Management of schizophrenia with medical disorders: cardiovascular, pulmonary, and gastrointestinal.

Medical illnesses are particularly common in patients who have schizophrenia and one of the major tasks for consultation-liaison psychiatrists, and others, is to determine which medications are safest in which co-morbid condition. The authors review the relative risks for various antipsychotics, especially focusing on cardiovascular, pulmonary, and gastrointestinal co-morbid illnesses. The authors further review the atypical antipsychotics' cardiovascular risks, especially for prolonging QT intervals, in trying to avoid the risk for torsades de pointes. The relative risk for anticholinergic actions for these medicines is also reviewed, as this is especially important in the medically ill or elderly. The authors also review the relative safety of antipsychotics in patients who have liver disease and pulmonary disease. Finally, the authors review specific drug interactions that may be problematic when treating the medically ill with atypical antipsychotics.

Telemental health for our soldiers: a brief review and a new pilot program.

This small but significant telemental health clinical pilot could easily serve as a "best practice" model for resource utilization between the nation's VHA/DOD institutions that wish to form partnerships and capitalize on resources. It demonstrates several potential areas of collaboration for TMH projects. For example, this study also points out requisite preparation needs, e.g., an information technology (IT) needs assessment, and gap analysis between neighboring VHA/DOD installations should be considered beforehand. This would address equipment compatibility and address protected health information privacy concerns. This preparation would also lead to savings by avoiding equipment redundancy and minimize infrastructure (space) investment. While in this instance the equipment proved compatible, that may not always be the case. Second, regional strategic mapping of staff and services between institutions could help in specialty service utilization. This would improve recourse allocation, trim numerous costs, and avoid service duplication. A third area of collaboration would be the creation of a DOD/VHA electronic credentialing packet. This would simplify the preparation phase for TMH delivery and expand the availability of scarce medical specialty consultants for both the VHA and DOD. This would serve to streamline medical care and expedite the deployment of "virtual" practitioners in the event of a national disaster or emergency. To date there have not been any technical difficulties at either site and PC-PTSD-positive soldiers continue to be evaluated at the SVMAC. Anecdotal reports from both clinicians and patients are that they are highly satisfied with TMH delivery services.

Hepatitis C treatment eligibility and outcomes among patients with psychiatric illness.

OBJECTIVE: This study characterized the utilization and outcomes of hepatitis C virus (HCV) treatment among patients with psychiatric illness. METHODS: HCV treatment evaluations were tracked among 360 patients with HCV infection and psychiatric illness (substance use disorders, anxiety disorders, affective disorders, or psychotic disorders). RESULTS: Two-thirds of patients did not receive HCV treatment, 11 percent of patients died during the study period, and 42 percent were excluded from HCV treatment because of nonadherence to the evaluation process or diagnoses of psychiatric and substance use disorders. Interferon-alpha and ribavirin treatment resulted in viral clearance in 10 percent of patients. CONCLUSIONS: A majority of patients with HCV and psychiatric illness did not receive HCV treatment, and HCV infection was associated with significant mortality. Study results highlight the need to develop innovative approaches to engage such patients in HCV treatment and to successfully manage psychiatric illness during HCV treatment.