Psychiatr News June 2, 2006
Volume 41, Number 11, page 3
© 2006 American Psychiatric Association
The Medical Director's Desk
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Research Thrives, Drives Many APA Activities
James H. Scully, Jr., M.D.
James H. Scully Jr., M.D., is medical director and CEO of APA.
The APA annual meeting displays the important role that research holds in
our professional lives. This year much of the "buzz" surrounded an
activity that is one of APA's most research-intensive undertakings—the
launch of a massive effort to prepare the fifth edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM).
The appointments of David Kupfer, M.D., chair of the APA Council on
Research, and Darrel Regier, M.D., M.P.H., director of the American
Psychiatric Institute for Research and Education (APIRE), as chair and vice
chair, respectively, of the DSM-V Task Force, closely link the
psychiatric and academic research communities in this effort. It is important
for psychiatrists to appreciate the solid scientific foundation of the
classification system. It is equally important to take every opportunity to
teach policymakers, patients, and others that the DSM not only
derives from research but also advances the scientific study of mental
disorders.
As the revision moves forward, DSM-V work groups will be able to
draw on a series of reviews of the scientific literature in key areas of
nosology. These reviews will be among the outcomes of a five-year
international cooperative research conference grant administered by APIRE,
with the collaboration of the World Health Organization and the National
Institutes of Health (NIH), which awarded APIRE a $1.2 million grant for the
project.
Participants in 12 planning conferences are considering how emerging
scientific findings might influence the shape of DSM-V and are
recommending longer-term research priorities that will enhance future
psychiatric classification systems in the United States and abroad.
Proceedings are being published by American Psychiatric Publishing Inc.
Another annual meeting highlight this year was a special research track,
which we are privileged to sponsor annually on a rotating basis with our
colleagues at the National Institute on Alcohol Abuse and Alcoholism (NIAAA),
National Institute of Mental Health, and National Institute on Drug Abuse. In
addition, each year we hold a mini-track under the Substance Abuse and Mental
Health Services Administration's sponsorship, to focus on an array of
service-delivery issues. This year the NIAAA track featured alcohol-related
disorders, including their comorbidity with other psychiatric and general
medical illnesses.
The quality and breadth of the research that the institutes highlight in
these tracks reflect one payoff of APA's investment in the Academic Consortium
(Psychiatric News, April 21). Planned and coordinated by our Division
of Research and Department of Government Relations, the Academic Consortium is
an annual Capitol Hill event at which psychiatrists, often accompanied by
patient/consumer advocates, make contact with key senators and representatives
who can help sustain the research budgets of the federal institutes.
Psychiatrists and advocates representing seven national organizations
participate in the consortium, and we appreciate their involvement all the
more in the current tough fiscal environment that now threatens to undermine
the NIH budget.
In addition, a number of projects being conducted by APIRE and by our
Practice Research Network (PRN) keep us at the leading edges at the interface
of science, services, and policy. Among them:
- Implementation of the Medicare Part D prescription drug benefit on January
1 raised concerns about the transition of an estimated 6 million to 7 million
Medicare and Medicaid "dual-eligible" beneficiaries who have
mental and addictive disorders, as they move from Medicaid to the new Medicare
prescription drug plans. In a national study, APIRE staff researchers are
monitoring dual-eligible psychiatric patients' access to medications and
disruptions in continuity that may lead to adverse clinical consequences.
Preliminary findings from the first three months of data collection show that
nearly half of all the patients studied have had at least one problem with
medication access or continuity, and more than one-quarter of those patients
experienced a serious adverse clinical consequence.
- The APIRE PRN, American Academy of Family Physicians, and American College
of Physicians recently completed the pilot phase of the National Depression
Management Leadership Initiative. This collaboration aims to assess the
clinical utility of a simple metric—the nine-item Patient Health
Questionnaire (PHQ-9)—to measure the severity of depression and test
office systems and management strategies to optimize depression monitoring in
routine clinical practice. A total of 16 primary care and 17 psychiatric
practices concluded data-collection activities for this project in April.
Records kept by the psychiatrists revealed that PHQ-9 scores influenced the
clinical decisions they made for 92 percent of their patients, leading to a
change in treatment for 37 percent of these patients. An expanded national
study is being developed.
- APIRE and PRN staff continue their involvement in a long-running study the
effect of parity on the use and cost of mental health care under the Federal
Employees Health Benefits program. Results will have important implications
for future parity legislation and will serve as a model for other insurance
plans.
More information about the important work of the Division of
Research and APIRE can be accessed from the APA Web site at
<www.psych.org>.
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American Psychiatric Association.
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