Thaddeus Ulzen

The nature and characteristics of psychiatric comorbidity in incarcerated adolescents

Objectives: To determine the prevalence of psychiatric disorders, the degree of psychiatric comorbidity, and the relationship between these and sociodemographic variables in a sample of incarcerated adolescents. A comparison with an age- and sex-matched community sample was conducted. Method: Age- and sex-matched samples of 49 incarcerated adolescents and 49 nondelinquents were compared for psychiatric morbidity and psychosocial characteristics. Psychiatric diagnoses were determined using the Diagnostic Interview for Children and Adolescents-Revised (DICA-R). Additional information on psychosocial, family, and offence characteristics was obtained using a semistructured interview designed specifically for this study. The prevalence of single and comorbid psychiatric disorders was determined. Results: Approximately 63.3% of incarcerated adolescents had 2 or more psychiatric disorders. The degree of psychiatric morbidity was directly related to indicators of family adversity, physical abuse, other psychosocial variables, or polysubstance abuse. Psychiatric comorbidity was more frequent in females. Incarcerated adolescents were more likely to endorse symptoms of thought disorder. Conclusions: Findings identify preventive intervention foci for policy makers and planners in the area of adolescent corrections. Implications for education and training of nonclinical custodial staff are discussed as is the need for a more therapeutic orientation in correctional facilities.

A Review of Empirical Evidence of Somatic Treatment Options for the MI/DD Population

This article reviews recent evidence in the literature for the use of psychotropic and other somatic treatments in the management of patients with mental retardation (MR). The search methodology included peer-reviewed English language publications in PubMed and PsychINFO with the words Mental Retardation, Intellectual Disability, Developmental Disability and Mental Disorders/Drug Therapy or Antipsychotic medications, Psychiatric Somatic therapies, Neuroleptic Drugs, Antidepressants and Electroconvulsive Therapy from 1998 to 2008. The review revealed few randomized controlled trials on the medications frequently prescribed for patients with MR. Three RCTs of Risperidone in children, one combining adults and children and one with adults only are discussed. There was one RCT involving Quetiapine and one on Citalopram. There is little evidence to support the scope of psychotropic medication use in the MR population though the field is advancing. The contribution of psychiatric illness to challenging behaviors is not systematically addressed in the literature.

The Evolution of a Community-Based Telepsychiatry Program in Rural Alabama: Lessons Learned—A Brief Report

The purpose of this paper is to describe the partnership between a community-based rural mental health clinic and an academic health center to provide telepsychiatry services in rural Alabama. The partnership was developed to meet the needs of a clinic that serves an underserved rural population with limited psychiatric services. This paper offers valuable lessons learned for mental health practitioners who may be considering the benefits and challenges of forming community-based partnerships in use of telepsychiatry to build capacity to deliver clinical mental health services to rural mental health shortage areas.

The Delusional Parent: Family and Multisystemic Issues

Objectives: To examine the dilemmas for children, family, and mental health professionals posed by the presence of a delusional parent in a family, including someone with induced psychotic disorder (IPD); to identify frequently unrecognized problems; and to propose practical suggestions for professionals. Method: The pertinent literature on the effects of delusional parents on children, families, and professionals is reviewed. By way of 3 case vignettes, the dilemmas are identified and discussed. Results: Delusional disorders are underdiagnosed, resulting in poor anticipation of their implications. Unanticipated family factors, such as “pursuit of isolation” and the related heightened risk of violence, contribute to the failure of professional interventions, which has been described as “therapeutic systems paralysis.” Conclusions: These cases are complex, often requiring multisystemic involvement to reduce the risks of flight, violence, psychosis, posttraumatic stress disorder, and other psychiatric sequelae to children and other family members. The critical features of the innovative collaboration (“therapeutic consensus”) required between professionals for successful therapeutic interventions with these families are described.

Evaluating the Impact of an Innovative Public Speaking Competition to Promote Psychiatry as a Career Option for Ghanaian Medical Students

ObjectiveThe psychiatrist workforce has been identified as an area in need of development, especially in low- to middle-income countries. The purpose of this project is to assess the perceptions of Ghanaian medical students of a novel mental health inter-medical school speaking competition on career interest in psychiatry and mental health education and advocacy.MethodsThe study employed quantitative and qualitative methods in a cross-sectional design. A paper-based survey was administered to medical students from four schools in Ghana, and focus groups were conducted.ResultsA 52% response rate (545/1041 fifth- and sixth-year medical students from the four public medical schools in Ghana) was achieved. The competition was successful in stimulating interest in psychiatry as a subject (25%) and as a career (14%) and was viewed as serving an important public health and mental health advocacy function (65% and 66% respectively). The competition stimulated interest in students who were undecided or had previously ruled out psychiatry specialization, in both those who had and had not already completed a psychiatry clerkship (23% and 13% before and after completing a clinical rotation in psychiatry, respectively). Overall, 29% of respondents who participated in at least one competition-related activity reported that the competition stimulated their interest in psychiatry, compared to 4% who did not participate in any competition-related activity (Ӽ2 = 80, p = 0.0). Analysis of focus group content echoed these themes and highlighted opportunities for improvement.ConclusionThe innovative public speaking competition was successful in stimulating interest in psychiatry and furthering mental health education and advocacy. Implications are discussed.