With implementation of Medicare Part D, concerns were raised that patients with severe mental illness who were dually eligible for both Medicaid and Medicare benefits would be at clinical risk. In addition to concerns about medication access and continuity, there were concerns about administrative burden for physicians and their staffs. This study aimed to quantify the amount of administrative burden for psychiatrists and their staff related to Medicare Part D prescription drug plan administration in a national sample of dually eligible psychiatric patients and to identify factors associated with increased burden.Methods: A total of 5,833 psychiatrists were randomly selected from the American Medical Association's Physicians Masterfile. Responses were obtained from 64% (N=3,247) with a mailed survey using practice-based survey research methods during the first four months of Medicare Part D implementation (January to April 2006); 1,183 psychiatrists met eligibility requirements.Results: Psychiatrists and their staff spent 45 minutes in administrative tasks for every one hour of direct patient care for dually eligible patients. Drug plan features, including prior authorization and preferred drug formularies, and medication access problems were associated with increased administrative time.Conclusions: Results of this study indicate several drug plan features and medication access problems related to Part D implementation were associated with significant increases in administrative burden for psychiatrists and their staff, which may result in less time for direct patient care. Given the vulnerability of this high-risk population, this increased administrative burden may pose a significant risk to the overall quality of care for psychiatric patients. [ABSTRACT FROM AUTHOR]

Objective: This study attempted to systematically assess the experiences of Medicare and Medicaid ‘dual-eligible’ psychiatric patients, including evaluating patients' access to medications and the administrative functioning of the program, during the first 4 months of the Medicare Part D prescription drug benefit. Method: Psychiatrists (N=5,833) were randomly selected from the American Medical Association's Physicians Master-file. After exclusion of those not practicing and with undeliverable addresses, 64% responded; 35% met study eligibility criteria of treating at least one dual-eligible patient during their last typical workweek and reported clinically detailed information on one systematically selected patient. Results: A total of 53.4% had at least one medication access problem to report between Jan. 1 and April 30, 2006. Although 9.7% experienced improved medication access, 22.3% discontinued or temporarily stopped taking medication because of prescription drug coverage or management issues, and 18.3% were previously stable but were required to switch medications. Among those with medication access problems, 27.3% experienced a significant adverse clinical event; 19.8% had an emergency room visit. Most drug plan features studied, including preferred drug/formulary lists, prior authorization, medication dosing/number limits, ‘fail-first’ protocols, and requirements to switch to generics, were associated with significantly higher rates of medication access problems. Conclusions: The findings indicate consequential medication access problems for psychiatric patients during the implementation of Medicare Part D. Although Centers for Medicare and Medicaid Services policies were enacted to ensure access to protected classes of psychopharmacologic medications, the high rates of medication access problems observed indicate further refinement of these policies is needed. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to present data on the rates of diagnosis and patterns of Axis I comorbidity treated by psychiatrists in routine psychiatric practice, ascertained by practicing psychiatrists, and compare them with those ascertained through structured interview in a national sample of individuals treated in the specially mental health sector for evidence of underdetection or underdiagnosis of comorbid disorders in routine psychiatric practice. Methods: Data on 2117 psychiatric patients gathered by 754 psychiatrists participating in the 1997 and 1999 American Psychiatric Institute for Research and Education's Practice Research Network's Study of Psychiatric Patients and Treatments (SPPT) were analyzed, assessing psychiatrist-reported rates of Axis I disorders and comorbidities. SPPT data on patients treated by psychiatrists were compared with a clinical subset of patients in the National Comorbidity Survey who bad been treated in the specialty mental health sector (SMA). Results: Rates of comorbidity were higher in the SMA (53.9%) than in the SPPT (31.5%). The prevalence of schizophrenia diagnoses was more than twice as prevalent in the SPPT as in the SMA sample; anxiety disorders were 2 to 22 times more prevalent in the SMA sample. In the SPPT, 4 of the l0 most prevalent comorbid pairs included schizophrenia or bipolar disorder: only one pair in the SMA sample included either diagnoses. Of the 10 most prevalent comorbidity pairings in the SMA sample, 6 included a phobia diagnosis. Conclusions: Results of these analyses suggest greater differences in the patterns and rates of comorbidities than one might expect between these 2 samples. Possible reasons for these disparities, including methodological differences in diagnostic ascertainment and underdiagnosis of anxiety disorders, are discussed. [ABSTRACT FROM AUTHOR]

The article examines the various patterns and predictors of adult psychotherapy in psychiatric practice in the U.S. The receipt of psychotherapy among psychiatric patients varied by demographic, diagnostic and health plan characteristics and by practice setting. This paper recommends further research on the differential outcome of the patterns observed.

The primary aim of this study was to present data on the relationship of mental and comorbid substance use disorders to work disability and functioning in routine psychiatric practice in the United States. Data were used from the 1997 and 1999 American Psychiatric Institute for Research and Education's Practice Research Network Study of Psychiatric Patients and Treatments, totaling 754 psychiatrists and 3,088 patients. Results found patients with comorbid substance use disorders had significantly higher rates of work disability. These findings highlight the critical need to address the disturbing lack of substance use treatment and rehabilitation services for this population. [ABSTRACT FROM AUTHOR]

This program calls attention to the upcoming timetable for the revision of the Diagnostic and Statistical Manual (DSM)-IV and the publication of DSM-V. It is vitally important for Research Society of Alcoholism members to be aware of the current discussions of the important scientific questions related to the next DSM revision and to use the opportunity for input. The title of the symposium highlights 1 key question, i.e., whether the DSM definitions should remain strictly categorical as in the past or whether a dimensional component should be included in this revision. Two substantive and 1 conceptual paper are included in this portion of the symposium. The fourth and final presentation detailing the revision timetable and the opportunities for input is by Dr. Darrel Regier. Dr. Regier is the director of American Psychiatric Institute for Research and Education the research and education branch of the American Psychiatric Association and the organization within the APA that will oversee the DSM revision. The discussion is by Marc Schuckit, who was chair of the Substance Use disorders (SUD) Committee for DSM-IV and cochair of the international group of experts reviewing the SUD definitions for DSM-V. [ABSTRACT FROM AUTHOR]

The staff of the American Psychiatric Assocition (APA), the American Psychiatric Institute for Research and Education (APIRE), and a national panel of experts in bipolar disorder and practice guideline development have collaborated to generate a set of quality of care indicators for the pharmacologic and psychosocial treatment of bipolar disorder. The indicators were derived from APA’s evidence-based Practice Guideline for the Treatment of Patients with Bipolar Disorder, 2002 (1) and the Expert Consensus Guideline Series: Medication Treatment of Bipolar Disorder, 2000 (2) These quality indicators can be used for quality monitoring, benchmarking, and quality improvement efforts across health plans, systems of care, and health care providers to improve quality and outcomes of care for patients with bipolar disorder. [ABSTRACT FROM AUTHOR]

Provides information on the treatment of adult patients with schizophrenia and assessed conformance with the practice guideline treatment recommendations of the Schizophrenia Patient Outcomes Research Team and the American Psychiatric Association in the U.S. Commonly used adjunctive medications in the treatment of schizophrenia; Development of practice guidelines and treatment recommendations to improve and standardize quality of care for patients with schizophrenia; Aims of the investigation; Indications that patients with schizophrenia who are treated by psychiatrist have complex clinical problems; Suggestions for psychosocial treatment services among individuals with schizophrenia.

Background: Current US mental disorder prevalence estimates have limited usefulness for service planning and are often discrepant. Data on clinical significance from the National Institute of Mental Health Epidemiologic Catchment Area Program (ECA) and the National Comorbidity Survey (NCS) were used to produce revised estimates, for more accurate projections of treatment need and further explication of rate discrepancies. Methods: To ascertain the prevalence of clinically significant mental disorders in each survey, responses to questions on life interference from, telling a professional about, or using medication for symptoms were applied to cases meeting symptom criteria in the ECA (n = 20 861) and NCS (n = 8098). A revised national prevalence estimate was made by selecting the lower estimate of the 2 surveys for each diagnostic category, accounting for comorbidity, and combining categories. Results: Using data on clinical significance lowered the past-year prevalence rates of "any disorder" among 18- to 54-year-olds by 17% in the ECA and 32% in the NCS. For adults older than 18 years, the revised estimate for any disorder was 18.5%. Using the clinical significance criterion reduced disparities between estimates in the 2 surveys. Validity of the criterion was supported by associations with disabilities and suicidal behavior. Conclusions: Establishing the clinical significance of disorders in the community is crucial for estimating treatment need. More work should be done in defining and operationalizing clinical significance, and characterizing the utility of clinically significant symptoms in determining treatment need even when some criteria of the disorder are not met. Discrepancies in ECA and NCS results are largely due to methodologic differences. [ABSTRACT FROM AUTHOR]

Abstract. Nine pediatricians reported on all patients seen during a four-week period in January and February 1976 in Monroe County, N.Y., to determine the prevalence and nature of mental health problems seen in their practices, the characteristics of the affected children, and the treatment provided to them. Of the 3,742 patients seen, 187, or 5.0%, were reported to have an emotional, behavioral, or school problem. The prevalence rate ranged from 1.4% to 7.8% by pediatrician, with five reporting rates within +/- 1.2% of the mean. High rates were associated with children in the 7 to 14 year age group (9.9%), those on Medicaid (8.6%), those who were not living with a father (10.9%), those whose presenting complaint was a chronic physical condition (11.7%), and children with a disease of the digestive system (16.7%) or with "symptoms, signs and ill-defined conditions" (14.3%). Functional impairment was reported to be moderate or severe in 40% of the 187 children with mental health problems, The most frequently reported problems (primary or otherwise) were adaptation reaction (22.5%), specific learning disorder (19.3%), hyperkinetic disorder (19.3%), psychosomatic disorder (12.8%), and conduct disorder (12.8%), The most frequent form of treatment provided was supportive therapy or counseling (85.6%) and suggestions regarding environmental changes (43.3%). Drugs were prescribed for 16.0% of the affected children, with 6.4% receiving methylphenidate or amphetamines. Referral for psychological care or consultation was made for 36.9%. The frequency of mental health problems observed by the pediatricians was about five times the annual rate of Monroe County children contacting a psychiatric in-patient or out-patient setting. [ABSTRACT FROM AUTHOR]

Unrecognized, untreated, and undertreated depressive disorders extract an inordinate human and economic cost, despite the availability of an extensive array of effective clinical interventions. To enhance the availability and quality of care, the National Institute of Mental Health launched the Depression Awareness, Recognition, and Treatment Program, a multiphase information and education program designed to alert health professionals and the general public to the fact that depressive disorders are common, serious, and treatable. The authors review the development of this program, describing the professional education efforts it supports in anticipation of increased demand for services, the public education campaign launched in May 1988, and highlights of the scientific advances that make the program feasible and timely. [ABSTRACT FROM AUTHOR]

Data from the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area Program, an epidemiologic survey of five communities, showed that four major disorders commonly begin in late adolescence or young adulthood. The median age at onset for anxiety disorders is 15 years; for major depressive episode, 24 years; for drug abuse or dependence, 19 years; and for alcohol abuse or dependence, 21 years. Findings also suggest that for respondents 18–30 years old, having a major depressive episode or anxiety disorder doubles the risk for later drug abuse or dependence. [ABSTRACT FROM AUTHOR]

Epidemiological studies of the prevalence of mental health disorders typically contain multiple measures of mental health, using different instruments and different informants (child, parent, and interviewer). We used the Methods for the Epidemiology of Child and Adolescents Mental Disorder (MECA) study of U.S. youth to assess the effects of employing a range of these measures in mental health services research. We examined the effect of including various measures of mental health status in regressions of income on mental health service use. The estimated effect of income on service use varied widely, depending on the measure of mental health status used. Some measures of mental health status have little explanatory power in service use regressions. Measures of mental health status based on parental assessment of impairment or need, such as the Columbia Impairment Scale, are less costly to collect and also have good explanatory power, but are more strongly correlated with income. The Non-Clinician Child Global Assessment Scale (NC-CGAS) performs best in terms of explanatory power and correlation with income. Higher income parents appeared to judge behaviors differently from lower income parents, so analyses based on measures derived from parental report may lead to an understatement of the effect of income on service use. [ABSTRACT FROM AUTHOR]

A letter to the editor and a response regarding an article on the integration of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 on many alterations to improve psychiatric diagnosis equated with DSM-IV.

Focuses on the access to psychiatrists in the public sector and in managed health plans in the U.S. Evidence that the costs and use of mental health services have been constrained; Assessment of the extent to which psychiatrists are accepting new patients with different types of insurance and care plans; Confirmation of a serious public health problem of access to psychiatric care in privately managed insurance plans.