March, 2004. In recent issues of the Journal of Psychiatric Practice, the importance of comprehensive treatment planning has been emphasized. In some cases, arguments have been made that “tried and true” medications that work well for certain psychiatric disorders should not be forgotten (e.g., lithium for bipolar disorder [Goodwin and Goldstein, September, 2003]). In other cases involving severe and persistent illness, in which medication may be the mainstay of treatment, there is renewed interest in the value of concomitant psychotherapy (e.g., cognitive-behavioral therapy for schizophrenia [Turkington et al., January, 2004]). Still again, some conditions remain at or beyond the border of treatability, and until more is learned about how to help patients with these conditions, it is important to remain level-headed about the limits of our therapeutic effectiveness (e.g., the more extreme forms of antisocial personality disorder [Stone, July, 2003; Rutter and Tyrer, July, 2003]).
In this issue of the journal, we continue to consider these evidence-based, practical approaches to treatment planning. Lembke et al., representing a group of investigators involved in the multi-center Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), point out that, despite many advances in pharmacotherapy for bipolar disorder, medication alone does not suffice for many patients, particularly those with extensive comorbidity or greater severity/complexity of illness. In these cases, adjunctive psychosocial services are especially important components of treatment. Mavissakalian presents the results of a study of patients with panic disorder who were switched from imipramine to sertraline, a process about which remarkably little has been reported other than anecdotal clinical information. Although it is generally assumed that SSRIs are the current treatment of choice for panic disorder, this study suggests that there are some patients who do better with tricyclic antidepressants than with SSRIs, so that continued familiarity with and use of this class of older medications may still be appropriate in selected cases. In a third article in this issue, Ng and McQuistion focus on multiply disabled patients who are homeless and mentally ill, for many of whom traditional treatment strategies are of negligible value, and they describe innovative outreach approaches that are a far cry from usual office-based practice. Finally, Robertson et al. review evidence concerning psychological treatments for posttraumatic stress disorder and clarify which interventions have been studied and shown to be effective and which post-trauma or post-disaster interventions are of questionable efficacy.