May 2004: This Month's Highlights

Posttraumatic stress disorder (PTSD) is one of the most common psychiatric disorders. In a review article in this issue, Frank B. Schoenfeld, M.D., and coauthors describe current pharmacologic approaches to the treatment of PTSD. Their literature review emphasizes data from pharmacologic treatment studies, results from studies of biologic alterations in PTSD that help inform drug choice, and, when available, established guidelines for pharmacologic treatment. Pharmacotherapy for PTSD that co-occurs with other psychiatric disorders is also highlighted. The authors point to a growing body of evidence of the efficacy of pharmacologic treatment for PTSD but note that controlled clinical trials with selective serotonin reuptake inhibitors, adrenergic-inhibiting agents, and mood stabilizers are needed to determine the efficacy of these agents for treating PTSD. They note that the choice of medication for PTSD is often determined by the prominence of specific PTSD symptoms and the pattern of comorbid psychiatric conditions (see page 519).

Although patient centeredness and equity are major quality-of-care goals, little is known about how these goals are affected by efforts to improve quality. Jodi Halpern, M.D., Ph.D., and her colleagues illustrate, using depression in primary care as an example, how four ethics goals—autonomy, distributive justice, beneficence, and avoiding harm—can be incorporated as outcomes in demonstrations of quality improvement. These authors identify intervention features, study measures, and hypotheses implemented in Partners in Care—a randomized trial that compared two quality improvement interventions with usual care—and summarize relevant published findings. They found that the interventions were associated with improvements in all four ethics domains. They conclude that it is feasible to explicitly address ethics outcomes in quality improvement programs for depression but that substantial additional resources may be required (see page 532).

Studies of personal experience with severe mental illness have been receiving increasing attention. Recovery has recently become an especially prominent concept. Sandra G. Resnick, Ph.D., and her colleagues conducted an exploratory study to develop an empirical model of factors associated with an individual's having a recovery orientation. They reanalyzed data from 825 persons with schizophrenia who were initially assessed through the Schizophrenia Patient Outcomes Research Team client survey. They identified client and service use variables associated with each of four domains considered to be important to a recovery orientation: life satisfaction, hope and optimism, knowledge about mental illness and psychiatric services, and empowerment. These researchers found that recovery is a complex concept that has multiple factors and correlates. The strongest relationship was observed between recovery orientation and lower severity of depressive symptoms. Among the authors' conclusions was that a polarized view of biomedical and recovery perspectives on mental illness may be unfounded, because these perspectives appear to be mutually reinforcing (see page 540).

The privacy rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a complex regulation developed to address concerns about electronic access to and use of private health information. Mental health professionals have been focusing on achieving compliance with the rule since last year's compliance deadline. However, less attention has been given to the potential impact of such compliance efforts on patient care. In a brief report published in this issue of the journal, Bryan K. Touchet, M.D., and his colleagues discuss this impact in the context of a community-based mental health system. They use case examples to highlight several issues—fear of violating HIPAA's privacy regulations, failure to understand the regulations, and ethical concerns—and offer several recommendations for maintaining excellent patient care while complying with HIPAA. The authors conclude that psychiatrists must be aware that their compliance efforts, however well-intentioned, may challenge their professional ethics. They warn, "Hiding behind HIPAA will ultimately fail patients and damage their trust in those who are most able to help them" (see page 575).

•The author of this month's Alcohol & Drug Abuse column proposes "population thinking" as an adjunct to the more traditional client-focused approach to substance abuse treatment (see page 509).

•The ethics of gifts from physicians to patients are discussed in the Practical Psychotherapy column (see page 505).