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Am J Psychiatry 2014;171:A12. doi:10.1176/appi.ajp.2013.17103issue
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Copyright © 2014 by the American Psychiatric Association

 
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Patients with mental illness and comorbid medical conditions received more preventive medical services when given electronic personal health records (Druss et al., p. 360)

A web-based personal health record (figure) improved the quality of medical care and increased use of medical services among patients with serious mental illness and comorbid medical conditions. Among 170 patients studied by Druss et al. (CME, p. 360) at a community mental health center, the proportion of recommended services received at 1-year follow-up was 40% for patients given personal health records with computer training and 18% for those receiving usual care. The group with personal health records also had greater improvement in care for hypertension but not for diabetes or hyperlipidemia. The improved outcomes were largely related to the greater number of outpatient medical visits. The editorial by Fortney and Owen (p. 259) points out the marked dose-response relationship between the amount of technical support provided the patients and their success in using the electronic record.

Clinical Guidance: Intensive Cognitive Therapy Speeds PTSD Response 

Standard once-weekly cognitive therapy and 7-day intensive cognitive therapy are both effective in reducing symptoms of posttraumatic stress disorder (PTSD), but intensive treatment does so faster. Three weeks after the beginning of treatment, Ehlers et al. (p. 294) found lower levels of PTSD symptoms in patients receiving intensive therapy, and outcomes were similar at 14 weeks. No patients dropped out of intensive treatment, and few discontinued standard cognitive therapy. A comparison treatment, emotion-focused supportive therapy, reduced symptoms more than a waiting list control condition but not as much as the two cognitive therapies. The rates of recovery at 14 weeks were 73% and 77% for intensive and standard cognitive therapy, respectively, 43% for supportive therapy, and 7% for the waiting list. Editorialist Cloitre (p. 249) highlights the potential for more personalized treatment of PTSD: intensive cognitive therapy could increase some patients’ involvement in treatment, and supportive therapy might engage patients who do not want trauma-focused treatment.

Shrestha et al. (CME, p. 323) report that fluoxetine increased the activity of a key component of serotonin neurotransmission in the brains of monkeys at an age corresponding to prepuberty childhood in humans. The increase in serotonin transporter protein (SERT) was apparent 1.5 years after drug discontinuation. The behavior of the monkey was assessed and not found to change significantly. Fluoxetine’s effects on SERT have not been similarly tested in humans. An editorial by Brent et al. (p. 252) reminds clinicians and parents, who might interpret these new findings as contraindicating treatment, to recognize that untreated depression carries substantial risk for adolescents and to continue to consider both pharmacotherapy and psychotherapy.

Clinical Guidance: Violence and Persecutory Delusions 

Individuals with schizophrenia who have been imprisoned for violent crimes but not treated are more likely to commit violent acts after release from prison than are those without psychosis or those with schizophrenia who are treated in prison or after release. Keers et al. (p. 332) followed 967 released prisoners in the United Kingdom for a mean of 39 weeks. In the United Kingdom Prisoner Cohort, 22% of those with schizophrenia reported that they had not received any treatment in prison or after release. The higher risk for violence is related to persecutory delusions but not to hallucinations or other psychotic experiences. In an editorial, Large (p. 256) underscores the value of antipsychotic treatment for violent prisoners with schizophrenia to prevent further violent crimes.

Patients with mental illness and comorbid medical conditions received more preventive medical services when given electronic personal health records (Druss et al., p. 360)
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