Steven E. Katz

Can cocaine addicts with severe mental illness be treated along with singly diagnosed addicts

Large numbers of indigent cocaine abusers now present in center-city hospitals. Since many are also diagnosed for severe mental illness, options for their effective treatment are needed. The authors investigated the feasibility of treating these dually diagnosed patients along with the majority of abusers who were not severely impaired in a program that combines peerled treatment with psychiatric management and pharmacotherapy. Although group confrontation techniques were used, schizophrenics (N = 71) and patients with major depressive disorder (N = 50) experienced an outcome as good or better than the less impaired (N = 177) on retention, visit rates, and urinalysis results.

Evidence-Based Care for Depression in Maine: Dissemination of the Kaiser Permanente Nurse TeleCare Program

This paper describes the program model, implementation and preliminary results from a dissemination of a nurse case management program for treating depression in primary care. The program design was modeled after the Kaiser Permanente Nurse TeleCare program, which in a randomized clinical trial had previously demonstrated significant improvement in depression outcomes and patient satisfaction over usual care. As illustrated in this pilot by patient outcomes measured using the Hamilton Depression Rating Scale, the SF-12 Mental Health Composite Score, and the Work Role, Household and Leisure Time Functioning, the authors believe that it is possible to implement successful interventions in smaller primary care practices in community-based settings.

Relative Blue-Light Extinction in Lens Nucleus Related to Age and Cataract

The extent of visual function loss from nuclear cataractous change can be estimated by observing the extinction of blue light compared to white light as a function of sagittal lens depth in standard slit lamps. Apparent extinction (loss of transmissivity) of 50% or more of the depth of the lens in blue light of maximal intensity compared to white light at minimal intensity is associated with marked visual loss. However, this transmissivity ratio of 0.5 or less also applies if light intensity remains constant and the blue filter is simply moved in and out of the light beam. Therefore, if 50% or more of the lens appears dark to blue-filtered light, nuclear changes have significantly decreased effective visual acuity. Relative blue-light extinction associated with nuclear change that may be amenable to surgical correction can thus be distinguished from the extinction effect caused by age alone.

Memories of Larry: A Tribute to Lawrence C. Kolb

It was the summer of 1966. After a stint as an on-the-job trained psychiatrist in the army during the Vietnam Era I began my psychiatric residency at Columbia University. As soon as I crossed the threshold of the austere New York State Psychiatric Institute the respected Chairman of the Department and coauthor of the preeminent psychiatric textbook in the world Lawrence Kolb became a ‘‘great eminence’’ to be both revered and feared. Little did I know that we would become good friends and colleagues of 40 years duration. Larry attended weekly resident meetings where I soon came to know him as a dedicated, sensitive but no nonsense ‘‘old school’’ administrator. I remember his response to a group of residents who complained about the condition of the bed in the resident on call room. I expected Larry to be sympathetic. He was anything but sympathetic and said that when he was a resident at Johns Hopkins there was no bed in the on call room and the residents were expected to stay up all night. He continued, ‘‘You guys should consider yourselves lucky to have a room or be able to sleep at all when you are on call.’’ Despite his ‘‘take no prisoners’’ attitude Larry soon impressed me as a warm, at times gentle, and compassionate person whose door was always open to students, residents and faculty. A quintessential academic, Larry was a consummate gentleman who never compromised his impeccable principles or values. Lawrence Kolb was also an outstanding clinician and a gifted teacher and supervisor. His theoretical approach was strongly influenced by Neo-Freudian psychoanalytic principles shaped by both formal training and his exposure to the faculty at Chestnut Lodge. However, for me it was his eclectic orientation and open minded pragmatic approach to patients that was most instructive. You intervened because your judgment was good and you believed that your intervention would benefit the patient. He never hesitated to break the mold. I vividly remember as a second year resident a clinical conference on the Adolescent Inpatient Service. Larry was interviewing a 17-year-old schizophrenic young man who exhibited a panoply of compulsive behaviors including intense sexual impulses and acting out. It was a coed service and the assembled staff hung on his every question.

Introduction to the Special Section on the Management of Depression in Primary Care

Depression is a common and significant illness in primary care. It has been reported that one half of patients with depression are treated exclusively by primary care clinicians. Studies have also shown that treatment and outcomes in usual practice are not as effective as in research studies. Efforts to improve performance in primary care, including clinician education and screening of patients in the waiting room for depression have generally not been successful. It has been suggested that a more systematic approach to depression care would lead to better performance and outcomes, and a number of recent studies have shown this to be true. Several of these studies contained common elements that are consistent with recommendations for improving chronic disease care which were first described in 1996 by Wagner and his colleagues at Group Health Cooperative in Seattle as “The Chronic Care Model” (CCM). The CCM has been shown to improve process and outcomes in a number of disparate chronic illnesses including depression. This model for organizing care is different from the way most primary care practices currently operate and therefore it has been difficult for organizations to sustain the positive changes of the research projects without support. The four initiatives described share the characteristic of searching for ways to continue these activities after the researchers are gone. The articles in this section describe four efforts to improve depression care by incorporating the CCM into primary care practice. Korsen et al report on the initial implementation of a multifaceted depression improvement project funded by the MacArthur Foundation. Meresman et al describe the Nurse Telecare model and its implementation at Kaiser Permanente and in several other locations. Oishi et al offer the