On the usefulness of structural brain imaging for young first episode inpatients with psychosis.

The objective of the study was to determine whether structural brain imaging was clinically useful in first episode psychosis (FEP) inpatient adolescents and young adults. The sample (N=115) was from the single largest medical center in the Pacific. A retrospective chart review design was used to review 12- to 30-year-old inpatient admissions with FEP. The primary measurement was whether structural brain imaging with computed tomography (CT) and magnetic resonance imaging (MRI) revealed any remarkable neurological findings related to FEP that led to non-psychiatric treatment. The data analyses entailed comparing the sample prevalence of clinical utility with the expected null hypothesis of a population parameter of 3% utility based on the binomial distribution. The main finding indicated that the sample prevalence of 0% was statistically lower than the null population parameter of 3%. The diagnostic yield and utility of structural brain imaging with younger FEP patients was found to be minimal. Radiation exposure with CT scans and the cost of MRI should be taken into account when evaluating younger FEP patients.

Proportional differences in emergency room adult patients with PTSD, mood disorders, and anxiety for a large ethnically diverse geographic sample.

Underserved populations often utilize the emergency room in place of primary care, particularly for short term behavioral health services. This study examined emergency department (ED) utilization rates for rurality, insurance, sex, and ethnicity in a large sample of adult patients in Hawai'i hospitals from 2000-2010 with a diagnosis of post-traumatic stress disorder (PTSD), mood disorder, or other anxiety disorder. Findings showed a higher rate of use by rural and suburban residents with a diagnosis of PTSD or other anxiety than by urban residents. Utilization of EDs by African Americans and Other Pacific Islanders with PTSD was proportionally higher than for those with mood disorders or other anxiety disorders. Military ED visits were also proportionally higher for individuals with PTSD than for those with mood or other anxiety disorders. Limited economic resources and increasingly costly mental health disorders such as PTSD highlight the importance of better understanding the needs for behavioral health services for underserved populations.

Public-academic partnerships: the University of Hawai'i Rural Health Collaboration: partnerships to provide adult telepsychiatry services.

To address the twofold problem of mental health disparities and limited access to health resources in rural areas, the University of Hawai'i Rural Health Collaboration aims to increase access to behavioral health services to rural areas across the state, primarily via telepsychiatry. The authors highlight lessons learned in regard to forging a university-community partnership, specifically community engagement for patient referral, the shift toward integrated services and away from a specialty clinic model, the importance of community diversity and contextual relevance, and ethical research and practice with indigenous communities.