August 2006: This Month's Highlights

A special section in this issue includes four reports on a diverse national sample of nearly 1,500 individuals with schizophrenia—enrollees in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE). In the first article, Miranda H. Chakos, M.D., and her colleagues report that the rate of antipsychotic polypharmacy (prescription of two antipsychotics) was relatively low at 5 percent. Rates of concomitant use of antidepressants and mood stabilizers, however, raise questions, because evidence for the effectiveness of adjunctive use of these agents in schizophrenia is mixed or absent ( page 1094 ). In the second article, Lydia A. Chwastiak, M.D., M.P.H., and coauthors report that more than half of 1,424 enrollees (58 percent) had at least one comorbid medical condition and that severity of schizophrenia symptoms was not associated with the number of comorbid illnesses ( page 1102 ). Marvin S. Swartz, M.D., and colleagues found that of the 1,460 enrollees 37 percent had a substance use disorder. Compared with abstinent enrollees, those with substance use and substance use disorder, unless they used cocaine, generally had higher levels of psychosocial functioning ( page 1110 ). In the final article, Deborah A. Perlick, Ph.D., and colleagues report appreciable and varied family burden among 623 family caregivers of enrollees who were interviewed. Demographic characteristics, especially age, and symptom severity accounted for the most burden; perceived patient helpfulness was a moderating factor ( page 1117 ). Robert A. Rosenheck, M.D., who served as guest editor, and coauthors introduce the section ( page 1093 ). In a commentary on page 1075, Jeffrey A. Lieberman, M.D., discusses the fears raised in September 2005 by the publication of early CATIE findings.

Four articles and a brief report present research on the identification and treatment of comorbid medical conditions and their effects on functioning. Greer Sullivan, M.D., M.S.P.H. and her colleagues examined data from nearly 4,300 visits for diabetes to an urban emergency department visit and found that people with co-occurring mental illness were less likely to be hospitalized, especially those who had nonpsychotic disorders ( page 1126 ). Leslie Citrome, M.D., M.P.H., and colleagues found that the incidence of newly treated diabetes doubled in state psychiatric hospitals in New York between 1997 and 2004, paralleling an increased surveillance rate and a dramatic rise in use of second-generation antipsychotics—from 9 percent to 79 percent of prescribing episodes between 1994 and 2000 ( page 1132 ). Using data from a national Canadian survey, Roger S. McIntyre, M.D., F.R.C.P.C., and colleagues found a significantly higher rate of physician-diagnosed common medical disorders and poorer functioning among people who screened positive for bipolar disorder ( page 1140 ). A study by Anthony P. Weiss, M.D., M.Sc., found few disparities in management of cardiac risk factors between 214 outpatients who had diabetes and schizophrenia and outpatients with diabetes who had no mental illness; however, lipid control for some patients with mental illness appeared difficult to attain ( page 1145 ). In a brief report, Robert J. Buchanan, Ph.D., and colleagues present data showing that among more than 1,500 people with multiple sclerosis, more than 90 percent of those who reported depression had access to and obtained mental health services ( page 1206 ).

Two studies reported in this issue took a close look at organizational factors that facilitate openness to change. Phyllis C. Panzano, Ph.D., and Dee Roth, M.A., examined survey and interview data from individuals involved in 78 projects involving decisions to adopt one of four innovative mental health practices. They found that contrary to the popular view of early adopters of innovations as willing to take enormous risks, early adopters appear to act because they see the risks associated with adopting as lower than their nonadopter counterparts ( page 1153 ). Gregory A. Aarons, Ph.D., surveyed more than 300 clinicians and case managers from 49 public-sector mental health programs about their attitudes toward evidence-based practices and the leadership behaviors of their supervisors. Both a transformational leadership style and a transactional leadership style were associated with more positive staff attitudes toward adoption of evidence-based practices ( page 1162 ).

• A review of 61 research studies identified several variables associated with discharge against medical advice from inpatient psychiatric care ( page 1192 ).

• An essay in the June issue that described historical links between the antipsychiatry movement and the current consumer movement generated a number of critical letters ( page 1212 ).