Psychiatric services最新文献

{"title":"Medical Malpractice: Coming Changes and Their Impact on Psychiatry.","authors":"Neil S Kaye, Paul S Appelbaum","doi":"10.1176/appi.ps.20250230","DOIUrl":"https://doi.org/10.1176/appi.ps.20250230","url":null,"abstract":"<p><p>In 2024, the American Law Institute revised its influential Restatement of the Law for medical malpractice. The most important change is an updated standard for determining when a clinician is negligent, which emphasizes the failure to provide reasonable care, replacing the traditional standard of customary care. Determinations of reasonable care can consider evidence from the medical literature and practice guidelines, even if they have not yet generally been adopted in ordinary practice, as well as contextual factors. Although not yet incorporated into law, the new standard underscores the importance of clinicians staying current with changes in evidence-based practice.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"appips20250230"},"PeriodicalIF":3.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent Trends in Medication Treatment for Attention-Deficit Hyperactivity Disorder.","authors":"Haiden A Huskamp, Alisa B Busch, Richard G Frank","doi":"10.1176/appi.ps.20240574","DOIUrl":"https://doi.org/10.1176/appi.ps.20240574","url":null,"abstract":"<p><strong>Objective: </strong>Attention-deficit hyperactivity disorder (ADHD) diagnosis rates and stimulant use have increased recently, particularly among adults, in the context of increased telehealth use and shortages in stimulant medications. To better understand changes in ADHD medication use and inform policy governing the prescribing of these medications, this study aimed to compare stimulant and nonstimulant fills for 2019 versus 2023.</p><p><strong>Methods: </strong>This study used national all-payer prescription claims data for 2019 (before onset of the COVID-19 pandemic) and 2023 to calculate stimulant and nonstimulant ADHD medication fill rates overall and by patient age and prescriber specialty.</p><p><strong>Results: </strong>Total ADHD medication fills increased 23.8%, from 72,849,441 in 2019 to 90,183,437 in 2023; stimulants accounted for most fills (91.4% in 2019; 88.9% in 2023). Whereas the number of stimulant fills rose 20.4% from 2019 to 2023, the number of nonstimulant fills increased at three times that rate (60.1%). Both stimulant and nonstimulant fills increased among adults, whereas stimulant fills decreased 6.5% among children (ages 0-18). Nurse practitioners and physician assistants were responsible for one in three ADHD prescription fills in 2023; nonstimulants were prescribed most commonly by these providers and by psychiatrists.</p><p><strong>Conclusions: </strong>The number of ADHD medication fills rose substantially from 2019 to 2023. Although a majority of 2023 fills were stimulants, nonstimulant fills sharply increased, even though nonstimulants are not the first-choice ADHD medication treatment. This increase was likely due in part to stimulant shortages that continue to limit access to ADHD pharmacotherapy nationwide.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"appips20240574"},"PeriodicalIF":3.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Nonpsychiatrists Want From Psychiatrists: Data From Chart Review Consultation Requests in a Rural Health Care System.","authors":"Evan M Calvo, Lauren K Walsh, Victoria M T Tyrell, Christopher F Chabris, Joanne A Byars","doi":"10.1176/appi.ps.20240263","DOIUrl":"https://doi.org/10.1176/appi.ps.20240263","url":null,"abstract":"<p><strong>Objective: </strong>Given the growing need for novel psychiatric service delivery, this study sought to characterize the use of an outpatient electronic consultation service, Ask-A-Doc (AAD), in a rural health care system.</p><p><strong>Methods: </strong>A qualitative codebook was developed (final interrater agreement=92%) and applied to the free text of all AAD questions (N=707) received by a psychiatry department during a 12-month period.</p><p><strong>Results: </strong>Primary care was the principal source of AAD questions (95%), with most submitted by physicians (56%) and advanced practitioners (44%). Medication management was the most common reason for AAD submission (90%). Submissions mentioned psychiatric symptoms (85%) more than diagnoses (52%). Commonly mentioned symptoms included anxiety and depression; frequently mentioned diagnoses included bipolar disorder, attention-deficit hyperactivity disorder, and major depressive disorder.</p><p><strong>Conclusions: </strong>Nonpsychiatrists find benefit in psychiatrist assistance in managing patients with mental health conditions; they generally want recommendations for medication management to target specific symptoms, not assistance with making or treating specific diagnoses.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"appips20240263"},"PeriodicalIF":3.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"I'm So Glad My Dad Didn't See a Psychiatrist.","authors":"Heather M Wobbe","doi":"10.1176/appi.ps.20250080","DOIUrl":"https://doi.org/10.1176/appi.ps.20250080","url":null,"abstract":"","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"appips20250080"},"PeriodicalIF":3.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors and Outcomes of Detention Under Psychiatric Holding Powers.","authors":"David Weir, Conan Brady, Art Malone, Declan M McLoughlin","doi":"10.1176/appi.ps.20240503","DOIUrl":"https://doi.org/10.1176/appi.ps.20240503","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to characterize the use of emergency psychiatric holding powers in Ireland, investigate predictors of their initiation, and describe clinical outcomes among patients subject to holds.</p><p><strong>Methods: </strong>This retrospective case-control study characterized and compared all voluntarily admitted patients who were either detained under holding powers (N=167 cases involving 162 unique patients) or not subject to holding powers (N=334 control patients) during a stay in one of two psychiatric hospitals in Dublin (January 2018-December 2020). These groups were examined from admission through 1 year after discharge.</p><p><strong>Results: </strong>The use of holding powers was rare (2% of voluntary admissions during the study). Patients in both groups were similar, with no significant sociodemographic differences. The case group was rated as having more severe illness at admission (p<0.001). Multivariable analyses demonstrated that detention was more likely in the presence of impaired insight (OR=4.14), psychotic symptoms (OR=7.56), and suicidal ideation (OR=2.58) at admission and with a diagnosis of bipolar disorder (OR=2.50). Mean length of stay was longer for case group (vs. control group) patients (81.37 vs. 45.74 days, z=-7.42, p<0.001), but illness improvement ratings at discharge did not significantly differ between the groups, nor did readmission rates for the year after discharge.</p><p><strong>Conclusions: </strong>Voluntarily admitted patients who became subject to holding powers had more severe illness at admission than did those without holds. The likelihood of experiencing detention increased with impaired insight, psychotic symptoms, and suicidal ideation at admission. However, the results suggested that treatment outcomes for both groups were similar.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"appips20240503"},"PeriodicalIF":3.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Buprenorphine Dispensing by Provider Type, 2013-2023.","authors":"Mir M Ali, Jie Chen, Priscilla J Novak","doi":"10.1176/appi.ps.20240175","DOIUrl":"https://doi.org/10.1176/appi.ps.20240175","url":null,"abstract":"","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"appips20240175"},"PeriodicalIF":3.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Past-Year Mental and Substance Use Disorders, 2021-2022.","authors":"Heather Ringeisen, Mark Edlund, Heidi Guyer, Jill Dever, Lisa Carpenter, Mark Olfson, Michael First, Paul Geiger, Dan Liao, Andy Peytchev, Christine Carr, Lydia Chwastiak, Lisa B Dixon, Maria Monroe-Devita, T Scott Stroup, Jeff Swanson, Marvin Swartz, Robert Gibbons, Leyla Stambaugh, Natalie Bareis, Thomas E Smith, Ronald C Kessler","doi":"10.1176/appi.ps.20240329","DOIUrl":"https://doi.org/10.1176/appi.ps.20240329","url":null,"abstract":"<p><strong>Objective: </strong>The authors aimed to estimate the past-year prevalence of mental and substance use disorders, including schizophrenia spectrum disorders (schizophrenia, schizoaffective, or schizophreniform disorder), among U.S. adults ages 18-65 years from samples of households and prisons and stratified samples from selected homeless shelters and state psychiatric hospitals. Such information is vital to meet the treatment needs of individuals with these disorders.</p><p><strong>Methods: </strong>The Mental and Substance Use Disorders Prevalence Study (MDPS) was conducted between October 2020 and October 2022. Interviewers administered a structured clinical interview for the <i>DSM-5</i> (N=5,679 participants; N=4,764 in households). Weighted past-year prevalence estimates of mental and substance use disorders were calculated. Level of impairment and the likelihood that a disorder was caused by the COVID-19 pandemic were assessed.</p><p><strong>Results: </strong>The prevalence estimates of lifetime and past-year schizophrenia spectrum disorders were 1.8% (95% CI=1.3%-2.5%) and 1.2% (95% CI=0.9%-1.8%), respectively. The most common past-year disorders were major depressive disorder (15.5%, 95% CI=13.6%-17.5%) and generalized anxiety disorder (GAD; 10.0%, 95% CI=8.3%-12.1%). About one in 10 participants had at least one substance use disorder (10.6%, 95% CI=8.7%-12.9%). Half of those with an MDPS mental disorder had moderate or serious impairment.</p><p><strong>Conclusions: </strong>The prevalence rates of lifetime and past-year schizophrenia spectrum disorders were two to four times higher than previously reported. The prevalence rates of major depressive disorder and GAD were substantially higher than reported in past national studies. Almost 20% of these cases were likely due to the pandemic. Increased mental health treatment resources are urgently needed.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"appips20240329"},"PeriodicalIF":3.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Risk Factors for Physical Assault in a Large Inpatient Behavioral Health System.","authors":"Tobias Wasser, Kevin Xia, David M O'Sullivan, Andre Newfield, Caren Teitelbaum","doi":"10.1176/appi.ps.20250075","DOIUrl":"https://doi.org/10.1176/appi.ps.20250075","url":null,"abstract":"<p><strong>Objective: </strong>To enhance understanding of the risk for violence in inpatient psychiatric environments, the authors studied assaultive behavior in a large health care system to explore the demographic, clinical, and other factors associated with the likelihood of patients' committing a physical assault.</p><p><strong>Methods: </strong>In this retrospective chart review study, 3 years of data were collected from a single-state health care system spanning >330 inpatient psychiatric beds across six separate hospitals. The system's risk management database was queried for all physical assaults during the study period (2021-2023), and these assaults were cross-matched with patients' electronic medical record data. Descriptive and inferential statistical analyses were conducted to investigate differences between patients who had committed an assault during the study period and those who had not.</p><p><strong>Results: </strong>A total of 15,186 unique inpatients were evaluated, and 556 physical assaults committed by 359 (2.4%) patients during the study period were identified. Patients who committed an assault were significantly more likely to be male, be younger, identify as Black or African American, have a psychotic disorder, be subject to conservatorship, have been admitted involuntarily, and have a known history of assault. Patients with a comorbid substance use disorder were significantly less likely to engage in assault.</p><p><strong>Conclusions: </strong>This study represents one of the largest investigations into rates of assault by patients in U.S. inpatient psychiatric hospitals. By attaining a greater understanding of risk factors for inpatient assault, this study may contribute to the development of risk assessment and management methodologies.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"appips20250075"},"PeriodicalIF":3.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and Ethnic Disparities in Self-Reported Postpartum Depressive Symptoms and Provider Identification of Depression.","authors":"Amy Ehntholt, Wei Zhang, Dana E Cohen, Emily DeLorenzo, Douglas Done, Audrey Erazo-Trivino, Stephanie Mack, Trang Nguyen, Loretta Santilli, Thomas E Smith","doi":"10.1176/appi.ps.20240535","DOIUrl":"https://doi.org/10.1176/appi.ps.20240535","url":null,"abstract":"","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"appips20240535"},"PeriodicalIF":3.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Cohort Study of Racial-Ethnic Disparities in Receipt of Electroconvulsive Therapy, 2016-2021.","authors":"Steven Sprenger, Gerardo Corsi, Alexandre Koumtchev, Natalie Hurlock","doi":"10.1176/appi.ps.20240400","DOIUrl":"https://doi.org/10.1176/appi.ps.20240400","url":null,"abstract":"<p><strong>Objective: </strong>Electroconvulsive therapy (ECT) is an effective treatment for severe depression, but racial-ethnic disparities in its receipt have long been observed, and previous studies have had limited generalizability. This study aimed to determine whether racial-ethnic disparities persist in contemporary treatment environments after adjustment for various demographic factors.</p><p><strong>Methods: </strong>A retrospective study was conducted among patients with data in the HCA Healthcare Enterprise Data Warehouse who were diagnosed as having severe unipolar depression (<i>ICD-10</i> codes F32-F33) and who sought care in any of 162 inpatient and outpatient facilities between 2016 and 2021. Patients were grouped by self-reported racial-ethnic identity. The association between race-ethnicity and selected covariates was determined by using chi-square tests (α=0.05), and the relationship between race-ethnicity and ECT receipt, given selected predictor variables, was estimated by using logistic regression.</p><p><strong>Results: </strong>Analyses were conducted for 19,011 unique patients. Significant variation by race-ethnicity was found for all covariates (p<0.001). ECT was administered to 3% of White patients and 1% of non-White patients. Compared with all other race-ethnicities, the unadjusted odds ratio for ECT receipt among White patients was 3.12 (p<0.001). Patients from each non-White racial-ethnic group had significantly lower rates of ECT receipt compared with White patients, including Asian (adjusted OR [aOR]=0.43, p<0.001), Black (aOR=0.27, p<0.001), and Hispanic (aOR=0.39, p<0.001) patients and patients identifying as other race-ethnicity (aOR=0.53, p=0.001).</p><p><strong>Conclusions: </strong>In this nationwide study, significant disparities in ECT use, by self-identified racial-ethnic identity, were observed even after demographic covariates were controlled.</p>","PeriodicalId":20878,"journal":{"name":"Psychiatric services","volume":" ","pages":"appips20240400"},"PeriodicalIF":3.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}