Department of Psychiatry

ADULT INPATIENT – A. Hal Thurstin, PhD

Patient Characteristics:
Patients include men and women aged 18 and older who are psychiatrically hospitalized on one of three inpatient units (two are locked units). All referrals are challenging to diagnose and treat. The full range of DSM-IV diagnostic categories is represented. There are high rates of comorbidity for substance abuse and medical/neurological diagnoses. Interdisciplinary team approach is emphasized.

Distribution of Clinical Activities: 
Interns participate in team rounds and consultation (20%), clinical interviews (20%), testing (25%), report writing (25%), and short-term cognitive-behavioral intervention (10%).

Assessment Characteristics:
Assessments is comprehensive and timely (we try to maintain 48-hour turn-around). A flexible battery approach is used to incorporate intellectual, neuropsychological, and personality testing. Psychometrician assistance (3 ½ full-time) is provided for administration and scoring of tests.

Intervention Characteristics: 
Brief cognitive-behavioral interventions are frequently a part of the comprehensive treatment plan. The intern may follow cases after discharge in afternoon clinic for brief duration. Interns will also attend weekly cognitive-behavioral therapy case conference.

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Adult Outpatient – Community Psychiatry: Robert M. Savage, PhD

Patient Characteristics:
Adults age 19 – 65 with serious mental illness; schizophrenia, bipolar disorder, major depression and sever anxiety disorders are the primary focus of this rotation. However, differential diagnosis issues encountered will include essentially all of the DSM-IV nosologies. Serious mental illness related neurocognitive disorders are a major focus of this rotation as well.

Distribution of Clinical Activities:
Fifty to seventy percent of the intern’s time is spent in differential diagnosis related activities ranging from interviewing, to neuropsychological testing, and report writing. Attendance and involvement in staff meetings, case conferences, and multidisciplinary evaluation clinics may also be expected. Providing inpatient coverage will be an element of this rotation from time to time, although the primary focus is outpatient.

Assessment Characteristics:
Assessment patients are seen by the intern and Dr. Savage for clinical interview. The majority of neuropsychological assessment procedures are conducted by the intern. Several computer based procedures are available. Assessments range from I.Q. screenings and personality assessment, to comprehensive neuropsychological evaluations. Psychotic symptoms are frequently reported and basic Rorschach skills are required or can be developed for assessing thought disorder.

Intervention Characteristics:
Interns are often sought out to provide short-term behavioral and cognitive behavioral interventions on this rotation. Intermediate and long-term therapy opportunities are available and may include group therapy and psycho-educational interventions (Rehabilitation Day Program).

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Adult Outpatient Psychotherapy – A. Hal Thurstin, PhD & Patricia Cornett, PhD

Characteristics:
Adult men and women (18 to 65 years) present to the Neuropsychiatry Clinic with a variety of psychiatric disorders. Most commonly seen diagnoses include anxiety, depression, adjustment disorder, and panic disorder. Axis I diagnoses are often complicated by Axis II traits.

Distribution of Clinical Activities:
This is a minor rotation. Interns spend approximately 60% of their time in assessment and intervention, 25% in supervision, and 15% documenting clinical activities. Interns are encouraged to attend Departmental Grand Rounds.

Assessment Characteristics:
Evaluation is done through diagnostic interviews, assessments of couples functioning, and symptom severity scales.

Intervention Characteristics:
Interventions are individualized and determined by patient characteristics and treatment plan. Individual therapy and couples therapy are the principle modalities with an emphasis on cognitive behavioral and interpersonal approaches.

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Clinical Activity in Substance Abuse

Preceptor: Karen Cropsey, Psy.D., Associate Professor, Department of Psychiatry, 401 Beacon Pkwy, 917-3786 x205.

Rotation Site: This rotation is at an off-site location and is located within the UAB Substance Abuse Program which provides substance abuse treatment and monitoring for community corrections substance abuse clients.  This minor rotation is generally for 12-15 hours per week and can accommodate 1-2 interns per rotation.

Population: This clinical rotation in substance abuse involves providing assessments for a range of individuals with substance abuse as well as comorbid psychiatric or medical conditions.  Psychological assessments and evaluations will involve clients who have criminal justice involvement and who are being maintained in the community under criminal justice supervision. In addition, interns could maintain an active caseload of psychotherapy patients with co-occurring substance abuse and psychiatric diagnoses.

Interns would also have the opportunity to provide psychological assessments for individuals who are being treated for substance abuse in an inpatient setting, including impaired provider evaluations for the Board of Nursing, the Board of Medicine, or other health providers.

For either population, these assessments would address referral questions regarding psychiatric illness or personality disorders as well as questions of cognitive functioning.

Expectations: Interns would be expected to gain proficiency in conducting clinical assessments with this population and would work collaborative with a range of mental health and medical professionals.  By the end of the rotation, interns would be expected to be proficient with identifying substance use disorders and will be able to provide basic recommendations for substance abuse treatment.

Clinical Duties: Interns would generally perform 2-3 new evaluations each week, including psychological testing, clinical interviewing, and write-up of the psychological report.  If interested, a group therapy experience could be organized for the intern that would likely involve providing group psychotherapy for Anger Management or other psychosocial groups for substance abusers. Opportunities for conducting individual therapy could also be arranged, with the active caseload to be determined by the intern and supervisor.

Intern Schedules: Interns selecting this rotation should plan to spend the bulk of their day onsite with Dr. Cropsey. These evaluations are generally performed on Tuesdays and Wednesdays. Therapy patients could be scheduled on other days  Free onsite parking is available.

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Behavioral Medicine / Neuropsychology
Preceptor: A. Hal Thurstin, PhD
Site: Neuropsychology Laboratory Center for Psychiatric Medicine

General Description
Patient Characteristics:

Patients on this service have acquired brain injury, usually by traumatic means. As a result of the brain injury they exhibit physical and cognitive disabilities which rapidly improve in many cases. Age ranges from sixteen years to geriatric cases, with preponderance of cases being in the young adult range. All activities take place at SRC, a multi-disciplinary rehabilitation facility.

Distribution of Clinical Activities:
The intern participates in morning rounds and learns to perform bedside cognitive screening (10%).  Neuropsychological assessment of inpatients and outpatients is typical, with the intern performing at least some of the testing (15%).  For those less experienced in neuropsychological assessment training is provided.  Interviewing patients and family members is an important component of the experience, as well as organizing and interpreting neuropsychological test results (30%).  Interns participate in feedback sessions with patients and family members (10%).  Concise and clear report writing is emphasized, ranging from short staffing notes to neuropsychological testing reports of several pages (35%).  There is also often time to read about interesting cases.

Assessment Characteristics: 
Interns will learn to employ measures of neurocognitive ability at a screening level and in a more comprehensive battery. The latter usually involves a full day of assessment focusing on major neuropsychological instruments. This includes assessment of intellectual and academic skills, as well as memory functioning, reasoning skills and language abilities. Personality assessment, particularly use of projective instruments, is not common. Interns are expected to participate in initial interviews for testing cases and also in feedback sessions, which usually occur at the end of the day. A psychometrician is available, but the intern may be performing some of the testing, which is considered an important part of the learning experience.

Intervention Characteristics:
Interventions with patients are primarily brief and directive due to the short length of stay. Behavior/environmental management is an important component. Outpatients are sometimes seen for therapy.  Interns are not expected to assume a leading role in intervention, unless they request to do so.

Clinical Activities-
Distribution of Intern Time:
 Approximately 40% of the intern time is spent providing assessment, including clinical diagnostic interviews and neuropsychological testing. Approximately 20% of time is spent reviewing patient medical records, neuropsychological test interpretation, and report writing, and 20% on intervention, feedback, or inpatient consultation. The remainder of the intern’s time is dedicated to supervision, didactics, and participating on multidisciplinary treatment teams.

Hours: This rotation is a Minor rotation (12-16 hours). There is flexibility in the intern’s schedule, but the interested intern may wish to participate in the multidisciplinary Liver Disease Conference held Tuesday mornings at 10 am. Pre-liver transplant evaluations are usually conducted Monday afternoons, and Tuesday – Thursday mornings; pre-bariatric evaluations are generally conducted on Monday and Wednesday mornings.

Goals of Rotation:  This rotation can be tailored to each intern’s specific training needs. Training and supervision will follow a graduated approach, increasing responsibilities as appropriate for each intern’s level of competency. Therefore, this rotation is appropriate for those with little to no experience in neuropsychological assessment and for those who have advanced neuropsychological assessment skills.

Note: Research activities are available for interested interns.
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GEROPSYCHOLOGY – A. Hal Thurstin, PhD

Patient Characteristics:
Patient population includes men and women over the age of 60. These individuals are seen on both an inpatient and outpatient basis. Common diagnostic categories represented include Dementia, Depression, Psychosis, and Personality disorders. A wide variety of medical problems also exist in this population.

Distribution of Clinical Activities:
Interns can expect to spend 40% of their time performing assessments, 20% writing, 20% at rounds, 5% intervention, and 15% in supervision.

Assessment Characteristics:
Assessments most often include brief neuropsychological screenings, interviews, and sometimes personality testing. Psychometrist support is available depending upon the intern’s skill level.

Intervention Characteristics:
When intervention is offered it usually consists of individual therapy with an emphasis on behavioral and cognitive orientations and techniques.
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Medical/Surgical Neuropsychology
Preceptor: A. Hal Thurstin, PhD & Patricia Cornett, PhD
Site: CPM Neuropsychology Laboratory and UAB University Hospital

Rotation Description-

Patient Population: The vast majority of patients seen on this rotation are candidates for heart and lung transplantation and are referred by the UAB Department of Surgery’s Cardiothoracic Transplant Service as part of a series of pre-transplant medical evaluations. Very occasionally, referrals for neuropsychological evaluations are made to this service by other medical/surgical services. Roughly 75 percent of patients are seen on an outpatient basis, while the remaining 25 percent are seen on an inpatient basis. Patients range in age from the mid-teens to mid-seventies and present with a wide range of medical, psychiatric, and behavioral diagnoses.

Evaluations:
All assessments include a diagnostic clinical interview that includes an evaluation of patients’ compliance, substance use, exercise, diet, and health behavior histories, as well as an evaluation of their psychiatric, social, academic, and vocational histories and their social support network and stress-coping skills. The evaluations are geared toward helping the Transplant Service determine the candidate’s suitability for transplantation, identifying those areas of concern, including cognitive and academic deficits, that may negatively impact upon the individuals transplant candidacy (e.g., limited and inconsistent social support), and suggesting ways in which these limitations may be practically addressed. The typical evaluation is three hours in length, with intellectual, attentional, memory, expressive language, visuoperceptual, and executive cognitive functions being assessed. Psychometrician support is available for test administration and scoring. While a “standard” battery of tests is routinely used, the battery may be tailored to accommodate the specific needs of patients.

Treatment / Intervention:
This rotation provides the occasional opportunity for short- and long-term psychotherapy, as well as patient education to improve/enhance compliance and adherence behaviors.

Clinical Activities-
Distribution of Intern Effort: Roughly 40 percent of the intern’s time is devoted to evaluation, which includes conducting clinical interviews and administering and scoring neuropsychological measures. Approximately 30 percent of the intern’s time is devoted to reviewing patient records and information, test interpretation, and report writing. Thirty percent of time is spent in heart and lung transplant team meetings, didactic meetings, and supervision.

Time Commitment:
This is a minor rotation and will require 12 to 16 hours per week. Some flexibility in the intern’s schedule can be accommodated. Lung and Heart transplant team meetings are held from 7:30 to 9:00 am on Wednesday and Thursday mornings, respectively, while most evaluations are conducted on Wednesday and Thursday afternoons and Friday mornings.

Rotation Goals:
Specific goals of this rotation are fairly flexible and can be accommodated to meet the intern’s specific training needs. However, the general goal for the rotation is to familiarize interns with neuropsychological evaluation for medical/ surgical patients. Supervision over the course of the rotation will typically follow a graduated approach, with increasing responsibility being given to interns as the competency increases. The rotation is appropriate for interns with limited neuropsychological assessment experience, as well as those with advanced pre-internship training in clinical neuropsychology.