Communication and Handoff Errors Within Treatment-Resistant Bipolar I Disorder.

Bipolar I disorder includes periods of acute mania, e.g., symptoms of risk-taking behavior and impulsivity, which may result in interpersonal conflict with long-term implications. Bipolar I disorder management may be complicated by disruptions in care, both by patients and healthcare systems. We present a case of a 69-year-old male who was involuntarily committed by his wife due to inappropriate sexual behavior and delusions secondary to mania. In the emergency department, the patient appeared agitated, guarded, and with impaired cognition. His medical history included cardiac comorbidities, requiring multidisciplinary involvement. We describe how our patient's decompensation was contributed by a combination of noncompliance, lack of provider communication, and handoff errors. Our patient met the diagnostic criteria for treatment-resistant bipolar I disorder with mania, generalized anxiety disorder, and severe tobacco use disorder. His treatment with neuroleptics was complicated by cardiac comorbidities, indications for pacemakers, and his lack of understanding regarding the need for treatment. Our case describes a uniquely complicated admission course in part by our patient's at-risk demographics and healthcare system shortcomings that may be more common in resource-limited facilities. We aim to integrate communication strategies for patients experiencing delusional symptoms, alongside individual and institutional strategies to mitigate systematic errors.

Measurement-based care training curriculum in psychiatry residency programs: I: Description of the curriculum and demonstration of implementation.

BACKGROUND: Recent literature shows that most practicing psychiatrists do not receive training in measurement-based care (MBC). Among the primary barriers to MBC implementation are the lack of formal training and curriculums. We present the first comprehensive MBC curriculum for use in adult psychiatric practice, and describe how the curriculum is adapted and implemented in psychiatry residency training programs. METHODS: The Standard for Clinicians' Interview in Psychiatry (SCIP) was developed as a measurement-based care tool for clinicians' use. The SCIP is the only instrument that includes 18 reliable and validated clinician-rated scales covering most adult psychiatric disorders. The SCIP has simple, unified rules of measurement that apply to the 18 scales. The MBC curriculum includes 2 instruction manuals, 4 didactic lectures, and 12 videotaped interviews. We describe the annual learning and implementation of MBC curriculum in residency programs. RESULTS: The curriculum implementation at West Virginia University and Delaware Psychiatric Center began in 2019 and is ongoing. We present 3 case demonstrations of the implementation of MBC in clinical settings. CONCLUSIONS: Comprehensive implementation of MBC curriculum in residency programs has the potential to facilitate research and create a "culture" of MBC in future generations of psychiatrists.

Measurement-based Care in Psychiatry-Past, Present, and Future.

The authors define measurement-based care (MBC) in psychiatry as the use of validated clinical measurement instruments to objectify the assessment, treatment, and clinical outcomes, including efficacy, safety, tolerability, functioning, and quality of life, in patients with psychiatric disorders. MBC includes two processes: routine assessments, such as measuring the severity of symptoms with rating scales, and the use of assessments in decision-making. MBC implementation was tested in the Texas Medication Algorithm Project and the German Algorithm Project and has been shown to improve patient outcomes. Even though more recent research has shown the many benefits of MBC compared to the usual care, MBC is still not the standard of care in psychiatric practice. This review article addresses the advantages of MBC, the barriers to implementing MBC in clinical practice, and the basic properties of MBC instruments. Recent developments in the 21st century that are expected to accelerate the adoption of MBC in clinical practice, including electronic health records, health information technology, and the development of the Standard for Clinicians' lnterview in Psychiatry (SCIP) as an MBC tool, will be reviewed. The authors recommend including MBC in psychiatry residency training to promote its use in future generations.