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.

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.