The effects of a staff-training program in behavior management and social-learning principles on staff-patient interactions within a psychiatric rehabilitation inpatient unit.

Despite the existence of effective behavioral interventions for people diagnosed with serious mental illness (SMI), these continue to be underutilized. Barriers to implementation include a low frequency of staff-patient interactions, as well as a lack of knowledge about, and negative attitudes toward, behavioral interventions. Therefore, we examined the effects of a mandatory behavioral staff-training program on staff-patient interactions on a long-term psychiatric inpatient program for individuals with SMI.

Enhancing and Promoting Recovery In Attentionally Impaired People Diagnosed With Schizophrenia: Results From A Randomized Controlled Trial Of Attention Shaping In A Partial Hospital Program.

The attentional impairments associated with schizophrenia are well-documented and profound. Psychopharmacological and most psychosocial interventions have been shown to have limited effect in improving attentional capacity. That said, one form of psychosocial treatment, attention shaping procedures (ASP), has been repeatedly demonstrated to produce significant and meaningful change in various aspects of participant attentiveness behaviors.

Enrollment in supported employment services for clients with a co-occurring disorder.

Objective: People with serious mental illnesses and co-occurring substance use disorders are often excluded from vocational services, despite the lack of evidence that having a substance use disorder prevents them from being able to work. This study explored enrollment in supported employment services among clients with and without co-occurring substance use disorders.

Methods: With data from electronic medical records from a psychiatric rehabilitation agency, relationships between co-occurring substance use disorders and supported employment were examined among 1,748 clients with serious mental illnesses who were consecutively admitted to the agency over a two-year period.

Paxton house: integrating mental health and diabetes care for people with serious mental illnesses in a residential setting.

Objective: This report provides a program description of a supported housing residence for individuals with co-occurring diabetes and serious mental illnesses and preliminary health outcome data.

Methods: Weight, blood glucose levels and satisfaction survey data were collected retrospectively on 13 individuals referred to the program.

Results: Results indicate that individuals lost weight and fasting glucose readings fell into the ADA recommended range in the first six months of participation.

Integrated primary and mental health care services: an evolving partnership model.

Topic: Persons with serious psychiatric disabilities experience high rates of medical co-morbidities that, if properly treated, could improve overall well-being and the course of recovery.

Purpose: This brief reports describes how two organizations-Thresholds Psychiatric Rehabilitation Centers and University of Illinois College of Nursing-partnered to offer integrated behavioral and physical health care responsive to the needs of the population and committed to consumer-centered, holistic and preventative care. Most recently, the partnership offers primary care in different community settings through different service models-tele-monitoring, home visits, group visits.

Trial of an electronic decision support system to facilitate shared decision making in community mental health.

Objectives: Involvement of community mental health consumers in mental health decision making has been consistently associated with improvements in health outcomes. Electronic decision support systems (EDSSs) that support both consumer and provider decision making may be a sustainable way to improve dyadic communication in a field with approximately 50% workforce turnover per year. This study examined the feasibility of such a system and investigated proximal outcomes of the system's performance.

Access to supported employment for consumers with criminal justice involvement.

Objective: This paper aims to provide further understanding of the influence of severe mental illness (SMI) and criminal justice involvement (CJI) on access to Supported Employment (SE) services. The authors investigate differences between consumers with and without CJI regarding access to SE and explore reasons for group differences.

Method: This study employs a mixed-methods design.

Psychotherapy and recovery from schizophrenia: A review of potential applications and need for future study.

Recovery from schizophrenia has been conceptualized to involve not only symptom remission of symptoms and achievement of psychosocial milestones but also subjective changes in how persons appraise their lives and the extent to which they experience themselves as meaningful agents in the world. In this paper we review the potential of individual psychotherapy to address these more subjective aspects of recovery. Literature on the effectiveness of psychotherapy for persons with schizophrenia is discussed and two different paths by which psychotherapy might modify self-experience are described.

A comparative study of the MATRICS and IntegNeuro cognitive assessment batteries.

Cognitive impairment is prevalent in schizophrenia and is related to poorer functional and treatment outcomes. Cognitive assessment is therefore now a routine component of clinical trials of new treatments for schizophrenia. The current gold-standard for cognitive assessment in clinical trials for schizophrenia is the MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) Consensus Cognitive Battery (MCCB), which was developed based on expert consensus and incorporates paper-and-pencil tests (and one computerized measure) with an established history in the field of neuropsychology.

SELF-STIGMA AND COMING OUT ABOUT ONE'S MENTAL ILLNESS.

Self-stigma can undermine self-esteem and self-efficacy of people with serious mental illness. Coming out may be one way of handling self-stigma and it was expected that coming out would mediate the effects of self-stigma on quality of life. This study compares coming out to other approaches of controlling self-stigma.

Self-stigma, group identification, perceived legitimacy of discrimination and mental health service use.

Stigma may interfere with mental health service use. We measured self-stigma and stigma-related cognitions (group identification and perceived legitimacy of discrimination) at baseline in 85 people with schizophrenia, schizoaffective or affective disorders. After 6 months, 75 (88%) had reported use of mental health services.

Improving outcomes for pregnant and parenting foster care youth with severe mental illness: an evaluation of a transitional living program.

Objective: This study provides preliminary evidence for the effectiveness of a residential program with comprehensive wrap-around services for pregnant and parenting foster care youth with severe mental illness or severe emotional disturbance who are preparing to transition to independent living.

Methods: Twenty-five females ages 18 to 21 participated. Program effectiveness was determined by tracking monthly status changes, such as education, employment, and hospitalizations, as well as by comparing scores on four bi-annually administered standardized assessments of parenting competency and stress, child maltreatment risk, and mental health symptoms.

A stress-coping model of mental illness stigma: I. Predictors of cognitive stress appraisal.

Stigma can be a major stressor for individuals with schizophrenia and other mental illnesses. It is unclear, however, why some stigmatized individuals appraise stigma as more stressful, while others feel they can cope with the potential harm posed by public prejudice. We tested the hypothesis that the level of perceived public stigma and personal factors such as rejection sensitivity, perceived legitimacy of discrimination and ingroup perceptions (group value; group identification; entitativity, or the perception of the ingroup of people with mental illness as a coherent unit) predict the cognitive appraisal of stigma as a stressor.

The Thresholds-Dartmouth partnership and research on shared decision making.

Thresholds Rehabilitation Centers is one of the largest providers of psychiatric rehabilitation services in the United States, and the Dartmouth Psychiatric Research Center is a highly regarded team of rehabilitation researchers. This column describes efforts to build upon the long-standing collaborative relationship between Thresholds (community partner) and Dartmouth (academic partner) to implement and study shared decision making in a community mental health care setting that serves an ethnoracially diverse population. Shared decision making encompasses a client-centered approach in which client and practitioner are equal partners.

Effects of stimulus structure and target-distracter similarity on the development of visual memory representations in schizophrenia.

Introduction: In a previous study (Silverstein, Bakshi, Chapman, & Nowlis, 1998a, Cognitive Neuropsychiatry) we demonstrated that while schizophrenia patients showed similar learning curves as nonpatient controls when determining whether a configural pattern of elements has been seen before or not, they did not demonstrate any learning curve with nonconfigural stimuli (in contrast to controls). Methodological limitations of that study, however, precluded generalisability of those effects.

Methods: In the present study, therefore, different groups of schizophrenia patients (n = 18) and controls (n = 22) were administered a modified version of the familiarity judgement task used in Silverstein et al.

Reduced top-down influences in contour detection in schizophrenia.

Introduction: Chronic schizophrenia patients have previously demonstrated performance deficits in contour integration tasks. The purpose of this study was to investigate whether schizophrenia patients, spanning a range of illness severity, would demonstrate responsiveness to manipulations that recruit top-down processing strategies involving learning and sequencing effects in a contour integration task.

Methods: We administered a contour integration test over four consecutive days and in two different presentation conditions each day.

Effectiveness of a two-phase cognitive rehabilitation intervention for severely impaired schizophrenia patients.

Background: Several small-N, uncontrolled reports have demonstrated that the behavioral technique of attention shaping has significantly increased attention span among severely ill schizophrenia patients.

Method: In this study, we evaluated the effectiveness of using an individually administered intervention for improving sustained attention, Attention Process Training (APT), followed by an attention-shaping procedure within the context of an ongoing skills training group. Patients were randomly assigned to receive either the APT and attention-shaping sequence (n = 18) or equivalent hours of treatment in the same intensive behavioral rehabilitation program (n = 13).

At issue: The future of cognitive rehabilitation of schizophrenia.

Cognitive rehabilitation is becoming an increasingly popular intervention in treatment programs for people with schizophrenia. Despite this increased acceptance, however, the evidence base on its effectiveness is not impressive. Moreover, given the evidence of cognitive recovery in treated patients who do not receive cognitive rehabilitation--from newer medications and from other evidence-based psychosocial interventions--it is not clear whether cognitive rehabilitation is worth its expense in time and resources.

[Multimodal treatment of aggression and violence in individuals with psychosis].

In this article, the authors offer a description of nonpharmacological treatments which have demonstrated effectiveness in reducing aggression and violence in patient with psychosis ; present a case formulation/treatment planning approach which addresses the complex etiological influences and multiple factors affecting maintenance of aggressive behavior in PI; finally, they provide a case example of this approach.

[Techniques for improving attentiveness and treatment engagement among "treatment refractory" schizophrenia patients with severe cognitive impairment].

While many effective group-based psychiatric rehabilitation interventions now exist, many severely disabled patients are unable to benefit from them due to a reduced ability to pay attention in group sessions. Moreover, inattentiveness can be due to one or more of multiple factors, including a sustained attention deficit, poor motivation, sedating side effects of medication, and the interfering effects of hallucinations and disturbing thoughts. Existing cognitive rehabilitation interventions for schizophrenia typically do not address these factors, instead targeting higher level functions such as memory, learning, problem-solving, and executive functioning.

[Interpersonal techniques for optimizing positive outcomes in the inpatient psychiatric rehabilitation of schizophrenia].

There now exist a number of milieu-based and group-based behavioral treatments that have demonstrated effectiveness with so-called "treatment-refractory" schizophrenia patients. These interventions are not likely to achieve their maximal impact, however, unless program staff consistently employ behavioral principles in their moment-to-moment interactions with patients throughout the day. In this paper we describe a number of interpersonal techniques that are effective in dealing with a variety of institutionalized/dependent and provocative/aggressive behaviors.