January 2011

Depression, Inflammation, and Statins
In patients who have had a recent cardiac event, statins are associated with a significant reduction in the risk of depression.

Treating BDD
Although body dysmorphic disorder is difficult to treat, serotonin reuptake inhibitors and cognitive behavioral therapy may improve symptoms.

Measurement-Enhanced Care
A measurement-enhanced care approach to psychiatry, in which symptoms are measured before and during treatment, is seldom used in clinical practice but may become more common in the future.

In Brief
Children with ADHD Have More Chromosomal Structural Abnormalities; Medicare/Medicaid Prescription Plan Switch Associated with Increases in Suicidal Ideation and Behavior

SRIs and Thinning Bone
Highly serotonergic agents may adversely affect bone density.

Stimulants in Dementia
Methylphenidate (Ritalin and others) may provide relief for apathy in patients with dementia but with the risk of adverse cardiovascular and behavioral effects.

Measurement-Enhanced Care

January 2011

When we go to a doctor to receive treatment for hypertension, we expect our blood pressure to be measured—as part of an initial assessment and subsequently to monitor response to treatment. Measurement-based, or more accurately measurement-enhanced, care in psychiatry means measuring actual symptoms of a psychiatric disorder—before and during treatment. This approach is routine in clinical research but seldom applied in day-to-day clinical practice.

Many rating scales—some clinician-administered and some completed by patients—cover virtually all psychiatric conditions. They help practitioners to know which symptoms have responded to an intervention and which have not. It is particularly elegant and useful if the doctor, patient, and family can see a graphic representation of response to treatment—whether good or inadequate. That sets the stage for discussion about next steps or continuation.

Today, every practitioner worries about increased demands and decreased resources. Time is so precious. Ideally, a movement towards measurement-enhanced care in psychiatry will be done by health care systems. Having patients complete most ratings before seeing the doctor, preferably electronically, will be most efficient. Some patients will require assistance, which can be provided by family members or staff. In an optimal health care system, graphic data about a patient's progress will be available when the patient arrives to see a physician, supplemented by decision-support information available electronically in a user-friendly format.

What's to be done in the meantime, particularly for psychiatrists in less organized settings? Doing anything is preferable to doing nothing. Some rating scales are available in paper format and can be given to patients to complete at home or in a waiting area. Most patients appreciate these additional tangible signs that they are being carefully monitored. And such a system facilitates additional communication between doctors and patients.

Health care in the United States is in a period of rapid change. Exactly what that change will be remains a work in progress. Undoubtedly, measurement-enhanced care will be required in psychiatry. The more we can work together to embrace the concept and find practical and efficient means to implement this strategy, the more we will fulfill our mission and improve lives.