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Psychiatric Patients and Treatments in 1997:  Findings From the American Psychiatric Practice Research Network

Harold A. Pincus, MD; Deborah A. Zarin, MD; Terri L. Tanielian, MA; Julia L. Johnson, MA; Joyce C. West, MPP, PhD; Amy R. Pettit; Steven C. Marcus, PhD; Ronald C. Kessler, PhD; John S. McIntyre, MD
Arch Gen Psychiatry. 1999;56(5):441-449. doi:10.1001/archpsyc.56.5.441.
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Despite extensive studies on the epidemiology of mental disorders and advances in the treatment of these conditions, there is a paucity of detailed information concerning the characteristics of psychiatric patients and how treatments are administered in routine psychiatric practice. This 1997 observational study collected detailed information from 417 psychiatrists on the demographic, diagnostic, clinical, and treatment characteristics of a systematic sample of 1228 patients. Six hundred thirty-seven patients (51.9%) were women and the mean patient age was 41.9 years. The most common diagnostic category (53.7%) was mood disorders, followed by schizophrenia/psychotic disorders (14.6%), anxiety disorders (9.3%), and disorders of childhood (7.7%). Six hundred seventy-one patients (54.6%) had at least one comorbid Axis I condition and almost half (49.8%) had a history of psychiatric hospitalization. Patients received a mean of 2.0 psychotherapeutic medications, most commonly antidepressants (62.3%). Findings demonstrate that psychiatrists in routine practice treat a patient population with severe, complex conditions.

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Figure 1.

The percentage of patients (N=1124) receiving psychiatric care in various treatment settings. HMO indicates health maintenance organization.

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Figure 2.

Current treatment services provided by the psychiatrist (N=1228 patients). Psychiatrists were asked to check all that applied. Patients who received more than 1 service during the current visit were counted in each of the relevant service categories, so percentages add to more than 100%. Medication represents patients who were receiving 1 or more medications at the time of the visit, regardless of whether this medication was monitored or adjusted. Psychiatric management was defined as monitoring clinical status; educating patients and families; prescribing, monitoring, or adjusting medications and/or other treatments; establishing and maintaining a therapeutic alliance; and developing or modifying treatment plans. Psychotherapy includes individual, group, and couples/family therapy.

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Figure 3.

Percentage of patients (N=1228) receiving medications, by medication class. Patients receiving more than 1 type of medication were counted in each of the relevant categories, so percentages add to more than 100%. Categories are parallel to those in the Physicians' Desk Reference25 and refer to medication type (eg, antidepressant) rather than treatment indication (eg, for the treatment of an anxiety disorder). General medical indicates medications that are not psychotropic but may be prescribed for the treatment of psychiatric symptoms or psychotropic side effects (eg, antihypertensive and antiparkinsonian medications); anti–substance use includes antibuse, naltrexone, and methadone hydrochloride; and other includes vitamins and herbal remedies prescribed by the psychiatrist. In cases in which a substance had more than 1 therapeutic classification (eg, clonazepam), it was listed in the category for which it was thought to be most commonly prescribed.

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