Agenesis of the Corpus Callosum in a Patient With Schizophrenia.

The aim of this study is to report the case of a 25-year-old male with a history of schizophrenia who presented involuntarily to the psychiatric emergency department (ED) due to worsening agitation, paranoia, and disorganized behavior concerning a psychotic episode. During medical clearance to rule out acute organic causes of altered mental status prior to admission, the patient was found to have agenesis of the corpus callosum (ACC) on CT of the brain. ACC is a rare congenital disorder characterized by the partial or complete absence of the commissural pathway that connects the two cerebral hemispheres. This case presents a thought-provoking incidental anatomical finding in a patient with an acute exacerbation of chronic schizophrenia and allows for further discussion about the prevalence of undiagnosed malformations and possible underlying genetic contributions in patients with chronic mental illness.

Mobilization of Telepsychiatry in Response to COVID-19-Moving Toward 21st Century Access to Care.

The COVID-19 pandemic threatens to disrupt the provision of mental health services. In response, policymakers, administrators, and providers have taken bold steps toward enabling telepsychiatry to bridge this sudden gap in care for our most vulnerable populations. With rapid deregulation and adoption of this modality of care, careful consideration of issues related to policy and implementation is essential to maximize its effectiveness and mitigate unintended consequences. Though the crisis places the healthcare system under strain, it sets the stage for a lasting shift in not only how care is delivered, but also our beliefs around the system's capacity for rapid, innovative change.

Efforts to reduce seclusion and restraint use in a state psychiatric hospital: a ten-year perspective.

OBJECTIVE: The authors previously demonstrated an 82.3% reduction in seclusion and restraint use at an inpatient psychiatric facility, largely attributable to changes to the physical environment. This study investigated whether the reduction was sustained over time. METHODS: This follow-up study examined archival data by using a longer preintervention baseline phase and examined the sustainability of intervention gains in the absence of a research agenda. Over ten years, 3,040 seclusion and restraint incidents were analyzed across 254,491 patient-days. RESULTS: The extended baseline phase (N=38 months) exhibited a linear trend upward in seclusion and restraint use, and the formal intervention period and subsequent follow-up periods (N=82 months) showed a stabilization effect (p<.001). CONCLUSIONS: The findings suggest that reduction in seclusion and restraint use is sustainable, and judicious use of seclusion and restraint can become the new normative practice-even in the face of potentially disruptive administrative and environmental changes.

Excess health care service utilization and costs associated with underrecognition of psychiatric comorbidity in a medical/surgical inpatient setting.

Psychiatric comorbidity is common among chronically medically ill populations and the presence of psychiatric conditions tends to be associated with increased costs and excess utilization of general medical services. The purpose of this pilot investigation was to determine whether differences in nonpsychiatric inpatient hospitalization frequency, duration, and costs existed between patients receiving outpatient psychiatric treatment and patients without identified psychiatric problems. Length of stay and cost information for patients that had at least 1 inpatient medical/surgical hospitalization during a 6-month period was extracted from the hospital's inpatient billing database (n = 10,865). The medical record numbers of these patients were then cross-referenced against the outpatient psychiatry-billing database for the same 6-month period, thereby identifying all patients that had both a nonpsychiatric inpatient hospitalization and an outpatient psychiatry visit (n = 149). Patients identified as having outpatient psychiatry involvement had significantly more nonpsychiatric hospitalizations on average (mean = 1.60) than nonpsychiatric patients (mean = 1.34) during the study period (t4381 = 2.94, P = .003). There was no difference in the total costs associated with these hospitalizations between the 2 groups. Those that had a psychiatry consult during the nonpsychiatric hospitalization had a significantly higher length of stay and costs than those without. Thus, the criteria used to determine whether or not a psychiatry consultation is triggered, and the timing of the consultation request need further study.

Routine assessment of patient-reported outcomes in behavioral health: room for improvement.

Outcomes assessment has become an important tool in assessing the quality of health care. To date, most quality initiatives have focused on adverse events, clinical processes, and/or cost variables. Considerably less attention has been paid to indices of clinical improvement, especially from a patient's perspective and in behavioral health settings. The relative inattention given to clinical improvement is attributable to a number of reasons, including (but not limited to) a lack of consensus regarding measures of improvement, few simple methods for data collection and analysis, and an inability to provide timely feedback. In this article, the authors describe a Web-based system designed to routinely collect quality-of-life ratings from patients in outpatient behavioral health clinics, allowing for real-time feedback at the patient levels regarding clinical improvement. The system also allows for administrative evaluation of overall clinic performance. The costs and benefits of this system are discussed.

Project among African-Americans to explore risks for schizophrenia (PAARTNERS): recruitment and assessment methods.

The Project among African-Americans to Explore Risks for Schizophrenia (PAARTNERS) is a multi-site, NIMH-funded study that seeks to identify genetic polymorphisms that confer susceptibility to schizophrenia among African-Americans by linkage mapping and targeted association analyses. Because deficits in certain dimensions of cognitive ability are thought to underlie liability to schizophrenia, the project also examines cognitive abilities in individuals affected by schizophrenia and their extended family members. This article describes PAARTNERS study design, ascertainment methods and preliminary sample characteristics. We aim to recruit a sample of 1260 African-American families, all of whom have at least one proband with schizophrenia or schizoaffective disorder. The data collection protocol includes a structured Diagnostic Interview for Genetic Studies, Family Interview for Genetic Studies, focused neurocognitive assessment, medical records review, and the collection of blood or buccal cells for genetic analyses. We have currently completed study procedures for 106 affected sib-pair, 457 case-parent trio and 23 multiplex families. A total of 289 probands have completed the best estimate final diagnosis process and 1153 probands and family members have been administered the computerized neuropsychological battery. This project lays the foundation for future analysis of cognitive and behavioral endophenotypes. This novel integration of diagnostic, neurocognitive and genetic data will also generate valuable information for future phenotypic and genetic studies of schizophrenia.