The present study examined the efficacy of fluvoxamine in the treatment of trichotillomania (TM) and coexistent clinical features. Twenty-one participants with a principal diagnosis of TM were given fluvoxamine in a 12-week open trial. For 13 patients who completed treatment, significant improvement was noted on only a few measures of hair pulling. End-state analyses for the entire group of participants, however, demonstrated significant improvement in measures of distress, duration, control, and resistance. Significant decreases over treatment were also found on measures of coexistent anxiety for both the completer and the entire participant groups; depressive symptoms improved for completers. Conclusions about the effectiveness of fluvoxamine for treatment of TM cannot be drawn, given the uncontrolled nature of the study; however, end-state analyses suggest the potential utility of fluvoxamine in a subset of patients with TM.

To develop a model using administrative variables to predict number of days in the hospital for a mental health condition in the year after discharge from a mental health hospitalization. Background, index hospitalization and preindex inpatient, emergency room, and outpatient utilization information were collected for 766 adult members discharged from a mental health hospitalization during a 1-year period. A regression model was developed to predict hospitalized days for a mental health condition in the year after discharge. A regression model was created containing five statistically significant predictors: Medicare insurance coverage, preindex mental health inpatient days, index length of stay, depression diagnosis, and number of mental health outpatient visits with a professional provider. It is possible to predict future mental health inpatient utilization at the time of discharge from a mental health hospitalization using administrative data, thus allowing disease managers to better identify members in greatest need of additional services and interventions.

The objective of this study is to determine the reduction in inpatient psychiatric recidivism and costs associated with an intensive case management (ICM) program among high-risk adults with chronic mental health conditions. An intent-to-treat, historical control design was used to examine utilization differences between 306 intervention group (IG) members eligible to receive ICM services and a cohort of 290 baseline group (BG) members over a six-month outcome period. Members were identified retrospectively using identical criteria during one year prior to implementation of the program. The six-month recidivism rate for BG members was 49.67% compared to 22.07% among IG members. Forward stepwise regression results indicated a significant main effect for the ICM intervention on inpatient psychiatric costs. Inpatient psychiatric costs for the six-month outcome period were $4,982.90 lower per member in the IG group. Additional models demonstrated that the ICM intervention was associated with significantly lower inpatient substance abuse costs and psychiatric emergency department costs. There were no statistically significant increases in utilization associated with the ICM intervention. After factoring in program costs, it is estimated that the ICM services contributed to almost $1,500,000 in cost savings over the six-month outcome period. The ICM intervention was associated with significant reductions in inpatient, psychiatric six-month readmission rates and associated costs among adult members who are at elevated risk of inpatient, psychiatric recidivism. The intervention, enrollment process, and measurement strategies can be adapted for use by health plans looking to reduce psychiatric costs.

The integration of behavioral health into the primary care setting provides an opportunity for psychologists to improve care for the treatment of depression. In this study, a pilot program was created integrating psychologists into 4 medical centers. Results indicated a significant improvement in depressive symptoms and health status, and an improvement in overall antidepressant medication adherence. Physicians were highly satisfied with the integrated program. To guide behavioral health specialists considering work in the primary care setting, a description of the program and a discussion of the lessons learned from the project are provided.