In This Issue

A 2-year program providing monthly medical care management to low-income patients with serious mental illness improved health outcomes and lowered costs. However, Druss et al. (CME, p. 1171) discovered that the program was not financially sustainable, as only 40.5% of the patients had Medicaid or other insurance. The editorial by Sharfstein (p. 1134) describes how the Affordable Care Act could help integrate mental health and other medical care.

Two studies of attention deficit hyperactivity disorder (ADHD) highlight long-term outcomes. The meta-analysis of brain imaging studies by Nakao et al. (CME, p. 1154) confirmed that gray matter volume deficits are less abnormal for patients taking stimulants and for adults with the disorder. The latter finding suggests that development may “catch up” as the patient ages. The longitudinal study of 2,000 children by Pingault et al. (p. 1164) revealed that inattention, but not hyperactivity, is related to whether children graduate from high school. Of those with inattentive behaviors enduring from age 6 to 12, only 29% graduated from high school. Hyperactivity was not independently associated with graduation. In an editorial, Gau (p. 1131) notes that another ADHD dimension, impulsivity, may also influence educational attainment.