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Psychiatric Services

Psychiatric Services
A Journal of the American Psychiatric Association

Edited by Howard H. Goldman, M.D., Ph.D.
2014
ISSN 1075-2730
Journal
Item #PSY




Psychiatric Services focuses on the delivery of behavioral health services in organized systems, such as public mental health systems, correctional systems, and health maintenance organizations. Under health care reform, systems of care are changing to maximize quality and accessibility and lower costs. Clinicians and administrators look to Psychiatric Services for research on how to deliver evidence-based treatments, to take an integrated “whole-health” approach to care, and to better engage their patients—especially those with severe and persistent mental illnesses, who are often served by multiple systems.

Psychiatric Services, established in 1950, is published monthly by the American Psychiatric Association. The journal focuses on issues related to the delivery of mental health services, especially for people with severe mental illness in community-based treatment programs. Each month, Psychiatric Services features 15 research reports with results that have practical applications in the diverse settings where today's practitioners work. The journal has long recognized that providing high-quality care involves collaboration among a variety of professionals. Authors of research reports include psychiatrists, psychologists, pharmacists, drug and alcohol treatment counselors, social workers, nurses, economists, and professionals in related systems such as welfare and criminal justice systems. Monthly columns keep readers up to date on important developments in areas such as law and psychiatry and state mental health policy. Issues feature book reviews, news, and letters to the editor. Every member of the treatment team will find Psychiatric Services a valuable source of information.

To visit Psychiatric Services online, please go to http://ps.psychiatryonline.org

In This Issue - October 2013

DSM-5 Field Trials in Routine Practice Settings
DSM-5 attempts to capture the latest scientific advances and to enhance the reliability of diagnostic criteria. Among the new manual’s most noticeable differences is the inclusion of patient-reported measures to identify initial clinical status and monitor progress. In 2011 and 2012, clinicians and their patients from the United States, Canada, Australia, and the United Kingdom undertook to assess the clinical utility and feasibility of the new manual. The results of the field trials are reported.

Looking for a Gold Standard to Measure Recovery
Recovery from mental illness is a deeply personal process, which raises the question of how best to measure it. This review identified 13 instruments currently in use and compared how well each assessed the five domains of recovery identified by the CHIME framework—connectedness, hope and optimism, identity, meaning and purpose, and empowerment. Some instruments have sound psychometric properties, but none can be considered a gold standard.

2013 APA Achievement Awards: Four Exemplary Programs
For more than 60 years, the October issue of Psychiatric Services has featured descriptions of the outstanding programs that receive APA Achievement Awards. This year’s Gold, Silver, and Bronze Award winners include a New York City program that has been improving the lives of homeless people for nearly three decades, a Pennsylvania managed behavioral health company with an exceptional commitment to shared decision making, a VA program located on the campus of the City College of San Francisco that helps veterans make the transition from military to college life, and a Providence, Rhode Island, partial-hospital program for children with co-occurring general medical and mental illnesses.

Insanity Defense: A Constitutional Right?
The Idaho legislature abolished the insanity defense in 1982. Thus, when a defendant in a multiple-murder case came to trial in 2009, he was unable to plead insanity, even though evaluators found him severely psychotic. After he was convicted, Idaho’s supreme court rejected his appeal, holding that there is no constitutional right to an insanity defense. This month’s Law & Psychiatry column describes what happened when the case—supported by a friend-of-the-court brief submitted jointly by the APA and the American Academy of Psychiatry and the Law—was taken to the U.S. Supreme Court.

Stepped Care for Borderline Personality Disorder
Because most clinicians tend to see patients with BPD whose recovery has been unsuccessful, they may not know that some patients respond to brief interventions. Recent research suggests that therapists do not need to define full remission as the end-point of an intervention but can set less ambitious goals, aiming for a level of recovery after which patients carry out self-care with intermittent follow-up. In this review, the author describes a stepped-care model that conserves time and personnel for those who need treatment most.

A Better EMR: Advancing Best Practices in the Digital Age
Many clinicians have had the experience of being handed a heavy patient file with thousands of historical notes to review for an intake. But some electronic medical records (EMRs) are just as unwieldy, chock-full of useless information that obscures clinically relevant material. This month’s Best Practices column describes an attempt to reengineer the EMR to produce a graphical, single-page “dashboard” that displays patient history, measures progress, and facilitates clinical research.

“It’s All Chemical!” Marvelous Discovery or Cruel Burden?
The recent discovery of a genetic risk factor shared by five psychiatric disorders reminds the author of this month’s Personal Accounts column of a visit he and his parents made 50 years ago to his teenage brother Robert, a patient at Creedmoor. “Someday,” his mother assured him, “they’ll discover it’s all chemical!” But no marvelous discoveries spared Robert from a life spent shuttling in and out of hospitals, leading his brother to ask whether promises of “treatments on the horizon” are not sometimes a cruel burden.

Howard H. Goldman, M.D., Ph.D., is Professor of Psychiatry, University of Maryland School of Medicine, Baltimore, where he is the Director of the Mental Health Systems Improvement Collaborative.

Editor
Howard H. Goldman, M.D., Ph.D.

Editorial Board
David A. Adler, M.D.
Benjamin G. Druss, M.D., M.P.H.
Javier I. Escobar, M.D.
Stephen M. Goldfinger, M.D.
Richard K. Harding, M.D.
Grayson S. Norquist, M.D., M.S.P.H.
Martha Sajatovic, M.D.
Bradley D. Stein, M.D., Ph.D.
Marvin S. Swartz, M.D.
Marcia Valenstein, M.D.
Roy C. Wilson, M.D.
Bonnie T. Zima, M.D., M.P.H.

Editor Emeritus
John A. Talbott, M.D.

Book Review Editor
Jeffrey L. Geller, M.D., M.P.H.

Contributing Editors
Law & Psychiatry: Paul S. Appelbaum, M.D.
Frontline Reports: Francine Cournos, M.D., and Stephen M. Goldfinger, M.D.
Public-Academic Partnerships: Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D.
Personal Accounts: Jeffrey L. Geller, M.D., M.P.H.
Best Practices: William M. Glazer, M.D.
Datapoints: Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D.
Mental Health Care Reforms in Europe: Matt Muijen, M.D.
Mental Health Care Reforms in Latin America: Jos� Miguel Caldas de Almeida, M.D., and Marcela Horvitz-Lennon, M.D., M.P.H.
State Mental Health Policy: Fred C. Osher, M.D.
Case Studies in Public-Sector Leadership: Jules M. Ranz, M.D. and Susan M. Deakins, M.D.
Economic Grand Rounds: Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D.

Editorial Consultants
Norman Clemens, M.D.
Julie M. Donohue, Ph.D.
Robert E. Drake, M.D., Ph.D.
Marcia Kraft Goin, M.D., Ph.D.
Shelly F. Greenfield, M.D., M.P.H.
M. Susan Ridgely, J.D.
Laura Van Tosh

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