Abnormal early brain responses during visual search are evident in schizophrenia but not bipolar affective disorder.

People with schizophrenia show deficits in processing visual stimuli but neural abnormalities underlying the deficits are unclear and it is unknown whether such functional brain abnormalities are present in other severe mental disorders or in individuals who carry genetic liability for schizophrenia. To better characterize brain responses underlying visual search deficits and test their specificity to schizophrenia we gathered behavioral and electrophysiological responses during visual search (i.e., Span of Apprehension [SOA] task) from 38 people with schizophrenia, 31 people with bipolar disorder, 58 biological relatives of people with schizophrenia, 37 biological relatives of people with bipolar disorder, and 65 non-psychiatric control participants. Through subtracting neural responses associated with purely sensory aspects of the stimuli we found that people with schizophrenia exhibited reduced early posterior task-related neural responses (i.e., Span Endogenous Negativity [SEN]) while other groups showed normative responses. People with schizophrenia exhibited longer reaction times than controls during visual search but nearly identical accuracy. Those individuals with schizophrenia who had larger SENs performed more efficiently (i.e., shorter reaction times) on the SOA task suggesting that modulation of early visual cortical responses facilitated their visual search. People with schizophrenia also exhibited a diminished P300 response compared to other groups. Unaffected first-degree relatives of people with bipolar disorder and schizophrenia showed an amplified N1 response over posterior brain regions in comparison to other groups. Diminished early posterior brain responses are associated with impaired visual search in schizophrenia and appear to be specifically associated with the neuropathology of schizophrenia.

Inpatient utilization before and after implementation of psychosocial rehabilitation programs: analysis of cost reductions.

Research on psychosocial rehabilitation (PSR) interventions generally indicates that these approaches are effective in facilitating improved functioning for persons with serious mental illness (SMI; schizophrenia, schizoaffective disorder, bipolar disorder, and other psychotic disorders). In this quasi-experimental study, we assessed the effectiveness of PSR interventions through a records review of 311 veterans who received outpatient services for SMI. From 2002 to 2008, a midwestern VA Medical Center implemented a number of PSR interventions. By 2008, veterans who used PSR interventions demonstrated reductions in their use of inpatient psychiatric care, whereas veterans who did not access PSR interventions showed no change in inpatient psychiatric care use. Analyses revealed that the provision of PSR services to veterans with SMI who had been hospitalized was associated with decreased duration of hospitalizations and costs savings of $17,739 per veteran per year in total mental health care. Findings are consistent with implementation of PSR programs within VA Medical Centers yielding the greatest cost savings through creation of effective outpatient services that reduce inpatient service needs for veterans with SMI.