Julie Kreyenbuhl

Circumstances of suicide among individuals with schizophrenia

Very little is known about the circumstances surrounding suicides in people with schizophrenia. Between September 1989 and August 1998, 15 and 100 suicide victims with and without schizophrenia, respectively, were examined from the Maryland Brain Collection (MBC). Next-of-kin interview and medical record review following death collected demographic and clinical characteristics, family history, psychiatric symptoms, and variables surrounding the suicide. Individuals with schizophrenia exhibited significantly more lifetime depressive symptoms than those without schizophrenia. Jumping from a height was the most frequently used method among people with schizophrenia (40%), whereas gunshot wounds were most common among persons without schizophrenia (37%). A trend was noted for a smaller proportion of those with schizophrenia (20%) to plan the suicide, compared to 47% of those without the disorder. Suicide in schizophrenia is a significant clinical problem; thus, prior suicidal activity and depressive symptoms should be addressed because opportunities to intervene immediately before the act are limited.

Consumer satisfaction with inpatient psychiatric treatment among persons with severe mental illness

Consumer satisfaction with inpatient care is an important component of quality of care and a recovery-oriented system of care. This study assessed association of patient, demographic and process of care variables with inpatient satisfaction focusing on modifiable service delivery factors. Participants were 136 people with psychotic or affective disorders recruited from VA inpatient units who were interviewed with an extensive assessment. Staff teaching efforts regarding medication, illness management, substance abuse, outpatient treatment and living skills were significantly associated with greater levels of satisfaction with care, controlling for demographic and clinical variables. This may reflect value consumers place on staff time, attention and communication. Teaching may enhance self-efficacy and hope thereby facilitating recovery.

Clinically unintended medication switches and inability to prescribe preferred medications under Medicare Part D

Medicare Part D has expanded medication access; however, there is some evidence that dually eligible psychiatric patients have experienced medication access problems. The aim of this study was to characterize medication switches and access problems for dually eligible psychiatric patients and associations with adverse events, including emergency department visits, hospitalizations, homelessness, and incarceration. Reports on 986 systematically sampled, dually eligible patients were obtained from a random sample of practicing psychiatrists. A total of 27.6% of previously stable patients had to switch medications because clinically indicated and preferred refills were not covered or approved. An additional 14.0% were unable to have clinically indicated/preferred medications prescribed because of drug coverage/approval. Adjusting for case-mix, switched patients (p = 0.0009) and patients with problems obtaining clinically indicated medications (p = 0.0004) had significantly higher adverse event rates. Patients at greatest risk were prescribed a medication in a different class or could not be prescribed clinically-indicated atypical antipsychotics, other antidepressants, mood stabilizers, or stimulants. Patients with problems obtaining clinically preferred/indicated antipsychotics had a 17.6 times increased odds (p = 0.0039) of adverse events. These findings call for caution in medication switches for stable patients and support prescription drug policies promoting access to clinically indicated medications and continuity for clinically stable patients.