In This Issue

A web-based personal health record (figure) improved the quality of medical care and increased use of medical services among patients with serious mental illness and comorbid medical conditions. Among 170 patients studied by Druss et al. (CME, p. 360) at a community mental health center, the proportion of recommended services received at 1-year follow-up was 40% for patients given personal health records with computer training and 18% for those receiving usual care. The group with personal health records also had greater improvement in care for hypertension but not for diabetes or hyperlipidemia. The improved outcomes were largely related to the greater number of outpatient medical visits. The editorial by Fortney and Owen (p. 259) points out the marked dose-response relationship between the amount of technical support provided the patients and their success in using the electronic record.

Shrestha et al. (CME, p. 323) report that fluoxetine increased the activity of a key component of serotonin neurotransmission in the brains of monkeys at an age corresponding to prepuberty childhood in humans. The increase in serotonin transporter protein (SERT) was apparent 1.5 years after drug discontinuation. The behavior of the monkey was assessed and not found to change significantly. Fluoxetine’s effects on SERT have not been similarly tested in humans. An editorial by Brent et al. (p. 252) reminds clinicians and parents, who might interpret these new findings as contraindicating treatment, to recognize that untreated depression carries substantial risk for adolescents and to continue to consider both pharmacotherapy and psychotherapy.