Case manager as therapy extender for cognitive behavior therapy of serious mental illness: a case report.

Cognitive behavior therapy (CBT) is an evidence-based intervention for individuals with serious mental illness and potentiates standard medication management. Americans receiving publicly funded treatment for serious mental illnesses have limited access to CBT and hence we need to devise innovative ways of providing access to this important intervention. We present a case of a man who had severe disability, was medication resistant, and diagnosed with Obsessive Compulsive Disorder and Major Depressive Disorder. After being home bound for many years he was provided CBT utilizing his existing case manager as a therapy extender. The specific roles of the primary therapist and case manager as well as the improvement in quality of life of the individual are delineated. This case report opens up the possibility of further studying case managers as therapy extenders for treating serious mental illnesses.

Feasibility and usefulness of training assertive community treatment team in cognitive behavioral therapy.

Individuals with Serious mental illness require psychosocial treatments as adjunct to pharmacotherapy to promote recovery. An ACT team was trained in CBT interventions and charts were reviewed to identify sessions where CBT was utilized. Subjects who received at least 3 sessions of CBT went from 10% before training to 44% after training and 54% in the follow up period. All team members including bachelor's level staff provided CBT interventions. Results show that ACT Team members including those at bachelor's level can be trained in CBT and they utilize these interventions after training is completed.

Correlates of periodic limb movements of sleep in the pediatric population.

Periodic limb movements of sleep are clinically underdiagnosed in children. Polysomnography is the most accurate diagnostic test. There is a paucity of information regarding polysomnography findings in children. We evaluated the prevalence and correlates of pediatric periodic limb movements detected by polysomnography. Periodic limb movements of sleep were identified in 77 of 982 polysomnograms, with a prevalence of 7.8% and male predominance (47 boys; 30 girls). Mean age was 9.4 +/- 4.2 years (1-19 years) (body mass index, 24.1 +/- 12.3). Mean sleep time was 395.4 +/- 73.4 minutes, of which rapid eye movement sleep constituted 16.6% +/- 6.7%, and slow-wave sleep, 22% +/- 10%. Sleep efficiency was 93.8 +/- 9.83, periodic limb movement index, 9.78 +/-7.9; periodic limb movement arousal, 4.5 +/- 8.4; arousal index, 27.8 +/- 12.4; and peak end-tidal CO(2), 48.9 +/- 10.5 mm Hg. Associated diagnoses included obstructive sleep apnea in 36 (46.8%), attention deficit hyperactivity disorder in 10 (13%), migraine in 7 (9.1%), seizures in 7 (9.1%), autism spectrum disorders in 5 (6.5%), and narcolepsy in 7 (9.1%). Serum ferritin was decreased (mean, 26.1 mug/L) in 29 (96.6%). Prospective studies may clarify the significance of incidental pediatric periodic limb movements in sleep detected on polysomnograms.

Multinational comparative cross-sectional survey of views of medical students about acceptable terminology and subgroups in schizophrenia.

AIM: The aim of this study was to inform thinking around the terminology for 'schizophrenia' in different countries. OBJECTIVES: The objective of this study was to investigate: (1) whether medical students view alternative terminology (psychosis subgroups), derived from vulnerability-stress models of schizophrenia, as acceptable and less stigmatising than the term schizophrenia; (2) if there are differences in attitudes to the different terminology across countries with different cultures and (3) whether clinical training has an impact in reducing stigma. DESIGN: This is a cross-sectional survey that examined the attitudes of medical students towards schizophrenia and the alternative subgroups. SETTING: The study was conducted across eight sites: (1) University of Southampton, UK; (2) All India Institute of Medical Science, India; (3) Rowan University, USA; (4) Peshawar Medical College, Pakistan; (5) Capital Medical University, China; (6) College of Medicine and Medical sciences, Bahrain; (7) Queens University, Kingston, Canada and (8) University of Cape Town, South Africa. METHOD: This study extended an initial pilot conducted by the Royal College of Psychiatrists on the term schizophrenia and psychosis subgroups to assess whether the subgroup terminology might have an effect on the attitudes of a convenience sample of medical students from eight different countries and potentially play a role in reducing stigmatisation. RESULTS: 1873 medical students completed a questionnaire recording their attitudes to schizophrenia and the psychosis subgroups. A reduction in negative perceptions were found for the psychosis subgroups, especially for the stress sensitivity psychosis and anxiety psychosis subgroups. Negative perceptions were found for drug-related psychosis. Participants who had undergone clinical training had overall positive attitudes. Differences across different countries were found. CONCLUSION: The attitudes towards psychosis subgroups used in this study have shown mixed results and variation across countries. Further research is warranted to investigate acceptability of terminology. Methods of reducing stigma are discussed in line with the findings. ETHICS: The study received ethical approval from ERGO (Ethics and Research Governance Online; ID: 15972) and subsequently from the ethics committee at each site.

Mental Health Service Provision in Low- and Middle-Income Countries.

This article discusses the provision of mental health services in low- and middle-income countries (LMICs) with a view to understanding the cultural dynamics-how the challenges they pose can be addressed and the opportunities harnessed in specific cultural contexts. The article highlights the need for prioritisation of mental health services by incorporating local population and cultural needs. This can be achieved only through political will and strengthened legislation, improved resource allocation and strategic organisation, integrated packages of care underpinned by professional communication and training, and involvement of patients, informal carers, and the wider community in a therapeutic capacity.

Are Second-Generation Antipsychotics Useful in Tardive Dystonia?

OBJECTIVE: To review the current evidence on the effectiveness of second-generation antipsychotics (SGAs) in the treatment of tardive dystonia (TDt) and give recommendations for treatment. METHODS: Medline/PubMed/Psyclit/Embase database searches were conducted in January 2015, and a manual review of references within the retrieved articles was done. All articles in English and those that had English abstracts and dealt with treatment of TDt were included. RESULTS: Our search and review yielded a total of 88 reports (none of them a controlled trial) involving 145 patients treated with one of the 5 SGAs. Clozapine has the maximum number of published reports (52 reports involving 90 subjects, whereas there were 36 reports involving 55 subjects treated with other SGAs, including olanzapine, risperidone, quetiapine, aripiprazole, and perospirone). CONCLUSIONS: The available evidence points to the effectiveness of clozapine as monotherapy and in combination with clonazepam for the treatment of TDt. When clozapine is not an option, olanzapine and quetiapine are reasonable alternatives. Given the lack of controlled trials, future focus should be on conducting randomized, placebo-controlled, multicenter, collaborative controlled clinical trials of several years' duration.

Efficacy of Transcranial Magnetic Stimulation (TMS) in the Treatment of Schizophrenia: A Review of the Literature to Date.

We reviewed the literature on transcranial magnetic stimulation and its uses and efficacy in schizophrenia. Multiple sources were examined on transcranial magnetic stimulation efficacy in relieving positive and negative symptoms of schizophrenia. Literature review was conducted via Ovid Medline and PubMed databases. We found multiple published studies and metaanalyses that give evidence that repetitive transcranial magnetic stimulation can have benefit in relieving positive and negative symptoms of schizophrenia, particularly auditory hallucinations. These findings should encourage the psychiatric community to expand research into other applications for which transcranial magnetic stimulation may be used to treat patients with psychiatric disability.

MINI International Neuropsychiatric Schedule: clinical utility and patient acceptance.

OBJECTIVE: Clinical diagnosis has been shown to be unreliable compared to structured diagnostic schedules. However, clinicians rarely use structured diagnostic schedules due to concerns about the feasibility in clinical practice and about patient acceptance. Mini International Neuropsychiatric Schedule is a short diagnostic instrument validated against SCID and CIDI but its feasibility and patient acceptance has not been studied. SUBJECTS AND METHODS: One hundred and eleven patients admitted to a partial program were administered Mini International Neuropsychiatric Schedule and the interview was timed. A short questionnaire was administered to assess patients' views about the interview. For a subgroup of patients, diagnoses by both open interviews and Mini International Neuropsychiatric Interview (MINI) were available. These were compared to look for agreement in primary diagnoses and co-morbid conditions. RESULTS: MINI took an average of 16.4 min to administer. Patients' views of MINI were positive. It was considered comprehensive enough to cover all patient symptoms and at the same time not unduly lengthy. Patients were not bothered by the interview format. There was disagreement between MINI primary diagnosis and open diagnosis in 42% cases. In 33% the disagreement was of substantial clinical significance. MINI diagnosed more co-morbid conditions (average 2.05 compared to 0.5 in open interview). CONCLUSIONS: MINI is a short diagnostic interview schedule that can be easily incorporated into routine clinical interviews. It has good acceptance by patients.

Severity and internal consistency of self-reported anxiety in psychotic outpatients.

To assess the severity of self-reported anxiety in psychiatric adult outpatients (> or = 18 yr. old) who were diagnosed with psychotic disorders, the Beck Anxiety Inventory was administered to 55 (50%) women and 55 (50%) men who were diagnosed with paranoid schizophrenia, schizoaffective, or delusional disorders. The internal consistency of the scores was high (coefficient alpha=.92), and the scores were not significantly correlated with sex, being Euro-American, or age. Furthermore, the mean cores of the three diagnostic groups were comparable. Based on the interpretive cut-off score guidelines given in the manual, 24% of the patients were mildly anxious, 22% were moderately anxious, and 18% were severely anxious. The results are discussed as indicating that there is a high prevalence of self-reported anxiety in outpatients who are diagnosed with psychotic disorders.

Cognitive-behavioral therapy as an adjunct to second-generation antipsychotics in the treatment of schizophrenia.

OBJECTIVE: This study determined whether adding cognitive-behavioral therapy to treatment for outpatients with schizophrenia would be more effective than the use of second-generation antipsychotics alone. Thirty-three patients were randomly assigned to receive either second-generation antipsychotics alone (N=18) or second-generation antipsychotics plus cognitive-behavioral therapy (N=15). METHODS: All patients received pharmacotherapy from a single provider and in a predetermined standard manner. Psychopathology ratings were done at baseline, at the end of treatment (12 weeks) and three months after completion of treatment (24 weeks). RESULTS: Twenty-five (76%) patients completed baseline and 12-week evaluations, and 17 (68%) patients who finished treatment also completed evaluations at 24 weeks. At the end of treatment persons in the second-generation antipsychotics plus cognitive-behavioral therapy group were rated as having less severe delusions than patients in the group receiving second-generation antipsychotics only, and this difference was maintained three months after treatment ended. CONCLUSIONS: Adding cognitive-behavioral therapy may help with reducing the severity of delusions among patients with schizophrenia.

Quetiapine in the successful treatment of psychosis and comorbid brittle diabetes mellitus: a case report.

BACKGROUND: As evidence of a biologic determinant of schizophrenia has been elaborated, an interest in the relationship between schizophrenia and autoimmune disorders has become increasingly more developed over the last decade. Pedigree analysis has shown that schizophrenia, like autoimmune disorders, is likely a heritable phenomenon, and a genetic liability in this disorder is hardly disputed. Research has indicated that physiologic connections between IFN-gamma and TNF-alpha are suggestive of a connection between the symptoms associated with schizophrenia and those of hypoglycemic events in IDDM. Autoimmune pathogeneses of schizophrenia have been hypothesized; however, the clinical delineation of a potentially corresponding subset of patients is rarely addressed. CASE REPORT: We treated a 22-year-old white female who carried the concomitant diagnoses of Schizophrenia, IDDM, and Hypothyroidism with quetiapine and risperidone on an acute basis at our inpatient facility, and observed an apparent resolution of her brittle diabetes with the successful treatment of her psychotic disorder. CONCLUSIONS: The well documented link between antipsychotic agents and changes in blood glucose may be of benefit in a subset of patients who suffer from both psychotic and diabetic disorders.