Anu Matorin

Nicotine reduces antisaccade errors in task impaired schizophrenic subjects.

Nicotine and/or smoking have been shown to reduce various cognitive deficits associated with schizophrenia. Here, we examine the effects of nicotine gum on repeated performance on a simple eye movement task. Eight schizophrenic subjects and eight controls participated in three days of testing on saccade (S) and antisaccade (AS) tasks. On each testing day, subjects participated in four testing sessions and received both of two nicotine gum treatments (4 and 6 mg) and both of two control conditions (placebo gum and no gum), each followed by a recovery period. Overall, schizophrenics showed significant impairments on the AS task. However, upon individual examination only four schizophrenics showed significant differences in AS errors or reaction times (RTs) when compared to controls. The other four schizophrenic subjects showed control level performance. All schizophrenic subjects showed normal and better than control level performance on the simple S task. Furthermore, no effects of nicotine were seen on the simple S task. There were significant treatment effects on the AS task. Nicotine treatment significantly decreased errors in the task impaired schizophrenic group and this effect was most pronounced at the 6 mg level. No nicotine effects were demonstrated for non-impaired schizophrenic subjects or controls. This study demonstrates a benefit of short exposure to nicotine in cognitively impaired schizophrenic subjects. These results support previous findings of cognitive benefits of nicotine in schizophrenics.

Integration of international medical graduates in u.s. Psychiatry: the role of acculturation and social support.

ObjectiveThe authors investigated whether social support and acculturation could predict the mental health of international medical graduates pursuing psychiatric residencies in the United States.MethodsA 55-item online survey was assembled by combining three validated instruments for mental health, social support, and acculturation. A link to the survey was e-mailed to training directors of all psychiatric residency and fellowship programs. Directors were requested to forward the survey to their international medical graduate residents for completion between December 2008 and February 2009.ResultsOne hundred eight international medical graduates from 70 different psychiatric residencies and fellowships completed the entire survey. Respondents’ mental health scores were normally distributed. The vast majority scored very high on survey items related to mental health. Acculturation, social support, and postgraduate training year were significant predictors of mental health.ConclusionResidency training programs should attempt to incorporate measures that would help boost the social support and acculturation of international medical graduates (especially junior-level trainees). Acculturation could be improved by language training and courses in American history, culture, and customs, and social support could be expanded by mentoring relationships.

Depression and the Suicidal Patient

Depression is the most common psychiatric illness in the general community, with 3% to 4% of depressives dying by suicide today. Studies have shown that depression has considerable morbidity and mortality. This article focuses on depressed patients and their management within the emergency department. Understanding the intricacies of the interview process and identifying which patients need immediate attention are important skills for the emergency physician.

Down the Rabbit Hole: Emergency Department Medical Clearance of Patients with Psychiatric or Behavioral Emergencies.

Patients presenting with behavior or psychiatric complaints may have an underlying medical disorder causing or worsening their symptoms. Misdiagnosing a medical illness as psychiatric can lead to increased morbidity and mortality. A thorough history and physical examination, including mental status, are important to identify these causes and guide further testing. Laboratory and ancillary testing should be guided by what is indicated based on clinical assessment. Certain patient populations and signs and symptoms have a higher association with organic causes of behavioral complaints. Many medical problems can present with or exacerbate psychiatric symptoms, and a thorough medical assessment is imperative.

Training family practice residents in psychiatry : An ambulatory care training model

Objective: To demonstrate the importance of providing psychiatric training to primary care practitioners in ambulatory care settings. Additionally, to describe the model used for this purpose in the Department of Psychiatry and Behavioral Sciences of the University of Texas Medical School at Houston in order to further stimulate educational opportunities on this topic. Method: A review of the psychiatric curriculum offered to family practice residents during their PGY-2 year one-month rotation in psychiatry at the University of Texas Mental Sciences Institute is provided. Emphasis is given to key areas of the curriculum such as: knowledge, skills, and attitude development. Special focus on the clinical and educational experiences is also offered for the purpose of providing unique perspectives about the curriculum methodology. Results: The careful assessment of the feedback obtained from the family practice residents who were exposed to this ambulatory training model demonstrates that this type of setting was satisfactory for the teaching of psychiatry to primary care residents. Conclusions: Primary care residents have always treated a large number of psychiatric patients. Given the current status of our health care system, primary care practitioners should have even a greater role in the future delivery of psychiatric services. In this article, we offer a model of training for primary care residents in psychiatry, which emphasize cost-effectiveness, high quality of care, and ambulatory care settings.

Psychiatric considerations in the diagnosis, treatment, and prevention of HIV/AIDS.

&NA; HIV/AIDS has the unfortunate distinction of being one of the most devastating epidemics of the twentieth century. By the end of June, 1999, 420,201 deaths in persons with AIDS had been reported in the United States. While HIV/AIDS patients are currently living longer as a result of more effective and complex treatments, no vaccination or cure has yet been discovered. Over the years, the HIV/AIDS epidemic has become multifactorial and currently affects several different special population groups. Individuals who are at high risk for becoming infected with HIV or who already suffer from HIV/AIDS can benefit greatly from the interventions of psychiatrists or other mental health professionals. It is important that psychiatrists collaborate very closely with infectious disease specialists in the management of HIV/AIDS and its psychological sequelae. The authors describe the psychiatric conditions that most often occur in association with HIV/AIDS: mood disorders, anxiety disorders, substance‐related disorders, psychotic disorders, insomnia and sleep disorders, delirium, dementia, and pain syndromes. We present guidelines for diagnosis and psychopharmacological and psychotherapeutic treatment of these disorders in patients with HIV/AIDS. The article concludes with a discussion of prevention strategies that can be used in a mental health treatment setting and special issues related to treating HIV/AIDS in certain special population groups.

Stabilization and Management of the Acutely Agitated or Psychotic Patient

Acutely agitated or psychotic patients are particularly challenging to manage in the emergency department. Often these patients present with little or no history, and an adequate assessment may initially be difficult because of the condition of the patient. This article discusses basic concepts regarding agitation, and the related management goals and strategies.

Psychotherapy with African-American patients: a training perspective.

Given the increasingly multicultural and pluralistic society in the United States, training in cross-cultural psychotherapy during psychiatry residency should not be neglected. Psychiatric training programs need to provide a broad comprehensive didactic and clinical experience in psychotherapy that will enable psychiatrists to meet the mental health care needs of our growing multicultural society. Although the American Council of Graduate Medical Education (ACGME) stresses the importance of preparing residents to demonstrate competency in five areas of psychotherapy as part of the required “core competencies,”1,2 little emphasis has been given to training in cross-cultural psychotherapy. The Residency Review Committee in psychiatry has made an effort to place a priority on cross-cultural training as a requirement for accreditation, but academic departments of psychiatry have not been able to rise fully to this challenge, in part because of limited financial resources for training and education.3 However, this void in residency training must be addressed if we are to broaden access to and quality of care within the increasingly pluralistic society of the United States. Population growth in the United States reflects these changing patterns. According to the 2000 U.S. Census Bureau, the Hispanic population of the United States grew at a rate of 55% in the last 10 years and is currently estimated to be approximately 46,000,000, including unregistered aliens. The Asian population is also growing at a rate of 50% and is now approximately 11,000,000. The growth rate of the African-American population is approximately 17% and is now approximately 34,000,000. There are also about 35,000,000 people from other ethnic minority groups in the United States. Ethnic minority populations are playing an increasingly prominent role in U.S. society through political influence and entrepreneurial enterprises. At the same time, this growing population has mental health needs that must be addressed.4 Although about 25% of psychiatrists currently practicing in the United States are international medical graduates, the psychiatric field still lacks the required ethnic manpower to meet the mental healthcare needs of our expanding multi-ethnic population. Currently, there are about 1,500 Hispanic psychiatrists, 900 African-American psychiatrists, and 2,500 Asian psychiatrists in the United States—numbers far short of what is required to meet the demand for their services. Furthermore, from a training perspective, international medical graduates, who comprise about 40% of psychiatric residents in the United States, come from a wide range of backgrounds, have varying types of experience, and tend to have limited prior exposure to psychotherapy training. As part of a strong psychiatric training, psychiatric residents— both American and international medical graduates— require more extensive training and experience in psychotherapy not only from a historically western point of view, but also a more comprehensive educational experience that will allow them to develop the psychotherapy skills needed to provide the best quality of care to the continuously changing U.S. population. In the Department of Psychiatry and Behavioral Sciences of the University of Texas Medical School at Houston, we have made a concerted effort to develop a psychiatry residency training curriculum that incorporates training in cross-cultural psychiatry via actual case experiences, case discussions, and seminars focusing on African-American, Hispanic, Asian, and other cultures. In this report, we present the case of a 51-year-old African-American female and discuss a number of cul-

Termination of psychotherapy: a training perspective.

&NA; Given the constraints of the prevailing mental health system in the United States, it has become very challenging for psychiatrists to offer psychotherapy services to patients in need of this modality of treatment. In spite of this situation, the profession has made a consistent effort not only to retain this type of psychiatric care but also to train psychiatric residents in this psychiatric intervention technique and its appropriate indications. In this article, the authors highlight a very important aspect of psychotherapy treatment—the termination phase. They review relevant literature on this subject, discuss some of the most common problems faced by psychiatrists, especially psychiatric residents, when addressing the termination phase of psychotherapy, and then present two cases to illustrate these issues. (Journal of Psychiatric Practice 2000;6:334‐340)

True costs of medical clearance: Accuracy and disagreement between psychiatry and emergency medicine providers

Introduction: Medical clearance is required to label patients with mental illness as free of acute medical concerns. However, tests may extend emergency department lengths of stay and increase costs to patients and hospitals. The objective of this study was to determine how knowledgeable emergency and psychiatric providers are about the costs of tests used for medical clearance. Materials and Methods: We surveyed the department of psychiatry (Psych) and department of emergency medicine (EM) faculty and residents to obtain their estimates of the costs of 18 laboratory/imaging studies commonly used for medical clearance. Survey responses were analyzed using the Wilcoxon signed-rank test to compare the median cost estimates between residents and faculty in EM and Psych. Results: A total of 99 physicians (response rate, 47.8%) completed the survey, including 47 faculty (EM = 28; Psych = 20) and 52 residents (EM = 29; Psych = 23). Across all the groups, cost estimates for tests were inaccurate, off by several hundred dollars for three tests, and by