This Month’s Highlights

This month Psychiatric Services has a new look, as do the three other journals published by American Psychiatric Publishing: The American Journal of Psychiatry, Journal of Neuropsychiatry and Clinical Neurosciences, and FOCUS. For the past year, publishing staff have worked with a professional design firm on a comprehensive redesign, with the goals of enhancing the readership experience and underscoring the connections between the four journals with a consistent design. The new table of contents includes brief descriptions of each article to help readers quickly identify items to turn to or mark for later reading. Symbols on the table of contents page and on the articles themselves draw readers’ attention to articles that address the “Core Competencies” defined by the Accreditation Council of Graduate Medical Education and the American Board of Medical Specialties: Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Practice-Based Learning and Improvement, Professionalism, and Systems-Based Practice. In addition, all journal content has been moved to a new online platform that has similar features intended to unify the print and online reading experience. Feedback on the new design and online platform is welcome.

Psychiatric advance directives can empower consumers by facilitating collaborative, consumer-directed treatment planning. Research has shown that advance directives reduce the need for coercive measures. Two-thirds of states have passed legislation authorizing use of psychiatric advance directives, but few consumers complete a directive. Virginia is the first state to commit itself to the goal of ensuring that all individuals in treatment for serious mental illness complete a directive. In the lead article, Kathleen Kemp, Ph.D., and colleagues describe challenges encountered in the first three years of Virginia’s implementation efforts, such as how to present a clear message to various audiences about the purposes and potential advantages of advance directives and how to overcome resource constraints and sustain interest in the process (page 10). In the Law & Psychiatry column, the same authors describe three approaches to facilitating completion of advance directives by consumers (page 7).

Cross-sectional studies have shown that patients with borderline personality disorder are more likely than patients with other mental disorders to use treatments. A longitudinal investigation, the McLean Study of Adult Development, has followed up at intervals over 16 years with a group of patients with borderline personality disorder. Mary C. Zanarini, Ed.D., and colleagues examined use of various treatment modalities by these patients over the long term. They found that compared with patients with other axis II disorders, those with borderline personality disorder reported significantly higher rates of use of 12 of the modalities studied. Rates of participation in 13 modalities declined significantly over the first eight years, but not over the second. The authors raise the question of whether these “chronic rates of treatment” will remain stable going forward (page 15). In the Taking Issue commentary, David A. Adler, M.D., notes that “sustained recovery remains elusive” for these patients and that “understanding and utilizing a longitudinal perspective grounds the work in the particulars of the person, privileging that over diagnostic status” (page 1).

Latinos are the largest U.S. racial-ethnic minority group. Most research on treatment use focuses on Latinos collectively, without fully recognizing the diversity within the Latino population. Using data for more than 2,500 Latino adult participants in the National Latino and Asian American Study, Sungkyu Lee, Ph.D., and Mary L. Held, Ph.D., L.C.S.W., focused on services used and providers visited by Cuban, Puerto Rican, and Mexican subgroups. A fifth of the sample (21.3%) had a psychiatric disorder, but only 9.6% reported receipt of past-year mental health services. The rate of psychiatric disorders among Puerto Ricans was high (29.9%), and they were more likely than the other subgroups to use services, regardless of provider type. Compared with Puerto Ricans, Mexicans with a psychiatric disorder were more likely to visit a general medical provider. Findings can inform effective outreach efforts to a population that underutilizes mental health treatment, the authors conclude (page 56).

A randomized controlled study documented a reduction in violent behaviors among inpatients at a state psychiatric hospital who were randomly assigned to receive equine-assisted therapy. The effect persisted for three months after the intervention. The inpatients in the study had a history of recent violent incidents on the hospital’s wards. Jeffry R. Nurenberg, M.D., and colleagues also assigned a subgroup of patients to canine-assisted therapy, and they noted a reduction in the need for one-on-one clinical observation among these patients (page 80).