Optimizing managed care peer reviews: turning a "Doc to Doc" talk into better advocacy for psychiatric inpatients.

Clinicians often resent behavioral health managed care peer reviews. However, such reviews need not be onerous. This Open Forum, written by managed care physician reviewers, attempts to help attending psychiatrists, specifically those on inpatient units, achieve more satisfying outcomes for patients by adhering to a few basic principles. Beyond the level-of-care guidelines, attending psychiatrists are advised to focus on immediate acuity, along with specific life events that may have immediate impact on the patient's well-being. A clear diagnosis, relevant treatment plan, salient updates, and strategies for preventing readmission can justify additional treatment time. By contrast, "time-based treatments," dispositional issues, or a patient's lack of acceptance or effective use of treatment are harder to justify.

Introducing residents to geroneuropsychology in one day: an enriched curriculum.

We used the technology and principles of adult learning to enhance a one-day geroneuropsychology rotation for internal medicine residents in a busy neuropsychology clinic. We created a multimedia Microsoft PowerPoint presentation highlighting the role of neuropsychology in the medical care of older adults. We added an active learning experience in which the resident administered a screening tool. Finally, we incorporated a video-recording of the resident's administration in the feedback session. We evaluated the effectiveness of these innovations by assessing change in performance on an objective test administered at the beginning and end of the rotation day and by analyzing residents' ratings of the rotation. Objective testing showed significant learning regardless of level of curriculum enrichment. However, residents' ratings generally rose as we added enhancements. These results suggest that health care professionals without technical training can devise effective setting-specific, computer-delivered educational programs. These techniques show promise for boosting learning in clinical settings without lengthening the rotation or increasing direct supervisor contact.

Aspects of social and emotional competence in adult attention-deficit/hyperactivity disorder.

Social and emotional competence were evaluated using self-report and behavioral measures in adults with attention-deficit/hyperactivity disorder (ADHD) and controls. Adults with ADHD viewed themselves as less socially competent but more sensitive toward violations of social norms than controls. Films depicting emotional interactions were used to assess linguistic properties of free recall and perceived emotional intensity. Although adults with ADHD used more words to describe the scenes, they used fewer emotion-related words, despite rating the emotions depicted as more intense than did controls. In contrast, no group differences for words depicting social or cognitive processes were observed. Overall, adults with ADHD appear more aware of their problems in social versus emotional skills. Findings may have implications for improving the psychosocial functioning of these adults.

Experienced emotion and affect recognition in adult attention-deficit hyperactivity disorder.

Emotional competence and deficits that may disrupt interpersonal interactions were evaluated in 28 adults with attention-deficit hyperactivity disorder (ADHD) and 28 demographically equivalent controls. Participants completed tasks assessing affect recognition and experienced emotional intensity. Adults with ADHD performed worse in affect recognition than did adults without the disorder; however, the impairment was unrelated to gross perceptual processes, fundamental abilities in facial recognition, or attentional aspects of affect perception. Moreover, intensity of experienced emotion moderated affect recognition: Among controls, experienced emotion facilitated affect recognition. Among adults with ADHD, who reported significantly greater intensity, experienced emotion was inversely related to affect recognition. Results are consistent with theories of ADHD as a deficit in behavioral inhibition; yet, results may merely reflect a constellation of deficits associated with the disorder.