Electroconvulsive therapy use in the adult U.S. correctional setting: A case report and literature review.

Mr. C is a 45-year-old male inmate who was found in his cell unresponsive and mute. He had poor food and fluid intake for the last four days and was later found standing in place, frozen, and resistant to movement when encouraged by a corrections officer to rest in his bed. His symptoms were consistent with catatonia, a severe motor syndrome that can be life-threatening. The patient had a psychiatric history of bipolar I disorder with multiple past episodes of catatonia. Lorazepam was ineffective at reversing his catatonic symptoms, and his serum creatinine kinase level eventually began to rise, suggestive of muscle breakdown and worsening severity. The treating psychiatrist wanted access to electroconvulsive therapy (ECT) to treat Mr. C's catatonia but encountered numerous legal and logistical barriers which made this treatment option unavailable. The article reviews the scant literature on ECT use in the adult U.S. correctional system, identifies barriers, and discusses a recommended ECT referral process for inmates.

Improving Mental Health Training for Primary Care Residents: A Resident-Led Educational Intervention.

OBJECTIVE: Psychiatric training in family medicine residency programs is necessary but not always sufficient. A brief educational intervention was designed to help improve family medicine residents' knowledge, comfort, and attitudes in delivering mental health care. METHODS: A 6-hour didactic curriculum was taught by 2 psychiatry residents to family medicine residents between February and April 2015. Preintervention and postintervention surveys assessed participant demographics, knowledge, comfort levels, and attitudes regarding treating patients with psychiatric illness. Descriptive statistics were used to summarize results. Relationships between the sessions attended and preintervention and postintervention knowledge, comfort, and attitudes were investigated. RESULTS: Of 24 eligible residents, 15 completed each of the surveys preintervention and postintervention. Psychiatric knowledge scores were similar in the preintervention (mean score = 70%, SD = 15%) and postintervention (mean score = 69%, SD = 16%) groups. A significant positive correlation emerged between the number of didactic sessions attended and postintervention comfort levels (Spearman rank correlation coefficient: ρ = 0.61, P = .02). The number of sessions attended was also positively associated with postintervention knowledge scores, although this did not reach statistical significance (ρ = 0.40, P = .16). No relationship emerged between the number of sessions attended and participant attitudes (F2,12 = 1.88, P = .19). CONCLUSIONS: A brief, resident-led educational intervention positively impacted family medicine residents' comfort in managing patients with psychiatric comorbidities. Further research is needed to establish the sustainability of gains and the impact of such educational interventions on patient care outcomes.

Time to sign: The relationship between health literacy and signature time.

OBJECTIVE: To evaluate the relationship between amount of time taken to sign one's name and health literacy. METHODS: A prospective, one time assessment was conducted on a convenience sample of 98 patients recruited in an inner-city outpatient internal medicine clinic. The amount of time required to sign (i.e. initiation to completion of writing) was measured by stopwatch. Health literacy was measured with the REALM. RESULTS: The sample averaged 54.1 (SD 16.2) years of age. Twenty-seven percent had less than high school education and 33% had a terminal general equivalency diploma or high school degree. The time required to sign ranged from 0.91 to 21.3s. Sixty-two percent of the sample had health literacy challenges. Signature time was longest for those with inadequate health literacy (mean 10.0 s), compared with marginal (7.3s) and adequate (4.7s, p ≤ 0.001). Signature time remained significant in a logistic regression model after controlling for education and age (AOR = 0.785, CI = 0.661-0.932). CONCLUSION: Individuals with signatures completed in six seconds or less were highly likely to display adequate health literacy. PRACTICE IMPLICATIONS: Signature time may offer a practical and quick approach to health literacy screening in the health care setting.