Care and outcomes for people with schizophrenia have improved in recent years, but further progress is needed to help more individuals achieve an independent and fulfilled life. This report sets out the current need, informs policy makers and all relevant stakeholders who influence care quality, and supports their commitment to creating a better future. The authors recommend the following policy actions, based on research evidence, stakeholder consultation, and examples of best practice worldwide. (1) Provide an evidence-based, integrated care package for people with schizophrenia that addresses their mental and physical health needs. (2) Provide support for people with schizophrenia to enter and to remain in their community, and develop mechanisms to help guide them through the complex benefit and employment systems. (3) Provide concrete support, information, and educational programs to families and carers on how to enhance care for an individual living with schizophrenia in a manner that entails minimal disruption to their lives. (4) All stakeholders, including organizations that support people living with schizophrenia, should be consulted to regularly revise, update, and improve policy on the management of schizophrenia. (5) Provide support, which is proportionate to the impact of the disease, for research and development of new treatments. (6) Establish adequately funded, ongoing, and regular awareness-raising campaigns that form an integral part of routine plans of action. Implementation of the above recommendations will require engagement by every stakeholder, but with commitment from all, change can be achieved.

Current treatments such as selective serotonin reuptake inhibitors and psychotherapy may have a beneficial impact on the HPA axis in PTSD populations. Somatic approaches to treating PTSD have not yet been studied in relation to their impact on HPA axis parameters in PTSD patients. Treatment studies of DHEA or glucocorticoids have not yet used HPA axis endpoints. PTSD treatment studies that include measures of HPA axis target mechanisms and consider HPA axis regulation as an additional treatment outcome are warranted.

C on cern h a s b e e n e x p ressed th a t th e life tim e c a r e n e ed s o f m any p e o p le w ith p s y c h ia tric d is a b ilitie s su ch a s sch izop h ren ia, m a jo r d e p re s sion , a n d th e b ip o la r spectru m d is o r d e r s w ill le a d th e h e a lth c a r e in du stry in to ban kru ptcy. A pproxim ately 3 .3 m illion a d u lts 18 y e a r s o f a g e o r o ld e r in th e c iv ilia n , n on -in stitu tion alized U nited S tates p o p u la tio n h a v e a serio u s p s y c h ia tric d is a b ility d u rin g an y 12-m onth p e r io d . This p r ev a le n c e rep resen ts a r a t e o f 18.2 a d u lts p e r 1 000p erso n s, o r 41 m illion ad u lts. An ep id em io lo g y c a l c o n tr o lle d c a s e d esig n o f fin d in g s r e la t e d to 88 p a tie n ts d ia g n o se d with e ith e r sch iz o p h ren ia o r a m o od d is o r d e r w as co n d u cted to e v a lu a te i f e n r o ll m en t in a 12-session co u rse d e sig n ed to sim u ltan eou sly tr e a t p a tien ts, fa m ilie s , a n d p r o v id e r s w ou ld resu lt in a d e c r e a s e in in p a tien t days. When c o m p a red to a ra n d o m iz ed m a tch ed c o n tro l grou p , th e trea tm en t g rou p d e c r e a s e d fr o m a p retrea tm en t a v e r a g e o f 5 7 d a y s p e r 2 y e a r s p e r p a tie n t to 3 .8 d a y s p e r 2 y e a r s p e r p a tie n t. A co n serv a tiv e estim a te o f 2 1 7 3 .6 in p a tien t d ay s w ere s a v e d f o r th e study c o h o rt o v e r a 2 -y ea r tim e p e r io d . E stim ated sav in g s fr o m th is d e c r e a s e w as $1,086,800. R esults w ere s ig n ifica n t a t th e p = < 0 0 2 lev el. E arly id e n tific a tio n o f r e la p s e e ffe c ts a g r e a te r r e la p s e p rev en tio n r a t e th an th ose p rev iou sly r e p o r te d in th e litera tu re. U sual a n d cu stom ary d e c r e a s e in in p a tien t d a y s a ttr ib u te d to c a p ita tio n is 40%. The T hree R 's R e h a b ilita tio n P rogram d e c r e a s e d p s y c h ia tric in p a tien t d a y s 93-5% f o r th is coh ort.I n t r o d u c t i o n C o n c e rn has been expressed that the lifetime care needs of many persons diagnosed with psychiatric disabilities such as schizophrenia, major depres sion, and the bipolar spectrum disor ders will lead the health care industry into bankruptcy. An estimated 257,446 multiple-episode patients were dis charged from short-stay inpatient units

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The American Psychiatric Nurses Association and the American Nurses Credentialing Center conducted a logical job analysis based on three recent role-delineation studies (RDSs) to determine whether there was enough commonality in the practice of psychiatric and mental health nursing by clinical nurse specialists (PMH-CS) and nurse practitioners (PMH-NP) to support the development of a single certification examination. Three hundred seventy-one work tasks gleaned from the three RDSs were presented for systematic review and discussion by the logical job analysis committee of 28 nurses certified in the specialty. Of the 371 work tasks, 332 (90%) were considered important enough to test for both the PMH-CS and PMH-NP. The results of the logical job analysis indicated that there was enough commonality in the practices of the PMH-CS and PMH-NP in psychiatric mental health nursing to warrant the development of one advanced practice examination for both roles. J Am Psychiatr Nurses Assoc, 2007; 13(3), 153-159.