Engagement-focused care during transitions from inpatient and emergency psychiatric facilities.

Objectives: As many as 40% of those with serious mental illness (SMI) do not attend any outpatient visits in the 30 days following discharge. We examined engagement-focused care (EFC) versus treatment as usual in a university-based transitional care clinic (TCC) with a 90-day program serving individuals with SMI discharged from hospitals and emergency rooms. EFC included a unique group intake process (access group) designed to get individuals into care rapidly and a shared decision-making coach.

Conceptualization and treatment of negative symptoms in schizophrenia.

Negative symptoms of schizophrenia including social withdrawal, diminished affective response, lack of interest, poor social drive, and decreased sense of purpose or goal directed activity predict poor functional outcomes for patients with schizophrenia. They may develop and be maintained as a result of structural and functional brain abnormalities, particularly associated with dopamine reward pathways and by environmental and psychosocial factors such as self-defeating cognitions and the relief from overstimulation that accompanies withdrawal from social and role functioning. Negative symptoms are more difficult to treat than the positive symptoms of schizophrenia and represent an unmet therapeutic need for large numbers of patients with schizophrenia.

Following AACP Guidelines for Transitions in Care: The Transitional Care Clinic.

The period of transition from hospital to community services is critical for individuals with serious mental illness. The American Association of Community Psychiatry developed guidelines for transitional services in behavioral health care. This column describes ways in which the Transitional Care Clinic (TCC) at the University of Texas Health Science Center at San Antonio has implemented these guidelines.