DSH - Patton: Postdoctoral Fellowship in Neuropsychology
The Department of State Hospitals (DSH) - Patton Postdoctoral Fellowship in Neuropsychology is a two-year, training program in neuropsychology that provides advanced training in the specialized practice of psychiatric neuropsychology in a forensic setting. Our neuropsychology fellowship is a member of the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN) and participates in the APPCN match. The fellowship program meets the requirements of the Houston Conference, and will provide a training experience consistent with board certification in the two main Neuropsychology boards: ABN and ABPP-CN.
Due to the size, breadth, and setting of the facility as a large, state forensic hospital, the Postdoctoral Fellowship in Neuropsychology provides a unique, advanced training experience in psychiatric neuropsychology with a forensically-committed, severely mentally ill population. In recent years, psychiatric neuropsychology has emerged in response to a developing body of literature that demonstrates compromised neurocognition in individuals with psychotic-spectrum mental illnesses, and is seen by many as a core feature of schizophrenia. The growing demand for neuropsychologist with a psychiatric specialization has not been matched by the development of widespread training resources in this area.
The Postdoctoral Fellowship in Neuropsychology at DSH - Patton is one of the few training sites in the country that provides training in psychiatric neuropsychology. But, the fellowship also provides training in traditional medical neuropsychology issues, such as traumatic bring injury, dementias, and a wide array of other medical conditions, which come from placements in traditional neuropsychology settings in the community. As a function of the DSH - Patton patient population, neuropsychology fellows therefore will have the advantage of learning to consider the interplay of neuropsychology, psychiatry, and forensic mental health issues with each assessment or treatment case from within the hospital.
Approach to Neuropsychology:
The fellowship training program emphasizes a “Process” model, which utilizes a flexible (rather than fixed) battery based on a hypothesis-testing method. To respond to referral questions in this setting, neuropsychologists integrate both qualitative and quantitative data (cognition, personality, and behavior) to help provide effective treatment recommendations to meet forensic and clinical goals.
The fellowship is an intensive training experience, with the fellow typically dividing time between didactic seminars, supervision, consultation, and the provision of direct services to the population served.
Seminars:
- Advanced Neuropsychology Seminar: This seminar meets weekly throughout the training year. Topics discussed will include neuroanatomy, neuropsychological assessment, and neurobehavioral syndromes, as well as other topics of interest. Reading assignments will be provided at the beginning of the training year (e.g., Lezak, Kolb & Wishaw, Heilman and Valenstein, Snyder & Nussbaum, etc.).
- Neuropsychology: Research and Theory: This seminar meets weekly throughout the year. Fellows will be required to research and present an informal talk on recent advances in the field of neuropsychology.
- Case Conference Seminar: This weekly seminar is attended by the postdoctoral fellows from all three fellowship tracks. Cases are presented from the institutional and private practices of the seminar leaders, as well as from the work of the fellows themselves, in a forum where participants can critically analyze the procedures and conclusions from multiple perspectives. The types of cases presented vary to provide a broad-based experience for the seminar participants.
Neuropsychological Assessment:
- Dementia & other neurodegenerative conditions: There is wide age range of patients at DSH - Patton, including a significant geriatric population. All types of dementia are seen, including Alzheimer’s Disease, Frontotemporal Dementia, Vascular Dementia, subcortical dementias, as well as other neurodegenerative conditions (e.g., Parkinson’s Disease).
- Traumatic Brain Injury: Although acute cases are rarely seen, a large percentage of patients have a reported history of head trauma. Many of our patients have comborbid conditions that complicate the diagnostic picture (e.g., substance abuse, chronic mental illness, learning disorders).
- Chronic viral infection: There is the opportunity to provide ongoing and serial assessments of patients with chronic viral infections (HIV, Hepatitis C, etc.).
- Chronic Mental Illness: The majority of patients at DSH - Patton have longstanding mental illness, with the majority of our patients diagnosed with a psychotic spectrum illness. Therefore, it is important that fellows learn to identify the neuropsychological correlates of these conditions.
- Cognitive Malingering: A variety of commitment types are represented at DSH - Patton, including those adjudicated to be incompetent to stand trial. In addition to other mediating factors, this creates the potential for exaggeration of cognitive deficits in patients who are assessed.
- Other forensic issues: At DSH - Patton, the Neuropsychology Service is often called
Neurocognitive Treatment:
The fellowship places an equal emphasis on neuropsychological assessment and cognitive remediation. Cognitive remediation is a growing treatment modality at DSH - Patton. There are currently three types of cognitive remediation treatment provided: (1) a single 12-week cognitive remediation group treatment; (2) a six-month cognitive remediation group treatment program (FREE); and (3) individualized cognitive remediation. A brief introduction to each type of treatment is provided below:
- 12-Week Cognitive Remediation Group Treatment: Currently we have several cognitive remediation groups that are provided in 12-week cycles. We have two computerized cognitive remediation groups, which focus upon improving cognition through a variety of computer-based cognitive rehabilitation programs. We also have one 12-week cognitive remediation group that focuses upon improving memory, attention, and executive functions through a variety of traditional cognitive rehabilitation drills and tasks.
- FREE: The FREE Program is a six-month intensive cognitive remediation treatment group that focuses upon improving attention, memory, executive functions, and social skills. This group is intended for individuals with the greatest level of impairment. The treatment provided is multi-modal and informed by the Recommendations for Cognitive Rehabilitation (Cicerone, et al., 2000).
- Individualized Cognitive Remediation: Individuals whose cognitive impairments are not amenable to treatment in a group setting are provided with individualized cognitive remediation. Treatment is provided in either 30 minute or 1-hour sessions and the treatment is usually provided on the patient’s unit.
Neuropsychology Consultation:
The fellows will gain experience in providing consultative feedback to the treatment teams for the individuals evaluated and with whom they have worked. Usually this feedback will be directed to the psychologists and psychiatrists who requested the evaluations, but also the fellow may participate in the treatment team conferences of the individuals evaluated, to provide useful information for disposition decisions and treatment planning.