Literature Collection

OBJECTIVE: The authors sought to describe the early use of collaborative care model (CoCM) and general behavioral health integration (BHI) billing codes among clinicians. METHODS: Counts and payments were calculated for accepted and denied claims for CoCM and general BHI services delivered to Medicare beneficiaries nationwide in 2017-2018. Payment and utilization data were stratified by clinical specialty and site of service. RESULTS: Overall, 10,294 CoCM and general BHI services were delivered in 2017, totaling $626,292 in payments, and 81,433 CoCM and general BHI services were delivered in 2018, totaling $7,442,985 in payments. Medicare denied 5% of services in 2017 and 32% in 2018. Most CoCM and general BHI services were delivered by primary care physicians in office-based settings. CONCLUSIONS: This study of codes designed to promote BHI revealed an eightfold increase in CoCM and general BHI use between 2017 and 2018. However, denied services represent a barrier, and use among eligible beneficiaries remains low.

Recent research reported an association between pediatric Restless Leg Syndrome (RLS) and psychiatric disorders, in particular attention-deficit hyperactivity disorder in which shared symptoms, such as restlessness and difficulty concentrating, can make differential diagnosis challenging. Comorbidities with depression and anxiety, present in adults, have to be considered in children. Behavioral and psychosomatic disorders and autism can be associated with RLS. Both neurobiologic mechanisms and clinical implication could explain the several comorbidities. In clinical practice, pediatric RLS patients should be evaluated for the presence of psychiatric disorders to tailor multidisciplinary intervention and integrated treatment.

CONTEXT: Understanding mental health issues facing individuals with disorders/differences of sex development (DSD) is crucial for optimizing evidence-based practices in this population. OBJECTIVES: This work aimed to compare the prevalence of psychiatric diagnoses among patients diagnosed with complete androgen insensitivity syndrome (CAIS) or müllerian duct aplasia/agenesis (MA) to male and female reference groups. METHODS: A retrospective cohort study was conducted among 3 large integrated health systems. Participants included all individuals with confirmed CAIS or MA enrolled in 1 of 3 Kaiser Permanente health-care systems between January 1, 1988, and January 31, 2017. For each DSD patient, age-, race/ethnicity- and health system-matched male and female referents with typical sex development were randomly selected. Outcome measurements were mental health diagnoses and use of psychiatric medications. RESULTS: The prevalence of anxiety and depressive disorders in the CAIS and MA cohorts was approximately twice as high as in male referents without DSD, but the corresponding differences relative to female referents were less evident. A subgroup of MA patients with uterine agenesis had a higher prevalence of bipolar disorder than either reference group, but these results were accompanied by wide CIs. Women with CAIS and MA more frequently filled psychiatric medications compared to male but not female referents. CONCLUSION: On balance, these findings are reassuring, albeit requiring confirmation in other settings. Future studies using longitudinal designs and patient-reported outcomes are needed to evaluate changes in mental health status of CAIS and MA patients at different ages and different intervals following initial diagnosis.

Psychiatric conditions are prevalent among adults with intellectual and developmental disabilities (IDDs), with studies estimating that 33% of this population experiences psychiatric disorders such as mood, anxiety, and behavioral issues. These rates are significantly higher than the general population, underscoring the need for proper management within primary care settings. Although the integration of mental health services into primary care is increasing, general practitioners often report a lack of training and time to treat psychiatric conditions in adults with IDDs. Collaborative care models, involving partnerships between primary care providers and mental health specialists, have emerged as a promising solution, offering tailored, patient-centered treatment. Barriers like diagnostic overshadowing, communication challenges, and stigmatization hinder access to appropriate care, however. In recent years, the inclusion of genetic testing in psychiatric care has gained traction, especially in managing IDDs associated with specific genetic conditions like fragile X syndrome and DiGeorge syndrome. Genetic testing can help identify the underlying causes of psychiatric symptoms, offering valuable insights into appropriate treatment pathways. Pharmacogenetic insights provided by genetic testing can guide more personalized medication management, reducing adverse effects and improving outcomes. Effective management of psychiatric conditions in adults with IDDs requires further research, particularly randomized controlled trials, to establish evidence-based treatment approaches. Expanding research on interventions, including psychotherapy, pharmacotherapy, and genetic testing, is essential to improve patient outcomes in this underserved population.