Psychiatric services : a journal of the American Psychiatric Association
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Shared decision making is advocated as a way of involving patients in medical decisions, but it can be achieved only when both patients and physicians commit to sharing decisions. This study explored psychiatrists' views of shared decision making in schizophrenia treatment. ⋯ It should be clarified whether and how patients with schizophrenia can be empowered and educated so they can share important treatment decisions.
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This study examined the role of workplace mandates to chemical dependency treatment in treatment adherence, alcohol and drug abstinence, severity of employment problems, and severity of psychiatric problems. ⋯ Workplace mandates can be an effective mechanism for improving work performance and other outcomes. Study participants who had a workplace mandate were more likely than those who did not have a workplace mandate to be abstinent at follow-up, and they did as well in treatment, both short and long term. Pressure from the workplace likely gets people to treatment earlier and provides incentives for treatment adherence.
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Few data exist on the cost and quality effects of increased use of prior-authorization policies to control psychoactive drug spending among persons with serious mental illness. This study examined the impact of a prior-authorization policy in Maine on second-generation antipsychotic and anticonvulsant utilization, discontinuations in therapy, and pharmacy costs among Medicaid beneficiaries with bipolar disorder. ⋯ The small reduction in pharmacy spending for bipolar treatment after the policy was implemented may have resulted from higher rates of medication discontinuation rather than switching. The findings indicate that the prior-authorization policy in Maine may have increased patient risk without appreciable cost savings to the state.
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This study examined the association of maternal depression with the emotional and behavioral problems and adaptive skills of four- to ten-year-old children as rated by their mothers, fathers, and teachers. ⋯ This study contributes to the scientific literature by demonstrating the effects of raters and testing mediators of maternal depression in low-income African-American and Latino families. It demonstrated that mothers, fathers, and teachers observed worse functioning among children of mothers with depression than without depression, although reporters' perspectives varied somewhat. The impact of maternal depression over and above that of poverty suggests the importance of developing and funding services to address the needs of affected families.