Psychiatric research and clinical practice最新文献

{"title":"Rural and Non-Rural U.S. Veterans Receiving Virtual Geriatric Mental Health Services in the Clinical Resource Hubs.","authors":"Christine E Gould, Chalise Carlson, Susan K Schultz, Julie Filips, Ranak B Trivedi, Zach Burningham","doi":"10.1176/appi.prcp.1441996","DOIUrl":"10.1176/appi.prcp.1441996","url":null,"abstract":"<p><strong>Objective: </strong>Veterans Health Administration Clinical Resource Hubs are regional telehealth hubs that provide Veterans access needed to geriatric mental health (GMH) services without long drive times to urban centers to find specialists. This analysis characterized the GMH telehealth services to examine differences between rural and non-rural Veterans.</p><p><strong>Methods: </strong>Electronic health record data were extracted (October 2021 to September 2023) for encounters delivered by telehealth GMH teams staffed by geriatric psychiatrists, pharmacists, geropsychologists, and neuropsychologists. Variables included Veteran demographics, diagnoses, severity of care needs, services delivered and visit modality. Descriptive statistics, chi-square and <i>t</i>-tests summarized the data and examined rural and non-rural differences.</p><p><strong>Results: </strong>GMH clinicians completed 9282 encounters with 2013 Veterans (Mean age = 75.8). Most services were video to home (48.2%) followed by video to clinic (25.4%), and phone (22%) with no differences in service delivery modality among rural and non-rural Veterans. Rural Veterans had a higher proportion of psychotherapy and dementia-related services, and lower proportions of medication management and services for depression, anxiety, and serious mental illness compared with non-rural Veterans.</p><p><strong>Conclusions: </strong>Older Veterans access virtual GMH care for a wide range of mental health and cognitive disorders. The apparent higher utilization of psychotherapy and dementia services for rural compared with non-rural Veterans may relate to barriers to obtaining these services locally, although it may be partially explained by variations in virtual team compositions and settings served.</p><p><strong>Relevance to clinical practice: </strong>This evaluation suggests high acceptability of video-delivered care for older, rural Veterans with high care needs.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV Testing and Care Among Publicly Insured Enrollees With Schizophrenia: Is There a Benefit to Dual Eligibility?","authors":"Karly Murphy, Marilyn D Thomas, Paola Alonso-Fraire, Alexander R Bazazi, Priya Dahiya, Mark Olfson, Francine Cournos, Emily Arnold, James Dilley, Paul Wesson, Richard Hermida, James Walkup, Stephen Crystal, Christina Mangurian","doi":"10.1176/appi.prcp.2023776","DOIUrl":"10.1176/appi.prcp.2023776","url":null,"abstract":"<p><strong>Background: </strong>Patients with schizophrenia experience gaps in the human immunodeficiency virus (HIV) care continuum. We examined the impact of dual enrollment in Medicare upon HIV testing and retention among Medicaid-enrolled patients with schizophrenia.</p><p><strong>Methods: </strong>Using Medicaid Analytic eXtract and Medicare files from 2008 to 2012, we examined adult participants with schizophrenia enrolled in Medicaid or dually enrolled in Medicare and Medicaid. Our outcomes were (a) HIV testing probability among participants without HIV and (b) retention in HIV care among people living with HIV (PLWH) (two HIV viral loads or CD4+ counts >90 days apart and within 1 year).</p><p><strong>Results: </strong>The average annual HIV testing probability was 4.9% among dually enrolled and 7.4% among Medicaid-enrolled patients (<i>p</i> < 0.001). Compared to Medicaid-only, HIV testing for dually enrolled patients were highest among those with opioid use disorder or sexually transmitted infection (STI); and lowest among study sample aged 50-59 years, Asian or White race. Among PLWH, the average retention probability in care was 54.7% for dually enrolled and 44.7% for Medicaid-enrolled patients (<i>p</i> < 0.001). Compared to Medicaid-only, retention probability for dually enrolled patients were highest among those with an STI or dyslipidemia, and lowest among younger sample.</p><p><strong>Conclusions and relevance: </strong>Dual Medicare enrollment for Medicaid-enrolled patients benefitted HIV retention efforts more than HIV testing efforts. Differences in public insurance coverage between HIV care retention and testing among patients with schizophrenia, emphasizes the need for ongoing evaluation of the HIV care continuum as payor coverage and policies continue to evolve.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Psychiatry: Five Decades of Progress and Persistent Translational Challenges.","authors":"Esteban Zavaleta-Monestel, Luis Guillermo Herrera-Jiménez, Sofía Suárez-Sánchez, Sebastián Arguedas-Chacón, Jeaustin Mora-Jiménez, Ricardo Millán-González","doi":"10.1176/appi.prcp.20260059","DOIUrl":"10.1176/appi.prcp.20260059","url":null,"abstract":"<p><strong>Objective: </strong>This review examined the historical development of artificial intelligence (AI) in psychiatry from 1972 to 2025 and identified persistent barriers to clinical translation.</p><p><strong>Method: </strong>The review used a structured source-identification approach across PubMed/MEDLINE, Web of Science, Google Scholar, ScienceDirect, citation tracking, and targeted historical searches. It synthesized sources qualitatively and organized them chronologically. A structured evidence table summarized representative milestones by era, AI paradigm, clinical task, data modality, validation approach, implementation status, and translational limitation.</p><p><strong>Results: </strong>Psychiatric AI evolved from symbolic simulation and rule-based expert systems to connectionist models, supervised machine learning, computational psychiatry, digital phenotyping, multimodal monitoring, digital mental health tools, and large language models. Despite increasing computational sophistication, recurring barriers persisted, including uncertain target validity, diagnostic heterogeneity, limited external validation, poor transportability, interpretability challenges, workflow integration, equity, patient trust, and governance. Across eras, technical progress was cyclical rather than linear, with successive waves reproducing unresolved clinical and implementation challenges.</p><p><strong>Conclusions: </strong>The clinical impact of psychiatric AI will likely depend less on algorithmic novelty alone than on clearer clinical targets, prospective validation, implementation trials, patient-centered evaluation, equity-sensitive generalizability, and mental health-specific governance.</p><p><strong>Relevance to clinical practice: </strong>For routine psychiatric care, AI tools require evidence of clinical validity, transportability, workflow compatibility, patient acceptability, equity, and appropriate governance rather than technical performance alone.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Risks of Pregnancy Complications in Women Prescribed Psychostimulants or Atomoxetine During Pregnancy Following Pre-Pregnancy Stimulant Use.","authors":"Wen-Jan Tuan, Nandini Sarkar, Paul Griffin, Dara E Babinski","doi":"10.1176/appi.prcp.20250149","DOIUrl":"10.1176/appi.prcp.20250149","url":null,"abstract":"<p><strong>Objective: </strong>Prescription stimulants are commonly used to manage attention deficit hyperactivity disorder among women of reproductive age, yet their safety during pregnancy remains unclear. This study leveraged large-scale electronic health record data to assess whether use of these medications during pregnancy was associated with adverse pregnancy outcomes and to support clinicians in making informed treatment decisions.</p><p><strong>Methods: </strong>The study included adult women with deliveries from 2010 to 2022 who had two or more stimulant prescriptions before pregnancy. Participants were categorized into three mutually exclusive groups: stimulant, atomoxetine, and control (neither medication during pregnancy). The outcomes of interest included prenatal maternal, placental, fetal growth, labor-delivery, and birth-related complications occurring during pregnancy. Propensity score matching analysis was applied to reduce confounding effects in patient baseline characteristics, followed by logistic regression to assess the likelihood of each adverse pregnancy outcome type.</p><p><strong>Results: </strong>There were 32,152 pregnant women in the analysis, including 8394 (26.1%) prescribed stimulants, 405 (1.3%) prescribed atomoxetine, and 23,353 (72.7%) controls during pregnancy. The stimulant group was 1.2-3.1 times more likely to develop prenatal maternal, placental, and birth-related complications than the atomoxetine and control groups, while the atomoxetine group was 1.1-2.3 times more likely to experience fetal growth abnormality and labor-delivery issues than the control groups. Interestingly, the stimulant group showed 54% lower odds of fetal growth restriction than the atomoxetine group.</p><p><strong>Conclusions: </strong>This study highlighted differential risk profiles between stimulant and non-stimulant therapies, contributing evidence that informs future research on perinatal safety.</p><p><strong>Relevance to clinical practice: </strong>The distinct risk profiles identified for stimulant and atomoxetine therapies underscore the need for personalized treatment decisions during pregnancy.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":" ","pages":"103-111"},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Health Emergency Department Visits and Hospitalizations Among Alabama Publicly Insured Youth During COVID-19.","authors":"Hao Zhang, Pradeep Sharma, Theodoros Giannouchos, Jillur Rahim, Itopa Jimoh, David Becker, Justin Blackburn, Ye Liu, Wanda Davis, Michael A Morrisey, Julie McDougal, Bisakha Sen","doi":"10.1176/appi.prcp.8014456","DOIUrl":"10.1176/appi.prcp.8014456","url":null,"abstract":"<p><strong>Objective: </strong>Increases in the proportion of pediatric emergency department (ED) visits due to mental illness (MI) or intentional self-harm (ISH) in early months of the COVID-19 pandemic have been documented. Less is known about hospitalizations, or trends during later months of the pandemic. This study assessed changes in MI/ISH-related ED visits and hospitalizations among enrollees in Alabama's Children's Health Insurance Program, ALL Kids, during the pandemic.</p><p><strong>Methods: </strong>Administrative claims data from ALL Kids, were used for enrollees aged 6-17 from 2017 to 2022. The study-period was divided into pre-COVID (January 2017-March 2020), early COVID (April 2020-May 2021), and late COVID (June 2021-December 2022). Multivariate logistic regressions were employed to estimate the probabilities that ED visits and hospitalizations were MI/ISH related.</p><p><strong>Results: </strong>The study sample included 72,870 ED visits and 8205 hospitalizations for all causes. After adjusting for covariates, the proportion of MI/ISH-related ED visits increased from 2.5% pre-COVID to 4.1% in early COVID (<i>p</i> < 0.01), then declined to 2.8% in late COVID. MI/ISH-related hospitalizations rose from 26.3% pre-COVID to 31.3% in early COVID and remained elevated at 30.2% in late COVID. Increases were more pronounced among females and older enrollees.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic was associated with increased MI/ISH-related ED visits and hospitalizations among publicly-insured youth, with hospitalizations remaining elevated later into the pandemic. Shifts in healthcare-seeking behaviors or admission criteria during the pandemic may have impacted these findings.</p><p><strong>Relevance to clinical practice: </strong>Findings on pediatric mental health during the COVID-19 pandemic can inform efficient health resources allocation for future public health crises. Our findings highlight the need for ensuring adequate access to health care for youth with severe mental health conditions during public health emergencies.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":" ","pages":"136-145"},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Probable Culture-Specific Disorder of Pathological Weight Gain: Psychocultural Inversion of Anorexia Nervosa in Southern Morocco, Mauritania, and the Sahel.","authors":"Mounir Jaafari, Abdi Cheikh Mohamed Fadel, Ahmed Gourani, Rachid Aalouane, Ismail Rammouz","doi":"10.1176/appi.prcp.20250138","DOIUrl":"10.1176/appi.prcp.20250138","url":null,"abstract":"<p><p>We describe a young woman with a compulsive drive to gain weight, characterized by fear of weight loss, distorted body image, and deliberate use of weight-inducing strategies.Her presentation reflects a pathological internalization of culturally valued corpulence, exceeding socially accepted behaviors and associated with psychological distress.This case may represent a probable culture-specific disorder and a psychocultural inversion of anorexia nervosa, highlighting the need for culturally informed diagnostic frameworks.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":" ","pages":"146-147"},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resisting Contagious Hopelessness: Therapeutic Alliance and the Limits of Physician-Assisted Death in Severe and Enduring Anorexia Nervosa.","authors":"Elizabeth M Olson, Fabian M Saleh, Angela S Guarda","doi":"10.1176/appi.prcp.20260038","DOIUrl":"10.1176/appi.prcp.20260038","url":null,"abstract":"<p><p>Contemporary psychiatric ethics emphasize autonomy and shared decision-making, yet these frameworks may be strained in severe mental illnesses characterized by cognitive rigidity, fluctuating decisional capacity, and undue clinician influence. Severe and enduring anorexia nervosa serves as a case example to explore how therapeutic alliance, clinician expectations, and suggestibility may shape expressions of choice in high-stakes decision-making, including discussions of physician-assisted death. Drawing on psychotherapy theory, placebo science, and clinical outcome data, this paper argues that clinician framing and prognostic stance function as treatment variables that may transmit either hope or hopelessness. Ongoing therapeutic engagement focused on improving quality of life and the instillation and preservation of hope should precede any consideration of end-of-life interventions.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Effectiveness and Cost-Differential of Intranasal Esketamine Versus Intramuscular Ketamine.","authors":"Kush V Bhatt, Tara Austin, Danny Alam, Jason N Compton, Em Ellerman-Tayag, Gabrielle Awodele, Joel M Boerth, Dimitri Periviliotis, Andrew Bismark, Michelle A Singh, Michael J McCarthy, James Pittman, Dhakshin Ramanathan","doi":"10.1176/appi.prcp.20260041","DOIUrl":"10.1176/appi.prcp.20260041","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated whether intramuscular (IM) ketamine is non-inferior to intranasal (IN) esketamine for treatment-resistant depression (TRD) and assessed differences in safety and healthcare costs.</p><p><strong>Methods: </strong>In a retrospective, observational sequential cohort at the VA San Diego, 179 Veterans with TRD received eight treatments of either IN esketamine (<i>n</i> = 89) or IM ketamine (<i>n</i> = 90). The primary outcome was change in depressive symptoms (PHQ-9) analyzed via linear mixed-effects models with a non-inferiority margin of -1.25 points. Secondary outcomes included Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5 symptoms, adverse events, and a cost-difference analysis.</p><p><strong>Results: </strong>IM ketamine was non-inferior to IN esketamine for depression, with a baseline-adjusted estimated marginal mean PHQ-9 difference of 0.04 points (95% CI: -1.21 to 1.29). Reductions in PTSD symptoms were also non-inferior. Incidence of sentinel adverse events were comparable, with no significant differences in emergency department visits or hospitalizations. Cost analysis revealed a significant disparity: the total cost per eight-treatment course was $6069 for IN esketamine versus $647 for IM ketamine, with this difference driven primarily by the cost of IN esketamine.</p><p><strong>Conclusions: </strong>IM ketamine demonstrated comparable clinical effectiveness and safety to FDA-approved IN esketamine while offering a significant reduction in cost. These findings suggest IM ketamine may be a high-value alternative to IN esketamine that could significantly expand access to psychiatric care for individuals with TRD.</p><p><strong>Relevance to clinical practice: </strong>These findings provide real-world evidence supporting the use of IM ketamine for TRD, and suggests that this formulation could offer a pathway for improving access to ketamine treatment by lowering the cost to healthcare systems.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":" ","pages":"112-119"},"PeriodicalIF":0.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics Associated With Response and Remission From Depression Using Measurement-Based Care.","authors":"Andres R Schneeberger, Joelle Robinett, Katia M Harlé, Eve Lasswell, Kristen L Duarte, Ashley Clark, Savita G Bhakta, Jessica Thackaberry, Kelly C Lee","doi":"10.1176/appi.prcp.20250158","DOIUrl":"10.1176/appi.prcp.20250158","url":null,"abstract":"<p><strong>Objective: </strong>Measurement-based care (MBC) is a vital tool in outpatient psychiatric care, enhancing treatment outcomes through systematic symptom monitoring. This study aimed to identify factors associated with remission and response in depression treatment using MBC, focusing on longitudinal changes in Patient Health Questionnaire-9 (PHQ-9) scores.</p><p><strong>Methods: </strong>Electronic health records of 4778 patients aged 12+ from an academic outpatient psychiatry clinic were analyzed. Inclusion criteria required a baseline PHQ-9 score > 9 and at least one follow-up PHQ-9 measurement. Factors associated with treatment response and remission, using different definitions, were evaluated using Cox regression models, adjusting for demographic and clinical covariates.</p><p><strong>Results: </strong>Response and remission rates were 46.3% and 28.2%, respectively. For response, significant associated factors were combined treatment (HR = 1.189, <i>p</i> = 0.014), follow-up PHQ-9 within 4-9 months (HR = 1.303, <i>p</i> < 0.001), and absence of post-traumatic stress disorder (PTSD) (HR = 0.817, <i>p</i> = 0.018). Key factors associated with faster remission (HR > 1) included combined psychiatry and psychotherapy treatment (HR = 1.189, <i>p</i> = 0.014), timely follow-up PHQ-9 administration within 4-9 months (HR = 1.255, <i>p</i> = 0.002), lower baseline PHQ-9 scores (HR = 0.931, <i>p</i> < 0.001), and absence of PTSD (HR = 0.751, <i>p</i> = 0.010). Alternative remission definitions (PHQ-9 < 12 or < 9) yielded similar findings.</p><p><strong>Conclusion: </strong>Integrated psychiatry-psychotherapy approaches, regular symptom monitoring, and addressing comorbid conditions like PTSD are critical for improving depression outcomes. The findings shed light on how MBC can be used to evaluate treatment effectiveness, inform clinical practice, and guide optimized treatment strategies.</p><p><strong>Relevance to clinical practice: </strong>Integrating MBC into a combined psychiatry-psychotherapy framework and systematically addressing comorbidities provides clinicians with powerful strategies to significantly improve depression remission rates.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":" ","pages":"120-129"},"PeriodicalIF":0.0,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13398457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Real-World Pilot of the Collaborative Care Model for Adults With Cognitive Impairment and Neuropsychiatric Symptoms in Primary Care.","authors":"Daniel Y Johnson, Erin M Staab, Peter Hahn, Carly Lusk, Erin K Zahradnik, Neda Laiteerapong","doi":"10.1176/appi.prcp.20240109","DOIUrl":"10.1176/appi.prcp.20240109","url":null,"abstract":"<p><strong>Objective: </strong>The Collaborative Care Model, which integrates primary care, behavioral health, and structured care management, is a promising approach to improving outcomes for patients with cognitive impairment and neuropsychiatric symptoms. This study evaluated a pilot of Cognitive Impairment Collaborative Care (CICC) at a large urban academic medical center.</p><p><strong>Method: </strong>Retrospective chart review of adults enrolled in the first year of the program (November 1, 2021 to October 31, 2022). CICC included assessments, biweekly telehealth visits, care management, psychiatric consultation, and therapy. The primary outcome was clinical effectiveness, defined as the change in Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores. Secondary outcomes were adoption (number of clinicians referring), reach (patient enrollment), and implementation (number of encounters and psychiatric case reviews).</p><p><strong>Results: </strong>Twenty-two patients enrolled in CICC; all had depression or anxiety. About 5% of primary care clinicians referred an average of 1.6 patients (SD 1.7) in the first year. On average, patients were enrolled for 144.9 days (SD 79.7), had 2.3 encounters per month (SD 1.0), were case reviewed 8.6 times (SD 5.3), and 50% graduated in the first year. Patients exhibited significant reductions in depression (PHQ-9: mean change -4.7, SD 5.0, <i>p</i> = 0.003) and anxiety scores (GAD-7: mean change -4.3, SD 5.5, <i>p</i> = 0.01).</p><p><strong>Conclusions: </strong>CICC achieved modest adoption and reach with demonstrated effectiveness in reducing depression and anxiety among patients with cognitive impairment.</p><p><strong>Relevance to clinical practice: </strong>Amid a shortage of geriatricians and geriatric psychiatrists in the U.S., collaborative care is a possible therapeutic option for the growing geriatric population.</p>","PeriodicalId":74592,"journal":{"name":"Psychiatric research and clinical practice","volume":" ","pages":"130-135"},"PeriodicalIF":0.0,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13399420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148586194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}