A survey of national trends in psychiatric patients found incompetent to stand trial: reasons for the reinstitutionalization of people with serious mental illness in the United States.

OBJECTIVE: Recent information indicates that the number of forensic patients in state hospitals has been increasing, largely driven by an increase in patients referred to state hospitals as incompetent to stand trial (IST). This survey was intended to broaden the understanding of IST population trends on a national level. METHODS: The authors developed a 30-question survey to gather specific information on IST commitments in each state and the District of Columbia. The survey was administered to all 50 states and the District of Columbia via email. Specific individuals identified as primary administrators responsible for the care and evaluation of IST admissions in each state were contacted. RESULTS: A total of 50 out of the 51 jurisdictions contacted completed the survey. Fully 82% of states indicated that referrals for competency evaluation were increasing. Additionally, 78% of respondents thought referrals for competency restoration were increasing. When asked to rank factors that led to an increase, the highest ranked response was inadequate general mental health services in the community. Inadequate crisis services were the second ranked reason. Inadequate number of inpatient psychiatric beds in the community was the third highest, with inadequate assertive community treatment services ranking fourth. CONCLUSIONS: Understanding the national trend and causes behind the recent surge in referrals for IST admissions will benefit states searching for ways to remedy this crisis. Our survey indicates most states are facing this issue, and that it is largely related to insufficient services in the community.

Alpha power and coherence primarily reflect neural activity related to stages of motor response during a continuous monitoring task.

Previously, EEG theta (4-6 Hz) was related to goal conflict resolution [Moore, R.A., Gale, A., Morris, P.H., Forrester, D., 2006. Theta phase locking across the neocortex reflects cortico-hippocampal recursive communication during goal conflict resolution. Int. J. Psychophysiol. 60, 260-273] in the context of theory linked with animal hippocampal theta [Gray, J.A., McNaughton, N., 2000. The Neuropsychology of Anxiety: An Enquiry into the Functions of the Septo-Hippocampal system, 2nd ed, Oxford University Press, Oxford]. Here, the hypothesis that human EEG alpha (8-12 Hz) may also be a natural analogue to animal hippocampal theta is tested. Participants engaged in a monitoring task where the object was to press a response key immediately after presentation of 4 individual, non-repeating, single integer odd digits. These were presented amongst a continuous stream of single integer digits and Xs. EEG recorded in the earlier study were reanalysed; this time extracting alpha power and coherence from the same 34 participants. Alpha had a different profile to theta and was not primarily related to goal conflict. Low alpha (8-10 Hz) coherence consistently increased at electrodes close to primary sensorimotor cortex; particularly during response execution and response inhibition. The coherence analysis revealed that high alpha (10-12 Hz) related to response execution. Supplementary analyses demonstrated widespread high alpha coherence increase during response execution, inhibition and preparation. These data were discussed within the context of motor driven 'classic alpha' and Rolandic mu. A coherence profile which differentiated response execution and response inhibition was proposed to reflect a working memory network which was activated during response execution. Also, alpha power (8-12 Hz) reduced at several central electrodes during response execution. This reflected classic Rolandic mu response. Participants displaying a predicted low alpha power trend had the fastest response times; this was linked with traditional views of low alpha's functional significance.

Theta phase locking across the neocortex reflects cortico-hippocampal recursive communication during goal conflict resolution.

EEG theta coherence, EEG theta power and subjective levels of response were examined in a continuous monitoring target detection task where periodic goal conflicts were introduced as 34 participants progressed through a stimulus sequence leading to response. EEG theta coherence revealed increases in phase locking between cortical areas at specific task stages involving goal conflict. Theta power also increased at points of goal conflict. The temporal characteristics of subjective response (measured continuously throughout the task) indicated a delay between participants actually experiencing goal conflict and overt indications of conflict. The starting point for the study was based on a specific aspect of Gray and McNaughton's [Gray, J.A., McNaughton, N., 2000. The Neuropsychology of Anxiety: An Enquiry into the Functions of the Septo-Hippocampal System, 2nd ed. Oxford University Press, Oxford] behavioural inhibition system model-namely, septo-hippocampal system involvement in the resolution of goal conflicts. We drew on Gray and McNaughton's [Gray, J.A., McNaughton, N., 2000. The Neuropsychology of Anxiety: An Enquiry into the Functions of the Septo-Hippocampal system, 2nd ed. Oxford University Press, Oxford] suggestion that septo-hippocampal involvement in this process is reflected by EEG theta. While their theory explains many of our findings, we also drew upon Given's [Givens, B., 1996. Stimulus-evoked reseting of the dentate theta rhythm: relation to working memory. Neuroreport 8 (1), 159-163] proposal that the dentate theta rhythm is reset by behaviourally relevant stimuli. We made further proposals based on Makeig et al.'s [Makeig, S., Westerfield, M., Jung, T.-P., Enghoff, S., Townsend, J., Courchesne, E., Sejnowski, T.J., 2002. Dynamic brain sources of visual evoked responses. Science 295, 690-694] view that specific stimulus events invoke concurrent phase resetting and transient frequency domain coherence across different areas of neocortex. Relations with Go/NoGo event related potentials (P300 and N2; e.g., [Bokura, H., Yamaguchi, S., Kobayashi, S., 2001. Electrophysiological correlates of response inhibition in a Go/NoGo task. Clin. Neurophysiol. 112 (12), 2224-2232]) were also discussed, as well as parallels between our data and interpretation, and other theoretical models of theta (e.g., [Kahana, M.J., Selig, D., Madsen, J.R., 2001. Theta returns. Curr. Opin. Neurobiol. 11, 739-744]). Suggestions for further research were made.

A systematic investigation of same and cross modality priming using written and spoken responses.

Effects of presentation modality and response format were investigated using visual and auditory versions of the word stem completion task. Study presentation conditions (visual, auditory, non-studied) were manipulated within participants, while test conditions (visual/written, visual/spoken, auditory/written, auditory/spoken, recall-only) were manipulated between participants. Results showed evidence for same modality and cross modality priming on all four word stem completion tasks. Words from the visual study list led to comparable levels of priming across all test conditions. In contrast, words from the auditory study list led to relatively low levels of priming in the visual/written test condition and high levels of priming in the auditory/spoken test condition. Response format was found to influence priming performance following auditory study in particular. The findings confirm and extend previous research and suggest that, for implicit memory studies that require auditory presentation, it may be especially beneficial to use spoken rather than written responses.