Jill RachBeisel

Drug-use behavior and correlates in people with schizophrenia

This study examined how illicit drugs were accessed, reasons for drug use, prevalence of emotional, physical, and sexual abuse, psychiatric symptomatology, level of functioning, and the relationship of these factors to substance use in 25 schizophrenia outpatients. To identify unique substance-use behaviors or correlates, this information was compared to 25 substance-abusing outpatients with major affective disorders, and 30 people with schizophrenia alone. Patients largely financed their drug habits with money given by immediate family members, and reported using drugs primarily for social reasons. While all three groups reported high levels of physical, sexual, and emotional abuse, a relationship between emotional abuse and substance use was observed only for people with schizophrenia. There were no differences between the two schizophrenia groups in psychiatric symptoms or level of functioning. The treatment implications of these findings are discussed.

Relationships Among Motivation to Change, Barriers to Care, and Substance-Related Consequences in People With Dual Disorders

Despite the importance of motivation to change substance use and outcomes in primary substance abusers, less is known about motivation in people with serious mental illness and substance use disorders. The present study sought to better understand the relationships among substance use and consequences, perceived barriers to care, and motivation to change in a sample of people with serious mental illness and substance use disorders who were entering outpatient mental health care. Participants were 41 dually diagnosed outpatients who completed self-report measures at intake to outpatient mental health treatment. Participants endorsed many barriers to treatment and many negative consequences resulting from substance use. Findings showed positive relationships between substance-related problems and both motivation to change (r = .42, p < .01) and perceived importance of change (r = .68, p < .001). Higher maintenance stage scores were related to a greater number of barriers to care (r = .34, p < .03). Higher action scores were inversely related to past-month drug use (r = –.59, p < .001). Relationships among variables were similar to what has been found in primary substance abusers. Two ideas are discussed: (1) dually diagnosed patients may encounter unique challenges when seeking care, and 2) those who have made changes continue to perceive barriers to treatment.

Integrated Care and the Behavioral Health Home: A New Program to Help Improve Somatic Health Outcomes for Those With Serious Mental Illness.

Abstract Research indicates that individuals with serious mental illness (SMI) consistently have lower access to primary care and much higher rates of preventable somatic health problems, like diabetes, hypertension, and hyperlipidemia. These higher rates of preventable somatic health problems result in poorer quality of life, lower life expectancy, and higher use of expensive emergency care. With this growing awareness and the recent health care reform, a new program, called the Behavioral Health Home (BHH), has been created to reduce barriers that individuals with SMI face when trying to access primary care. This report provides information on the how these health disparities were well documented at a university-based psychiatric clinical program and the creation of a BHH to help address these health needs. Lessons learned from initial implementation and future directions of the BHH are discussed.

Adjunct Aripiprazole Reduces Prolactin and Prolactin-Related Adverse Effects in Premenopausal Women With Psychosis: Results From the DAAMSEL Clinical Trial.

Purpose/Background Prolactin-related adverse effects contribute to nonadherence and adverse health consequences, particularly in women with severe mental illness. Treating these adverse effects may improve treatment acceptability, adherence, and long-term outcomes. Methods/Procedures Premenopausal women with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder were recruited for a randomized, double-blind, placebo-controlled 16-week trial of adjunct aripiprazole (5–15 mg/d). Participants had elevated prolactin (>24 ng/mL) and were experiencing galactorrhea, amenorrhea, oligomenorrhea, or sexual dysfunction on a prolactin-elevating antipsychotic. Participants were evaluated biweekly for prolactin elevation and galactorrhea and completed a menstrual diary review. Psychiatric symptoms and adverse effects were closely monitored. Findings/Results Forty-six women were randomized (n = 25 aripiprazole, n = 21 placebo). Thirty-seven completed at least 8 weeks of the study (n = 20 [80%] aripiprazole and n = 17 [81%] placebo). Aripiprazole (mean dose, 11.7 ± 2.4 mg/d) was effective for lowering prolactin relative to placebo (P = 0.04). In addition, 45% (9/20) of the aripiprazole group had a normalized prolactin (<24 mg/mL) compared with 12% (2/17) of the placebo group (P = 0.028). Galactorrhea resolved in 77% (10/13) of the aripiprazole-treated participants compared with 33% (4/12) in the placebo group (P = 0.028). Normalization of sexual function (<16 on the Arizona Sexual Experience Scale) occurred in 50% on aripiprazole (7/14) versus 9% (1/11) on placebo (P = 0.030). No differences between groups in symptoms or adverse effects were noted. Overall, women rated a mean score of 4.6 ± 0.6 on a 5-point Likert scale for sexual function improvement, suggesting their particular satisfaction with improvement in this domain. Implications/Conclusions Building upon prior studies, this rigorous evaluation confirms the utility of adjunctive aripiprazole as a strategy for improving prolactin and managing prolactin-related adverse effects in premenopausal women with psychosis.

Preliminary Results From a Newly Established Behavioral Health Home: Early Identification of Glucose Metabolism Disorders in Individuals With Serious Mental Illness

Objective: Individuals with serious mental illness (SMI) have higher rates of preventable diseases such as diabetes in comparison to the general population. While multifaceted, these high rates of preventable diseases in the population with SMI may be partially attributed to limited access to primary care. A new program, the Behavioral Health Home (BHH), which allows for the delivery of somatic care coordination and population-based care, may provide this population with the much needed somatic coordination and education it requires. Methods: The impact of the population-based health management program of the BHH identification and severity rating of glucose metabolism disorders was assessed during the initial 10 months of the BHH. Results: Multiple patients were identified who either were not having hemoglobin A1c (HbA1c) levels drawn per recommended guidelines for individuals prescribed antipsychotic medications or were within diabetic range but did not have a diagnosis of diabetes. Mixed results occurred in regard to patients’ HbA1c levels while engaging in the BHH. Conclusion: This case study provides some initial evidence for the utility of the BHH in regard to identifying patients who need preventive care.