Treatment Bed Utilization Following Placement in a Foster Care Program for Veterans with Serious Mental Illness.

Hospital and residential treatment bed utilization rates were measured before and after foster home placement in individuals with serious mental illness. Medical records of all Veterans consecutively enrolled in a Department of Veterans Affairs Community Residential Care (CRC) program during a 6 year period (N = 140) were reviewed retrospectively. Treatment bed days were tabulated by bed type (psychiatric hospital, inpatient detoxification, medical hospital, physical rehabilitation, and psychosocial residential treatment) for each patient during symmetric pre- and post-placement time intervals.

A COMMENTARY ON IMPROVING CLOZAPINE ACCESSIBILITY AND REDUCING TREATMENT COST.

Clozapine is vastly underutilized in the United States and many other countries. The most commonly cited reason for this is the requirement for frequent blood monitoring, which continues for the duration of treatment. Despite the notoriety clozapine achieved early in its development, accumulated evidence has demonstrated that close blood monitoring beyond the first year of treatment yields minimal safety benefits.

Recognizing psychiatric presentations of anti-NMDA receptor encephalitis in children and adolescents: A synthesis of published reports.

Aim: The aim of this study was to improve early recognition of anti-N-methyl-d-aspartate receptor encephalitis (anti-NMDArE) in children and adolescents by identifying characteristic temporal patterns of clinical features in patients likely to be referred for psychiatric evaluation. In this form of autoimmune encephalitis, NMDAr hypofunction is caused by autoantibodies to receptor surface components. Clinical outcomes following prompt immunotherapy are usually good, but delayed treatment often results in a protracted course with significant residual disability or death.

Frequency and temporal sequence of clinical features in adults with anti-NMDA receptor encephalitis presenting with psychiatric symptoms.

Background: Anti-NMDA receptor (NMDAr) encephalitis is the most common autoimmune encephalitis in adults. It mimics psychiatric disorders so often that most patients are initially referred to a psychiatrist, and many are misdiagnosed. Without prompt and effective treatment, patients are likely to suffer a protracted course with significant residual disability, or death.

Potentially fatal outcomes associated with clozapine.

Clozapine has been shown to be the most efficacious therapy for treatment resistant schizophrenia, estimated at one third of all schizophrenia cases. There is significant morbidity and mortality associated with clozapine including risk of agranulocytosis, aspiration pneumonia, bowel ischemia, myocarditis, seizures, and weight gain. Here we present a case of a 62-year-old man with chronic paranoid schizophrenia refractory to numerous antipsychotics who was started on clozapine therapy during an acute inpatient psychiatric admission.

A systematic review of sex and age factors in neuroleptic malignant syndrome diagnosis frequency.

Objective: To examine sex and age distributions in neuroleptic malignant syndrome (NMS) patients based on a systematic literature review.

Method: EMBASE and PubMed databases were searched to identify any observation of NMS published from January 1, 1998 through November 1, 2014 that was accessible and interpretable (using language translation software). Redundant and equivocal reports were excluded.

A Validation Study of the International Consensus Diagnostic Criteria for Neuroleptic Malignant Syndrome.

Background: Neuroleptic malignant syndrome requires prompt recognition for effective management, but there are no established diagnostic criteria. This is the first validation study of recently published international expert consensus (IEC) diagnostic criteria, which include priority points assigned on the basis of the importance of each criterion for making a diagnosis of neuroleptic malignant syndrome.

Methods: Data were extracted from 221 archived telephone contact reports of clinician-initiated calls to a national telephone consultation service from 1997 to 2009; each case was given a total priority point score on the basis of the IEC criteria.

Preparing residents in training to become health-care leaders: a pilot project.

Objective: The aim of this study is to describe a successful and exportable training module that addresses Next Accreditation System (NAS) behavioral milestones for leadership competencies.

Methods: A novel leadership training module, which required the creation of original business plans by teams of residents, was incorporated into a psychiatry PGY-2 training curriculum.

Results: In the creation and presentation of their business plans, the residents demonstrated competencies in the NAS functional domains of interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice.

Cognitive task performance and symptoms contribute to personality abnormalities in first hospitalized schizophrenia.

Chronic schizophrenia patients have personality abnormalities and cognitive deficits that are associated with poor clinical, social, and vocational outcomes. Very few studies have examined relationships between personality and cognitive function, and chronic illness effects may have confounded those studies. In this study personality traits in clinically stable first episode schizophrenia patients (21M, 9F) and psychiatrically healthy controls (38M, 24F) were measured with the NEO-FFI, a self-report measure of neuroticism, extraversion, openness, agreeableness, and conscientiousness.

WITHDRAWN:A Validation Study of the International Consensus Diagnostic Criteria for Neuroleptic Malignant Syndrome.

Ahead of Print article withdrawn by publisher.

Neuropsychological performance within-person variability is associated with reduced treatment consent capacity.

Objective: The capacity of older adults to make healthcare decisions is often impaired in dementia and has been linked to performance on specific neuropsychological tasks. Within-person across-test neuropsychological performance variability has been shown to predict future dementia. This study examined the relationship of within-person across-test neuropsychological performance variability to a current construct of treatment decision (consent) capacity.

An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method.

Objective: The lack of generally accepted diagnostic criteria for neuroleptic malignant syndrome (NMS) impedes research and clinical management of patients receiving antipsychotic medications. The purpose of this study was to develop NMS diagnostic criteria reflecting a broad consensus among clinical knowledge experts, represented by an international multispecialty physician panel.

Participants: Eleven psychiatrists, 2 neurologists, 2 anesthesiologists, and 2 emergency medicine specialists participated in a formal Delphi consensus procedure.

Reasoning in the capacity to make medical decisions: the consideration of values.

Purpose: To examine the contribution of "values-based reasoning" in evaluating older adults' capacity to make medical decisions.

Design And Methods: Older men with schizophrenia (n=20) or dementia (n=20), and a primary care comparison group (n=19), completed cognitive and psychiatric screening and an interview to determine their capacity to make medical decisions, which included a component on values. All of the participants were receiving treatment at Veterans Administration (VA) outpatient clinics.

Neuropsychological disturbance in schizophrenia: a diffusion tensor imaging study.

Patients with schizophrenia and healthy control subjects underwent both neuropsychological evaluation and magnetic resonance diffusion tensor imaging, during which the cingulum bundle (CB) and the uncinate fasciculus (UF) were defined with fiber tractography and their integrity was quantified. On the basis of prior findings, it was hypothesized that neuropsychological disturbance in schizophrenia may be characterized, in part, by 2 dissociable functional neuroanatomical relationships: (a) executive functioning-CB integrity and (b) episodic memory-UF integrity. In support of the hypothesis, hierarchical regression results indicated that reduced white matter of the CB and the UF differentially and specifically predicted deficits in executive functioning and memory, respectively.

Episodic memory and neuroimaging of hippocampus and fornix in chronic schizophrenia.

A group of 44 patients with schizophrenia and 43 age-matched controls completed psychometrically-matched tasks of recall and recognition. The patients showed similarly depressed scores across both recall and recognition matched tasks, independent of their reduced IQ and executive functioning scores. In addition, reduced memory scores correlated in the expected direction with magnetic resonance imaging (MRI) of the hippocampus and diffusion tension imaging (DTI) of the fornix for subsets of both patients and controls that had available these structural imaging measures.

Assessment of Capacity to Consent to Treatment: Challenges, the "ACCT" Approach, Future Directions.

OBJECTIVE: To review approaches to assessing consent capacity in patients with neurocognitive or neuropsychiatric illness; to summarize the rationale behind our structured interview for consent capacity; and to outline questions for future research. METHOD: After reviewing legal and clinical literature, and empirically comparing three leading consent capacity instruments, we developed the Assessment of Capacity to Consent to Treatment (ACCT) interview and administered it to adults with dementia (n=20), schizophrenia (n=20), and controls (n=19). Capacity ratings by primary care clinicians and experts blind to the patients' status were obtained for a subsample.

Meta-analytic evidence of systematic bias in estimates of neuroleptic malignant syndrome incidence.

Objective: The aim of this study was to examine published reports for sources of excessive variance in neuroleptic malignant syndrome (NMS) incidence estimates.

Data Sources: An unrestricted computerized MEDLINE search was conducted with a comprehensive search logic and supplemented by secondary references and a manual search of an extensive personal library.

Study Selection: Studies were analyzed if they presented original data and provided at least 2 of the following: number of NMS cases, number of patients at risk, or ratio of cases to patients at risk.

Agreement between instruments for rating treatment decisional capacity.

Objective: The objective of this study was to measure agreement between three treatment decisional capacity assessment instruments in mild to moderate dementia.

Method: Subjects (N=79) were recruited from the community. Rating agreement was evaluated with kappa statistics.

Dissociable contributions of MRI volume reductions of superior temporal and fusiform gyri to symptoms and neuropsychology in schizophrenia.

We sought to identify the functional correlates of reduced magnetic resonance imaging (MRI) volumes of the superior temporal gyrus (STG) and the fusiform gyrus (FG) in patients with chronic schizophrenia. MRI volumes, positive/negative symptoms, and neuropsychological tests of facial memory and executive functioning were examined within the same subjects. The results indicated two distinct, dissociable brain structure-function relationships: (1) reduced left STG volume-positive symptoms-executive deficits; (2) reduced left FG-negative symptoms-facial memory deficits.