Perspectives on the Use of eHealth in the Management of Patients With Schizophrenia.

Mobile devices, digital technologies, and web-based applications-known collectively as eHealth (electronic health)-could improve health care delivery for costly, chronic diseases such as schizophrenia. Pharmacologic and psychosocial therapies represent the primary treatment for individuals with schizophrenia; however, extensive resources are required to support adherence, facilitate continuity of care, and prevent relapse and its sequelae. This paper addresses the use of eHealth in the management of schizophrenia based on a roundtable discussion with a panel of experts, which included psychiatrists, a medical technology innovator, a mental health advocate, a family caregiver, a health policy maker, and a third-party payor. The expert panel discussed the uses, benefits, and limitations of emerging eHealth with the capability to integrate care and extend service accessibility, monitor patient status in real time, enhance medication adherence, and empower patients to take a more active role in managing their disease. In summary, to support this technological future, eHealth requires significant research regarding implementation, patient barriers, policy, and funding.

Sex Chromosome Rearrangement Associated With Hormonal Abnormalities and Gender Dysphoria.

Although disorders arising from sex chromosome and sex steroid abnormalities are well characterized from the perspectives of endocrinology, dysmorphology, and reproductive health, relatively little is known about neuropsychiatric development, gender identity, incongruence, and dysphoria in the populations with these disorders. In this report, we describe the case of a 21-year-old gender nonbinary individual identified as male at birth who presented to an academic psychiatry consultation clinic because of life-long gender dysphoria. The patient was found to have a complex sex chromosomal rearrangement and associated hormonal abnormalities that may, at least in part, explain the patient's history. In addition to describing a novel genetic change, this case and the accompanying review of the existing literature highlight the need for an increased focus on the psychiatric perspective, and sex and gender issues in particular, among all patients with sex chromosome abnormalities and inborn errors of steroid metabolism.

Telemedicine and the sharing economy: the "Uber" for healthcare.

Telehealth platforms, which include both competitors and complements to traditional care delivery, will offer many benefits for both consumers and clinicians, and may promote increased specialization and competition in service delivery. Traditional medical services providers face a challenge similar to that faced by traditional taxicabs after Uber entered the marketplace: how to compete with a connection services platform that threatens to disrupt existing, regulated, and licensed service providers.

A model for managed behavioral health care in an academic department of psychiatry.

In response to the effects of the managed care environment on patient flow and care, the department of psychiatry and behavioral sciences of the Johns Hopkins School of Medicine developed and has been managing a capitated behavioral health care program. The program is responsible for providing mental health and substance abuse services for 22,000 members of the TRICARE Uniformed Services Family Health Plan (USFHP), directed by the U.S. Department of Defense. The integration of primary care and behavioral health care is a major feature of the USFHP/TRICARE program. The authors describe the transition from a carve-out for-profit managed care organization to the integrated program managed by the department. During the first two years of the program, access to services increased and use of inpatient services decreased without the need to deny service use. To supplement previous reports of the involvement of academic psychiatry departments in behavioral health care, the authors supply utilization and financial data that may serve as benchmarks for similar efforts by other departments.

Developing a model psychiatric treatment program for patients with intellectual disability in a community mental health center.

The Special Needs Clinic of the Johns Hopkins Bayview Medical Center in Baltimore, Maryland provides comprehensive treatment for patients with developmental or intellectual disability and psychiatric illness. This report describes the clinical characteristics and service utilization of patients attending this clinic. Factors that support quality mental health services that are both cost-effective and accessible are identified.

Alexithymia in patients attending a sexual disorders clinic.

We measured alexithymic traits with the Toronto Alexithymia Scale (TAS; Bagby, Taylor, & Parker, 1988) in 170 individuals attending a sexual disorders clinic. We diagnosed 114 of the subjects with a sexual dysfunction and 56 with paraphilic disorders. We determined that 20.2% of the dysfunctional group and 26.8% of the paraphilic were alexithymic when the TAS was measured categorically. When we considered the TAS as a dimensional variable, the subset with paraphilias had significantly higher scores on the TAS only when depressed mood, as measured by the Brief Symptom Inventory (Derogatis, 1993), was covaried. These data suggest that alexithymia in both sexually dysfunctional and paraphilic individuals is related to depressed mood, although the effect is more pronounced in paraphilics.

Pedophilia.

This article addresses the risk factors associated with the psychiatric disorder pedophilia, its treatment, and treatment outcomes. It addresses physician responsibilities associated with case identification of victims and possible roles in the medical management of pedophilia. The essential feature of pedophilia is that an individual is sexually attracted exclusively or in part to prepubescent children. While pedophilia may be limited to fantasies and impulses, pedophilic behaviors are the primary concern of both the mental health and criminal justice systems. Remote risk factors for development of pedophilia often include the individual having been sexually abused as a child. Proximate risk factors for its behavioral expression are prevalence of comorbid psychiatric disorders and substance abuse disorders. Current treatment goals focus on stopping the behavior and achieving long-term behavioral control in the community. Common treatment methods are cognitive-behavioral, group therapy, and, when appropriate, medications such as androgen-lowering agents that can act as sexual appetite suppressants. Meta-analyses have established that treatment is more effective than nontreatment in preventing recidivism of sexual offenders in general, a finding that has a high probability of application to individuals with pedophilia. Pedophilia is a chronic psychiatric disorder, but it is treatable in terms of developing strategies for preventing behavioral expression. Ultimately, reducing the prevalence of pedophilic behavior requires further collaboration between the criminal justice system and the health care communities.

Erectile dysfunction and depression: category or dimension?

Depression, as a risk factor for erectile dysfunction (ED), has received minimal systematic attention. One-hundred twenty men with ED evaluated in a sexual behaviors clinic were studied. The categorical Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) diagnosis of a depressive disorder was found in only 14 subjects (14.7%). Dimensional quantification of depression was measured with the Brief Symptom Inventory (BSI). The BSI data revealed clinically significant elevations of depression and other dysphoric affects. The presence of a comorbid medical diagnosis did not affect the rates of categorical diagnosis of depression or the dimensional levels. The five factors of personality in the NEO-PI were within normal range. The data demonstrates that men with ED are affectively distressed but infrequently meet criteria for categorical DSM-IV depression.