David R. Diaz

Inpatient Psychiatric Treatment of Deaf Adults: Demographic and Diagnostic Comparisons With Hearing Inpatients

OBJECTIVE This study examined the diagnostic and clinical features of deaf psychiatric inpatients. METHODS Archival clinical data for deaf and hard-of-hearing adults (N=30) were compared with data for a random sample of hearing adults (N=60) admitted to a state psychiatric hospital from 1998 to 2008. RESULTS Significant differences were found between deaf and hearing inpatient groups in the frequency of impulse control disorders (23% versus 2%), pervasive developmental disorders (10% versus 0%), substance use disorders (20% versus 45%), mild mental retardation (33% versus 3%), and personality disorders (17% versus 43%). The deaf group had a larger proportion with diagnoses of psychotic disorder not otherwise specified (17% versus 2%). Deaf inpatients had longer hospitalizations than hearing inpatients (17 months versus ten months). CONCLUSIONS Clinicians working with the underserved, understudied population of deaf and hard-of-hearing psychiatric inpatients should be aware of the cultural and linguistic differences in assessment and treatment and make efforts to modify their approach.

Psychiatric disorder prevalence among deaf and hard-of-hearing outpatients

OBJECTIVES To contribute to the dearth of literature on the prevalence rates of psychiatric disorders in deaf adults, this study examined the diagnostic and clinical characteristics of deaf psychiatric outpatients in comparison to hearing psychiatric outpatients. METHODS Archival clinical data for deaf adults (N=241), treated at a specialized, linguistically and culturally affirmative outpatient community mental health program from 2002 to 2010, was compared to data from a random sample of hearing adult outpatients (N=345) who were treated at the same community mental health center. RESULTS In various diagnostic categories, significant differences were seen between the deaf and hearing groups: bipolar disorders (3.7% versus 14.2%), impulse control disorders (15.8% versus 5.2%), anxiety disorders (18.7% versus 30.1%), attention deficit hyperactivity disorder (11.2% versus 4.9%), pervasive developmental disorders (3.3% versus 0.3%), substance use disorders (27.8% versus 48.4%), and intellectual disabilities (10.4% versus 2.9%). CONCLUSIONS The deaf outpatient group evidenced a different diagnostic profile than the hearing sample. It is suggested that the use of culturally competent and fluent ASL-signing clinicians provides more diagnostic clarity and is encouraged as a best practice for the care of deaf individuals.

Assessment and treatment of deaf adults with psychiatric disorders: a review of the literature for practitioners.

Many deaf individuals comprise a unique cultural and linguistic minority group. This article reviews the current research literature related to the evaluation, diagnosis, and treatment of culturally Deaf individuals suffering from mental disorders. Appropriate psychiatric assessment and treatment requires that clinicians be sensitive to issues of language and differences in social norms and cultural values. Emerging trends in research indicate greater diagnostic specificity and a broader range of diagnoses being assigned in services that are specialized for the treatment of deaf people with mental health issues. Culturally sensitive evaluation and treatment involves a thorough assessment of language modality and language fluency, deafness/audiological history, and cultural identification. Failure to consider these factors during the mental status exam can lead to misdiagnosis. Important issues that confound differential diagnosis and psychiatric treatment of the deaf population are highlighted and discussed. Recommendations for the provision of culturally and linguistically appropriate care are provided. (Journal of Psychiatric Practice 2013;19:87–97)

Identifying and Assessing Psychosis in Deaf Psychiatric Patients

This article reviews recent research in the area of psychotic disorders in deaf psychiatric patients. Comparisons of the rates of psychotic disorders in the deaf and hearing populations suggest that psychotic disorders occur equally as often or even somewhat less often in the deaf population as in the hearing population. Consideration is given to the limitations of this small body of research, and recommendations for future research are provided. The contradictory literature on hallucinations in the deaf is also reviewed, and current theory about the manner in which hallucinations are manifested and experienced based on audiological history is presented. The challenges encountered by clinicians in accurately assessing symptoms of thought disorganization in deaf people are reviewed. Specifically, the etiology of deafness, language dysfluency, and the skill and training of American Sign Language interpreters are considered as factors impacting accurate diagnosis. Recommendations from the current literature are also provided.

Mentorship of clinical-track junior faculty: impact of a facilitated peer-mentoring program to promote scholarly productivity.

a specific course in nearly half of the responding training programs. Specific BPD courses entail a considerably higher number of hours than when BPD is presented within other didactic courses. DBT was the most prominentlytaught treatment technique, likely because of its longstanding presence in the literature. Challenges in teaching BPD were reported infrequently. BPD was taught in an individualized course context at a similar level as bipolar disorder, despite differences in prevalence rates.Overall, didactic training in BPD appeared to be present in all of the responding programs, in one format or another, but its overall presence may be insufficient, given BPD’s prevalence rate. Our study has potential limitations. First, all data were self-report in nature and may reflect recollection bias. Second, because of anonymity, we cannot determine how representative our sample is in relation to the non-responding programs. Third, although respectable for mailed surveys, the response rate was only 43.7%. Fourth, non-responders may not have participated because of a lack of programming in BPD, thereby affecting results. Fifth, course material on BPD may have been present in other types of courses not mentioned, such as a course on DBT. Last, the presence of instruction about BPD cannot be equated with trainee competence to treat this often-challenging disorder. Despite these potential limitations, this is the first study, to our knowledge, to examine the didactic presence of BPD in psychiatric training curriculums. Is it really sufficient?

Differential Diagnosis of Psychosis in a Deaf Inpatient with Language Dysfluency: A Case Report

This case report demonstrates challenges diagnosing psychosis in language dysfluent deaf patients. Treatment of a 34-year-old deaf man on an inpatient psychiatric unit is described. He had a history of physical aggression and possible symptoms of paranoia and thought disorganization, in addition to learning difficulties and minimal language skills. The patient was placed on a combined hearing/deaf inpatient unit, received specialized programming for deaf patients and was prescribed risperidone and divalproex sodium to treat his aggressive behavior and possible psychosis. Uncertainty if the patient were having psychotic symptoms remained throughout his hospitalization, although he improved behaviorally and was discharged after 13 months of treatment. The patients pre-existing language deficits made accurate diagnosis and appropriate treatment challenging. It is important for clinicians to be aware of the frequency of language dysfluency in the deaf inpatient population and have a strategy for evaluating and treating this complex subgroup of deaf people.

Scratching the Surface of Psychiatric Services Distribution and Public Health: an Indiana Assessment

Mental illness is a leading cause of disability with many public health implications. Previous studies have demonstrated a national shortage of psychiatrists, particularly in rural areas. An analysis of how this workforce distribution relates to population demographics and public/behavioral health is lacking in the literature. This study encompassed a statewide assessment of the Indiana psychiatric workforce as it relates to population characteristics and public/behavioral health. This study’s findings demonstrate a profoundly low psychiatry workforce in rural counties of Indiana. The low psychiatry workforce capacity in rural counties is so disparate that the demographic and public/behavioral health characteristics differ from the State averages in the same manner as counties without a psychiatrist at all. The psychiatric workforce distribution did not differ significantly on the basis of poverty prevalence. The potential utility of indicators of population health was also evaluated and revealed that social factors such as poverty and Medicaid prevalence may be superior to more traditional measures.

Experiences in Psychiatric Residency Training: Teaching About the Mental Health of Persons Who Are Deaf or Hard of Hearing

To the Editor: Over the last decade, there has been an increased emphasis on preparing young physicians to care for the nation’s minority populations. One minority group that has received minimal attention in the psychiatry training literature is people who are Deaf or hard of hearing. One in 10 people in the USA has a hearing loss that makes hearing spoken language difficult [1]. “Deaf” with a capital “D” refers to individuals who use American Sign Language (ASL) as their primary language. Approximately 500,000 ASL users who are Deaf are believed to exist in the USA [2]. Many Deaf people view themselves as a minority group rather than a disability group with their own language, values, and culture [2]. In contrast, many individuals who are hard of hearing inherently rely on speech-reading and their residual hearing to assimilate with the hearing world. As such, people who self-identify as hard of hearing more typically view themselves as having a disability. It is widely known that people with all types and degrees of hearing loss have more risk factors for the development of emotional and behavioral health problems and face unique barriers that influence access to and provision of mental health care [1, 2]. Risk factors for psychiatric and behavioral issues in people who are Deaf or have hearing loss include the brainrelated infectious and/or inflammatory processes that underlie some etiologies of deafness and hearing loss as well as impaired cognitive and social development due to lack of early language access [2]. Deaf people also face unique barriers to access to psychiatric care. Providers need to recognize and be able to adapt aspects of their psychiatric practice to meet the needs of people who are Deaf or have hearing loss. Specifically, clinicians must be comfortable with languagerelated accommodations; deletions/additions to a standard mental status exam; and awareness of social, economic, language, and cultural stressors that might exacerbate mental health symptoms. To reduce barriers and promote culturally and linguistically appropriate care, the field of psychiatry needs clinicians trained to serve people who are Deaf or have hearing loss. Integration of specific clinical and didactic training on the mental health issues and needs of the Deaf community into residency training programs is an important step in reducing barriers and disparities in psychiatric care and access. In this study, we aimed to assess whether programs are teaching about the diagnosis and treatment of persons who have hearing loss and which methods programs are utilizing. All study procedures were approved by the Institutional Review Board at the University of Pittsburgh Medical School. We developed a 10-item survey, based-on feedback from cognitive interviews of training directors at the authors’ home institutions [3]. Residency training directors and/or coordinators of the 226 general psychiatry residency programs in the USA on the Accreditation Council for Graduate Medical Education (ACGME) website for the 2016–2017 training year were contacted by email to request participation. Of the 226 programs, 29 completed the survey (response rate of 13%). The respondents reported the greatest likelihood of resident contact with patients who are deaf or have hearing loss was in emergency departments (75.9%, n = 22), inpatient settings (72.4%, n = 21), and outpatient clinics (65.5%, n = 19). Few programs reported having subspecialty clinics aimed to serve minority or disability populations (6.9%, n = 2). One third of the responding programs (37.9, n = 11) reported either no opportunities for resident clinical training with these populations (24.1%, n = 7) or did not know if residents had any access to clinical training with these groups (13.8%, n = 4). Nearly 90% of programs were endorsed providing some cultural awareness training to their residents about diverse topics though not typically including deafness or hearing loss. * Kimberly K. Mathos Mathoskk2@upmc.edu