Improving quality of antipsychotic polypharmacy: a pilot study.

Background: Concurrent prescription of more than one type of antipsychotic for the same patient - antipsychotic polypharmacy (APP) - is associated with increased incidence of side effects, uncertain therapeutic benefit and general guidelines advise against it. Nevertheless, APP is common and there is little evidence about possible interventions to improve practice.Aims: To investigate the prevalence and documentation quality of APP in specialized psychiatric care and assess the feasibility and effect of a simple intervention to improve clinical practice.Methods: We examined the prevalence and the quality of documentation of APP in medical records from a large inpatient treatment department before and 6 months after an intervention, which consisted of giving feedback to doctors on their prescription practices as well as teaching about current guidelines. Prescription and documentation before and after intervention were compared between intervention and control wards.Results: One hundred and twenty-one medical records were examined at baseline. 43% of these had APP, of these 27% was satisfactory documented. After the intervention, the proportion with APP was reduced from 42% to 29% in the intervention group. There was a statistically significant interaction effect of the intervention group and the after-intervention condition on this reduction. The percentage with satisfactory documentation of APP was increased after the intervention in both groups, but we found no corresponding interaction effect.Conclusion: APP is prevalent in inpatient treatment of patients with mainly psychotic disorders but documentation of this is insufficient. Simple education and feedback on prescription and records documentation practices may increase adherence to guidelines.

Democratic therapeutic community treatment for personality disorder: randomised controlled trial.

BACKGROUND: Democratic therapeutic community (DTC) treatment has been used for many years in an effort to help people with personality disorder. High-quality evidence from randomised controlled trials (RCTs) is absent. AIMS: To test whether DTC treatment reduces use of in-patient services and improves the mental health of people with personality disorder. METHOD: An RCT of 70 people meeting DSM-IV criteria for personality disorder (trial registration: ISRCTN57363317). The intervention was DTC and the control condition was crisis planning plus treatment as usual (TAU). The primary outcome was days of in-patient psychiatric treatment. Secondary outcomes were social function, mental health status, self-harm and aggression, attendance at emergency departments and primary care, and satisfaction with care. All outcomes were measured at 12 and 24 months after randomisation. RESULTS: Number of in-patient days at follow-up was low among all participants and there was no difference between groups. At 24 months, self- and other directed aggression and satisfaction with care were significantly improved in the DTC compared with the TAU group. CONCLUSIONS: DTC is more effective than TAU in improving outcomes in personality disorder. Further studies are required to confirm this conclusion.

How activation, entanglement, and searching a semantic network contribute to event memory.

Free-association norms indicate that words are organized into semantic/associative neighborhoods within a larger network of words and links that bind the net together. We present evidence indicating that memory for a recent word event can depend on implicitly and simultaneously activating related words in its neighborhood. Processing a word during encoding primes its network representation as a function of the density of the links in its neighborhood. Such priming increases recall and recognition and can have long-lasting effects when the word is processed in working memory. Evidence for this phenomenon is reviewed in extralist-cuing, primed free-association, intralist-cuing, and single-item recognition tasks. The findings also show that when a related word is presented in order to cue the recall of a studied word, the cue activates the target in an array of related words that distract and reduce the probability of the target's selection. The activation of the semantic network produces priming benefits during encoding, and search costs during retrieval. In extralist cuing, recall is a negative function of cue-to-distractor strength, and a positive function of neighborhood density, cue-to-target strength, and target-to-cue strength. We show how these four measures derived from the network can be combined and used to predict memory performance. These measures play different roles in different tasks, indicating that the contribution of the semantic network varies with the context provided by the task. Finally, we evaluate spreading-activation and quantum-like entanglement explanations for the priming effects produced by neighborhood density.