The American Journal of Psychiatry

Expenses for mental illness and substance abuse treatment increased only slightly after implementation of Oregon's law requiring parity between insurance coverage for these disorders and coverage for other conditions. Management of behavioral health benefits through nonquantitative treatment limitations, such as documentation of medical necessity, prior authorization, and utilization review, was allowed but had to conform with restrictions on medical-surgical coverage. This similarity to the federal parity law implemented in 2009 suggests that the new federal requirement of insurance parity will not “break the bank.”

Patients with PTSD from experiences during the World Trade Center attack responded better to paroxetine, up to 50 mg/day, than placebo over 10 weeks of exposure therapy that included weekly 90-minute guided imagery sessions and cognitive-behavioral exercises. By week 10, 42% of patients in the paroxetine group remitted, compared with 17% in the placebo group. The differences did not persist for patients who continued therapies beyond 10 weeks; by week 22, the remission rate was 45% for both treatments among those remaining in the study.

Haloperidol had 1.5 times the risk of mortality of other psychotropics in patients with dementia studied in an outpatient VA setting. Risperidone, valproic acid and derivatives, and olanzapine had intermediate risk, and quetiapine had the lowest risk. Haloperidol was more frequently prescribed by nonpsychiatrists and more often in older, medically ill African Americans. Quetiapine was prescribed in lower doses, often for less ill patients, but was associated with increased parkinsonian symptoms. The increased risk of haloperidol was primarily in the first 30 days. The efficacy of quetiapine in the behavioral disturbances associated with dementia is questionable, whereas risperidone and olanzapine have significant beneficial effects and therefore would be preferred for treatment.