Southern Ohio Curriculum

Speaker: Mark R. Munetz, M.D.

Required reading:

1. Grob, GN: The severely and chronically mentally ill in America: a historical perspective. In Soreff SM (editor): Handbook for the treatment of the seriously mentally ill. Hogrefe and Huber Publishers, Seattle, 1996.

Additional Readings:

1. Community Mental Health Centers- The Dream. In: Madness in the Streets by RJ Isaac and VC Armat Chapter 3. pp 67- 85, Free Press, New York, 1990

2. How No One Planned Deinstitutionalization: It Would Have Happened Anyway. In : Out of Bedlam: The Truth About Deinstitutionalization. Ann Braden Johnson. Basic Books, 1990.

3. Appelbaum PS: Crazy in the streets. Commentary Magazine. May 1987 (pages 34-39.)

4. Minkoff K. Beyond Deinstitutionalization: A new ideology for the postinstitutional era. H & CP 38: 945-950, 1987.

5. Lamb HR: Deinstitutionalization at the crossroads. Hospital and Community Psychiatry, 39: 941-945, 1988.

Session 5: January 11, 2001

Topic: Models of care in the community setting: Can we reconcile the medical model, the rehabilitation model and the recovery model?

Speaker: Mark R. Munetz, M.D.

Required Reading:

1. Bachrach LL: Psychosocial rehabilitation and psychiatry in the care of long-term patients. American Journal of Psychiatry 149: 1455-1463, 1992.

Additional reading:

1. Munetz MR, Birnbaum A, Wyzik PF: An integretive ideology to guide community-based multidisciplinary care of severely mentally ill patients. Hospital & Community Psychiatry, 44: 551 - 555, 1993.

Session 6: January 18, 2001

Topic: People with mental illness: Patient, client,consumer or member ?

Speaker: Members of Choices

Readings:

1. Anonymous: How I've managed chronic mental illness. Schizophrenia Bulletin 15:635-640, 1989.

2. Lovejoy M: Recovery from schizophrenia: A personal Odyssey. Hospital & Community Psychiatry 35: 809 - 812, 1984.

3. Vonnegut M: Why I want to bite R.D. Laing. Harpers Magazine. April 1974.

Session 7: February 1, 2001

Topic: Working with the family of the severely mentally disabled.

Speakers: Maggie Smith and other members of NAMI of Summit County

Required reading:

1. Bernheim KF, Lehman AF: Working with Families of the Mentally Ill. Chapter 2. The Family's Plight. W. W. Norton & Company, New York, 1985, pps. 18-34.

Additional readings:

1. Wish VR: Catch-22 for the mentally ill. Newsweek, December 9, 1985, p. 10.

2. Lamb HR, Oliphant E: Schizophrenia through the eyes of families. Hospital & Community Psychiatry 12: 803-806, 1978.

Session 8: February 8, 2001

Topic: Emergency psychiatry and the least restrictive alternative

Speaker: Antonio Montinola, M.D.

Readings:

1. Lake R, Moriarity KM, Alagna SW: The acute psychiatric diagnostic interview. Psychiatric Clinics of North America, 7:657-669, 1984.

2. Bassuk EL: General Hospital Psychiatry Emergency Services. In: General Hospital Psychiatry, Chapter 21, pp. 383 - 392, Boston, MA, 1979.November 10, 1994

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Community Psychiatry II (PGY 2) Didactic Series

September-November 2000

AGMC 10:00 a.m. - 10:50 a.m.

Series Coordinator: Mark R. Munetz, M.D.

Session 1: September 7, 2000

Topic: Ohio Mental Health Law: Part 2

Speakers: Barry Ward, Esq.

Magistrate Ann Snyder

Session 2: September 14, 2000

Topic: The role of the psychiatrist as a member (?leader) of a multidisciplinary team in the community.

Speaker: Hem Sharma, M.D.

Required Reading:

1. Knoedler W: The continuous treatment team model: role of the psychiatrist. Psychiatric Annals. 19: 35-40, 1989.

Additional reading:

1. Cutler DL, Bloom JD, Shore JH: Training psychiatrists to work with community support systems for chronically mentally ill persons. American Journal of Psychiatry. 138: 98-101, 1981.

2. Guidelines for psychiatric practice in community mental health centers. American Psychiatric Association, 1988.

Session 3. September 21, 2000

Topic: What is case management - different models for the severely mentally ill

Speaker: Linda Omobien, CSS Case Management Track Supervisor

Required reading:

1. Kanter J: Case management with longterm patients: a comprehensive approach. In Soreff SM (editor): Handbook for the treatment of the seriously mentally ill. Hogrefe and Huber Publishers, Seattle, 1996.

Additional Readings:

1. Rapp CA, Wintersteen R: The strengths model of case management: result from twelve demonstrations. Psychosocial rehabilitation journal. 13: 23 - 32, 1989.

2. Stein L: On the abolishment of the case manager. Health Affairs 11: 172 -177, 1992.

Session 4: October 5, 2000

Topic: Basic concepts in psychiatric/vocational rehabilitation

Speaker: Frank Sepatauc, CSS Vocational Unit Manager

Required Readings:

1. Bond GR, Drake RE, Mueser KT, Becker DR: An Update on supported employment for people with mental illness. Psychiatric Services 48: 335-346, 1997.

2. Blankertz L, Robinson S: Adding a vocational focus to mental health rehabilitation. Psychiatric Services 47: 1216-1222, 1996.

Additional readings:

1. Rutman ID: The psychosocial rehabilitation movement in the United States. In Myerson and Fine: Psychiatric Disability: Clinical, Administrative and Legal Dimensions, APA Press.

2. Anthony WA, Liberman RP: The practice of psychosocial rehabilitation: Historical, conceptual and research base. Schizophrenia Bulletin 12: 542 - 559, 1986.

3. Munich RL, Lang E: The boundaries of psychiatric rehabilitation. Hospital & Community Psychiatry 44: 661 - 665, 1993.

Session 5: October 12, 2000

Topic: Residential programs for the severely mentally ill - housing, homes and other places to live.

Speaker: Jerry Craig, CSS Residential Unit Manager

Required reading:

1. Hogan MF, Carling PJ: Normal housing: a key element of a supported housing approach for people with psychiatric disabilities. Community Mental Health Journal 28: 215 - 226, 1992.

Additional reading:

1. Diamond RJ: The psychiatrist's role in supported housing. Hospital & Community Psychiatry. 44: 461 - 464, 1993.

2. Hodgins S, Cyr M, Gaston L: Impact of supervised apartments on the functioning of mentally disordered adults. Community Mental Health Journal 26: 507- 516, 1990.

3. Geller JL, Fisher WH: The linear continuum of transitional residences: debunking the myth. American Journal of Psychiatry. 150:1070 - 1076.

Session 6: October 19, 2000

Topic: Dual Diagnosis - substance abuse and major mental

illness - Part 1

Speaker: Bahman Sharif, M.D.

Required Reading:

1. Minkoff K: Models for addiction treatment in psychiatric populations. Psychiatric Annals 24: 412 - 417, 1994.

Additional Readings:

1. Miller NS: Prevalence and treatment models for addictions in psychiatric populations. Psychiatric Annals 24: 399 - 406, 1994.

2. Group for the Advancement of Psychiatry Committee on Alcoholism and the Addictions. Substance abuse disorders: a psychiatric priority. American Journal of Psychiatry 148: 1291-1300, 1991.

Session 7: November 2, 2000

Topic: Managing violence in the acute and the chronically aggressive patient.

Speaker: Brad Winkhart, M.D.

Reading:

1. Lion JR: Training for battle:Thoughts on managing aggressive patients. H & CP 38:882-884, 1987.

2. Eichelman B: Toward a rational pharmacotherapy for aggressive and violent behavior. H & CP 39: 31 -39, 1988.

3. Tupin JP: The violent patient: a strategy for management and diagnosis. H & CP 34:37-40, 1983.

4. Garza-Trevino ES: Management of acute psychotic agitation. Clinical Advances in the treatment of Psychiatric Disorders (Roerig) July 1992.

5. Felthous AR: Preventing assaults on a psychiatric inpatient ward. H & CP 35:1223-1226, 1984.

6. Soloff PH, Gutheil TG, Wexler DB: Seclusion and restraint: a review and update. H & CP 36:652-657,1985.

Session 8: November 9, 2000

Topic: Treatment of the severely mentally disabled - maintaining hope, respect and optimism.

Speaker: Mark Munetz M.D.

Required reading:

1. Lefley HP: Thinking about recovery: paradigms and pitfalls. Innovations & Research 3:19 - 23, 1994.

Additional Reading:

1. Minkoff K, Stern R: Paradoxes faced by residents being trained in the psychosocial treatment of people with chronic schizophrenia. Hospital & Community Psychiatry 36: 859-864.

2. Harding CM, Zubin J, Strauss JS: Chronicity in schizophrenia: Revisited. British Journal of Psychiatry 161 (suppl. 18) 27-37, 1992.

3. Blaska B: The myriad medication mistakes in psychiatry: a consumer's view. Hospital & Community Psychiatry 41: 993-997, 1992.

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COMMUNITY PSYCHIATRY III (PGY 3) DIDACTIC SERIES

OCTOBER 2000 - MAY 2000

THURSDAYS 11:00 - 11:50 a.m.

Series coordinator: Mark R. Munetz, M.D.

Core Reference Textbook: Practicing Psychiatry in the Community: A Manual by Jerome Vaccaro, M.D. and Gordon H. Clark, Jr.,M.D., M.Div., APA Press, 1996.

1. September 21, 2000

Topic: Introduction and re-orientation:

Speaker: Mark R. Munetz, M.D.

Text: Chapter 2: Conceptual Issues for Contemporary Community Psychiatry Practice

Optional Readings:

1. Brown DB, Goldman CR, Thompson KS, Cutler DL: Training residents for community psychiatric practice: guidelines for curriculum development. Community Mental Health Journal 29: 271- 283, 1993.

2. Minkoff K: Development of a training guide for psychiatric residents in the psychosocial treatment of people with long-term mental illness. Innovations & Research 1: 31- 34, 1993.

2. October 5, 2000

Topic: The Role of the Psychiatrist on the Multidisciplinary Team in the CMHC

Speaker: Roger Sparhawk, M.D.

Text: Chapter 19: Multidisciplinary Teamwork by Ronald J. Diamond, M.D.

3. October 12, 2000

Topic: Understanding entitlements: SSI, SSDI, DA, Medicaid, Medicare, HAP, Section 8, etc.

Speakers: Frank Sepatauc

Readings:

4. October 19, 2000

Topic: Treatment of schizophrenia: Maintenance strategies for people whose schizophrenia responds to neuroleptic drugs -lowest effective dose vs. targeted chemotherapy

Speaker: Mark R. Munetz, M.D.

Case Presentation: Joseph O’Lear, M.D.

Required reading: (THESE READINGS WILL BE USED FOR SESSIONS 4 - 13)

1. McEvoy JP, Scheifler PL, Frances A: The Expert Consensus Guideline Series: Treatment of Schizophrenia 1999. Journal of Clinical Psychiatry 60 (Suppl. 11) 1- 80, 1999.

2. Lehman AF, Steinwachs DM, et. al., At Issue: Translating Research into practice: the schizophrenia patient outcomes research team (PORT) treatment recommendations. Schizophrenia Bulletin 24: 1-10, 1998.

Additional reading:

1. Schooler NR, Keith SJ, Severe JB, et. al.: Relapse and rehospitalization druing maintenance treatment of schizophrenia: the effects of dose reduction and family treatment. Arch Gen Psych 54: 453 - 463, 1997.

2. Kane JM, Marder SR: Psychopharmacologic treatment of schizophrenia. Schizophrenia Bulletin 19: 287 - 302, 1993.

3. Schooler NR: Maintenance medication for schizophrenia: strategies for dose reduction. Schizophrenia Bulletin. 17: 311 - 323, 1991.

4. Van Putten T, Marder SR, Mintz J, Poland RE: Haloperidol plasma levels and clinical response: a therapeutic window relationship. American Journal of Psychiatry. 149: 500 - 505, 1992.

5. Van Putten T, Crumpton E, Yale C: Drug refusal in schizophrenia and the wish to be crazy. Arch Gen Psychiatry 33: 1443 - 1445, 1976.

5. November 2, 2000

Topic: The role of atypical antipsychotics and augmentation strategies for the person with treatment-resistant schizophrenia: clozapine, risperidone, olanzapine, quetiapine and beyond...

Speaker: Michael Schechter, M.D.

Additional Readings:

1. Meltzer HY: Treatment of the neuroleptic-nonresponsive patient. Schizophrenia Bulletin 18: 515 - 542, 1992.

2. Farmer AE, Blewett A: Drug treatment of resistant schizophrenia. Drugs 45: 374 - 383, 1993.

3. Kane J, Hongfeld G, Singer J, et. al.: Clozapine for the treatment-resistant schizophrenic: A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 45: 789 - 796, 1988.

4. Safferman A, Lieberman JA, Szymanski S, Kinon B: Update on the clinical efficacy and side effects of clozapine. Schizophrenia Bulletin 17: 247 - 261, 1991.

5. Meltzer HY: Serotonin-dopamine interactions and atypical antipsychotic drugs. Psychiatric Annals 23: 193 - 200, 1993.

6. Lindenmayer JP: Recent advances in pharmacotherapy of schizophrenia. Psychiatric Annals 23: 201 - 208, 1993.

7. Marder SR, Meibach RC: Risperidone in the treatment of schizophrenia. American Journal of Psychiatry 151: 825 - 835, 1994.

6. November 9, 2000

Topic: The rational use of depot neuroleptics

Speaker: Mark R. Munetz, M.D.

Case Presentation: Tahmina Rahman, M.D.

Required reading:

1. Glazer WM, Kane JM: Depot neuroleptic therapy: an underutilized treatment option. J Clinical Psychiatry 53: 426 -433, 1992.

Additional reading:

1. Burnett PL, Galletly CA, Moyle RJ, Clark CR: Low-dose depot medication in schizophrenia. Schizophrenia Bulletin 19: 155- 164, 1993.

2. Yadalam KG, Simpson GM: Changing from oral to depot fluphenazine. J Clinical Psychiatry 49: 346 - 348, 1988.

3. Ereshefsky L, Toney G, Saklad SR, Anderson C, Seidel D: A

loading dose strategy for converting from oral to depot haloperidol. Hospital and Community Psychiatry 44: 1155 - 116, 1993.

7. November 30, 2000

Topic: Management of acute and subacute side effects - akinesia, akathisia and parkinsonism

Speaker: Mark R. Munetz , M.D.

Required reading:

1. Weiden PJ, Mann JJ, Haas G, et. al., Clinical nonrecognition of neuroleptic - induced movement disorders: a cautionary study. Am. Journal of Psychiatry 144: 1148 - 1153, 1987.

Additional readings:

1. Van Putten T: The many faces of akathisia. Comprehensive Psychiatry 16: 43 - 47, 1975.

2. Van Putten T, May PRA, Marder S: Akathisia with haloperidol and thiothixene. Arch Gen Psychiatry 41: 1036 - 1039, 1984.

3. Munetz MR, Cornes CL: Distinguishing akathisia and tardive dyskinesia: a review of the literature. J Clin Psychopharmacology 3: 343- 350, 1983.

4. Rifkin A, Quitkin F, Klein DF: Akinesia: A poorly recognized drug-induced extrapyramidal behavioral disorder. Archives of General Psychiatry 32: 672 - 674, 1975.

8. December 7, 2000

Topic: Recognition of tardive dyskinesia and spectrum disorders - How to do the AIMS examination -

Speaker: Mark R. Munetz, M.D.

Required reading:

1. Munetz MR, Benjamin S: How to examine patients using the abnormal involuntary movement scale. 39: 1172 - 1177, 1988.

2. Kane JM, Jeste DV, Barnes TRE, et. al.,: Tardive Dyskinesia: A Task Force Report of the American Psychiatric Association. Chapter 12: Summary, Conclusions and Recommendations for the Prevention and Management of Tardive Dyskinesia. pp. 231 - 251, Washington, D.C. 1992.

9. December 14, 2000

Topic: The differential diagnosis and treatment strategies for depression in schizophrenia

Speaker: Mark R. Munetz, M.D.

Case Presentation: Anand Chaturvedi, M.D.

Required reading:

1. Siris SG: Diagnosis of secondary depression in schizophrenia: Implications for DSM-IV. Schizophrenia Bulletin 17: 75 - 98, 1991.

Additional reading:

1. Knights A, Hirsch SR: 'Revealed' depression and drug treatment for schizophrenia. Arch Gen Psychiatry 38: 806 - 811, 1981.

2. Hogarty GE, Munetz MR: Pharmacogenic depression among outpatient schizophrenic patients: A failure to substantiate. J Clinical Psychopharmacology. 4: 17 - 24, 1984.

10. December 21, 2000

Topic: Informed consent for antipsychotic drug treatment.

Speaker: Mark R. Munetz, MD

Required reading:

1. Gutheil TG, Bursztajn HJ, Brodsky A, et. al: Managing Uncertainty: the therapeutic alliance, informed consent, and liability. In: Gutheil TG, Bursztajn HJ, Brodsky A, et. al., Decision Making in Psychiatry and the Law. Baltimore, Williams & Wilkins, 1991.

Additional Reading:

1. Munetz MR: Overcoming resistance to talking to patients about tardive dyskinesia. Hospital & Community Psychiatry 36: 283 - 287, 1985.

2. Irwin M, Lovitz A, Marder SR, et. al.: Psychotic patients' understanding of informed consent. American Journal of Psychiatry 142: 1351 - 1354, 1985.

3. Munetz MR, Roth LH: Informing patients about tardive dyskinesia. Archives of General Psychiatry 42:866-871, 1985.

4. Munetz MR, Peterson GA: Documenting informed consent for neuroleptic drugs: an alternative to the consent form. Psychiatric Services, 47: 302 - 303, 1996.

11. January 11, 2001

Topic: When the patient fights recovery - Commitment to outpatient treatment

Speaker: Greg A. Peterson, M.D.