February 2006: This Month's Highlights

In this issue, research groups in the United States, Canada, Italy, and Spain report on a variety of interventions designed to improve the lives of people with mental illnesses. One study examined representative payeeship—specifically, whether collaboration between the clinical staff of an outpatient treatment program and staff of an independent payeeship agency would be more effective than usual care, which involved the typical availability of a payee (page 197). Another study compared two ways of providing environmental supports, such as signs, calendars, and pill containers, to clients with serious mental illness—a more intensive approach known as cognitive adaptation training and a package of generic supports (page 219). In Akron, Ohio, researchers analyzed police department data to determine the effects of providing crisis intervention training to a group of officers (page 232). Canadian clinicians caring for patients with severe borderline personality disorder report on the use of relationship management therapy, an innovative approach designed to facilitate "behavioral settling" of patients before they enter dialectical behavior therapy or other treatments (page 179). Groups from Italy describe the feasibility of providing psychoeducation to patients and their families (page 266) and the use of problem-solving skills to improve cognitive functioning (page 172), while clinicians from Córdoba, Spain, report outcomes of in-home psychosocial skills training (page 260). Another research group pooled data from studies of various treatments for depression to determine the effects of depression interventions on the labor supply (page 212).

Integrated mental health and substance abuse treatment is becoming the standard approach for patients with co-occurring disorders. However, questions remain about the most effective way of delivering such treatment. Susan M. Essock, Ph.D., and her coworkers sought to determine whether any additional benefits are evident when assertive case management is used instead of standard case management. To do so they randomly assigned 198 clients who had co-occurring disorders and were homeless or unstably housed to either one of the models and assessed multiple outcome domains every six months. Participants in both groups improved over time in multiple domains, and few differences were found between the two models (page 185).

Severe mental disorders take a toll on the body. For their age groups, young and middle-aged adults with severe and persistent mental illness have higher death rates than their peers. In view of the early mortality among adults with mental illness, do they also experience earlier onset of the kinds of physical limitations more commonly seen among elderly persons? To answer this question, Linda Chafetz, D.N.Sc., R.N., and her colleagues recruited more than 300 adults from short-term residential treatment facilities and interviewed them about their health and their ability to engage in activities of daily living. Significant deviations from a number of national norms were found (page 225).

Little is known about routine psychiatric management of medication nonadherence among patients with schizophrenia who lack insight into their illness. Mark Olfson, M.D., M.P.H., and his colleagues asked psychiatrists from a nationally representative sample to provide information on one of their patients with schizophrenia who was nonadherent to medication. Patients judged by their psychiatrist to lack insight were compared with patients who were aware that they had an illness in terms of the types of interventions that the psychiatrists used to address nonadherence and patient characteristics that were associated with nonadherence (page 205).

Concerns have been raised about the declining numbers of clinically trained individuals who conduct research. The clinician-researcher, an individual who both conducts research and provides direct services, has special skills, knowledge, and perspectives that are critical to scientific endeavors. In this month's Open Forum, Philip T. Yanos, Ph.D., and Douglas M. Ziedonis, M.D., M.P.H., describe the contributions to research studies of the patient-oriented clinician-researcher. They also discuss the ethical considerations and practical challenges of undertaking this role, and the role conflicts that might ensue (page 249).

• A brief report describes challenges encountered in conducting evaluations of enemy prisoners in Iraq (page 258).