This longitudinal cohort study uses data from the National Medicaid Analytic Extract and the National Center for Health Statistics to assess the postdischarge risk for suicide among psychiatric inpatients.
This systematic review and meta-analysis establishes which interventions (advance statements, community treatment orders, compliance enhancement, or integrated treatment) effectively reduce compulsory admissions in adult psychiatric patients in outpatient settings.
Hampton et al estimate the numbers and rates of adverse drug event emergency department visits involving psychiatric medications among US adults between 2009 and 2011. Medical records from national probability samples were reviewed and analyzed. Exposures were antidepressants, antipsychotics, lithium salts, sedatives and anxiolytics, and stimulants.
Cummings et al examine the availability of outpatient substance use disorder treatment facilities that accept Medicaid across US counties and whether counties with a higher percentage of racial/ethnic minorities are more likely to have gaps in this infrastructure.
Sigmon et al evaluate the relative efficacy of 1-, 2-, and 4-week buprenorphine tapering regimens and subsequent naltrexone therapy in outpatients with prescription opioid dependence.
Cummings et al examine the availability of outpatient mental health care facilities that accept Medicaid across US counties and whether specific types of communities are more likely to lack this infrastructure.
Crump and coauthors examine the physical health effects of bipolar disorder using outpatient and
inpatient data for a national population.
It has been suggested that patients with major depressive disorder (MDD) who display pretreatment features suggestive of bipolar disorder or bipolar spectrum features might have poorer treatment outcomes.
To assess the association between bipolar spectrum features and antidepressant treatment outcome in MDD.
Open treatment followed by sequential randomized controlled trials.
Primary and specialty psychiatric outpatient centers in the United States.
Male and female outpatients aged 18 to 75 years with a DSM-IV diagnosis of nonpsychotic MDD who participated in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study.
Open treatment with citalopram followed by up to 3 sequential next-step treatments.
Number of treatment levels required to reach protocol-defined remission, as well as failure to return for the postbaseline visit, loss to follow-up, and psychiatric adverse events. For this secondary analysis, putative bipolar spectrum features, including items on the mania and psychosis subscales of the Psychiatric Diagnosis Screening Questionnaire, were examined for association with treatment outcomes.
Of the 4041 subjects who entered the study, 1198 (30.0%) endorsed at least 1 item on the psychosis scale and 1524 (38.1%) described at least 1 recent maniclike/hypomaniclike symptom. Irritability and psychoticlike symptoms at entry were significantly associated with poorer outcomes across up to 4 treatment levels, as were shorter episodes and some neurovegetative symptoms of depression. However, other indicators of bipolar diathesis including recent maniclike symptoms and family history of bipolar disorder as well as summary measures of bipolar spectrum features were not associated with treatment resistance.
Self-reported psychoticlike symptoms were common in a community sample of outpatients with MDD and strongly associated with poorer outcomes. Overall, the data do not support the hypothesis that unrecognized bipolar spectrum illness contributes substantially to antidepressant treatment resistance.