Psychiatry
is the medical specialty that diagnoses
and treats brain problems leading
to mood, thinking, and behavioral
disturbances. In the last two
decades, great strides have been made in
building an evidence base for treating
psychiatric disorders. For example,
very large studies investigating
treatments for schizophrenia, bipolar
disorder, and depression have recently
been completed. The CATIE trial for
schizophrenia, STEP-BD trial for bipolar
disorder, and STAR-D trial for
depression were national studies,
sponsored by the National Institute for
Mental Health (NIMH). Results are
continuing to be published. Similar
projects have been completed in Europe
as well. These studies provide a wealth
of information and will help guide
treatment for these disabling conditions
in the future.
However,
despite the progress in the past two
decades, psychiatry is still without
objective measurements, such as genetic
testing or clinically reliable brain
imaging. As such, progress relies on
good clinical practice. Nowhere
is it more
important to have good
clinical practice
than
in community mental health centers.
These centers provide treatment for a
large group of patients with serious
psychiatric conditions, including
those who are severely
and persistently mentally ill.
Even
though the results of the CATIE, STEP-BD
and STAR-D trials are difficult to
interpret at times, certain
recommendations are clear-cut. These
recommendations include incorporating
standardized assessment techniques,
measurement based practice, and stepwise
treatment algorithms in community
clinics.
At Family
Services of Western Pennsylvania, strong
efforts are being made to follow these
guidelines and recommendations. The
fact remains that there is a large
difference between research studies and
real-world treatment in the community.
Many factors are responsible for these
differences. Research studies select
patients carefully, and follow strict
protocols, which include much support
for the participating subjects.
Real-world clinics cannot exclude or
select patients, and cannot support
patients as well as researchers
do.
Therefore, it remains to be seen how
research results translate into the
community.
At Family
Services of Western Pennsylvania,
ongoing outcome studies are
being performed to evaluate how certain
psychiatric conditions respond to the
real-world treatments. These outcome
studies have focused on depression,
attention deficit hyperactivity
disorder, aggression, and bipolar
disorder, among others.
In the
future, these real-world outcome studies
will be discussed on this web site.
I invite
you to return to this web site in the
future to review the results of our
treatments.
Leo
Bastiaens MD
Medical Director
