Psychiatric symptoms and medical utilization in primary care patients

In two studies, the authors evaluated the impact of psychiatric disorders on medical care utilization in a primary care setting. In the first study, 526 consecutive patients in a teaching hospital primary care practice completed the 18-item RAND Mental Health Inventory to identify clinically significant depression and/or anxiety and a questionnaire about the use of psychiatric treatment and psychoactive medications. The medical utilization of those patients defined as depressed and/ or anxious was compared with those defined as not depressed and/or anxious. Patients identified as depressed and/or anxious reported significantly increased medical utilization, but this was not confirmed by the hospital's computerized record system. In the second study, the authors analyzed medical care utilization for the years before and after the first outpatient psychiatry appointment of a sample of 91 patients referred from the same primary care practice to the hospital's outpatient psychiatry clinic over a 1-year period. In both studies there was not a statistically significant difference in medical utilization among those patients receiving psychiatric treatment. The findings demonstrate the difficulties in examining cost offset in a primary care population and raise questions about it as a realistic outcome measure of the effect of psychiatric treatment.     

The Community Mental Health Center and the Private Medical Practitioner: A First Step

Abstract

The vast majority of young adults with Attention–Deficit/Hyperactivity Disorder (ADHD) report interpersonal difficulties, which are likely exacerbated by others' negative perceptions of ADHD. Therefore, researchers and clinicians have called for the development of attitude change strategies. One strategy is preventative disclosure, in which one selectively informs and educates others about their condition. No known research has explored preventative disclosure with ADHD. To examine the effects of disclosure, 306 young adults read vignettes that varied in a two (ADHD symptom presentation: hyperactive/impulsive vs. inattentive) by two (preventative disclosure vs. nondisclosure) design. A factor analysis of the questions following each vignette resulted in two factors: Socially Rejecting Attitudes (alpha = .82) and Potential Benefits with Treatment (alpha = .61). Results suggest that preventative disclosure may greatly reduce Socially Rejecting Attitudes (d = -.95). When ADHD was disclosed, respondents were more likely to report that the character would benefit from treatment (d = .39). A character presenting with hyperactive/impulsive (compared to inattentive) symptoms was more likely to be viewed as potentially benefiting from treatment (d = .50). If the results of the present study replicate with clinical samples, preventative disclosure could have a significant impact on the psychosocial functioning of people with ADHD.     

Likelihood‐based dynamic factor analysis for measurement and forecasting

We present new results for the likelihood‐based analysis of the dynamic factor model. The latent factors are modelled by linear dynamic stochastic processes. The idiosyncratic disturbance series are specified as autoregressive processes with mutually correlated innovations. The new results lead to computationally efficient procedures for the estimation of the factors and for the parameter estimation by maximum likelihood methods. We also present the implications of our results for models with regression effects, for Bayesian analysis, for signal extraction, and for forecasting. An empirical illustration is provided for the analysis of a large panel of macroeconomic time series.     

A reexamination of the psychiatric resident's experience in the general hospital

The authors discuss three phases of psychiatric residency training: the beginning psychiatry training syndrome, the professional and psychologic changes associated with the second year, and the senior resident year, characterized by transition to practice issues. Since most residency training experiences occur in general hospital settings, it is imperative that general hospital psychiatrists be aware of the professional and emotional changes that residents experience as they move from inpatient to outpatient settings and assume more administrative responsibilities in departments of psychiatry. The authors recommend preventive steps that residency training directors in general hospitals might take to reduce residents' adverse emotional responses to stresses associated with each training period in the general hospital.     

Poor intentions or poor attention: misrepresentation by applicants to psychiatry residency.

OBJECTIVE: This study examines the veracity of self-reported data by applicants to psychiatry residency. METHODS: The authors reviewed the reported publications of all applicants to a psychiatry residency training program over a 2-year span. RESULTS: Nine percent of applicants reporting publications were found to have misrepresented them. International medical graduates were found to be more likely to have misrepresented their publications than U.S. medical graduates. CONCLUSION: A small but significant number of applicants to psychiatry residency training misrepresent their publications. Identification of misrepresentation may provide valuable information about the applicant and their future performance in training and practice.     

Ongoing evaluation in psychiatry: the first step toward quality

Concern about quality control in psychiatric training has been heightened by the lack of standardized assessment within residencies to ensure that graduates reach a level of competence commensurate with the ability to practice independently and the high failure rate on the American Board of Psychiatry and Neurology examination. An APA task force explored the paucity of evaluation of both training programs and residents and made 10 recommendations for improving the quality of residency training. The authors describe the evaluative components of these recommendations and the political steps taken to gain professional consensus for their requirement in all training programs.