Faculty Bibliography

OBJECTIVES: In certain clinical contexts, the sensitivity of the Mini-Mental State Examination (MMSE) is limited. The authors developed a new cognitive screening instrument, the Brief Cognitive Screen (BCS), with the aim of improving diagnostic accuracy for cognitive dysfunction in the psychiatric emergency department (ED) in a quick and convenient format. METHODS: The BCS, consisting of the Oral Trail Making Test (OTMT), animal fluency, the Clock Drawing Test (CDT), and the MMSE, was administered to 32 patients presenting with emergent psychiatric conditions. Comprehensive neuropsychological evaluation served as the criterion standard for determining cognitive dysfunction. Diagnostic accuracy of the MMSE was determined using the traditional clinical cutoff and receiver operating characteristic (ROC) curve analyses. Diagnostic accuracy of individual BCS components and BCS Summary Scores was determined by ROC analyses. RESULTS: At the traditional clinical cutoff, MMSE sensitivity (46.4%) and total diagnostic accuracy (53.1%) were inadequate. Under ROC analyses, the diagnostic accuracy of the full BCS Summary Score (area under the curve [AUC]=0.857) was comparable to the MMSE (AUC=0.828). However, a reduced BCS Summary Score consisting of OTMT Part B (OTMT-B), animal fluency, and the CDT yielded classification accuracy (AUC=0.946) that was superior to the MMSE. CONCLUSIONS: Preliminary findings suggest the BCS is an effective, convenient alternative cognitive screening instrument for use in emergent psychiatric populations

Research has shown that follow-up rates with aftercare recommendations upon discharge from psychiatric emergency services are low. These patients are in need of additional wrap-around support services. This article illustrates how an innovative program has been effective in utilizing crisis intervention services and mobile crisis outreach within an emergency room (ER) setting and how these unique services can be integral in preventing psychiatric decompensation and repeated presentations to the ER. In addition, implementing these services helps ensure better compliance with follow-up recommendations, allowing for the resolution of the crisis, enhanced diagnositic clarification, and identification of barriers to continued care in the community. Essential elements of successful application of this model include providing an immediate appointment, having close follow up, and ensuring a collaborative and interdisciplinary approach that addresses the biopsychosocial needs of patients. Further research is needed to better understand the patient characteristics and systemic factors that contribute to issues of compliance with community mental health services upon discharge from a psychiatric emergency service.

This study explored the subjective experience of the immigration process among young adult Russian Jews and what it reveals about their sense of self. Goals of the study were to describe patterns of personal change associated with immigration, and develop a description of Jewishness for this population and the impact of immigration on Jewishness. Eleven Russian Jews who immigrated to the US as adults five to eleven years ago were interviewed using a semi-structured interview. The data were analyzed using qualitative methodology, informed by psychodynamic theory. Participants conveyed a multiplicity of affective experiences related to their immigration process, including depression, uncertainty, fear, loneliness, excitement, embarrassment, anger, and nostalgia. The inherent quality of uprootedness associated with immigration experience presented a challenge to the participants, which expressed itself in the process of managing rapid, unanticipated pressures to change while trying to preserve the sameness and continuity of self over time. Positive changes in sense of self included increased confidence in abilities, increased independence, and self-actualization. For some participants, changes came at a cost of depression, feelings of instability, and a tendency to become emotionally harsh. Jewishness was an important part of the participants' identities and is a changing rather than static construct. The study revealed multiple and coexisting meanings of Jewishness, such as a sense of being different and belonging to a group or a nation. The immigration process challenged participants by forcing them to reflect on their Jewishness, engage in the process of exploring its meanings, and find a way to express their Jewishness such that it conforms with their self-concept. This occurs in the same way that immigrants negotiate the meanings of Russianness and Americanness. More generally, each person's story indicated a close relationship between the dominating affects they reported and their general defensive style and identity. While the psychoanalytic literature on immigration and its impact on sense of self has typically focused on trauma, the current study revealed a more normative process of coping with significant life transition. Factors that promoted or impaired participants' ability to manage the difficulties of immigration journey are discussed. (PsycINFO Database Record (c) 2007 APA, all rights reserved)