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Managing bipolar disorder (BD) is particularly challenging for adolescents and young adults (AYAs) ages 16 to 21. Few interventions exist that address self-management in AYAs with BD. Thus, this study aimed to modify the customized adherence enhancement behavioral intervention for AYAs through an iterative, patient-centered process.

To develop an understanding of the quality of life of older adults with osteoarthritis (OA) with varying levels of depression and social supportas a basis for nursing interventions. Osteoarthritis in the United States is the number one chronic disease in late life and the major cause of disability in older adults. In addition to the functional disability and economic effect of OA, older people with this disease experience suffering, depression, and diminished quality of life.

BACKGROUND: Although several investigators have suggested that the primary care setting has become the "de facto"mental health provider, few researchers have docu mented the psychiatricreferral practices of providers in these settings.OBJECTIVE:In this study, the psychiatricreferral patterns of hospital-based outpatient clinics and the needs and characteristics of the referred patient population were examined.DESIGN: Aftera 4-year retrospective log audit, 2, 678 written referrals were examined for patients 18 years of age and older from a large urban medical center's outpatient clinics to the outpatient psychiatry clinic at the same site.RESULTS:Findings revealed a predominately middle-aged, white, female,Medicaid popu lation referred by physicianproviders in primarycare clinics for signs of depression and associated symptoms.However, of the patientsscheduled in the psychiatryclinic, only 56% actually had visits. Theaverage number of visits was five or less. CONCLUSIONS:Early assessment and triage by advanced practice psychiatricnurses can minimizethe length of time between psychiatricreferral and intervention.By iden tifying those personsin crisis and intervening in a timely fashion, failedappointements may be reduced. U Am PSYCHIATR NURSESAssoc [1995].1, 140-145)