Psychiatry chief resident opinions toward basic and clinical neuroscience training and practice.

OBJECTIVE: The authors queried attendees to a chief resident conference on whether program education and training in neuroscience or in translating neuroscience research into practice is sufficient and what changes are needed. METHODS: The authors developed and administered a 26-item voluntary questionnaire to each attendee at the Chief Residents' Leadership Conference at the American Psychiatric Association 2013 annual meeting in San Francisco, CA. RESULTS: Out of 94 attendees, 55 completed and returned questionnaires (58.5%). A majority of respondents stated that their program provided adequate training in neuroscience (61.8%); opportunities for neuroscience research existed for them (78.2%), but that their program did not prepare them for translating future neuroscience research findings into clinical practice (78.9%) or educate them on the NIMH Research Domain Criteria (83.3%). A majority of respondents stated that the ACGME should require a specific neuroscience curriculum (79.6%). CONCLUSION: Chief residents believe that curricular and cultural change is needed in psychiatry residency neuroscience education.

Increasing Abnormal Involuntary Movement Scale (AIMS) Screening for Tardive Dyskinesia in an Outpatient Psychiatry Clinic: A Resident-Led Outpatient Lean Six Sigma Initiative.

Objective To increase compliance with Abnormal Involuntary Movement Score (AIMS) documentation for patients taking antipsychotics to recognize and treat tardive dyskinesia in the psychiatry outpatient clinic. Methods The Lean Six Sigma quality improvement (QI) model, utilizing DMAIC steps of define, measure, analyze, improve, control, was followed. Psychiatry attendings and residents were surveyed to assess reasons for AIMS non-documentation, and they ranked their preferred solutions to increase compliance. A random sample of patient charts for individuals on antipsychotic medications was obtained to determine AIMS documentation compliance prior to and following the implementation of improvements. Results The most highly ranked solution was implementing a one-hour AIMS training session. Three months post-intervention, a random sample of 60 patient charts showed that 87% (52/60) of patients had AIMS documented which was a significant increase compared to 3% (1/30) pre-intervention (p<0.001). Conclusion An annual, one-hour AIMS training session for residents improved rates of AIMS documentation.

Acute Blood Pressure Changes Associated With Antipsychotic Administration to Psychiatric Inpatients.

OBJECTIVE: To investigate blood pressure (BP) changes within the first 3 days after initiating antipsychotic medication in psychiatric inpatients. METHODS: Through retrospective chart review using a repeated measures design, vital signs data were collected on 60 adult psychiatric inpatients who were psychiatrically hospitalized May 26, 2011, through September 4, 2012, at 9 time points within 3 days of initiation of 1 of 6 different antipsychotic medications. The random sample included patients with the following DSM-IV-TR diagnoses: schizophrenia (n = 25), schizoaffective disorder (either type; n = 19), and bipolar I disorder (n = 16). Data were analyzed using mixed-effects repeated measures analysis of variance to evaluate associations between the antipsychotic initiated and subsequent changes in BP. The main outcome variable was change in BP from baseline, and independent variables included age, sex, psychiatric diagnosis, and type of antipsychotic medication. Logistic regression was used to assess the relationship between each type of antipsychotic and hypotension (BP < 90/60 mm Hg) and hypertension (BP ≥ 140/90 mm Hg). RESULTS: Olanzapine (P < .01) and risperidone (P = .01) raised systolic BP to a statistically significant degree during the first 3 days after initiation. Clozapine, on the other hand, significantly reduced systolic BP (P = .02) and was associated with hypotension on linear regression. No statistically significant associations were found between the other antipsychotics and acute systolic BP changes or between any of the 6 antipsychotics and diastolic BP changes. CONCLUSIONS: Initiation of certain antipsychotic medications may be associated with statistically significant acute BP changes. These findings require further evaluation in well-designed prospective studies.

Schizoaffective disorder with missed diagnosis of acute porphyria: a case report and overview.

Acute porphyrias are often misdiagnosed and most commonly present as atypical neuropsychiatric symptoms or acute abdominal pain. Clinicians should suspect acute porphyrias in patients presenting with variable neuropsychiatric symptoms and unexplained pain. Proper identification can lead to less iatrogenicity associated with porphyrinogenic agents, appropriate management, and a better patient outcome. The case of a patient with hereditary coproporphyria, one of the acute porphyrias, is presented to illustrate the broad manifestations, unsuspected diagnosis, and difficulties in management.

A preliminary report on resident emergency psychiatry training from a survey of psychiatry chief residents.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) requirements stipulate that psychiatry residents need to be educated in the area of emergency psychiatry. Existing research investigating the current state of this training is limited, and no research to date has assessed whether the ACGME Residency Review Committee requirements for psychiatry residency training are followed by psychiatry residency training programs. METHODS: We administered, to chief resident attendees of a national leadership conference, a 24-item paper survey on the types and amount of emergency psychiatry training provided by their psychiatric residency training programs. Descriptive statistics were used in the analysis. RESULTS: Of 154 surveys distributed, 111 were returned (72% response rate). Nearly one-third of chief resident respondents indicated that more than 50% of their program's emergency psychiatry training was provided during on-call periods. A minority indicated that they were aware of the ACGME program requirements for emergency psychiatry training. While training in emergency psychiatry occurred in many programs through rotations-different from the on-call period-direct supervision was available during on-call training only about one-third of the time. CONCLUSIONS: The findings suggest that about one-third of psychiatry residency training programs do not adhere to the ACGME standards for emergency psychiatry training. Enhanced knowledge of the ACGME requirements may enhance psychiatry residents' understanding on how their programs are fulfilling the need for more emergency psychiatry training. Alternative settings to the on-call period for emergency psychiatry training are more likely to provide for direct supervision.

Postgraduate year-1 residency training in emergency psychiatry: an acute care psychiatric clinic at a community mental health center.

OBJECTIVE: The purpose of this study was to determine resident satisfaction with an acute care psychiatric clinic designed in collaboration with a nearby community mental health center. We also sought to demonstrate that this rotation helps meet program requirements for emergency psychiatry training, provides direct assessments of resident interviewing skills and clinical knowledge in the postgraduate year-1, and provides exposure to public sector systems of care. METHODS: We developed a resident satisfaction questionnaire and fielded it to each of the residents who participated in the clinic over the first 3 years. Data were collected, organized, and analyzed. RESULTS: Of the 15 residents in the acute care psychiatric clinic, 12 completed and returned the satisfaction questionnaires. Educational aspects of the clinic experience were rated favorably. CONCLUSIONS: This postgraduate year-1 acute care psychiatric clinic provides a mechanism for the fulfillment of emergency psychiatry training as well as direct supervision of clinical encounters, which is a satisfactory and useful educational experience for trainees.

Residency programs and psychotherapy competencies: a survey of chief residents.

OBJECTIVE: To survey chief residents' opinion about various aspects of psychotherapy competency determination. METHODS: Chief residents of various psychiatry residency programs were surveyed. RESULTS: One hundred two chief residents were surveyed. Seventy two (70.58%) completed the survey. Eighty four percent of the respondents reported that they were aware of the competencies. The number of patients required for competency determination in five areas of psychotherapy varied widely among the programs. Global assessment by psychotherapy supervisors was the most commonly used method of competency determination (61%). Nineteen (26%) chief residents opined that not all the faculty members involved in teaching and assessing competencies are qualified to do so. Only 23 (31%) of respondents reported that competency criteria were well integrated into the residency curriculum. CONCLUSION: The little consistency in psychotherapy competency determination across various programs, the differential preparedness of programs for competencies and the lack of consistent integration of competencies into residency curricula call for development and implementation of more uniform assessment methods. This variability also calls into question the decision to establish a standard in five areas of psychotherapy competency.