Program Design and Clinical Operation of Two National VA Initiatives for Homeless Mentally Ill Veterans

In 1987, in response to reports of large numbers of veterans among America\u27s homeless, the Department of Veterans Affairs established two new national health care initiatives, which have seen over 40,000 homeless veterans since their inception. We present here evaluation and treatment data on a sample of 14,000 of them. Because of differences in their design, the two programs vary in the degree to which they emphasize community outreach, homelessness prevention, and the provision of aftercare services to patients discharged from other VA programs. In spite of these differences, veterans treated in the two programs have similar health care problems and show similar degrees of improvement at the conclusion of residential treatment. About one third of those admitted complete residential treatment successfully; one third are known to be in stable community housing at the time of discharge; and more than one third are employed. These modest success rates reflect both the severity of psychiatric disorder and social dysfunction in this population, and the limited ability of health care programs to address the full range of problems faced by the homeless mentally ill, even when services are specifically tailored to meet their needs. In designing programs for the homeless, it is particularly important to link health care efforts directly with sustained vocational rehabilitation services, housing subsidies, and income supports. New VA initiatives in all three of these areas have been undertaken and are described

Is Shared Housing a Way to Reduce Homelessness?

Most single adults share housing with other adults, and living alone is considerably more expensive than living with someone else. Yet policies that discourage shared housing for formerly homeless people or people at risk of becoming homeless are common, and those that encourage it are rare. This would be understandable if such housing adversely affected its users in some way. We ask whether shared housing produces adverse effects. Our provisional answer is no. Indeed, shared housing is associated with reduced psychotic symptomology and it appears that this relationship is causal over some time frames, although the latter result is not robust. We use data from ACCESS, a 5-year, 18 site demonstration project with over 6,000 formerly homeless individuals as participants

The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in São Paulo, Brazil

OBJECTIVE: Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special program for victimized children in São Paulo, Brazil. METHODS: A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively. RESULTS: Children with mood disorders alone had the highest rate of adherence (79.5%); those with substance abuse disorders alone had the lowest (40%); and those with both disorders had an intermediate rate of adherence (50%). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence. CONCLUSIONS: Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing yout

The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in Sao Paulo, Brazil

OBJECTIVE: Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special programfor victimized children in Sao Paulo, Brazil. METHODS: A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively. RESULTS: Children with mood disorders alone had the highest rate of adherence (79.5%); those with substance abuse disorders alone had the lowest (40%); and those with both disorders had an intermediate rate of adherence (50%). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence. CONCLUSIONS: Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth.Fundacao Faculdade de Medicina (FFM)CNPq [573974/2008-0]Sao Paulo MunicipalityFAPESP [2010/15786-1, 2010/15604-0, 2010/18374-6]Eli LillyJanssen PharmaceuticaAstra-ZenecaWyeth PharmaceuticalsNational Institute for Developmental Psychiatry (INPD

Cost-Effectiveness of Long-Acting Injectable Paliperidone Palmitate Versus Haloperidol Decanoate in Maintenance Treatment of Schizophrenia

This study assessed the relative cost-effectiveness of a first generation and a second generation long-acting injectable antipsychotic: haloperidol decanoate (HD) and paliperidone palmitate (PP), respectively

The impact of obesity on health care costs among persons with schizophrenia

Obesity is the second leading cause of preventable death in the US, and is twice as common among individuals with schizophrenia as the general population

Impact of Second-Generation Antipsychotics and Perphenazine on Depressive Symptoms in a Randomized Trial of Treatment for Chronic Schizophrenia

According to the American Psychiatric Association Clinical Practice Guidelines for schizophrenia, second-generation antipsychotics may be specifically indicated for the treatment of depression in schizophrenia. We examined the impact of these medications on symptoms of depression using the data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), conducted between January 2001 and December 2004

A Randomized Trial Examining the Effectiveness of Switching From Olanzapine, Quetiapine, or Risperidone to Aripiprazole to Reduce Metabolic Risk: Comparison of Antipsychotics for Metabolic Problems (CAMP)

We conducted a multi-site, randomized controlled trial examining the strategy of switching from olanzapine, quetiapine, or risperidone to aripiprazole to ameliorate metabolic risk factors for cardiovascular disease

Effectiveness of Paliperidone Palmitate vs Haloperidol Decanoate for Maintenance Treatment of Schizophrenia: A Randomized Clinical Trial

Long-acting injectable (LAI) antipsychotics are used to reduce medication non-adherence and subsequent relapse in schizophrenia-spectrum disorders. The relative effectiveness of LAI versions of second-generation (atypical) and older antipsychotics has not been assessed