R E Drake

..Long-term, disabled patients with co-occurring bipolar and substance use disorders have potential for remission from substance abuse and substantial improvements in functioning and quality of life...

..We conclude with recommendations for future directions...

..Further research is needed to refine specific interventions and to improve knowledge regarding implementing integrated treatment settings in routine mental health programs...

..This joint project incorporates modern information technology, decision science, cultural competence, stakeholder collaboration, outcomes research, and training. The partnership itself provides an exemplar of shared decision making...

....

..Clinicians should understand the implications of each of these principles of care...

..Current treatments are based on a much stronger evidence base, are more patient-centered, and are more likely to target autonomy and recovery...

..These principles have important implications for the adoption of evidence-based practices in mental health care...

..Overall, the 10-year findings on recovery outcomes provide a hopeful long-term perspective for dual diagnosis clients...

..If so, the benefits of EBP can be realized by individuals who experience mental disorders, their families and friends, and the broader society...

..The project successfully combined industry's emphasis on outcomes with academia's emphasis on research-based interventions to enhance public services...

....

..Second, a number of critical issues that have been raised regarding the nature of treatment evidence are discussed. Finally, suggestions for further consideration in the process of synthesizing evidence for clinicians are offered...

..The future of personalized medicine is clearly linked with our ability to create the infrastructure and cultural receptivity to these changes...

..There were no group differences on nonvocational outcomes...

..The main hypothesis was that patients with substance-induced psychosis would have a more benign course of illness than those with primary psychosis..

....

..Further research is needed on the organization and financing of dual-diagnosis services and on specific components of the integrated treatment model, such as group treatments, family interventions, and housing approaches...

....

..The use of clozapine by patients with co-occurring substance disorders deserves further study in randomized clinical trials...

..We review the six areas of evidence-based treatment of schizophrenia, as well as knowledge regarding implementation of mental health programs in routine practice settings...

..They discuss common concerns about the use of evidence-based practices, such as whether ethical values have a role in shaping such practices and how to deal with clinical situations for which no scientific evidence exists...

..The authors argue that these systems have the potential to improve mental health care by enhancing and connecting the three elements of evidence-based medicine: client preferences, research evidence, and clinician skills...

....

....

..Because underdetection is related to the failure of traditional screening instruments with this population, the authors developed a new screen for detection of substance use disorder in people with severe mental illness...

..The sheltered work group showed no such advantage...

..This paper discusses issues of theory and methodology as they pertain to improving research of ACT, with particular attention paid to issues of sampling, process evaluation, measurement, and data analysis...

..The findings suggest that schizophrenia patients with APD represent a high-risk subgroup vulnerable to more severe substance abuse, psychiatric impairment, aggression, and legal problems...

..To evaluate the differences between two cohorts of patients with severe mental illness (schizophrenia-spectrum or bipolar disorder) and co-occurring substance-use disorders, living in either predominantly rural areas or urban areas...

..The study examined the association between fidelity of programs to the assertive community treatment model and client outcomes in dual disorders programs...

....

..55). Test-retest reliability was lower among less educated respondents and among ethnic minorities. We recommend close monitoring of psychometric issues in future multisite studies...

..The differences in risk behaviors may reflect urban-rural differences in drug availability and sexual practices...

....

..Special materials will address the concerns of mental health authorities (funders), administrators of provider organizations, clinicians, and consumers and their families...

..The authors also discuss some of the strengths and weaknesses of cost-benefit analysis in mental health care and suggest future directions for policy and research...

..Further clarification of etiologic factors, including the identification of subtypes of dual diagnosis, may have implications for developing more effective prevention efforts and treatment...

..The purpose of the study was to examine strategies for developing effective interventions for clients who have both serious mental illness and posttraumatic symptoms...

..Future clinical and neuroscience research and service development should emphasize measures of recovery as outcomes for people with schizophrenia...

..Current research aims to refine and test individual components and combinations of integrated treatments...

..This systematic review examines interventions for care of people with co-morbid chronic medical illness and anxiety/depression disorders--a group with high risks for morbidity and mortality...

....

..The purpose of this study is to elicit and examine first person accounts of work activity over a 16-year period from people with dual diagnosis, who were not selected for employment readiness or vocational interests...

..We suggest methods for incorporating shared decision-making into antipsychotic prescribing in the future, with an emphasis on the use of information technology...

..Many social functions provided by these social patterns must be continued by other means if clients, once persuaded to attempt abstinence, are to be effectively supported in their sobriety...

....

....

..Future research will need to address methodological standardization, longitudinal perspectives, interventions for subgroups and stages, sequenced interventions, and the changing realities of treatment systems...

..This exploratory study presents eight- to 12-year employment trajectories among adults with psychiatric disabilities who participated in supported employment...

..Perceived roles and preferences were explored for shared decision making among persons with severe mental illnesses...

..This article presents fidelity outcomes for five evidence-based practices that were implemented in routine public mental health settings in the National Implementing Evidence-Based Practices Project...

..However, no objective study of this model has been conducted...

..The authors examined the lived experience of residents with severe mental illness in a small-scale recovery-housing building in the inner city. They attempting to identify and understand factors that influenced adjustment and stability...

....

..This pilot study compared preferences for involvement in decision-making between older and younger adults with serious mental illness...

..Participants with alcohol dependence rather than alcohol abuse were less likely to attain 6-month remissions and more likely to relapse after attaining remissions...

..In this paper, we describe the current structural obstacles to collaborative psychiatric care and envision a redesigned office visit process that facilitates active informed patient involvement...

....

..This study examined service cost over ten years among participants in a co-occurring disorders study...

..This study identified and characterized groups of clients who have serious mental illness and co-occurring substance use disorders...

..The purpose of this ethnography was to elucidate ethnocultural aspects of illness accounts and interactions with the mental health system...

..In addition, expansion of integrated dual disorders treatments and improving linkage with specialty medical care providers are recommended...

....

....

..Further research is needed to examine relapse prevention therapies as a key component to continuing care for persons with co-occurring substance use and psychiatric disorders...

..This study addressed the rate and predictors of substance abuse relapse among clients with severe mental illness who had attained full remission from substance abuse...

..Translational strategies for treatment development and research dissemination are discussed...

..This research, however, could be biased by selection factors. Studying patients who are currently in substance abuse remission could control for level of motivation to stop using substances and other methodological confounds...

..The authors examined benzodiazepine use and associated psychiatric, substance abuse, and institutional outcomes in a six-year longitudinal study of patients with co-occurring disorders...

..Given the constraints of time and expertise, the authors anticipate that computerized expert systems, based on current evidence, will become increasingly prominent...

..The central recommendation is to move rapidly from efficacy studies to more credible and valid effectiveness studies, in order to facilitate the adoption of evidence-based interventions in routine practice settings...

....

..This objective information is critical for systems intending to enhance services to persons with co-occurring disorders...

..Improving access to EBPs for consumers with SMI may enhance outcomes in a cost-effective manner, helping them pursue their personal recovery goals with the support of professionals, family, and friends...

....

..However, little is known about HIV/HCV co-infection in this population. This paper examines the prevalence and correlates of HIV, hepatitis C, and HIV/HCV co-infection in a large, multisite sample of SMI clients...

..Overall, the findings provide a hopeful long-term perspective for dual diagnosis patients...

..The authors discuss several implications of these findings for vocational services...

....

..34.8% vs. 53.6%, respectively). There were few differences in nonvocational outcomes between programs. IPS is a more effective model than PSR or standard brokered vocational services for improving employment outcomes in clients with SMI...

..At follow-up, individuals in the long-term residential treatment group were more likely to have maintained abstinence and less likely to have experienced homelessness than those in the short-term group...

..To address this, an attempt was made to reduce medications for patients already receiving polypharmacy during an episode of acute psychiatric hospitalization...

..This study determined the costs of evidence-based supported employment programs in real-world settings...

..Although integrated mental health and substance abuse treatment is becoming a standard clinical approach for such clients, the optimal method for delivering integrated treatment remains unclear...

..The objective of this study was to examine the outcomes of supported employment ten years after an initial demonstration project...

..Our aim was to assess the effectiveness of IPS, and to examine whether its effect is modified by local labour markets and welfare systems...

..The Time-Line Follow-Back detected changes in clients with severe mental illness and in those with less severe psychiatric problems...

..To examine rates and predictors of psychosis remission at 1-year follow-up for emergency admissions diagnosed with primary psychotic disorders and substance-induced psychoses...

....

..An international six-centre randomised controlled trial comparing individual placement and support (IPS) with usual vocational rehabilitation for people with serious mental illness found IPS to be more effective for all vocational outcomes...

..g., gastritis). The results will be of interest to policy makers in many states that are replicating the model of integrated dual-diagnosis services that has been used in New Hampshire since 1988. ..

..After 7 days, the lungs will be analyzed to determine if connective tissue content and lung fluid have increased. These studies will test a previously unknown mechanism for the pulmonary edema associated with heart failure. ..

..Finally, we will take maximal advantage of conducting the rural and urban studies in conjunction with one another. ..