Ronald J. Diamond

Activation of existing memories in anterograde amnesia.

Two principal arguments against a consolidation-block formulation of anterograde amnesia are the existence of pnor-list intrusion errors and the facilitating effect of cued recall Both of these findings can be explained if one assumes an additional process trace activation of already existing memories. This consolidation-block plus trace-activation view predicts that in densely amnesic patients, learning of new items or relationships is almost impossible to demonstrate and cued recall facilitates performance only on already familiar material We test for trace activation by comparing the performance of six dense anterograde amnesia patients with control subjects on three tasks arbitrary word-paired associates (e.g., late-man), recall of disyllabic words cued with the first syllable (e.g., per-son), and recall of disyllabic pseudowords cued with the first syllable (e.g., com-da). As predicted, amnesic patients showed substantial cued-recall effects for real words and not for pseudowords or arbitrarily paired associates The effect of the cuemg on real words was demonstrated to decay over approximately 120 mm, providing some estimate of the time course of trace activation

Cost effectiveness of long-acting risperidone injection versus alternative antipsychotic agents in patients with schizophrenia in the USA

The availability of long-acting risperidone injection may increase adherence and lead to improved clinical and economic outcomes for individuals with schizophrenia. The objective of this study was to assess the cost effectiveness of longacting risperidone, oral risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and haloperidol depot in patients with schizophrenia over 1 year from a healthcare system perspective. Published medical literature, unpublished data from clinical trials and a consumer health database, and a clinical expert panel were utilized to populate a decision analytical model comparing the seven treatment alternatives. The model captured rates of patient compliance, the rates, frequency and duration of relapse, incidence of adverse events, and healthcare resource utilization and associated costs. Primary outcomes were expressed in terms of percentage of patients relapsing per year, number of relapse days per year (number and duration of relapses per patient per year), and total direct 2003 medical cost per patient per year. On the basis of model projections, the proportions of patients experiencing a relapse requiring hospitalization in 1 year were 66% for haloperidol depot, 41% for oral risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole, and 26% for long-acting risperidone, whereas the proportions of patients with an exacerbation not requiring hospitalization were 60% for haloperidol depot, 37% for oral risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole, and 24% for long-acting risperidone. The mean number of days of relapse requiring hospitalization per patient per year were 28 for haloperidol depot, 18 for oral risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole, and 11 for long-acting risperidone, whereas the mean number of days of exacerbation not requiring hospitalization were eight for haloperidol depot, five for oral risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole, and three for long-acting risperidone. This would translate into direct medical cost savings with long-acting risperidone compared with oral risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and haloperidol depot of US

A new look at an old issue: People with mental illness and the law enforcement system

161, 1425, 508, 259, 1068, and 8224, respectively. These findings were supported by sensitivity analyses. The utilization of long-acting risperidone is predicted to result in better clinical outcomes and lower total healthcare costs than its comparators, oral risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and haloperidol depot. Longacting risperidone may therefore be a cost saving therapeutic option for patients with schizophrenia.

A model community psychiatry curriculum for psychiatric residents.

Most research on encounters between persons with mental illness and the law enforcement system has focused on the extent to which persons with mental illness are shifted between the mental health and law enforcement systems. This article focuses instead on the interplay between the mental health and law enforcement systems for a group of persons with severe mental illness who continue to be actively treated by an Assertive Community Treatment (ACT) program. To better understand the connection between these two systems, profiles were constructed for 100 ACT clients, including data about arrests, other contacts with the law enforcement system, and mental health treatment. Results indicate that although the majority of ACT clients had some contact with the law enforcement system, most police encounters and arrests were for minor infractions. Those clients with the most frequent and serious contacts also received more expensive and intensive mental health treatment. Implications for future research and program design are discussed.

Coercion and Tenacious Treatment in the Community

The ability of mental health practitioners to work well with persons with serious long-term mental illness has expanded significantly over the past two decades. Learning to do this well involves acquiring a broad base of knowledge and a complex range of skills. Such knowledge and experience must be incorporated into the basic residency curriculum for general psychiatrists, though with some notable exceptions this has not occurred for a number of important reasons, including money and the new image that psychiatry is trying to assume. The key elements of such a curriculum include 1) specific learning goals, 2) working within an effective treatment system with high quality clinical rotations, 3) good role models, 4) high quality psychiatric supervision, 5) a well-grounded didactic program, and 6) high quality clinical rotations. We discuss these elements in detail, and we describe the training program in community psychiatry at the University of Wisconsin Medical School Department of Psychiatry. Our residency training program and supervising faculty are affiliated with and partially funded by the Mental Health Center of Dane County to the benefit of both. This marriage between the public-sector mental health care provider and the academic psychiatric training program has created benefits for both parents plus a fertile environment for training future generations of psychiatrists.

Using non-feature films to teach diversity, cultural competence, and the DSM-IV-TR outline for cultural formulation

Coercion in community-based programs has become an increasing concern (Parrish, 1992). Much of this concern has coincided with the development of assertive (or aggressive) community treatment programs. Prior to active community outreach teams, attempts to coerce the behavior of clients living in the community were limited by practical realities. Clients in traditional mental health systems always had the option of just not showing up. It is true that clients could be threatened with rehospitalization under court order, but enforcing such orders required cooperation from police, who typically had little interest in searching for a mentally ill client who had not committed any crime (Cesnik & Puls, 1977).

Developing a systems approach to caring for persons with borderline personality disorder

ObjectiveFeature films have been used for teaching in psychiatry for many years to demonstrate diagnoses, but the use of documentary and instructional films in resident and staff cultural competence training have not been extensively written about in the medical and psychological literature. This article will describe the films that have been used by the authors and suggest methods for their use in cultural competence and diversity training.MethodsA literature search was done using MEDLINE and PsychINFO and the authors were asked to describe their teaching methods.ResultsOne article was found detailing the use of videotapes as a stimulus but not for cultural competence education, and two articles were found documenting the use of The Color of Fear as a stimulus for the discussion of racism. However, many educators use these films all across the country for the purpose of opening discussion about racism.ConclusionDocumentary, instructional, and public service announcements can be useful in teaching culturally competent assessment and treatment.

Group treatment for individuals with schizophrenia

Most community mental health centers have not established a treatment approach for seriously ill persons with borderline personality disorder that is multi-focused, coordinated, comprehensive, and continuous. The authors propose that the systems approach to caring for persons with schizophrenia (Stein, Diamond, & Factor, 1990) be modified and tested for its efficacy in helping seriously ill persons with borderline personality disorder. The rationale for proposing this model of care and its underlying principles and clinical components is described in this paper.

The role of psychiatrists in community mental health centers: A survey of job descriptions

Comprehensive treatment programs for individuals with schizophrenia usually include a variety of groups, many of which have concrete tasks as a focus: medication management, social skills training, meal preparation, etc. These groups can simultaneously serve more general rehabilitative purposes if leaders apply principles of group leadership which recognize the neuropathological substrate of schizophrenia and which take into account the specific interpersonal characteristics and needs of individuals who have the illness. This paper presents a framework for leading task-oriented groups for individuals with schizophrenia and give examples from a medication group in a psychosocial rehabilitation program.

Response to “training residents for community psychiatric practice”

There is little data about the role of psychiatrists within CMHCs. To gain perspective on this issue, job descriptions for medical directors and staff psychiatrists were collected from 214 CMHCs. The data demonstrated that most CMHCs want fully trained psychiatrists involved in a variety of activities in addition to prescribing medication. Policy development was specifically included as part of the medical directors job for 69% of the CMHCs, and 50% mentioned training as part of the staff psychiatrists job. Although job descriptions may not accurately reflect the actual roles of the psychiatrist in all cases, these data suggest that CMHCs support a multifaceted role for their psychiatrists.