Using the objective structured clinical examination in a psychiatry residency.

Evaluation of psychiatric residents' clinical skills and knowledge is important to assure faculty that residents are achieving competence. Because psychiatric residents perform many activities without direct observation, it is necessary to construct techniques that allow careful objective evaluation of their performance. This article describes how one residency program developed an Objective Structured Clinical Examination (OSCE) to assess the clinical skills of its PGY-2 and PGY-4 psychiatric residents.

Self-injurious behavior in the developmentally disabled: assessment techniques.

Self-injurious behavior (SIB) is a major cause of difficulty for the developmentally disabled person. Causes are varied, but medical, neurological, and psychiatric disorders should be considered before nonspecific approaches to treatment are chosen. A careful assessment should include a thorough medical and psychiatric evaluation as well as laboratory and diagnostic studies. Various assessment instruments are available to aid in the evaluation process and, to some extent, in the evaluation of the effectiveness of treatment for SIB.

Self-injurious behavior in the developmentally disabled: pharmacologic treatment.

The current status of pharmacological treatments of self-injurious behavior (SIB) and aggression in persons with mental retardation and autism was reviewed in the literature. Much of the existing literature is derived from anecdotal clinical experience, with a relative lack of well-controlled studies to determine the efficacy of different treatments. Although all psychotropics have been used to manage SIB and aggression, particularly promising are the data on the use of opioid antagonists like naltrexone. Beta-blockers may also have some role, but more controlled, systematic studies are needed. Use of neuroleptics is on the decline because of their adverse effects, such as tardive dyskinesia and possible impairment of cognitive functions. We assert that the behavioral problems of SIB and aggression are at times manifestations of different psychiatric syndromes. They present in a modified, atypical form in the developmentally disabled population because of cognitive limitations. Further understanding and classification of the psychopathology associated with this behavior is essential for its successful treatment.

The challenge of providing quality psychiatric services in a rural setting.

The development of a system of services that addresses the medical, psychiatric, and social needs of mentally ill persons may be particularly difficult in rural health areas because of environmental, sociocultural, and program issues different from those in urban settings. The quality of rural mental health care must be evaluated in light of these unique needs and resources. This article identifies and discusses problems in delivery of services, including environment, denial, confidentiality, costs, and human resources, and outlines responses to these problems seen as challenges rather than as barriers.