Psychiatric services : a journal of the American Psychiatric Association
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A significant proportion of patients of assertive community treatment (ACT) teams will adamantly refuse medication. Whether the team should continue to encourage medication or put a hold on advocating for medication is a clinical and ethical dilemma. On the basis of their clinical experiences, the authors propose best-practices criteria that ACT teams can consider in deciding whether medications may be temporarily discontinued when a patient refuses them. The authors suggest that in some circumstances stopping medications in such a case may help in the development or repair of a therapeutic alliance over the long term.
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Global patient characteristics may affect adherence across all medications in a regimen, making medication-specific risk factors for adherence problems less important. Medication adherence was examined among patients with schizophrenia and comorbid physical conditions for consistency across therapeutic classes. ⋯ Patients with schizophrenia and comorbid physical conditions demonstrated important differences in adherence across medications in their regimen, reinforcing the importance of medication-specific factors in determining adherence behavior. The lower levels of adherence observed for antipsychotics may be associated with the shorter refill intervals for these medications.
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Qualitative methods were used to identify characteristics of "passionately committed psychotherapists" (experienced psychotherapists who would describe themselves as having found the vocation that suits them better than any other) identified by peers in the Utah public mental health system. Six themes were identified by all 15 interviewees: balance between work and nonwork passions, adaptiveness and openness, transcendence (the belief that the practice of psychotherapy has extraordinary significance), intentional learning, personal fit with the role, and passion-supporting beliefs. These are characteristics that psychotherapists should nurture in themselves, that program supervisors should seek in potential employees, and that training programs should develop in trainees.
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Comparative Study
Do Canada and the United States differ in prevalence of depression and utilization of services?
This study compared the prevalence of depression and the determinants of mental health service use in Canada and the United States. ⋯ There was no difference in the prevalence of depression and mental health service use between Canada and the United States. Among those with depression, however, disparities in treatment seeking were found to be associated with medical insurance in the United States. Both Canada and the United States need to improve access to health services for those with mental disorders, and special attention is needed for those without medical insurance in the United States.
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Watchful waiting to manage depression in primary care may be an appropriate management approach for some patients who present with less severe depression. This study examined factors associated with primary care clinicians' choice of a watchful waiting approach to care management for depression. ⋯ Primary care clinicians' knowledge of treatment and perception of barriers influence their proclivity for watchful waiting. Clinician education to promote appropriate use of watchful waiting on the basis of clinical need is recommended.