Nielsen, Bent; Nielsen, Anette Søgaard; Lolk, Anette
In Denmark, the treatment of alcoholics is provided by public outpatient alcohol clinics. The purpose of this study was to investigate whether elderly patients differ from younger patients with regards to sociodemographic data, drinking pattern and psychiatric comorbidity which may affect...
Eren, Gökhan; Hiss, Barbara; Maeck, Lienhard; Stoppe, Gabriela
10-year follow-up of the psychogeriatric inpatient care at the University Psychiatric Hospitals Basel following the establishment of an outpatient care service for the elderly (ADA). Standardized chart review of a random sample of psychogeriatric cases (≥ 65 y) of the years 1997 and 2007 (n = 100 each) in terms of socio-demographic, diagnostic, therapeutic und administrative data. The number of patients with contact to both inpatient and outpatient services prior to admission increased. There was no change regarding the amount of unvoluntary admissions. As expected more complex cases were treated. The case management showed changes towards greater guideline conformity. The 10-year follow-up shows a better outpatient treatment and the provision of inpatient facilities for complex multimorbid and emergency patients. © Georg Thieme Verlag KG Stuttgart · New York.
Recent research has shown that depression, anxiety disorders, and psychosis are more common than previously supposed in elderly populations without dementia. It is unclear whether the frequency of these disorders increases or decreases with age. Clinical expression of psychiatric disorders in old age may be different from that seen in younger age groups, with less and often milder symptoms. Concurrently, comorbidity between different psychiatric disorders is immense, as well as comorbidity with somatic disorders. Cognitive function is often decreased in people with depression, anxiety disorders, and psychosis, but whether these disorders are risk factors for dementia is unclear. Psychiatric disorders in the elderly are often related to cerebral neurodegeneration and cerebrovascular disease, although psychosocial risk factors are also important. Psychiatric disorders, common among the elderly, have consequences that include social deprivation, poor quality of life, cognitive decline, disability, increased risk for somatic disorders, suicide, and increased nonsuicidal mortality.
Ditchburn, K. Marie; Sellman, J. Douglas
Three main aims of this study were to ascertain the prevalence rate of smoking among adolescent psychiatric outpatients; estimate smokers' degree of nicotine dependence; and investigate the relationship between smoking and common mental health disorders. Face-to-face interviews were conducted on 93 patients ages 13-18 presenting to an adolescent…
Kaplan, M L; Asnis, G M; Lipschitz, D S; Chorney, P
The present study examines the relationship between suicidal behaviors and histories of abuse in psychiatric outpatients. Two hundred fifty-one psychiatric outpatients were evaluated for history of abuse, suicidal behavior, demographics, and clinical characteristics using self-report instruments and a face-to-face interview. Logistic regression analysis indicated that physical abuse (battering) in adulthood and histories of a combination of childhood and adulthood abuse were significant predictors of past suicide attempts and current suicidal ideation. Victims of abuse were more likely than nonvictim controls to have been suicidal at a younger age and to have made multiple suicide attempts. Among patients with a history of abuse, suicide attempters could be distinguished from nonattempters on the basis of higher levels of dissociation, depression, and somatization. Abusive experiences in adulthood appear to play an important role in suicidal behavior among psychiatric outpatients. High levels of specific symptoms (i.e., depression, somatization, and dissociation) among patients with a history of abuse can help to identify outpatients at risk for suicidal behavior.
Foote, Brad; Smolin, Yvette; Kaplan, Margaret; Legatt, Michael E; Lipschitz, Deborah
The purpose of the study was to assess the prevalence of DSM-IV dissociative disorders in an inner-city outpatient psychiatric population. Subjects were 231 consecutive admissions (84 men and 147 women, mean age=37 years) to an inner-city, hospital-based outpatient psychiatric clinic. The subjects completed self-report measures of dissociation (Dissociative Experiences Scale) and trauma history (Traumatic Experiences Questionnaire). Eighty-two patients (35%) completed a structured interview for dissociative disorders (Dissociative Disorders Interview Schedule). The 82 patients who were interviewed did not differ significantly on any demographic measure or on the self-report measures of trauma and dissociation from the 149 patients who were not interviewed. Twenty-four (29%) of the 82 interviewed patients received a diagnosis of a dissociative disorder. Dissociative identity disorder was diagnosed in five (6%) patients. Compared to the patients without a dissociative disorder diagnosis, patients with a dissociative disorder were significantly more likely to report childhood physical abuse (71% versus 27%) and childhood sexual abuse (74% versus 29%), but the two groups did not differ significantly on any demographic measure, including gender. Chart review revealed that only four (5%) patients in whom a dissociative disorder was identified during the study had previously received a dissociative disorder diagnosis. Dissociative disorders were highly prevalent in this clinical population and typically had not been previously diagnosed clinically. The high prevalence of dissociative disorders found in this study may be related to methodological factors (all patients were offered an interview rather than only those who had scored high on a screening self-report measure) and epidemiological factors (extremely high prevalence rates for childhood physical and sexual abuse were present in the overall study population).
Christine Grützmann Faustino
Full Text Available CONTEXT AND OBJECTIVESIn Brazil, few studies have investigated the prevalence of potentially inappropriate medications (PIMs among elderly outpatients. This study aimed to determine the prevalence of PIMs prescribed for elderly outpatients, identify the PIMs most commonly involved, and investigate whether age, sex and number of medications are related to prescription of such medications.DESIGN AND SETTINGObservational descriptive study developed in the Geriatrics Service of the Central Institute of Hospital das Clínicas (HC, Faculdade de Medicina da Universidade de São Paulo (FMUSP, São Paulo, Brazil.METHODSPrescriptions issued to 1,270 elderly patients (≥ 60 years were gathered from a database. These prescriptions had been written by geriatricians at a tertiary-level university hospital in São Paulo, Brazil, between February and May 2008. The prescriptions were divided according to sex and age group (60-69, 70-79 and ≥ 80. The Beers criteria were used to evaluate PIMs.RESULTSMost of the sample comprised women (77% and the mean age was 80.1 years. The mean prevalence of PIM prescriptions was 26.9%. Female sex and number of medications prescribed were associated with prescription of PIMs. The chance of having a PIM prescription was lower among patients ≥ 70 years.CONCLUSIONThe greater prevalence of PIMs was correlated with female sex. The chance of having a PIM prescription was lower among patients ≥ 70 years and became greater with increasing numbers of medications prescribed (≥ 7.
Wetterling, Tilman; Schneider, Barbara
Due to demographic changes there will be a fraction of elderly patients with substance use disorders. However, only a few data have been published about elderly abusers of prescription drugs. Since substance abuse is frequently comorbid with psychiatric disorders, treatment in a psychiatric hospital is often needed. In this explorative study elderly people with prescription drug abuse who required psychiatric inpatient treatment should be characterized. This study was part of the gerontopsychiatry study Berlin (Gepsy-B), an investigation of the data of all older inpatients (≥ 65 years) admitted to a psychiatric hospital within a period of 3 years. Among 1266 documented admissions in 110 cases (8.7 %) (mean age: 75.7 ± 7.1 years) prescription drug abuse, mostly of benzodiazepines was diagnosed. Females showed benzodiazepine abuse more often than males. In only a small proportion of the cases the reason for admission was withdrawal of prescribed drugs. 85.5 % suffered from psychiatric comorbidity, mostly depression. As risk factors for abuse depressive symptoms (OR: 3.32) as well as concurrent nicotine (OR: 2.69) or alcohol abuse (OR: 2.14) were calculated. Psychiatric inpatient treatment was primarily not necessary because of prescription drug abuse but because of other psychopathological symptoms. © Georg Thieme Verlag KG Stuttgart · New York.
Duran, Şahut; Fıstıkcı, Nurhan; Keyvan, Ali; Bilici, Mustafa; Çalışkan, Mecit
This study aimed to investigate the prevalence of attention-deficit/hyperactivity disorder (ADHD) in adult psychiatric outpatients. Moreover, comorbid psychiatric diagnoses in adults with ADHD were determined. Patients with and without ADHD were compared regarding DSM Axis I-II comorbidity and sociodemographic characteristics. The study included patients that presented for the first time to a psychiatric outpatient clinic during a 3-month period and were evaluated for adult ADHD. A sociodemographic form, Wender Utah Rating Scale, Turgay's Adult ADD/ADHD Evaluation Scale, Structured Clinical Interview I and II, Symptom Check List-90-R, and Beck Depression Inventory were administered. The study included 246 patients. Among the 39 patients diagnosed with ADHD, 25 were female (64.1%) and 14 were male (35.9%), and the mean age was 27.38 ± 8.3 years. The prevalence of ADHD in adult psychiatric patients was 15.9%. Adults with ADHD usually presented due to comorbid psychiatric problems; major depression (43%), generalized anxiety disorder (23%), and obsessive-compulsive disorder (17%) were the most common comorbid diagnoses. Substance abuse (58.9%) and attempted suicide (38.5%) were among the most prevalent psychiatric problems. The present findings show that ADHD is an important comorbidity in adult patients that present to psychiatric clinics, and may cause serious mental health problems or complicate mental illness.
Shacham, Enbal; Önen, Nur F; Donovan, Michael F; Rosenburg, Neal; Overton, E Turner
As individuals with HIV infection are living longer, the management of psychiatric disorders has increasingly been incorporated into comprehensive care. Individuals were recruited from an outpatient HIV clinic to assess the prevalence and related associations of current psychiatric disorders and biomarkers. Of the 201 participants who completed the interviews, the median age was 43.5 years, and the majority was male and African American. Most were receiving HIV therapy and 78% of those had achieved virologic suppression. Prevalent psychiatric diagnoses included major depressive disorder, generalized anxiety, and agoraphobia. Alcohol and cocaine/crack abuse and dependence were common substance use disorders. Current receipt of HIV therapy was less common among those diagnosed with generalized anxiety disorder. Agoraphobia was the only disorder associated with unsuppressed viral load. Psychiatric and substance use disorders are highly prevalent among an urban HIV clinic population, although we identified few associations between psychiatric diagnoses and HIV diseases status. © The Author(s) 2014.
Elkington, Katherine S.; Hackler, Dusty; McKinnon, Karen; Borges, Cristiane; Wright, Eric R.; Wainberg, Milton L.
This research explores the experiences of mental illness stigma in 24 youth (58.3% male, 13-24 years, 75% Latino) in psychiatric outpatient treatment. Using Link and Phelan's (2001) model of stigmatization, we conducted thematic analysis of the interview texts, examining experiences of stigma at individual and structural levels, in addition to the…
SPINHOVEN, P; LABBE, MR; ROMBOUTS, R
The feasibility of computerized psychological testing was investigated in a sample of 452 consecutive psychiatric outpatients. Forty-six percent of the solicited patients agreed to participate in the computerized assessment. Tested patients were significantly younger and better educated than those
Azimi, Kousha; Modi, Miti; Hurlbut, Janice; Lunsky, Yona
Despite the fact that adults with both intellectual disabilities (ID) and psychiatric disorders are at increased risk for physical health problems, few studies have described their medical concerns specifically. This study reports on the rates of physical health issues and completion of recommended health screenings among 78 adult outpatients with…
Bhar, Sunil; Ghahramanlou-Holloway, Marjan; Brown, Gregory; Beck, Aaron T.
Depression, hopelessness, and low self-esteem are implicated as vulnerability factors for suicide ideation. The association of self-esteem with suicide ideation after controlling for depressed mood and hopelessness was examined. Adult psychiatric outpatients (N = 338) completed measures of self-esteem, suicide ideation, hopelessness, and…
Kittelsen, Sverre A.C.; Magnussen, Jon
While measures of output in mental health care are even harder to find than in other health care activities, some indicators are available. In modelling productive efficiency the problem is to select the output variables that best reflect the use of resources, in the sense that these variables have a significant impact on measures of efficiency. The paper analyses cross-sectional data on the psychiatric outpatient clinics of Norway using the Data Envelopment Analysis (DEA) non-parametric effi...
Stroomer-van Wijk, Anne J. M.; Jonker, Barbara W.; Kok, Rob M.; van der Mast, Roos C.; Luijendijk, Hendrika J.
Background: Delirium may be more prevalent in elderly outpatients than has long been assumed. However, it may be easily missed due to overlap with dementia. Our aim was to study delirium symptoms and underlying somatic disorders in psycho-geriatric outpatients. Methods: We performed a case-control
Background No study has been performed to compare the impacts of migraine and major depressive episode (MDE) on depression, anxiety and somatic symptoms, and health-related quality of life (HRQoL) among psychiatric outpatients. The aim of this study was to investigate the above issue. Methods This study enrolled consecutive psychiatric outpatients with mood and/or anxiety disorders who undertook a first visit to a medical center. Migraine was diagnosed according to the International Classification of Headache Disorders, 2nd edition. Three psychometric scales and the Short-Form 36 were administered. General linear models were used to estimate the difference in scores contributed by either migraine or MDE. Multiple linear regressions were employed to compare the variance of these scores explained by migraine or MDE. Results Among 214 enrolled participants, 35.0% had migraine. Bipolar II disorder patients (70.0%) had the highest percentage of migraine, followed by major depressive disorder (49.1%) and only anxiety disorder (24.5%). Patients with migraine had worse depression, anxiety, and somatic symptoms and lower SF-36 scores than those without. The estimated differences in the scores of physical functioning, bodily pain, and somatic symptoms contributed by migraine were not lower than those contributed by MDE. The regression model demonstrated the variance explained by migraine was significantly greater than that explained by MDE in physical and pain symptoms. Conclusions Migraine was common and the impact of migraine on physical and pain symptoms was greater than MDE among psychiatric outpatients. Integration of treatment strategies for migraine into psychiatric treatment plans should be considered. PMID:23565902
Genovese, Timothy; Dalrymple, Kristy; Chelminski, Iwona; Zimmerman, Mark
The attention given to anger and aggression in psychiatric patients pales in comparison to the attention given to depression and anxiety. Most studies have focused on a limited number of psychiatric disorders, and results have been inconsistent. The present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project sought to replicate and extend prior findings examining which psychiatric disorders and demographic characteristics were independently associated with elevated levels of anger and aggression. 3800 individuals presenting to the Rhode Island Hospital Department of Psychiatry outpatient practice underwent a semi-structured interview to determine current Axis I (N=3800) and Axis II (N=2151) pathology. Severity of subjective anger and overt aggression within the past week were also assessed for each patient, and odds ratios were determined for each disorder. Multiple regression analyses were conducted to determine which diagnoses independently contributed to increased levels of anger and aggression. Almost half of the sample reported moderate-to-severe levels of current subjective anger, and more than 20% endorsed moderate-to-severe levels of current overt aggression. The frequency of anger was similar to the frequencies of depressed mood and psychic anxiety. Anger and aggression were elevated across all diagnoses except adjustment disorder. Anger and aggression were most elevated in patients with major depressive disorder, panic disorder with agoraphobia, post-traumatic stress disorder, intermittent explosive disorder, and cluster B personality disorders. Anger is as common as depressed mood and psychic anxiety amongst psychiatric outpatients, and problems with anger cut across diagnostic categories. Given the high prevalence of problems with anger in psychiatric patients, more research should be directed towards its effective treatment. Copyright © 2016 Elsevier Inc. All rights reserved.
(27.9%, and antianxiety (6.2%. However, compared to outpatients, the current use of medications for inpatients was more frequent (93.8% vs 89.9%, P=0.019 with inpatients more likely to be treated with multiple medications (2.1 vs 1.8 medications. A similar trend was observed in the case of antipsychotics, high potency first-generation antipsychotics, second-generation antipsychotics, mood stabilizers, and antianxiety medicines where inpatients were more frequently treated with these medications for all psychiatric diagnoses when compared with outpatients. On the contrary, in the case of antidepressant treatment, an opposite trend was observed with more number of treated outpatients in comparison to inpatients. Among elderly patients, 75.9% received antipsychotics, mainly second-generation formulations (67.2%, whereas only 41% received antidepressants and 13.8% received mood stabilizers.Conclusion: Based upon the present study data, it is concluded that among all the psychotropic medications, antipsychotics were heavily used and the frequency was found to be significantly high in the case of inpatients compared with outpatients. Such a practice may lead to multiple negative consequences among the Saudi psychiatric patient population. Further, extensive use of sodium valproate in the case of bipolar disorder, and also among females either in childbearing age or during pregnancy is also the cause of concern and warrants logical use. Overall, this study may help in assessing the burden of psychiatric illness within specific patient demographics and might be effectively used to strategically plan health resources allocation, generate new treatment hypothesis, or be used as a source of evidence that could further integrate other observational studies.Keywords: psychotropic, inpatient, outpatient, antipsychotics, antidepressants, mood stabilizers, Saudi Arabia
Sánchez Autet, Mónica; Garriga, Marina; Zamora, Francisco Javier; González, Idilio; Usall, Judith; Tolosa, Leticia; Benítez, Concepción; Puertas, Raquel; Arranz, Belén
Alcohol use disorders (AUD) are 2 times higher among psychiatric patients than in the general population. The under-recognition of this dual diagnosis can entail several negative outcomes. Early assessment with a screening tool like the CAGE questionnaire could be an opportunity to improve patients' prognoses. The objective of this study is to assess AUD risk in an outpatient psychiatric sample with a modified CAGE, considering the influence of age, gender and clinical psychiatric diagnosis. An observational, multicentric, descriptive study was carried out. The 4-item CAGE scale, camouflaged in a healthy lifestyle questionnaire, was implemented, using a cut-off point of one. 559 outpatients were assessed. 54% were female and the average age was 50.07 years. 182 patients presented a CAGE score ≥1 (45.1% of men and 21.9% of women). Gender was the strongest predictor of a positive result in CAGE, as men were 3.03 times more likely to score ≥1 on the CAGE questionnaire (p < .001, 95% CI: 0.22-0.49). Patients with bipolar and personality disorders had the highest rates of CAGE scores ≥1 (45.2 and 44.9%, respectively), with a significant association between diagnosis and a positive score (p = .002). Patients above 60 years were 2.5 times less likely to score ≥1 on the CAGE (p = .017, 95% CI: 0.19-0.85). Specific screening questionnaires, like the CAGE scale, can be an easy and useful tool in the assessment of AUD risk in psychiatric outpatients. Male patients with a bipolar or personality disorder present a higher risk of AUD.
Nakasujja, Noeline; Musisi, Seggane; Walugembe, James; Wallace, Daphne
The elderly are vulnerable to illness and particularly to psychiatric illness. Many mentally ill elderly patients end up on non-psychiatric wards owing to somatization of their illnesses. Even for these patients, a psychiatric diagnosis may not be made. The literature on the elderly in Uganda is very scanty. This study aims to establish the prevalence and factors associated with psychiatric disorders among elderly patients admitted to non-psychiatric wards. We carried out a descriptive cross-sectional study of 127 consenting elderly patients. They were administered a standardized questionnaire comprising the Self Reporting Questionnaire 25, the Mini-mental State Examination and the Structured Clinical Interview for the Diagnostic and Statistical Manual IV. Study variables included socio-demographic characteristics, physical illnesses, psychiatric disorders and the treatment given. The rate of psychiatric morbidity was 48%. The sex ratio was 1:1; however, women had a higher rate of psychiatric illness than men, 54.6% and 41.3% respectively. Being widowed or separated and having cancer were associated with SRQ>5, p=0.02 and p=0.04 respectively. Depressive disorders were the most common at 25.2% and were more common in women. Increasing age was associated with dementia (pUganda. Particular attention should be given to the psychological health of elderly people admitted to general hospitals.
Grifasi, Carlo; Calogero, Armando; Esposito, Anna; Dodaro, Concetta
Epidemiological data show a continuous expansion of elderly population in Europe. Older individuals require more medical services relative to their younger counterparts. The aim of this review was to summarize the most recent considerations in regards to preoperative assessment, postoperative outcomes, patient satisfaction and cost-effectiveness analysis of day surgery in the elderly. This review considered studies that included older patients who were undergoing day surgery general procedures (such as inguinal hernia repair, excision of breast lump, haemorrhoidectomy). The interventions of interest to this review included selection criteria, perioperative care, management of postoperative pain. According to a large number of studies, old age does not constitute a contraindication for elderly to undergo ambulatory surgery but this population may require more careful intraoperative cardiovascular management. Hospitalization of older patients is frequently associated with postoperative cognitive dysfunction (POCD). Management of postoperative pain in older patients may be complicated by a number of factors, including a higher risk of age- and disease-related changes in physiology and disease-drug and drug-drug interactions. Early studies evaluating approaches to facilitating the recovery process have demonstrated the benefits of multimodal analgesic techniques. A lot of studies show that even elderly patients can successfully undergo day surgery procedures by implementing evidence-based perioperative care programs, minimizing operative duration and tissue trauma and providing a comfortable setting.
Grifasi, Carlo; Calogero, Armando; Esposito, Anna; Dodaro, Concetta
Epidemiological data show a continuous expansion of elderly population in Europe. Older individuals require more medical services relative to their younger counterparts. The aim of this review was to summarize the most recent considerations in regards to preoperative assessment, postoperative outcomes, patient satisfaction and cost-effectiveness analysis of day surgery in the elderly. This review considered studies that included older patients who were undergoing day surgery general procedures (such as inguinal hernia repair, excision of breast lump, haemorrhoidectomy). The interventions of interest to this review included selection criteria, perioperative care, management of postoperative pain. According to a large number of studies, old age does not constitute a contraindication for elderly to undergo ambulatory surgery but this population may require more careful intraoperative cardiovascular management. Hospitalization of older patients is frequently associated with postoperative cognitive dysfunction (POCD). Management of postoperative pain in older patients may be complicated by a number of factors, including a higher risk of age- and disease-related changes in physiology and disease-drug and drug-drug interactions. Early studies evaluating approaches to facilitating the recovery process have demonstrated the benefits of multimodal analgesic techniques. A lot of studies show that even elderly patients can successfully undergo day surgery procedures by implementing evidence-based perioperative care programs, minimizing operative duration and tissue trauma and providing a comfortable setting.
Full Text Available Context: Aging of population is currently a global phenomenon. At least one in 5 people over the age of 65 years will suffer from a mental disorder by 2030. Study of psychiatric morbidities in this age group is essential to prepare for upcoming challenges. Aims: To find out the prevalence of different psychiatric morbidities in elderly population and to find out if there are any age and gender specific differences. Settings and Design: Retrospective review; Psychiatric outpatient department of Manipal Teaching Hospital, Pokhara, Nepal. Materials and Methods: Data for patients ≥ 65 years of age attending the psychiatric outpatient department of Manipal Teaching Hospital, Pokhara, Nepal, from 1 st January 2012 to 15 th January 2013 were collected retrospectively in a predesigned proforma. Statistical Analysis Used: Risk of having different psychiatric disorders was estimated using odds ratio. Results: The mean age of 120 patients included in this study was 69.67 (SD = 5.94 years. Depressive disorder (26.7% was the most common diagnosis. There was no statistically significant difference in psychiatric disorders in >75 years compared with ≤75 years except for dementia [odd ratio (OR (≤75 years/>75 years=0.055, 95% confidence interval (CI=0.016; 0.194]. Alcohol dependence syndrome [OR (male/female=7.826, 95% CI = 1.699;36.705] and dementia [OR (male/female=3.394, 95% CI = 1.015;11.350] was more common in males. Conclusions: Depressive disorder was the most common psychiatric morbidity among the elderly patients. The odds suffering from dementia increased with increasing age. The odds of having alcohol related problems and dementia were more in males compared with females.
Bjørkvik, Jofrid; Biringer, Eva; Eikeland, Ole-Johan; Nielsen, Geir Høstmark
This study explored associations between self-esteem and interpersonal functioning in a one-year clinic cohort of psychiatric outpatients (n= 338). At intake, patients completed questionnaires measuring self-esteem, interpersonal problems, interpersonal style, and general symptomatic distress. They were also diagnosed according to the ICD-10. Interpersonal behaviour was measured along the agency and communion dimensions of the Inventory of Interpersonal Problems-Circumplex [IIP-C]. The results show that lower self-esteem was associated with higher levels of interpersonal problems in general. Further, lower self-esteem was first and foremost linked to frustrated agentic motives, as measured by the IIP-C. Hence, the study concludes that fostering patient agency should be considered as an important goal in psychotherapy. Furthermore, the analyses revealed an interaction effect of agency and communion on self-esteem, indicating a need for balancing the two motive dimensions. Finally, some questions are raised concerning the interpretation of the IIP-C subscales in general.
Ramirez, Adriana; Ekselius, Lisa; Ramklint, Mia
The aim of this study was to examine differences in childhood, adolescent and adult onset of depression. Young psychiatric outpatients (n = 156) diagnosed with a lifetime depressive episode were divided into three groups according to age of onset of their first depressive episode: childhood (≤12 years, n = 21), adolescent (13-17 years, n = 58) and early adult onset (18-25 years, n = 77). Participants were assessed by diagnostic interviews and by questionnaires measuring previous life events and childhood developmental delays. Clinical characteristics and various risk factors were compared between groups. This clinical sample was dominated by women, with onset of their first depressive episode occurring during adolescence. Childhood onset was related to an increased number of depressive episodes, higher prevalence of personality disorders, more current social problems and more reported development delays during childhood regarding literacy learning, social skills and memory. They also reported more separation anxiety symptoms and neglect during childhood and more experiences of teenage pregnancies and abortions. Childhood onset of depression is associated with more severe symptoms, more psychosocial risk factors and childhood developmental delays. Because all onset groups shared many features, the results are inconclusive if there are distinct subgroups according to age of onset. © 2013 Wiley Publishing Asia Pty Ltd.
Clarissa Mendonça Corradi-Webster
Full Text Available ABSTRACT Objective: to examine the factors associated with problematic drug use among psychiatric outpatients. Method: a cross-sectional study was carried out in two mental health services. Eligible individuals were patients of these mental health services, who used them within the data collection period. Instruments: standardized questionnaire with sociodemographic, social network, social harm, and clinical information; Alcohol, Smoking and Substance Involvement Screening Test; Barratt Impulsiveness Scale; Holmes and Rahe Stress Scale. Statistical analysis was performed using parametric statistics considering a significance level of p ≤ 0.05. Study participants were 243 patients, with 53.9% of these presenting problematic drug use. Results: the most important independent predictors of problematic drug use were marital status (OR = 0.491, religious practice (OR = 0.449, satisfaction with financial situation (OR = 0.469, having suffered discrimination (OR = 3.821 and practicing sports activities in previous 12 months (OR = 2.25. Conclusion: the variables found to be predictors were those related to the social context of the patient, there, it is recommended that mental health services valorize psychosocial actions, seeking to know the social support network of patients, their modes of socialization, their financial needs, and their experiences of life and suffering.
Lima, Bruno R.; Pai, Shaila
Although the occurrence of medical illnesses in psychiatric patients is quite high, medical illnesses manifested by psychiatric symptoms are often overlooked. The higher mortality rates among psychiatric patients when compared to the general population may be a reflection of neglect or inadequate treatment of the psychiatric patients' medical…
Henrichs, J.; Bogaerts, S.; Sijtsema, J.J.; Klerx, F.
This study investigated criminological, psychopathological, and victimological profiles of intimate partner violence (IPV) perpetrators in a sample of 119 Dutch female and male forensic psychiatric outpatients aged 18 to 58 years. In addition, differences in criminological, psychopathological, and
However relatively few studies have been conducted on the pattern of psychiatric illnesses among the elderly in this environment. More over , with changing demographics, there is a need for more information. Objective: The objectives of this study were to: (1) examine the sociodemographic and clinical variables of patients ...
Khazaie, Habibolah; Rezaie, Leeba; de Jong, Desiree M
Outpatient psychiatric treatment provides both psychotherapy and pharmacotherapy for a large portion of psychiatric patients. Dropping out, or early termination of treatment, may be considered a common barrier to outpatient's psychiatric treatment. There are limited studies on this issue in Iran. The current study aimed to examine rates, predictors and reasons of dropping out of an outpatient psychiatric treatment. In this 6-month cohort study, 1500 outpatients who visited 10 psychiatrist's offices in the Iranian city of Kermanshah were recruited and followed for 2 years (2009-2011) for recommended treatments including admission to hospital, pharmacotherapy, psychotherapy and a combination of both psychotherapy and pharmacotherapy. Characteristics of patients who dropped out of the current study were collected, and reasons for dropping out were collected via phone or in person interview. Dropouts were prevalent in prescribed treatments. Pretreatment (primary) dropout rates in psychotherapy treatment were 4 times greater than dropout rates in pharmacotherapy treatment (80% and 20%, respectively). There were significance differences between dropouts and non-dropouts of pharmacotherapy with respect to patient characteristics; younger age, male gender, low level of education, unemployment, lack of insurance, new cases and divorce were more prevalent among dropouts (P<.001). With regard to diagnosis, dropping out was more prevalent among patients with substance-related disorders, schizophrenia and other psychotic disorders when compared to other diagnoses (P<.001). Commonly reported reasons for dropping out included overslept and too ill to attend treatment and fear of becoming addicted to prescribed psychotropic medication (30% and 18%, respectively). Lack of confidence in therapist ability and lack of confidence in the efficacy of the treatment were more prevalent in patients who dropped out of psychotherapy (P<.001). Patient dropout is a common problem in outpatient
Chen, Ying-Jen; Tsai, Yun-Fang; Ku, Yan-Chiou; Lee, Shwu-Hua; Lee, Hsiu-Lan
The purposes of this study were to explore elderly outpatients' perceived reasons for, opinions of, and suggestions for elderly people considering suicide in Taiwan. Elderly outpatients (N = 83) were recruited in 2011-2012 by convenience sampling from three randomly selected medical centers in Taiwan. Data were collected in individual interviews using a semi-structured guide and analyzed by content analysis. Findings revealed that most participants had heard of elderly suicide, with television news as the main source for their information. Their opinions about elderly suicide reflected judgmental attitudes, negative emotional reactions, expectations of social welfare, and could happen after losing one's meaning in life. Their suggestions for elderly people considering suicide fell into four major themes: give up suicidal ideas, seek help, enhance social welfare, and attend religious activities. Since television news was the main source for participants' information about elderly suicide, this mass medium should be used in suicide prevention to disseminate suicide knowledge, increase access to help, and strengthen suicide-protective factors among the elderly. Furthermore, no participants mentioned depression as a reason for attempted or completed suicide among older people despite depression being a well-known suicide-risk factor. Future suicide-prevention programs should emphasize the role of depression in suicide among older people. Participants also did not suggest that older people considering suicide seek help from the health system. Thus, older people should be educated about the role of the health system in suicide prevention and trained as gatekeepers to recognize signs of suicide ideation and respond appropriately.
André de Oliveira Baldoni
Full Text Available This cross-sectional study was carried out with 1000 elderly outpatients assisted by a Basic Health District Unit (UBDS from the Brazilian Public Health System (SUS in the municipality of Ribeirão Preto. We analyzed the clinical, socioeconomic and pharmacoepidemiological profile of the elderly patients in order to identify factors associated with polypharmacy amongst this population. We used a truncated negative binomial model to examine the association of polypharmacy with the independent variables of the study. The software SAS was used for the statistical analysis and the significance level adopted was 0.05. The most prevalent drugs were those for the cardiovascular system (83.4%. There was a mean use of seven drugs per patient and 47.9% of the interviewees used >7 drugs. The variables that showed association with polypharmacy (P value 75 years, self-medication, number of health problems, number of medical appointments, presence of adverse drug events, use of over-the-counter drugs, use of psychotropic drugs, lack of physical exercise and use of sweeteners. The exposition to all these factors justified the high prevalence of polypharmacy amongst the interviewees. These results showed the need to adopt clinical intervention and educational and managerial measures to analyze and promote rationality in the use of drugs amongst the elderly users of SUS.
Valdes-Stauber, Juan; Kilian, Reinhold
This study examines whether psychiatric outpatient clinics fulfill their statutory role of providing psychiatric services for patients with severe mental disorders. A retrospective cross-sectional study on 1,672 patients of a psychiatric outpatient clinic for the year 2010, based on 30 variables. Associations between variables were explored by means of robust multivariate regression models and polynomial regression plots. The patients' average CGI value was found to be 5.98, the mean GAF-score 47.3, and the mean duration of illness 13.8 years. A third of the sample attempted suicide in the past. Metabolic comorbidity was found in 23.1 % of the sample. Results of regression analyses reveal positive effects of the disease severity and functional impairment on the use of psychiatric care. Patients with affective and schizophrenic disorders received more units of care and caused more costs. Patients living in nursing homes received less in- and outpatient care but caused more medication costs. Study results support the assumption that German psychiatric outpatient clinics fulfill their statutory duties by treating severely chronically mentally ill patients. The patients' use of care is positively related to the disease severity and their functional impairment. However, results of the regression analyses suggest that patients living in nursing homes received less psychiatric care than patients who live more independently. © Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available Abstract Background Family practitioners take care of large numbers of seniors with increasingly complex mental health problems. Varying levels of input may be necessary from psychiatric consultants. This study examines patients'/family, family practitioners', and psychiatrists' perceptions of the bi-directional pathway between such primary care doctors and consultants. Methods An 18 month survey was conducted in an out-patient psychogeriatric clinic of a Montreal university-affiliated community hospital. Cognitively intact seniors referred by family practitioners for assessment completed a satisfaction and expectation survey following their visits with the psychiatric consultants. The latter completed a self-administered process of care questionnaire at the end of the visit, while family doctors responded to a similar survey by telephone after the consultants' reports had been received. Responses of the 3 groups were compared. Results 101 seniors, referred from 63 family practitioners, met the study entry criteria for assessment by 1 of 3 psychogeriatricians. Both psychiatrists and family doctors agreed that help with management was the most common reason for referral. Family physicians were accepting of care of elderly with mental health problems, but preferred that the psychiatrists assume the initial treatment; the consultants preferred direct return of the patient; and almost 1/2 of patients did not know what to expect from the consultation visit. The rates of discordance in expectations were high when each unique patient-family doctor-psychiatrist triad was examined. Conclusion Gaps in expectations exist amongst family doctors, psychiatrists, and patients/family in the shared mental health care of seniors. Goals and anticipated outcomes of psychogeriatric consultation require better definition.
Márlon Juliano Romero Aliberti
Full Text Available Abstract Dementia is a common disabling disease in the elderly. In such patients, general health conditions may worsen the functional decline and loss of autonomy. The Comprehensive Geriatric Assessment (CGA is a validated and recommended instrument for multidimensional evaluation of the aged. Nonetheless, it has yet to be assessed in demented patients. Objectives: To analyze the functional, emotional and clinical status in elderly with dementia measured by the CGA. We also compared the results obtained in the same patients stratified for severity of dementia. Methods: Transversal study with demented elderly outpatients. Subjects were evaluated by the CGA consisting of clinical data, Clinical Dementia Rating, performance-oriented mobility assessment of gait and balance (POMA, Cornell scale for depression, activities of daily living, Mini Mental Status Examination (MMSE, Mini Nutritional Assessment, Whispered and Snellen Test. Results: Fifty-two patients with mean age of 77 years were evaluated. Majority of patients had Alzheimer disease (77%. Depression was the most prevalent comorbidity. The POMA score was related to the number of falls in the previous year. Also, there was correlation between complaints of visual and hearing impairment and the results on the Snellen and Whispered Tests. Regarding severity, 56% presented mild, 33% moderate and 11% severe condition. Patients with moderate/severe dementia had less leisure activities, greater risk of falls, along with worse performance on the MMSE, POMA and activities of daily living. Conclusions: The CGA was applied in demented elderly with the help of their caregivers, and was able to better characterize patient state of health. Subjects with moderate/severe dementia obtained poor results in several assessed criteria.
Hefner, Gudrun; Stieffenhofer, Viktoria; Gabriel, Susanne; Palmer, Gerlind; Müller, Kay-Maria; Röschke, Joachim; Hiemke, Christoph
Potentially inappropriate medication (PIM) is suggested to give rise to adverse drug events. To study this suggestion for elderly psychiatric patients, an observational analysis related prescription of PRISCUS PIMs and drug-induced side effects in old aged (≥65 years) psychiatric inpatients and outpatients under conditions of everyday pharmacotherapy. Request forms from a therapeutic drug monitoring (TDM) survey and medical files were screened for medication to identify PIMs of the PRISCUS list and assessed using the Udvalg for Kliniske Undersøgelser (UKU) side effect rating scale. From 914 TDM request forms, data were available for 168 patients (64.3 % female). Patients (mean ± SD age 73.0 ± 5.5 years) received by mean 6.4 ± 3.9 drugs per day. More than half of them (53.0 %, n = 89) had at least one PIM, inpatients 0.9 ± 0.8 and outpatients 0.5 ± 0.7. Predominant PIMs were hypnotic drugs (69 %) in inpatients and antipsychotic drugs (35.6 %) in outpatients. The number of PIMs correlated with the total number of drugs administered per day (Spearman correlation coefficient 0.225, p 0.05) with number of PIMs. However, only 6 of 77 patients who took no PRISCUS PIMs but 2 of 3 patients who took 3 PRISCUS PIMs exhibited severe side effects. Though the prevalence for PIMs and side effects was high in old aged psychiatric inpatients and outpatients, PIMs could not be identified as major determinants of overall unwanted side effects. Nevertheless, prescription of PIMs should be minimized, especially of hypnotic drugs, to improve safety.
Corradi-Webster, Clarissa Mendonça; Gherardi-Donato, Edilaine Cristina da Silva
to examine the factors associated with problematic drug use among psychiatric outpatients. a cross-sectional study was carried out in two mental health services. Eligible individuals were patients of these mental health services, who used them within the data collection period. Instruments: standardized questionnaire with sociodemographic, social network, social harm, and clinical information; Alcohol, Smoking and Substance Involvement Screening Test; Barratt Impulsiveness Scale; Holmes and Rahe Stress Scale. Statistical analysis was performed using parametric statistics considering a significance level of p ≤ 0.05. Study participants were 243 patients, with 53.9% of these presenting problematic drug use. the most important independent predictors of problematic drug use were marital status (OR = 0.491), religious practice (OR = 0.449), satisfaction with financial situation (OR = 0.469), having suffered discrimination (OR = 3.821) and practicing sports activities in previous 12 months (OR = 2.25). the variables found to be predictors were those related to the social context of the patient, there, it is recommended that mental health services valorize psychosocial actions, seeking to know the social support network of patients, their modes of socialization, their financial needs, and their experiences of life and suffering. analisar os fatores associados ao consumo problemático de droga entre pacientes psiquiátricos ambulatoriais. estudo transversal em dois serviços de saúde mental. Foram considerados indivíduos elegíveis os usuários desses serviços de saúde mental, que os utilizaram dentro do período de coleta de dados. Instrumentos: Questionário padronizado sobre dados sociodemográficos, redes sociais, prejuízos sociais e informações clínicas; Teste de Triagem do Envolvimento com Álcool, Cigarro e outras Substâncias (ASSIST); Escala de Impulsividade de Barratt; e Escala de Avaliação de Reajustamento Social de Holmes e Rahe. A análise estat
Methods: A socio-demographic data questionnaire was administered on consecutive out patients of the Federal Psychiatric Hospital, Calabar. Male patients were also given the International Index of Erectile Function (IEEF) while female patients were given the Female Sexual Function Index (FSFI). The same questionnaires ...
Chandraiah, Shambhavi; Ainlay Anand, Susan; Avent, Lindsay Cherryl
This study evaluated the potential benefit of weekly group art therapy in groups of adult psychiatric outpatients at a university medical center. Eighteen patients participated in 4 successive 8-week groups of 6 to 8 patients each that met weekly and were led by 2 therapists (a board-certified art therapist and a psychiatry resident). The…
This study reviews the quality of outpatient care provided by the psychiatric service in the Mhala district of Northern Transvaal. A retrospective survey of 488 patient cards was undertaken at the end of 1989. Diagnoses showed a high proportion of epileptic (48%) and schizophrenic (22%) disorders, but few mood disorders ...
Øhre, Beate; Uthus, Mette Perly; von Tetzchner, Stephen; Falkum, Erik
Deaf and hard-of-hearing persons are at risk for experiencing traumatic events and such experiences are associated with symptoms of mental disorder. We investigated the prevalence of traumatic events and subsequent traumatization in adults referred to specialized psychiatric outpatient units for deaf and hard-of-hearing patients. Sixty-two…
E.C. Jochems (Eline)
textabstractThe main aim of the current thesis was to empirically test and compare three current theoretical models of motivation for treatment in the context of outpatient psychiatric care for patients with severe mental illness (SMI). In a literature review (Chapter 2), we argued that
Jantsje H Pasma
Full Text Available OBJECTIVES: Assessment of the association of blood pressure measurements in supine and standing position after a postural change, as a proxy for blood pressure regulation, with standing balance in a clinically relevant cohort of elderly, is of special interest as blood pressure may be important to identify patients at risk of having impaired standing balance in routine geriatric assessment. MATERIALS AND METHODS: In a cross-sectional cohort study, 197 community-dwelling elderly referred to a geriatric outpatient clinic of a middle-sized teaching hospital were included. Blood pressure was measured intermittently (n = 197 and continuously (subsample, n = 58 before and after a controlled postural change from supine to standing position. The ability to maintain standing balance was assessed during ten seconds of side-by-side, semi-tandem and tandem stance, with both eyes open and eyes closed. Self-reported impaired standing balance and history of falls were recorded by questionnaires. Logistic regression analyses were used to examine the association between blood pressure and 1 the ability to maintain standing balance; 2 self-reported impaired standing balance; and 3 history of falls, adjusted for age and sex. RESULTS: Blood pressure decrease after postural change, measured continuously, was associated with reduced ability to maintain standing balance in semi-tandem stance with eyes closed and with increased self-reported impaired standing balance and falls. Presence of orthostatic hypotension was associated with reduced ability to maintain standing balance in semi-tandem stance with eyes closed for both intermittent and continuous measurements and with increased self-reported impaired standing balance for continuous measurements. CONCLUSION: Continuous blood pressure measurements are of additional value to identify patients at risk of having impaired standing balance and may therefore be useful in routine geriatric care.
Ritsher, Jennifer Boyd; Phelan, Jo C
Stigma in society causes harm to people with severe mental illness (SMI) and internalized stigma represents its psychological point of impact. We evaluated the extent of internalized stigma in a sample of outpatients with SMI, using the Internalized Stigma of Mental Illness (ISMI) Scale, developed with consumer input. About a third of the sample reported high levels of internalized stigma. We tested whether internalized stigma predicted increased depressive symptoms and reduced self-esteem at 4-month follow-up, controlling for baseline levels. Depression was predicted by Alienation, Stereotype Endorsement, Social Withdrawal Scales and total ISMI score. Reduced self-esteem was predicted by Alienation. ISMI results were stronger than those for the widely used Devaluation-Discrimination Scale. The finding that alienation further reduces morale speaks to the difficulty of pulling oneself out of this type of vicious cycle without assistance.
Laudisio, Alice; Costanzo, Luisa; Di Gioia, Claudia; Delussu, Anna Sofia; Traballesi, Marco; Gemma, Antonella; Antonelli Incalzi, Raffaele
Chronic obstructive pulmonary disease (COPD) is often associated with malnutrition, which is in turn associated with poor outcomes. Accordingly, in COPD patients adequate nutrition might improve several clinical and functional outcomes. Nevertheless, information about nutrient intake of older populations with COPD is still scanty. We analysed data of 523 elderly attending a geriatric ambulatory. Of these, 165 had a diagnosis of COPD, while 358 were control participants, matched for demographic characteristics and free from respiratory diseases. COPD was diagnosed according to the global initiative for chronic obstructive lung disease (GOLD) criteria. The intake of micro and macronutrients was recorded using the European prospective investigation into cancer and nutrition (EPIC) questionnaire. Nutrient intake of COPD patients was compared with that of the control group and with recommended dietary allowances RDA. COPD patients had a lower energy intake, as compared with control participants (29.4 vs 34.4 kcal/kg of ideal weight; Pelderly COPD outpatients does not provide the recommended energy intake, nor does it meet the RDA for many micronutrients. Such deficits are more severe than in age matched non- respiratory subjects. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Valdes-Stauber, J; Putzhammer, A; Kilian, R
Psychiatric outpatient clinics (PIAs) are an indispensable care service for crisis intervention and multidisciplinary treatment of people suffering from severe and persistent mental disorders. The decentralization of outpatient clinics can be understood as a further step in the deinstitutionalization process. This cross-sectional study (n=1,663) compared the central outpatient clinic with the decentralized teams for the year 2010 by means of analyses of variance, χ(2)-tests and robust multivariate regression models. The longitudinal assessment (descriptively and by means of Prais-Winsten regression models for time series) was based on all hospitalizations for the two decentralized teams (n = 6,693) according to partial catchment areas for the time period 2002-2010 in order to examine trends after their installation in the year 2007. Decentralized teams were found to be similar with respect to the care profile but cared for relatively more patients suffering from dementia, addictive and mood disorders but not for those suffering from schizophrenia and personality disorders. Decentralized teams showed less outpatient care costs as well as psychopharmacological expenses but a lower contact frequency than the central outpatient clinic. Total expenses for psychiatric care were not significantly different and assessed hospitalization variables (e.g. total number of annual admissions, cumulative length of inpatient-stay and annual hospitalizations per patient) changed slightly 3 years after installation of the decentralized teams. The number of admissions of people suffering from schizophrenia decreased whereas those for mood and stress disorders increased. Decentralized outpatient teams seemed to reach patients in rural regions who previously were not reached by the central outpatient clinic. Economic figures indicate advantages for the installation of such teams because care expenses are not higher than for patients treated in centralized outpatient clinics and
choose the proper therapy is mandatory for all these cases. Dermatologists and all physicians who take care of old patients must recognize the disorder in order to provide optimum care for this chronic condition. We emphasize therefore the importance of psychiatric evaluation and treatment to avoid the major risk of suicide. Skin lesions must be regarded as an alarm signal in critical cases, especially in senior people. Keywords: pathomimia, elderly, psychiatric disorders
Sripada, Rebecca K; Bowersox, Nicholas W; Ganoczy, Dara; Valenstein, Marcia; Pfeiffer, Paul N
The objective of this study was to assess whether the constructs of self-determination theory-autonomy, competence, and relatedness-are associated with adherence to outpatient follow-up appointments after psychiatric hospitalization. 242 individuals discharged from inpatient psychiatric treatment within the Veterans Health Administration completed surveys assessing self-determination theory constructs as well as measures of depression and barriers to treatment. Medical records were used to count the number of mental health visits and no-shows in the 14 weeks following discharge. Logistic regression models assessed the association between survey items assessing theory constructs and attendance at mental healthcare visits. In multivariate models, none of the self-determination theory factors predicted outpatient follow-up attendance. The constructs of self-determination theory as measured by a single self-report survey may not reliably predict adherence to post-hospital care. Need factors such as depression may be more strongly predictive of treatment adherence.
Wöckel, Lars; Goth, Kirstin; Matic, Nina; Zepf, Florian Daniel; Holtmann, Martin; Poustka, Fritz
The majority of adult patients with borderline personality disorder (BPD) are treated with psychotropic drugs. However, there are no data on psychotropic therapy in adolescents. This study examines the prevalence of BPD in an adolescent population undergoing either inpatient or outpatient psychiatric treatment and assesses psychotropic prescription patterns in adolescent in- and outpatients with BPD. Out of a population of adolescents undergoing psychiatric treatment over a seven-year observation period, 58 adolescent patients with BPD (16.7 +/- 2.5 years) were investigated retrospectively with regard to their first episode of treatment, type of medication, and different risk variables. Out of the investigated population, 37 inpatients and 21 outpatients received treatment. Inpatients were shown to have higher rates of risk variables (approx. 68% with co-morbid disorders and approx. 49% with self-harmful behaviour, significantly (p NaSSA) were most commonly prescribed, followed by neuroleptics. More than 50% of the medicated patients were treated with multiple psychotropic drugs administered simultaneously. Pharmacotherapy in BPD has a high and increasing therapeutic value, with the prescription of psychotropic drugs being primarily symptom-orientated. Pharmacotherapy of co-morbid disorders should be accorded equal treatment priority. In line with this, psychotropic treatment of BPD in adolescents is increasingly important. Inpatient adolescents are more burdened in terms of psychiatric risk variables, and also receive medication more often.
Kidson, M A; Douglas, J C; Holwill, B J
To ascertain the frequency of post-traumatic stress disorder (PTSD) in World War II veterans attending a psychiatric outpatient clinic in an Australian veterans' hospital and to compare veterans with and without PTSD according to certain psychological variables. Over a three-month period veterans were assessed at their next appointment by their treating doctors (psychiatrists or psychiatric registrars) for PTSD according to the criteria of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III-R). At the same time they completed two questionnaires and provided information about their war experiences. The psychiatric outpatient department at Heidelberg Repatriation Hospital, Melbourne. One hundred and twenty World War II veterans attended during the three-month period and 108 (90%) agreed to participate and are included in this study. The treating doctors recorded the presence or absence and severity of veterans' symptoms of PTSD. The General Health Questionnaire (GHQ-60) and the Impact of Events Scale (IES) were then completed by participants under supervision. Forty-nine veterans (45%) were found to have active PTSD 45 years after the war. The presence of PTSD was significantly associated with the taking of casualties (an indicator of severity of war stress as reported by the veterans themselves) and with combat stress as rated by their treating doctors. The veterans with PTSD obtained significantly higher scores on both the GHQ-60 and the IES, and reported no significant reduction in symptoms of PTSD over the preceding 10 years. The presence of both an anxiety and a depressive disorder was substantially and significantly more common in the veterans who had PTSD. Overall, the study revealed a high frequency of PTSD and a strong persistence of this condition in psychiatric outpatients who were veterans of World War II.
Jochems, Eline C; Mulder, Cornelis L; Duivenvoorden, Hugo J; van der Feltz-Cornelis, Christina M; van Dam, Arno
Self-determination theory is potentially useful for understanding reasons why individuals with mental illness do or do not engage in psychiatric treatment. The current study examined the psychometric properties of three questionnaires based on self-determination theory-The Treatment Entry Questionnaire (TEQ), Health Care Climate Questionnaire (HCCQ), and the Short Motivation Feedback List (SMFL)-in a sample of 348 Dutch adult outpatients with primary diagnoses of mood, anxiety, psychotic, and personality disorders. Structural equation modeling showed that the empirical factor structures of the TEQ and SMFL were adequately represented by a model with three intercorrelated factors. These were interpreted as identified, introjected, and external motivation. The reliabilities of the Dutch TEQ, HCCQ, and SMFL were found to be acceptable but can be improved on; congeneric estimates ranged from 0.66 to 0.94 depending on the measure and patient subsample. Preliminary support for the construct validities of the questionnaires was found in the form of theoretically expected associations with other scales, including therapist-rated motivation and treatment engagement and with legally mandated treatment. Additionally, the study provides insights into the relations between measures of motivation based on self-determination theory, the transtheoretical model and the integral model of treatment motivation in psychiatric outpatients with severe mental illness. © The Author(s) 2013.
Biehl, Michelle; Takahashi, Paul Y; Cha, Stephen S; Chaudhry, Rajeev; Gajic, Ognjen; Thorsteinsdottir, Bjorg
Rationale Identifying patients at high risk of critical illness is necessary for the development and testing of strategies to prevent critical illness. The aim of this study was to determine the relationship between high elder risk assessment (ERA) score and critical illness requiring intensive care and to see if the ERA can be used as a prediction tool to identify elderly patients at the primary care visit who are at high risk of critical illness. Methods A population-based historical cohort study was conducted in elderly patients (age >65 years) identified at the time of primary care visit in Rochester, MN, USA. Predictors including age, previous hospital days, and comorbid health conditions were identified from routine administrative data available in the electronic medical record. The main outcome was critical illness, defined as sepsis, need for mechanical ventilation, or death within 2 years of initial visit. Patients with an ERA score of 16 were considered to be at high risk. The discrimination of the ERA score was assessed using area under the receiver operating characteristic curve. Results Of the 13,457 eligible patients, 9,872 gave consent for medical record review and had full information on intensive care unit utilization. The mean age was 75.8 years (standard deviation ±7.6 years), and 58% were female, 94% were Caucasian, 62% were married, and 13% were living in nursing homes. In the overall group, 417 patients (4.2%) suffered from critical illness. In the 1,134 patients with ERA >16, 154 (14%) suffered from critical illness. An ERA score ≥16 predicted critical illness (odds ratio 6.35; 95% confidence interval 3.51–11.48). The area under the receiver operating characteristic curve was 0.75, which indicated good discrimination. Conclusion A simple model based on easily obtainable administrative data predicted critical illness in the next 2 years in elderly outpatients with up to 14% of the highest risk population suffering from critical illness
Orestes Vicente Forlenza
Full Text Available CONTEXT: Most double-blind studies of efficacy and tolerability of sertraline as compared to tricyclics in the treatment of late-life major depression have used amitriptyline as a standard, leading to the inevitable conclusion that the former drug is better tolerated than the latter, with both being equally efficacious. OBJECTIVE: To compare the antidepressant efficacy and tolerability of sertraline (50 mg/day and imipramine (150 mg/day in the first 6 weeks of the treatment of major depression in the elderly. DESIGN: A randomized double-blind parallel study with 6 weeks of follow-up. SETTING: The psychogeriatric clinic at the Institute of Psychiatry, Hospital das Clínicas, Faculty of Medicine of the University of São Paulo. PARTICIPANTS: 55 severe and moderately depressed non-demented outpatients aged 60 years or more. INTERVENTION: Patients were assigned to sertraline 50 mg/day or imipramine 150 mg/day. MAIN MEASUREMENTS: CAMDEX interview. Psychiatric diagnosis followed the guidelines for "Major Depressive Episode" according to DSM-IV criteria. Severity of symptoms was evaluated using the "CGI" and "MADRS" scales. Cognitive state was assessed using the Mini-Mental State Examination. Side effects were assessed using the "Safetee-Up" schedule. RESULTS: Both groups had a significant decrease in depressive symptoms according to the MADRS scores after 6 weeks of treatment (P = 0.01. No significant differences between groups were detected regarding treatment outcome (t = 0.4; P = 0.7. Although the dropout rate was greater in the imipramine group, the overall tolerability among patients who completed the 6-week trial was similar in both test groups. CONCLUSIONS: Both sertraline and imipramine exhibited good efficacy and an acceptable side-effect profile for elderly depressed patients after 6 weeks of antidepressant treatment.
Degli Stefani, Mario; Biasutti, Michele
Objective: Framed in the patients’ engagement perspective, the current study aims to determine the effects of group music therapy in addition to drug care in comparison with drug care in addition to other non-expressive group activities in the treatment of psychiatric outpatients. Method: Participants (n = 27) with ICD-10 diagnoses of F20 (schizophrenia), F25 (schizoaffective disorders), F31 (bipolar affective disorder), F32 (depressive episode), and F60 (specific personality disorders) were randomized to receive group music therapy plus standard care (48 weekly sessions of 2 h) or standard care only. The clinical measures included dosages of neuroleptics, benzodiazepines, mood stabilizers, and antidepressants. Results: The participants who received group music therapy demonstrated greater improvement in drug dosage with respect to neuroleptics than those who did not receive group music therapy. Antidepressants had an increment for both groups that was significant only for the control group. Benzodiazepines and mood stabilizers did not show any significant change in either group. Conclusion: Group music therapy combined with standard drug care was effective for controlling neuroleptic drug dosages in adult psychiatric outpatients who received group music therapy. We discussed the likely applications of group music therapy in psychiatry and the possible contribution of music therapy in improving the psychopathological condition of adult outpatients. In addition, the implications for the patient-centered perspective were also discussed. PMID:27774073
Degli Stefani, Mario; Biasutti, Michele
Objective: Framed in the patients' engagement perspective, the current study aims to determine the effects of group music therapy in addition to drug care in comparison with drug care in addition to other non-expressive group activities in the treatment of psychiatric outpatients. Method: Participants ( n = 27) with ICD-10 diagnoses of F20 (schizophrenia), F25 (schizoaffective disorders), F31 (bipolar affective disorder), F32 (depressive episode), and F60 (specific personality disorders) were randomized to receive group music therapy plus standard care (48 weekly sessions of 2 h) or standard care only. The clinical measures included dosages of neuroleptics, benzodiazepines, mood stabilizers, and antidepressants. Results: The participants who received group music therapy demonstrated greater improvement in drug dosage with respect to neuroleptics than those who did not receive group music therapy. Antidepressants had an increment for both groups that was significant only for the control group. Benzodiazepines and mood stabilizers did not show any significant change in either group. Conclusion: Group music therapy combined with standard drug care was effective for controlling neuroleptic drug dosages in adult psychiatric outpatients who received group music therapy. We discussed the likely applications of group music therapy in psychiatry and the possible contribution of music therapy in improving the psychopathological condition of adult outpatients. In addition, the implications for the patient-centered perspective were also discussed.
Mario Degli Stefani
Full Text Available Objective: Framed in the patients’ engagement perspective, the current study aims to determine the effects of group music therapy in addition to drug care in comparison with drug care in the treatment of psychiatric outpatients. Method: Participants (n = 27 with ICD-10 diagnoses of F20 (schizophrenia, F25 (schizoaffective disorders, F31 (bipolar affective disorder, F32 (depressive episode and F60 (specific personality disorders were randomised to receive group music therapy plus standard care (48 weekly sessions of two hours or standard care only. The clinical measures included dosages of neuroleptics, benzodiazepines, mood stabilisers and antidepressants. Results: The participants who received group music therapy demonstrated greater improvement in drug dosage relative to neuroleptics than those who did not receive group music therapy. Antidepressants had an increment for both groups that was significant only for the control group. Benzodiazepines and mood stabilisers did not show any significant change in either group. Conclusions: Group music therapy combined with standard drug care is effective for controlling neuroleptic drug dosages in adult psychiatric outpatients who received group music therapy. We discuss the likely applications of group music therapy in psychiatry and the possible contribution of music therapy in improving the psychopathological condition of adult outpatients. In addition, the implications for the patient-centred perspective were also discussed.
Henrichs, Jens; Bogaerts, Stefan; Sijtsema, Jelle; Klerx-van Mierlo, Fanny
This study investigated criminological, psychopathological, and victimological profiles of intimate partner violence (IPV) perpetrators in a sample of 119 Dutch female and male forensic psychiatric outpatients aged 18 to 58 years. In addition, differences in criminological, psychopathological, and victimological factors between IPV perpetrators (n = 61, 51.3%) and non-intimate violence (NIV) perpetrators (n = 58, 48.7%) were examined. All data, including information on demographics, criminal history, history of psychological, sexual, and physical victimization during childhood or adolescence, family history of psychopathology, history of psychopathology in childhood and adolescence, and mental disorders, were derived from archival electronic medical records. Mental disorders were measured using structured psychiatric interviews and final consensus diagnoses were established during weekly case consultations. Both IPV and NIV perpetrators displayed high rates of criminal history, psychopathology, and previous victimization, but the two groups did not differ in these factors with two exceptions. IPV perpetrators were significantly more likely to have higher rates of previous physical victimization and intermittent explosive disorder than NIV perpetrators. The current study suggests that a history of physical victimization and intermittent explosive disorder are specific characteristics of IPV perpetrators in a forensic psychiatric outpatient setting. Future research should focus on mechanisms explaining the association of childhood victimization and IPV and increase our understanding of the role of intermittent explosive disorder in IPV. © The Author(s) 2014.
Palumbo, Piergaspare; Amatucci, Chiara; Perotti, Bruno; Zullino, Antonio; Dezzi, Claudia; Illuminati, Giulio; Vietri, Francesco
Elective inguinal hernia repair as a day case is a safe and suitable procedure, with well-recognized feasibility. The increasing number of elderly patients requiring inguinal hernia repair leads clinicians to admit a growing number of outpatients. The aim of the current study was to analyze the outcomes (feasibility and safety) of day case treatment in elderly patients. Eighty patients >80 years of age and 80 patients ≤55 years of age underwent elective inguinal hernia repairs under local anesthesia. There were no mortalities or major complications in the elderly undergoing inguinal herniorraphies as outpatients, and only one unanticipated admission occurred in the younger age group. Elective inguinal hernia repair in the elderly has a good outcome, and age alone should not be a drawback to day case treatment. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
Tseng, Ming-Hseng; Wu, Hui-Ching
Drug is an important part of disease treatment, but medication errors happen frequently and have significant clinical and financial consequences. The prevalence of prescription medication use among the ambulatory adult population increases with advancing age. Because of the global aging society, outpatients need to improve medication safety more than inpatients. The elderly with multiple chronic conditions face the complex task of medication management. To reduce the medication errors for the elder outpatients with chronic diseases, a cloud medication safety supporting system is designed, demonstrated and evaluated. The proposed system is composed of a three-tier architecture: the front-end tier, the mobile tier and the cloud tier. The mobile tier will host the personalized medication safety supporting application on Android platforms that provides some primary functions including reminders for medication, assistance with pill-dispensing, recording of medications, position of medications and notices of forgotten medications for elderly outpatients. Finally, the hybrid technology acceptance model is employed to understand the intention and satisfaction level of the potential users to use this mobile medication safety support application system. The result of the system acceptance testing indicates that this developed system, implementing patient-centered services, is highly accepted by the elderly. This proposed M-health system could assist elderly outpatients' homecare in preventing medication errors and improving their medication safety.
receiver operating characteristic curve was 0.75, which indicated good discrimination. Conclusion: A simple model based on easily obtainable administrative data predicted critical illness in the next 2 years in elderly outpatients with up to 14% of the highest risk population suffering from critical illness. This model can facilitate efficient enrollment of patients into clinical programs such as care transition programs and studies aimed at the prevention of critical illness. It also can serve as a reminder to initiate advance care planning for high-risk elderly patients. External validation of this tool in different populations may enhance its generalizability. Keywords: aged, prognostication, critical care, mortality, elder risk assessment
Pereira, Luis; Budovich, Aliaksandr; Claudio-Saez, Maria
Atypical antipsychotics are associated with metabolic complications that contribute to a higher risk of cardiovascular disease. Current evidence reveal suboptimal adherence to the complex and variable official recommendations on metabolic monitoring in the corresponding patient population. A study evaluating metabolic monitoring at guideline-recommended intervals may help identify areas for intervention. Describe the frequency of monitoring metabolic adverse effects in patients receiving atypical antipsychotics in an outpatient psychiatric clinic with respect to the specific guideline-recommended intervals. A retrospective chart review was conducted in the outpatient psychiatric clinic. The primary outcome measure was the percentage of patients monitored for metabolic parameters at the current guideline-recommended intervals. The secondary end points were the percentage of patients with documented primary care physician, untreated metabolic comorbidities, and treated metabolic comorbidities by disease state. The most assessed parameters were family history (98%), blood pressure (81%), and body mass index/body weight (83%) at the baseline interval. The least assessed parameters were lipids (14%) at the 12-week interval and waist circumference (0%) at any interval. Interventions are needed to encourage higher compliance with current recommendations. The complexity of the recommendations is the most likely reason for the suboptimal compliance.
Kamışlı, Songül; Dil, Satı; Daştan, Leyla; Eni, Nurhayat
In this study, we investigated whether liberty-restricting and other factors can predict internalized stigma among psychiatric inpatients and outpatients. The study sample comprised of 129 inpatients, admitted at least once to psychiatry ward, and 100 outpatients who have never been hospitalized, receiving psychiatric treatment. In addition to demographic and clinical features, patients were evaluated for perceived deprivation of liberty and internalized stigma levels. Patients stated that their liberty was restrained mostly due to involuntary treatment, communication problems, side effects of medical treatment and inability to choose their treatment team. Regression analysis showed that internalized stigma was predicted by perceived deprivation of liberty, marital status and number of admissions to ward. Stigma was related to marital status and admissions to the psychiatry ward. Perceived deprivation of liberty predicts stigma regardless of the disease severity CONCLUSION: Perception of stigma leads to self-isolation, behavioral avoidance and refusal of aid-seeking. Our study indicated that perceived deprivation of liberty is one of the most important factors that lead to increased stigma. Based on our findings, we can say that as patients experience less perceived deprivation of liberty, they would have less stigma and thus, their compliance would increase.
Kuo, Ren-Jieh; Wu, Yung-Hung; Hsu, Tsung-Shin; Chen, Liang-Kung
The rapid pace of population aging poses significant importance of establishing an age-friendly health care system, including outpatient, inpatient, intermediate, and long-term care. The main purpose of this study is to evaluate the quality of outpatient services for elderly patients in Taiwan. Quality function deployment (QFD) is a tool effectively shortening the research-and-development period, reducing costs, and fulfilling customer needs (CNs). This study applied Kano's model and the analytic network process (ANP) to improve the basic framework of QFD. Kano's model enables a thorough understanding of elderly patients' needs and problems with regard to medical care services, so that appropriate outpatient services can be offered to them from the outset. In addition, adapting the supermatrix of ANP to the calculation of the house of quality (HoQ) will reduce subjective judgments. Using Kano's model and an integrated ANP-QFD approach, we extracted five needs of elderly patients and calculated their priorities: 'Professional medical care services convincing patients' (27%), 'With sufficient knowledge to answer patients' questions' (23.5%), 'Providing fast services to solve patients' problems' (19.3%), 'Voluntarily serving patients' (19.1%), and 'Providing proper medical equipment to patients' (11.1%). We then identified six outpatient service attributes deserving of improvement and their priorities: 'Physician with a high level of professionalism and giving clear interpretation of patient's condition' (25%), 'Staff with good communication skills and assistance to patients' (22%), 'High standardization of operating procedures' (18%), 'Staff getting on-the-job training periodically' (15%), 'Facilities sufficient and fitting for elderly patients' (10%), and 'Applying IT (internet) to help patients to receive medical care' (10%). In conclusion, we reconstructed an integrated QFD model which will not only reduce costs but also reveal the crucial outpatient service items
Ricardo-Ramírez, Carmenza; Álvarez-Gómez, Matilde; Rodríguez-Gázquez, María de los Ángeles
Mental disorders in the world affecting 15% to 30% in children and adolescents, altering its function and emotional, cognitive and social. Affect interpersonal relationships, school performance and increased substance use and the risk of suicide. describe the social-demographic characteristics and mental disorders of children and adolescents of psychiatric consultation. Retrospective descriptive study that analyzed all the histories of children and adolescents of both sexes from 5 to 16 years who attended for the first time outpatient psychiatry university clinic of Medellin, from July 2010 to July 2012. We studied 197 patients, the average age was 11±3.5 years, male sex was the most common 69%, 46.2% belonged to nuclear family. The most prevalent psychiatric disorders were 44.2% ADHD, depressive disorders 9.1% and 8.1% TOC. 61% had psychiatric comorbidity, the most frequent was oppositional defiant disorder with ADHD 35.6%. The frequency of mental disorders and comorbidities found in this study were similar to those reported by other researchers. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.
Guo, Chao; Wang, Zhenjie; Li, Ning; Chen, Gong; Zheng, Xiaoying
To estimate the prevalence of, and association between, co-morbid visual and psychiatric disabilities among elderly (>65 years-of-age) persons in China. Random representative samples were obtained using multistage, stratified, cluster sampling, with probabilities proportional to size. Standard weighting procedures were used to construct sample weights that reflected this multistage, stratified cluster sampling survey scheme. Logistic regression models were used to elucidate associations between visual and psychiatric disabilities. Among the Chinese elderly, >160,000 persons have co-morbid visual and psychiatric disabilities. The weighted prevalence among this cohort is 123.7 per 100,000 persons. A higher prevalence of co-morbid visual and psychiatric disabilities was found in the oldest-old (pvisual disability was significantly associated with a higher risk of having a psychiatric disability among persons aged ≥80 years-of-age [adjusted odds ratio, 1.24; 95% confidence interval (CI), 1.03-1.54]. A significant number of Chinese elderly persons were living with co-morbid visual and psychiatric disabilities. To address the challenge of these co-morbid disorders among Chinese elders, it is incumbent upon the government to implement additional and more comprehensive prevention and rehabilitation strategies for health-care systems, reinforce health promotion among the elderly, and improve accessibility to health-care services.
Roberta Katz Abela
Full Text Available The Dimensional Clinical Personality Inventory (IDCP was developed in Brazil for the assessment of pathological personality traits. This study aimed to seek validity evidence for the dimensions of IDCP based on external criteria, psychiatric diagnosis. We examined the profile in IDCP of 105 psychotherapy outpatients, previously diagnosed with personality disorders. The profiles were compared with the profile of the normative non-clinical sample and we conducted the repeated measures analysis to investigate whether the IDCP is able to discriminate consistent profiles for different diagnoses and compared the general population. The results suggest validity evidence based on external criteria for the IDCP dimensions and points to the clinical effectiveness of the instrument.
Sar, Vedat; Onder, Canan; Kilincaslan, Ayse; Zoroglu, Süleyman S; Alyanak, Behiye
The aim of this study was to determine the prevalence of dissociative identity disorder (DID) and other dissociative disorders among adolescent psychiatric outpatients. A total of 116 consecutive outpatients between 11 and 17 years of age who were admitted to the child and adolescent psychiatry clinic of a university hospital for the 1st time were evaluated using the Adolescent Dissociative Experiences Scale, adolescent version of the Child Symptom Inventory-4, Childhood Trauma Questionnaire, and McMaster Family Assessment Device. All patients were invited for an interview with the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) administered by 2 senior psychiatrists in a blind fashion. There was excellent interrater reliability between the 2 clinicians on SCID-D diagnoses and scores. Among 73 participants, 33 (45.2%) had a dissociative disorder: 12 (16.4%) had DID, and 21 (28.8%) had dissociative disorder not otherwise specified. There was no difference in gender distribution, childhood trauma, or family dysfunction scores between the dissociative and nondissociative groups. Childhood emotional abuse and family dysfunction correlated with self-reported dissociation. Of the dissociative adolescents, 93.9% had an additional psychiatric disorder. Among them, only separation anxiety disorder was significantly more prevalent than in controls. Although originally designed for adults, the SCID-D is promising for diagnosing dissociative disorders in adolescents, its modest congruence with self-rated dissociation and lack of relationship between diagnosis and childhood trauma and family dysfunction suggest that the prevalence rates obtained with this instrument originally designed for adults must be replicated. The introduction of diagnostic criteria for adolescent DID in revised versions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, would refine the assessment of dissociative disorders in this age group.
Murakoshi, Akiko; Takaesu, Yoshikazu; Komada, Yoko; Ishikawa, Jun; Inoue, Yuichi
This study aimed to investigate the prevalence of the dependence for benzodiazepine or their agonist (BZDs) hypnotics, as well as factors associated with this dependence among Japanese psychiatric outpatients. One thousand and forty-three patients in the psychiatric outpatient clinic of Tokyo Medical University Hospital receiving treatment with BZDs hypnotics were analyzed. The subjects answered questionnaires including demographic variables, subjective sleep difficulty assessed by the Pittsburg Sleep Quality Index (PSQI), duration of hypnotics medication, dose of diazepam equivalent BZDs hypnotics, the presence or absence of subjective side effects due to BZDs hypnotics (dizziness, fatigue, daytime sleepiness, amnesia, and headache), and dependency assessed by the Dependency 2-A (D 2-A) score. Subjects with a D 2-A score ≥10 were considered as having BZDs hypnotics dependence, and the variables associated with the presence of dependence were examined using logistic regression analyses. Eighty-two out of the 1043 subjects (7.9%) were determined to have BZDs hypnotics dependence. Compared with the non-dependence group, the dependence group had a significantly higher proportion of positive respondents for all the side effects. Multiple logistic regression analyses showed that the dependence was significantly associated with younger age, higher total PSQI score, and higher daily dose of BZDs hypnotics. Younger age, higher total PSQI score, and higher dose may be associated with BZDs hypnotics dependence. The finding that patients with BZDs hypnotics dependence frequently suffered from subjective side effects and had greater sleep difficulty encourages the establishment of alternative treatments for patients with insomnia symptoms refractory to BZDs hypnotics treatment. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Karlsson, Linnea; Pelkonen, Mirjami; Ruuttu, Titta; Kiviruusu, Olli; Heilä, Hannele; Holi, Matti; Kettunen, Kirsi; Tuisku, Virpi; Tuulio-Henriksson, Annamari; Törrönen, Johanna; Marttunen, Mauri
To compare selected characteristics (age, sex, age of onset for depression, impairment, severity of depression, somatic comorbidity, and treatment status) of adolescents with currently comorbid and non-comorbid depression. A sample of 218 consecutive adolescent (13-19 years) psychiatric outpatients with depressive disorders, and 200 age- and sex-matched school-attending controls were interviewed for DSM-IV Axis I and Axis II diagnoses. Current comorbidity, most commonly with anxiety disorders, was equally frequent (>70%) in outpatients and depressed controls. Younger age (OR 0.20; 95% CI 0.08, 0.51) and male gender (OR 0.02; 95% CI 0.09, 0.55) were associated with concurrent disruptive disorders. Current comorbidity with substance use disorders (SUD) was independent of age (OR 1.13; 95% CI 0.51, 2.49) and sex (OR 0.51; 95% CI 0.22, 1.17). Personality disorders associated with older age (OR 2.06; 95% CI 1.10, 3.86). In multivariable logistic regression analysis, impairment (GAF
Carey, Michael P.; Carey, Kate B.; Maisto, Stephen A.; Gordon, Christopher M.; Schroder, Kerstin E. E.; Vanable, Peter A.
This study investigated the efficacy of a 10-session, HIV-risk-reduction intervention with 221 women and 187 men receiving outpatient psychiatric care for a mental illness. Patients were randomly assigned to the HIV intervention, a structurally equivalent substance use reduction (SUR) intervention, or standard care; they were assessed pre- and…
Full Text Available The short form of the Beck Depression Inventory (BDI-13 is useful for the screening and assessment of depression in clinical and research settings. The aim of the present study was to investigate the psychometric properties of the Persian (Farsi version of BDI-13 in an Iranian clinical sample. The sample consisted of 52 Iranian psychiatric outpatients who received services at psychiatric and psychological clinics at the School of Behavioral Sciences & Mental Health-Tehran Institute of Psychiatry, Iran University of Medical Sciences (IUMS in Tehran, Iran. The study examined the reliability, construct validity, and factor structure of the instrument. The instrument indicated good reliability with Cronbach’s alpha of .85 and strong construct validity based on moderate to strong positive correlations with other measures of mental health issues. Using a Principal Component Analysis and Varimax Rotation with Kaiser Normalization, three factors were identified and labeled Affective (F1, Somatic/Vegetative (F2, and Cognitive/Loss of Functioning (F3. The current factor structure suggests that depression is a multidimensional construct in an Iranian clinical sample. This study provides further evidence that the Persian version of the BDI-13 is a psychometrically sound instrument that can be used for clinical and research purposes in Iran.
Thaís Cano Miranda de Nóbrega
Full Text Available INTRODUCTION: Substantial medical research has established an inverse relationship between quality of life and illness. However, there exists minimal evidence for such a connection in the context of stable and controlled diseases. OBJECTIVE: We wished to correlate multimorbidity with quality of life for elderly patients who suffer from stable chronic diseases. METHODS: We used a tool to evaluate quality of life, namely World Health Organization quality of life-BRIEF, together with a scale of multimorbidity known as the Cumulative Illness Rating Scale - Geriatric Version. Furthermore, the quality of life data were correlated with scores recorded on the Cumulative Illness Rating Scale - Geriatric Version, the number of drugs used, and individual perceptions of health and age. RESULTS: We studied 104 elderly patients who suffered from chronic diseases. The patients had exhibited neither acute events nor secondary complications, their cognition was intact, and they were functionally independent. The Cumulative Illness Rating Scale - Geriatric Version showed an inverse correlation with the physical domain (p= 0.008 and a tendency toward an inverse correlation with the psychological domain (p= 0.052. Self-perception of health showed a high correlation with the physical domain (p= 0.000, psychological domain (p= 0.000 and environmental domain (p= 0.000. The number of drugs used correlated only with the physical domain (p= 0.004. Age and social domain showed a tendency toward a positive correlation (p= 0.054. DISCUSSION: We uncovered an inverse relationship between quality of life and multimorbidity in a group of patients who suffered from stable chronic diseases, with no functional limitations, pain or complications. Our data suggest that a patient's knowledge that they have a certain clinical condition changes their subjective assessment of quality of life in the related domain. CONCLUSION: The perceived quality of life of the sample was affected by
Over two-third elderly were having somatic (72.1%) and depression (68.2%) related symptoms of anger - hostility, cognition and anxiety. Paranoid and psychotic symptoms were noticed among 6.9% and 6.6% of elderly, respectively. Anxiety, depression, somatic, cognitive symptoms were more prevalent in females while ...
Conclusion: In this study, HFMEA was extended to explore the impacts of geriatric outpatient service process failures on elderly patients. Using fuzzy set theory and the TOPSIS method in multiple criteria decision making to rank the severity of the failure modes, the risk assessment of the geriatric outpatient service process was more objective when analyzed with quantitative data.
Full Text Available Urinary tract infections (UTI are considered to be the most frequent human infections. Elderly people are especially prone to those infections. The aim of this study was to compare the characteristics of UTI in elderly patients with patients younger than 65, and to find any possible differences in incidence and etiology between those two groups. Between 1 January and 31 October 2005 at the Zagreb Institute of Public Health 22046 urine samples from City of Zagreb and Zagreb region outpatients were cultivated. A total of 6,310 samples was collected from elderly patients (≥65 years. In elderly populations with UTI, male to female ratio was 1:1.7, while in patients younger than 65 years the ratio was 1:5. The difference in the incidence of UTI according to age and gender was observed. In elderly population the urinary tract pathogens showed significantly higher resistance rates to fluoroquinolones (p<0.01, whereas in male patients higher resistance rates were found to beta-lactams, aminoglicosides and cotrimoxazole as compared to women irrespective of age (p<0.01. In elderly persons changes in health also affect the features of UTI. There is a constant need to monitor the epidemiology and resistance of urinary tract pathogens to assure an appropriate antimicrobial therapy.
Sundararajan, L; Balami, J; Packham, S
Pulmonary rehabilitation (PR) has been shown to be an effective intervention in the management of patients with chronic obstructive pulmonary disease (COPD), but its role in elderly patients is not clearly defined. We investigated the effectiveness of rehabilitation in elderly patients with COPD. Patients underwent multidisciplinary PR in a hospital outpatient gym twice weekly for 6 weeks. Lung function, shuttle walk distance, breathlessness (using a 10-point Borg scale), and responses to the Chronic Respiratory Questionnaire (CRQ) were assessed before and after rehabilitation. Patients (N = 200; 131 male) were divided into 2 groups: group A, those 70 years or older (n = 102, mean age 76 years); and group B, those younger than 70 years (n = 98, mean age 61.4 years). Shuttle walk distance increased significantly (P Elderly patients with COPD gain similar improvements from PR as younger patients and should not be excluded from rehabilitation based on age alone.
Full Text Available Objectives: The psychiatric problems of pilgrims fromnon-Arabic speaking countries have not been investigatedsufficiently. The aim of this study was to investigate thefrequency of psychiatric disorders and socio-demographiccharacteristics of Turkish pilgrims in psychiatry departmentof Turkish Mecca Hospital.Methods: A detailed psychiatric interview was performedon 294 Turkish Pilgrims who attended the outpatient clinicof the psychiatric unit at the Turkish hospital in Mecca,Saudi Arabia, during 2008 Hajj period. Information wascollected by using a semi-structured form and the patients’diagnoses were done according to the DSM-IV-TRcriteria.Results: The study group consisted of 175 women (59.5% and 119 men (40.5 % with the mean age of 53.0±13years. A total of 71 % patients had not traveled abroadpreviously, and 60% had received a former psychiatrictreatment. The commonest disorders were found asdepression (26.5%, adjustment disorder with anxiety(16.3% and panic disorder (14% in the patients. Anxietydisorders alone or co-morbid with any other psychiatricdisorder were found in 49% of the patients. Nine percentof the patients had symptoms of acute psychosis, schizophrenia,dementia or mania which could prevent pilgrimsfrom performing Hajj rituals. Suicide attempt, alcohol andillicit drug use were not detected.Conclusions: Previous psychiatric admission and absenceof any foreign travel experience were commonamong Turkish pilgrims who had sought psychiatric helpduring the Hajj. Psychiatric disorders seems to be relatedwith older age, low educational level, and having previousmedical and psychiatric problems.
Demir, Nurhan; Yuruyen, Mehmet; Atay, Kadri; Yavuzer, Hakan; Hatemi, Ibrahim; Doventas, Alper; Erdincler, Deniz Suna; Dobrucalı, Ahmet
Data on the prevalence of fecal incontinence in elderly patients admitted to outpatient clinics in Turkey are scarce. The aim of this study was to assess the prevalence of fecal incontinence and the associated risk factors in the elderly outpatients. Patients 60 years and older admitted to a geriatrics outpatient clinic between October 2013 and March 2014 were included. Demographic characteristics, anthropometric measurements, marital status, educational status, parity (for females), fecal incontinence (FI), urinary incontinence (UI), constipation, comorbid conditions, and medications were recorded. FI assessment was based on the Fecal Incontinence Severity Index (FISI). A total of 364 patients (64.8% female, n = 236) with a mean age of 73.2 ± 8.1 years were enrolled in the study. The prevalence of FI was 9.9% (10.2% female, 9.4% male). UI was 42.6%. Co-occurrence of FI and UI was 7.4%. According to the FISI, the most frequent type of defecation was liquid stool (61.1%). While the predictive factors for FI were polypharmacy (standardized coefficient, [r] = 0.203, 95% confidence interval [CI] = 0.009-0.040, p = 0.002), UI (r = 0.134, 95% CI = 0.006-0.156, p = 0.035), and being married (r = 0.200, 95% CI = -0.088 to -0.020, p = 0.002) in females, those were UI (r = 0.306, 95% CI = 0.093-0.309, p incontinence and polypharmacy seem to be the most important risk factors for fecal incontinence. Fecal incontinence should be questioned in detail and evaluated using FISI in elderly outpatients.
Hayashi, N; Yamashina, M; Taguchi, H; Ishige, N; Igarashi, Y
Schizophrenic patient perceptions of treatment have clinical value and deserve detailed psychiatric investigation. The present study sought a model indicating statistically estimated cause-effect relationships of perceptions and psychotic symptomatology of outpatients with schizophrenia by applying a method of structural equation modeling. The perceptions included in this model were patient satisfaction with treatment, perceptions of their treating psychiatrists, and patient-role perception. Scores of Positive and Negative Syndrome Scale and poor insight measures were added to the model as possible influential factors. The constructed model revealed that the poor insight exerted a major influence on the patient-role perception that had small effects on the reliable therapist perception and the satisfaction. It was also shown that satisfaction was chiefly determined by the reliable therapist perception that was formed in the treatment relationship, rather independently of the other construct. These findings were valuable in terms of their implications for understanding the makeup of the perceptions and the strategy for interventions to improve them.
Blomqvist, Marjut; Sandgren, Anna; Carlsson, Ing-Marie; Jormfeldt, Henrika
It is well known that people with severe mental illness have a reduced life expectancy and a greater risk of being affected by preventable physical illnesses such as metabolic syndrome, cardiovascular disease and type 2 diabetes. There are still, however, only a few published studies focusing on what enables healthy living for this group. This study thus aimed to describe what enables healthy living among people with severe mental illness in psychiatric outpatient services. The data were collected in qualitative interviews (n = 16) and content analysis was used to analyze the data. The interviews resulted in an overall theme "Being regarded as a whole human being by self and others", which showed the multidimensional nature of health and the issues that enable healthy living among people with severe mental illness. Three categories emerged: (i) everyday structure (ii), motivating life events and (iii) support from significant others. The results indicate that a person with severe mental illness needs to be encountered as a whole person if healthy living is to be enabled. Attaining healthy living requires collaboration between the providers of care, help and support. Health care organizations need to work together to develop and provide interventions to enable healthy living and to reduce poor physical health among people with severe mental illness. © 2017 Australian College of Mental Health Nurses Inc.
Picco, Louisa; Pang, Shirlene; Lau, Ying Wen; Jeyagurunathan, Anitha; Satghare, Pratika; Abdin, Edimansyah; Vaingankar, Janhavi Ajit; Lim, Susan; Poh, Chee Lien; Chong, Siow Ann; Subramaniam, Mythily
This study aimed to: (i) determine the prevalence, socio-demographic and clinical correlates of internalized stigma and (ii) explore the association between internalized stigma and quality of life, general functioning, hope and self-esteem, among a multi-ethnic Asian population of patients with mental disorders. This cross-sectional, survey recruited adult patients (n=280) who were seeking treatment at outpatient and affiliated clinics of the only tertiary psychiatric hospital in Singapore. Internalized stigma was measured using the Internalized Stigma of Mental Illness scale. 43.6% experienced moderate to high internalized stigma. After making adjustments in multiple logistic regression analysis, results revealed there were no significant socio-demographic or clinical correlates relating to internalized stigma. Individual logistic regression models found a negative relationship between quality of life, self-esteem, general functioning and internalized stigma whereby lower scores were associated with higher internalized stigma. In the final regression model, which included all psychosocial variables together, self-esteem was the only variable significantly and negatively associated with internalized stigma. The results of this study contribute to our understanding of the role internalized stigma plays in patients with mental illness, and the impact it can have on psychosocial aspects of their lives. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
Full Text Available Abstract Background Patients suspected of personality disorders (PDs by general practitioners are frequently referred to psychiatric outpatient clinics (POCs. In that setting an effective screening instrument for PDs would be helpful due to resource constraints. This study evaluates the properties of The Iowa Personality Disorder Screen (IPDS as a screening instrument for PDs at a POC. Methods In a cross-sectional design 145 patients filled in the IPDS and were examined with the SCID-II interview as reference. Various case-findings properties were tested, interference of socio-demographic and other psychopathology were investigated by logistic regression and relationships of the IPDS and the concept of PDs were studied by a latent variable path analysis. Results We found that socio-demographic and psychopathological factors hardly disturbed the IPDS as screening instrument. With a cut-off ≥4 the 11 items IPDS version had sensitivity 0.77 and specificity 0.71. A brief 5 items version showed sensitivity 0.82 and specificity 0.74 with cut-off ≥ 2. With exception for one item, the IPDS variables loaded adequately on their respective first order variables, and the five first order variables loaded in general adequately on their second order variable. Conclusion Our results support the IPDS as a useful screening instrument for PDs present or absent in the POC setting.
Landes, Sara J; Chalker, Samantha A; Comtois, Katherine Anne
Rates of treatment dropout in outpatient Dialectical Behavior Therapy (DBT) in the community can be as high as 24 % to 58 %, making dropout a great concern. The primary purpose of this article was to examine predictors of dropout from DBT in a community mental health setting. Participants were 56 consumers with borderline personality disorder (BPD) who were psychiatrically disabled participating in a larger feasibility trial of Dialectical Behavior Therapy- Accepting the Challenges of Exiting the System. The following variables were examined to see whether they predicted dropout in DBT: age, education level, baseline level of distress, baseline level of non-acceptance of emotional responses, and skills module in which a consumer started DBT skills group. These variables were chosen based on known predictors of dropout in consumers with BPD and in DBT, as well as an interest in what naturally occurring variables might impact dropout. The dropout rate in this sample was 51.8 %. Results of the logistic regression show that younger age, higher levels of baseline distress, and a higher level of baseline non-acceptance of emotional responses were significantly associated with dropout. The DBT skills module in which an individual started group did not predict dropout. The implications of these findings are that knowledge of consumer age and pretreatment levels of distress and non-acceptance of emotional responses can impact providers' choice of commitment and treatment strategies to reduce dropout. Future research should examine these strategies, as well as the impact of predictor variables on outcome and reasons for dropout.
Busetto, L; Mazza, M; Salvalaio, S; De Stefano, F; Marangon, M; Calò, E; Sampietro, S; Enzi, G
Obesity is increasing in the elderly and it is associated with an increased risk of medical complications, decline in physical function and disability. Very few studies specifically evaluated the outcome of obesity treatment in the aging patients. Aim of this work is therefore the evaluation of the efficacy of medical therapy in a group of obese patients >or=65 years old. The study has been performed on the clinical records of obese outpatients treated at the medical branch of the Unit for Medical and Surgical Therapy of Obesity at the University of Padova. Patients were recruited from January 1st, 2001 to June 30th, 2006 in order to have patients with at least one year of potential follow-up. In particular two groups were enrolled: 100 patients >or=65 years old and 200 patients treatment outcome were compared. Mean age of the elderly patients was 69.1+/-3.7 years (range 65-80 years). We did not find any significant difference between elderly and adult patients in the sex distribution (female patients 76% in the elderly group and 72% in the adult group; p=0.276) and in the severity of overweight (body mass index: 37.8+/-6.0 kg/m2 in the elderly; 37.2+/-6.3 kg/m2 in adults; p=0.425). The elderly group was characterized by a higher incidence of comorbidities and a lower incidence of eating behavior disorders at baseline. No significant differences in the dietary prescription were found, whereas physical activity was prescribed in 27/100 elderly patients (27%) and in 97/200 (48%) adults patients (ptreatment. In elderly patients still in active treatment after 12 months, only 5/28 (18%) patients reached the specified goal, whereas in adult patients still in treatment, 18/47 (38%) patients reached the goal (page at baseline, female sex, and lower body mass index were found to be the only significant predictors of 10% weight loss in logistic regression. In our experience, drop-out rate after 12 months was similar in adults (77%) and in older patients (72%). In a
Ajit Kumar Sah
Full Text Available Background & Objectives: Older individuals often suffer from multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The study was conducted with objectives to determine the prevalence of potentially inappropriate medicine (PIM prescribing in older Nepalese patients in a medicine outpatient department.Materials & Methods: A prospective observational analysis of drugs prescribed in medicine out-patient department (OPD of a tertiary hospital of central Nepal was conducted during November 2012 to October 2013 among 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM in elderly patients was analysed using Beer’s Criteria updated to 2013. Results: In the 869 patients included, the average number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%, amlodipine (23.16%, paracetamol (17.6%, salbutamol (15.72% and vitamin B complex (13.26%. The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Conclusion: Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with number of medications prescribed. Further research is warranted to study the impact of PIMs towards health related outcomes in these elderly.
Sposito, Giovana; D'Elboux, Maria José; Neri, Anita Liberalesso; Guariento, Maria Elena
Aging is often accompanied by functional limitations that affect self esteem, lowering the level of satisfaction with life. Studies highlight satisfaction with life as a predictor of quality of life and has a marked correlation with a decrease in functionality. Therefore, this study sought to examine the relationship between satisfaction with life and functional independence and performance of the lower limbs (muscle strength, gait speed and balance) among the elderly in outpatient care with respect to age groups and genders. A total of 125 elderly men and women aged 60 years and above, attending a geriatric outpatient clinic. The instruments used were: 1) Functional Independence Measure (FIM) to evaluate functional dependence; 2) Short Physical Performance Battery (SPPB) to measure physical performance; 3) Satisfaction with life. The sample was random, with a predominance of females, in which the older participants had greater functional impairment. In univariate logistic regression analysis and multivariate analysis, overall self reported and comparative satisfaction with life was more satisfactory among the oldest elderly. The results suggest that older individuals have better satisfaction with life even though they have greater functional impairment.
Trull, Timothy J; Wycoff, Andrea M; Lane, Sean P; Carpenter, Ryan W; Brown, Whitney C
Cannabis and alcohol are the most commonly used (il)licit drugs world-wide. We compared the effects of cannabis and alcohol use on within-person changes in impulsivity, hostility and positive affect at the momentary and daily levels, as they occurred in daily life. Observational study involving ecological momentary assessments collected via electronic diaries six random times a day for 28 consecutive days. Out-patients' everyday life contexts in Columbia, MO, USA. Ninety-three adult psychiatric out-patients (85% female; mean = 30.9 years old) with borderline personality or depressive disorders, who reported using only cannabis (n = 3), only alcohol (n = 58) or both (n = 32) at least once during the study period. Real-time, standard self-report measures of impulsivity, hostility and positive affect, as impacted by momentary reports of cannabis and alcohol use. Cannabis use was associated with elevated feelings of impulsivity at the day level [b = 0.83, 95% confidence interval (CI) = 0.17-1.49] and increased hostility at the momentary (b = 0.07, 95% CI = 0.01-0.12) and person (b = 0.81, 95% CI = 0.15-1.47) level. Alcohol use was associated with elevated feelings of impulsivity at the momentary (b = 0.42, 95% CI = 0.13-0.71) and day levels (b = 0.82, 95% CI = 0.22-1.41) and increased positive affect at the momentary (b = 0.12, 95% CI = 0.06-0.18) and day (b = 0.33, 95% CI = 0.16-0.49) levels. Cannabis and alcohol use are associated with increases in impulsivity (both), hostility (cannabis) and positive affect (alcohol) in daily life, and these effects are part of separate processes that operate on different time-scales (i.e. momentary versus daily). © 2016 Society for the Study of Addiction.
Ana Flávia Marostegan de Paula
Full Text Available This study intended to evaluate the functional profile of the elderly in the Geriatric Outpatient Clinic of the Hospital of the State University of Campinas, correlating it with the occurrence of death. We evaluated 120 elderly outpatients (≥60 years, considering sociodemographic data, cognition by the Mini-Mental State Examination, Activities of Daily Living (ADL, Instrumental Activities of Daily Living (IADL, self-assessment of memory, depressive symptoms, number of medical consultations, and probability of death within one year. Cluster analysis, chi-square or Fisher’s exact test, and Mann-Whitney test were used as statistical analysis to compare the variables between the groups (p < 0.05. The mean age was 76.81 (±7.56 years; 66.7% were women; 63.33% were independent for ADL and 68.33% were dependent for IADL; 31.67% presented depressive symptoms; 30% presented cognitive impairment; 56.67% reported difficulty of remembering recent events; 83.33% had no difficulty emembering ancient events; 6.67% died within one year. It was possible to observe a profile consisting predominantly of younger elders, more educated, with more difficulty of remembering recent and ancient events, worse self-rated memory, and who died in greater proportion. The second profile consisted predominantly of older subjects, with higher percentage of illiteracy, less memory complaint, and no evolution to death. The study registered the existence of a group of elderly people who survive to older age with better cognitive performance. This finding is probably related to the greater resilience of these individuals.
de Niet, G. J. (Gerrit); Tiemens, B. G. (Bea); Lendemeijer, H. H. G. M. (Bert); Hutschemaekers, G. J. M. (Giel)
This paper aims at acquiring knowledge about the quality of sleep of adult and elderly psychiatric patients who receive clinical or outpatient nursing care, and identifying key factors in perceiving a sleep problem. To do so, a sample of 1699 psychiatric patients were asked whether they perceived a
Halsteinli, Vidar; Kittelsen, Sverre A.C.; Magnussen, Jon
BACKGROUND: It is generally believed that 5 percent of the population under 18 years is in need of specialist psychiatric care. In 1998, however, services were delivered to only 2.1 percent of the Norwegian population. Access to services can be improved by increasing capacity, but also by increasing the utilization of existing capacity. Changing financial incentives has so far not been considered. Based on a relatively low number of registered consultations per therapist (1.1 per therapist day) the ministry has stipulated that productivity should increase by as much as 50 percent. AIMS OF THE STUDY: Measuring productivity in psychiatric care is difficult, but we believe that studies of productivity should be an important input in policy making. The aim of this paper is to provide such an analysis of the productive efficiency of psychiatric outpatient clinics for children and youths, and in particular to focus on three issues: (i) is an increase in productivity of 50 percent a realistic goal, (ii) are there economies of scale in the sector, and (iii) to what extent can differences in productivity be explained by differences in staff-mix and patient-mix? METHODS: We utilize an approach termed Data Envelopment Analysis (DEA) to estimate a best-practice production frontier. The potential for efficiency improvement is measured as the difference between actual and best-practice performance, while allowing for trade-offs between different staff groups and different mixes of service production. The DEA method gives estimates of efficiency and productivity for each clinic without the need for prices, and thus avoids the pitfalls of partial productivity ratios. The Kolmogorov-Smirnov statistic is used to compare efficiency distributions, providing tests of variable specification and scale properties. RESULTS: Based on 135 observations for the years 1997 to 1999, the tests lead to a model with two inputs, two outputs and variable returns to scale. The outputs are number of
The prevalence of personality disorders in psychiatric outpatients with borderline intellectual functioning: Comparison with outpatients from regular mental health care and outpatients with mild intellectual disabilities.
Wieland, Jannelien; Van Den Brink, Annemarie; Zitman, Frans G
There is little research on the subject of personality disorder (PD) in individuals with borderline intellectual functioning (BIF). Unlike in most countries, in the Netherlands, patients with BIF are eligible for specialized mental health care. This offers the unique possibility of examining the rates of PDs in patients, who in other countries are treated relatively invisibly in regular mental health care. To compare, in a naturalistic setting, the frequency of PD diagnoses in outpatients with BIF with outpatients from regular mental health care and outpatients with mild ID. We compared the rates of all DSM-IV-TR axis II PDs in outpatients with BIF (BIF group; n = 235) with rates of the same disorders in outpatients from regular mental health care (RMHC group; n = 1026) and outpatients with mild intellectual disability (ID) (mild ID group; n = 152) in a naturalistic cross-sectional anonymized medical chart review. Over half of the patients with BIF (52.8%) were diagnosed with a PD, compared with one in five in the RMHC group (19.3%) and one in three of the mild ID group (33.6%). All PD diagnoses, except for cluster A PDs and histrionic PDs, were most frequently diagnosed in the BIF group. PD NOS and borderline PD were the most frequently diagnosed PDs in BIF. The majority of PD patients had one or more comorbid axis I disorder. There is a high frequency of PD diagnoses in BIF outpatients in daily clinical practice. In anticipation of further scientific research, results suggest that PDs should not be overlooked in patients with BIF.
Feinstein, Robert E; Yager, Joel
Violence in psychiatric outpatient settings is a ubiquitous concern. This article describes the development, implementation, and evaluation of a live threat violence simulation exercise, designed to reduce the risk of future outpatient clinic violence and minimize the effects of future incidents on staff. The psychiatric outpatient clinic at the University of Colorado Hospital developed, implemented, and evaluated a 4-hour live violence threat simulation exercise as a companion to a 7-hour violence prevention program. The simulation includes an orientation, two threat simulation scenarios, three debriefings, satisfaction surveys, problem identification, action plans, and annual safety and process improvements. The authors have conducted live violence simulation exercises from 2011-2016, and have collected survey data about our annual simulation exercise from 2014-2016. Each year ≥ 52% of participants responded, and each year ≥ 90% of respondents rated the simulation as "very helpful/helpful", ≥ 86% believed themselves to be "much better/better" prepared to deal with violent episodes, and simulation side effects such as worries about past trauma; anxiety; sleep problems; increase in workplace concerns. From 2011-2016, the clinic experienced 4 major violent episodes and 36 episodes of potential violence with no staff injuries and minimal psychological sequelae to one staff member. Violence prevention efforts and the development of close police/staff relationships may have contributed to these fortunate outcomes. Satisfaction surveys suggest that the simulations are very helpful/helpful, with participants feeling much better/ better prepared to manage violence. The exercises led the authors to initiate staff safety related behavioral changes as well as physical space and safety processes improvements. The violence prevention program and simulation exercises have promoted excellent relationships with police and a consistent safety record over six years. This
Vyssoki, B; Willeit, M; Blüml, V; Höfer, P; Erfurth, A; Psota, G; Lesch, O M; Kapusta, N D
During the last 20 years Austrian psychiatric services underwent fundamental changes, as a focus was set on downsizing psychiatric hospitals. Little is known about how restructuring of mental health services affected patients with major depression and suicide rates. Monthly hospital discharges from all hospitals in Austria with the diagnosis of unipolar major depression as primary reason for inpatient treatment were obtained for the time period between 1989 and 2008. These data were correlated with relevant parameters from the general health system, such as number of hospital beds, suicide rate, density of psychotherapists and sales of antidepressants. While the number of psychiatric beds was reduced by almost 30%, the total annual numbers of inpatient treatment episodes for depression increased by 360%. This increase was stronger for men than for women. Further on this development was accompanied by a decrease in the suicide rate and an improvement in the availability of professional outpatient mental health service providers. Only aggregated patient data and no single case histories were available for this study. The validity of the correct diagnosis of unipolar major depression must be doubted, as most likely not all patients were seen by a clinical expert. Our data show that although inpatient treatment for unipolar major depression dramatically increased, reduction of psychiatric beds did not lead to an increase of suicide rates. Copyright © 2011 Elsevier B.V. All rights reserved.
Picco, Louisa; Lau, Ying Wen; Pang, Shirlene; Abdin, Edimansyah; Vaingankar, Janhavi Ajit; Chong, Siow Ann; Subramaniam, Mythily
Objectives To examine whether self-stigma mediates the relationship between perceived stigma and quality of life, self-esteem and general functioning among outpatients with depression, schizophrenia, anxiety and obsessive-compulsive disorder (OCD). Design Cross-sectional survey. Setting Outpatient clinics at a tertiary psychiatric hospital in Singapore. Participants 280 outpatients with a primary clinical diagnosis of either schizophrenia, depression, anxiety or OCD. Methods Data were collect...
Tian, Wei-Hua; Liu, Li-Fan; Wang, Jiu-Yao
According to the estimates of the World Health Organization (WHO), there were about 300 million people in the world suffering from asthma in 2005. Among the risk factors of asthma is obesity, which was found to be significantly associated with asthma in recent decades. In this study, we analyze the relationship between obesity risk class and asthma outpatient service utilization by the middle-aged and elderly in Taiwan. Adopting data from the 2005 Nation Health Interview Survey (NHIS) and National Health Insurance Research Database (NHIRD), we first utilize latent class analysis (LCA) to identify obesity risk classes. Next, we utilize a logit and a negative binominal model to analyze the relationship between each obesity risk class and asthma outpatient service utilization. Results indicate that compared with the "overweight/obese with low consumption of vegetable/fruit and little exercise" class, the classes "normal-weight with high consumption of vegetable/fruit and moderate exercise" and "overweight/obese with high consumption of vegetable/fruit and moderate exercise" tend to have low probabilities and less number of visits of utilizing asthma outpatient services. Our results may constitute useful references for clinicians and government policy makers formulating strategies for asthma management and prevention. Better informed strategies for asthma management could, in turn, increase the efficiency of asthmatic patients' care, which could provide efficient assistance to the target group based on the obesity risk classes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
García Marchena, Nuria; Araos, Pedro; Pavón, Francisco Javier; Ponce, Guillermo; Pedraz, María; Serrano, Antonia; Arias, Francisco; Romero-Sanchiz, Pablo; Suárez, Juan; Pastor, Antoni; De la Torre, Rafael; Torrens, Marta; Rubio, Gabriel; Rodríguez de Fonseca, Fernando
Alcohol addiction is associated with high psychiatric comorbidity. Objective stratification of patients is necessary to optimize care and improve prognosis. The present study is designed to gain insights into this challenge by addressing the following objectives: a) to estimate the prevalence of psychiatric comorbidities in a sample of outpatients seeking treatment for alcohol use disorder, b) to describe the existence of gender differences and c) to validate 2-acyl-glycerols as biomarkers of alcohol use disorder and/or psychiatric comorbidity. One hundred and sixty-two patients were recruited and evaluated with the semi-structured interview PRISM. The presence of psychopathology was associated with a greater number of criteria for alcohol abuse and dependence according to DSM-IV-TR. We found gender differences in psychiatric comorbidity, e.g., mood disorder, as well as in comorbid substance use disorders. The prevalence of lifetime psychiatric comorbidity was 68.5%, with mood disorders the most frequent (37%), followed by attention deficit disorder (24.7%) and anxiety disorders (17.9%). Substance-induced disorders were more frequent in mood and psychotic disorders, whereas the primary disorders were more prevalent in patients with comorbid anxiety disorders. We found that 2-acyl-glycerols were significantly decreased in comorbid anxiety disorders in alcohol dependent patients in the last year, which makes them a potential biomarker for this psychopathological condition.
Yvette M Nel
Full Text Available Background. Evidence suggests that the presence of mental illness may be associated with poorer adherence to antiretroviral therapy (ART. There is also a general understanding that patients initiated on ART as inpatients have poorer outcomes than those initiated as outpatients. Negative perceptions regarding future adherence may affect the clinical decision to initiate ART in hospitalised psychiatric patients. Attendance at clinic appointments is an indicator of medication adherence, and is easily measurable in a limited-resource setting. Objectives. The primary objective of this study was to examine the rate of attendance at the first clinic appointment post discharge from a period of psychiatric hospitalisation in HIV-positive psychiatric patients initiated on ART as inpatients. A secondary objective was to determine which factors, if any, were associated with clinic attendance. Methods. This study was a retrospective record review, conducted at the Luthando Neuropsychiatric HIV Clinic in Soweto, which is an integrated mental healthcare and ART clinic. Patients who were initiated on ART as psychiatric inpatients from 1 July 2009 to 31 December 2010, and subsequently discharged for outpatient follow-up at Luthando Clinic were included in the sample. Results. There were 98 patients included in the analysis. The sample was predominantly female. The rate of attendance was 80%. The attendant and non-attendant groups were similar in terms of demographic and clinical data. Significantly fewer non-attendant patients had disclosed their HIV status to their treatment supporter (p=0.01. Conclusion. Non-disclosure of HIV status needs to be further addressed in integrated psychiatric HIV treatment facilities in order to improve attendance. Female predominance in this setting should also be further investigated.
Jochems, Eline C.; Mulder, Cornelis L.; Duivenvoorden, Hugo J.; van der Feltz-Cornelis, Christina M.; van Dam, Arno
Self-determination theory is potentially useful for understanding reasons why individuals with mental illness do or do not engage in psychiatric treatment. The current study examined the psychometric properties of three questionnaires based on self-determination theory—The Treatment Entry
Walsh, Patrick G.; Currier, Glenn; Shah, Manish N.; Lyness, Jeffrey M.; Friedman, Bruce
In 2011 the oldest baby boomers will turn age 65. Although healthcare researchers have started to examine the future preparedness of the healthcare system for the elderly, psychiatric emergency services (PES) have been widely overlooked. Research is needed to address PES need and demand by older patients, assess the consequences of this need/demand, and establish recommendations to guide PES planning and practice. The authors examined journal articles, review papers, textbooks, and electronic...
Risgaard, Bjarke; Waagstein, Kristine; Winkel, Bo Gregers
hospital contact and was identified using The Danish Psychiatric Central Research Register. All diagnoses in Danish registries are coded according to ICD-8 or ICD-10. All hospital records were retrieved manually. Results: Among 5,178 deaths, 395 were due to SCD and autopsies were performed on 262 (66......Introduction: Psychiatric patients have premature mortality compared to the general population. The incidence of sudden cardiac death (SCD) in psychiatric patients is unknown in a nationwide setting. The aim of this study was to compare nationwide SCD incidence rates in young individuals...... with and without previous psychiatric disease. Method: Nationwide, retrospective cohort study including all deaths in people aged 18–35 years in 2000–2006 in Denmark. The unique Danish death certificates and autopsy reports were used to identify SCD cases. Psychiatric disease was defined as a previous psychiatric...
Full Text Available Abstract Background A growing body of literature shows that patients accept the use of computers in clinical care. Nonetheless, studies have shown that computers unequivocally change both verbal and non-verbal communication style and increase patients' concerns about the privacy of their records. We found no studies which evaluated the use of Electronic Health Records (EHRs specifically on psychiatric patient satisfaction, nor any that took place exclusively in a psychiatric treatment setting. Due to the special reliance on communication for psychiatric diagnosis and evaluation, and the emphasis on confidentiality of psychiatric records, the results of previous studies may not apply equally to psychiatric patients. Method We examined the association between EHR use and changes to the patient-psychiatrist relationship. A patient satisfaction survey was administered to psychiatric patient volunteers prior to and following implementation of an EHR. All subjects were adult outpatients with chronic mental illness. Results Survey responses were grouped into categories of "Overall," "Technical," "Interpersonal," "Communication & Education,," "Time," "Confidentiality," "Anxiety," and "Computer Use." Multiple, unpaired, two-tailed t-tests comparing pre- and post-implementation groups showed no significant differences (at the 0.05 level to any questionnaire category for all subjects combined or when subjects were stratified by primary diagnosis category. Conclusions While many barriers to the adoption of electronic health records do exist, concerns about disruption to the patient-psychiatrist relationship need not be a prominent focus. Attention to communication style, interpersonal manner, and computer proficiency may help maintain the quality of the patient-psychiatrist relationship following EHR implementation.
Conclusion: Elderly constitute more than one fourth of outpatients load from siddha health facilities. Degenerative diseases like arthritis and non-communicable diseases were the common morbidities in this age group. Geriatric clinics and mobile clinics under siddha system may help in improving health care services.
lisorders (4%) and no anxiety disorders. A number of drug. ;ombinations and usages for the ... psychiatric care provided by the PS in the Mhala district of. Northern Transvaal. The PS in Mhala. Mhala district is ... nurse (CPN) being responsible for the continuing care of all patients discharged from the hospital's psychiatric ...
Robertson, D.; DesJardin, J. A.; Lichtenstein, M. J.
Factors associated with orthostatic blood pressure change in elderly outpatients were determined by surveying 398 medical clinical outpatients aged 65 years and older. Blood pressure was measured with random-zero sphygmomanometers after patients were 5 minutes in a supine and 5 minutes in a standing position. Orthostatic blood pressure changes were at normally distributed levels with systolic and diastolic pressures dropping an average of 4 mm Hg (standard deviation [SD]=15 mm Hg) and 2 mm Hg (SD=11 mm Hg), respectively. Orthostatic blood pressure changes were unassociated with age, race, sex, body mass, time since eating, symptoms, or other factors. According to multiple linear regression analysis, supine systolic pressure, chronic obstructive pulmonary disease (COPD), and diabetes mellitus were associated with a decrease in systolic pressure on standing. Hypertension, antiarthritic drugs, and abnormal heartbeat were associated with an increase in systolic pressure on standing. For orthostatic diastolic pressure changes, supine diastolic pressure and COPD were associated with a decrease in diastolic pressure on standing. Congestive heart failure was associated with an increase in standing diastolic pressure. Using logistic regression analysis, only supine systolic pressure was associated with a greater than 20-mm Hg drop in systolic pressure (n=53, prevalence=13%). Supine diastolic pressure and COPD were the only variables associated with a greater than 20-mm Hg drop in diastolic pressure (n=16, prevalence=4%). These factors may help physicians in identifying older persons at risk for having orthostatic hypotension.
Dreher, Annegret; Hahn, Eric; Diefenbacher, Albert; Nguyen, Main Huong; Böge, Kerem; Burian, Hannah; Dettling, Michael; Burian, Ronald; Ta, Thi Minh Tam
Despite an extensive body of research on somatic symptom presentation among people of East- and Southeast-Asian descent, results are still inconclusive. Examining and comparing symptom presentation in clinically and ethnically well-characterized populations may constitute a step towards understanding symptom presentation between patients with a different cultural background. This study aims to compare Vietnamese and German patients regarding cultural dynamics of symptom presentation upon first admission to a psychiatric outpatient service. 110 Vietnamese and 109 German patients seeking psychiatric treatment at two outpatient clinics completed the Patient Health Questionnaire (PHQ). The somatic symptom subscale (PHQ-15), the depression subscale (PHQ-9) and PHQ-subscales examining anxiety and psychosocial stress levels were analyzed and compared for both groups using multivariate analysis of covariance. Regression analysis was utilized to examine the influences of sociodemographic and migration specific factors. Vietnamese and German patients showed comparable Cronbach's alpha for all subscales. Vietnamese patients endorsed significantly higher levels of somatic symptoms overall and on certain items (as pain-related items, dizziness, and fainting spells) despite similar levels of depression severity in comparison with German patients. Vietnamese patients with poor German language skills showed a significantly higher focus on somatic symptoms. Raising awareness for cultural dynamics of symptom presentation in patients with depression is indispensable. Cross-cultural symptom assessment using the PHQ seems feasible and expands our understanding of depressive and psychosomatic symptoms when assessed by clinicians. Copyright © 2017. Published by Elsevier Inc.
Gandotra, Aditi; Mehrotra, Seema; Bharath, Srikala
The study was designed to explore psychological recovery and its correlates in adults receiving outpatient mental health services for psychiatric disorders. It specifically aimed at examining the association of psychological recovery with symptomatic and functional recovery and with selected illness and treatment variables. The relationship of psychological recovery with perceived social support was also the focus of inquiry. The study utilized a cross sectional survey design with a sample of 90 participants diagnosed with severe and common mental illness who had been seeking outpatient psychiatric follow up services. The data was collected with the help of both clinician rated and self-rated measures. The study findings suggested that symptomatic, functional and psychological recovery are significantly correlated but not completely overlapping constructs. Nearly 40% of the sampled participants were at the lower stages of psychological recovery, despite the fact that a majority of them were rated by clinicians as having mild or lower severity of symptoms. With respect to socio-demographic variables, a significant association was found between higher levels of education and psychological recovery. The participants with common mental illness were significantly lower on self-reported improvement and higher on moratorium subscale of psychological recovery (as compared to those with severe mental illness), indicating their struggle in dealing with a sense of loss and despair. Findings also suggested that higher levels of overall perceived social support is likely to facilitate psychological recovery. Copyright © 2017 Elsevier B.V. All rights reserved.
Landes, Sara J; Chalker, Samantha A; Comtois, Katherine Anne
.... Participants were 56 consumers with borderline personality disorder (BPD) who were psychiatrically disabled participating in a larger feasibility trial of Dialectical Behavior Therapy- Accepting the Challenges of Exiting the System...
Krane-Gartiser, Karoline; Breum, Leif; Glümrr, Charlotte
The incidence of the metabolic syndrome, a major risk factor for diabetes and cardiovascular disease, is increasing worldwide and is suggested to be higher among psychiatric patients, especially those on antipsychotic treatment.......The incidence of the metabolic syndrome, a major risk factor for diabetes and cardiovascular disease, is increasing worldwide and is suggested to be higher among psychiatric patients, especially those on antipsychotic treatment....
Kurki, Marjo; Hätönen, Heli; Koivunen, Marita; Anttila, Minna; Välimäki, Maritta
The aim of this explorative study was to describe nurses' opportunities to integrate computer and Internet-based programmes in psychiatric out-patient care among adolescents with depression. Therefore, nurses' daily computer use and possible problems related to it were investigated. The data were collected by conducting focus group interviews with Finnish registered nurses (n =12) working at the out-patient clinics of two university central hospitals. The data were analysed using inductive content analysis. The analysis showed that nurses used the computer and Internet in their daily work for data transmission and informal interaction with adolescents. Findings revealed that nurses have good computer skills, a positive attitude towards using the computer and Internet and were motivated to make use of both on a daily basis. Problems faced in daily computer use were a lack of instructions and education, and lack of help and support. We can conclude that nurses have good opportunities to implement computer and Internet-based programmes in adolescent out-patient care. These results are encouraging keeping in mind that adolescents are the most active Internet users in society.
Imran, A; Azidah, A K; Asrenee, A R; Rosediani, M
Depression among elderly primary care patients is a serious problem with significant morbidity and mortality. This is a cross sectional study to determine the prevalence of depression and its associated factors among the elderly patients attending the outpatient clinic, Universiti Sains Malaysia Hospital. This study utilized Malay version Geriatric Depression Scale 14 (M-GDS 14) to screen for elderly depression among Malaysian population. It also looked into associated risk factors for elderly depression using sociodemographic, family dynamics, and medically related questionnaires. Out of 244 subjects, 34 or 13.9% were found to have depression. Three variables were found to be significantly associated with depression. Elderly patient with any illness that limits the patient's activity or mobility has more risk of developing depression (OR 2.68 CI 1.15 - 6.24). Elderly patients who were satisfied with their personal incomes (OR 0.29 CI 0.10 - 0.85), and who had children or son/daughter-in-law to take care of them when they are sick (OR 0.10 CI 0.01 - 0.83) have a lower chance of having depression. Screening the elderly for depression, would help in diagnosing the elderly depression better and offer them the treatment needed.
Giordana, J Y; Roelandt, J L; Porteaux, C
Upon the national data basis of the huge study "Mental Health in General Population", elaborated by the WHO Collaborating Centre, our research tries to identify the particularities of the advanced years population. The increasing number of the elderly in France and all over the world, as well as the demographic evolution prospects, truly justify our interest for them. A group of subjects older than 65 years old - representing 21,1% of the general population - was divided into two parts and the 65-74 years old (12.6%) - the 75 old years old and more (8.5%) - and was compared to the population between 18 and 74 years old (78.9%) who answered this investigation. The aim of our study was to detect the prevalence of the main psychic troubles of the elderly (depression, anxiety, addiction and psychiatric disorders), with a psychiatric tool, the Mini International Neuropsychiatric Interview (MINI). We also wanted to perceive how their perceptions and representations of the behaviours and clinical symptoms of the psychic troubles could be different from the ones of younger people. Thus, and according to the answers "normal/abnormal", "dangerous/not dangerous" linked to each item, we measured the possible difference between the answers and the representations of the general population towards the elderly. The elderly are generally confronted to multiple psychosocial stress factors (decrease of the cognitive performances, decline of the sensory abilities, drop of the social relationships, change of status, succession of loss and breach as well as the cessation of the professional activity and its network, which may favour the emergence of troubles. According to this, a higher rate of psychic troubles among the elderly than in the general investigated population, may be suspected. However, the study in general population points out that the prevalence of persons suffering from at least one trouble with the MINI declines among the subjects belonging to the highest brackets: 34
Background: Information on adherence of adult psychiatric patients to biological modes of treatment is scarce in Ethiopia. Knowledge on adherence is essential in terms of future prognosis, quality of life and functionality of such patients. This study was conducted to assess the magnitude and associated factors of ...
'ospital was low, even in patients who suffered numerous. ·elapses. These results show a psychiatric .... 'depressive psychosis', 'reactive depression', Schizophrenia includes 'schizophrenia', 'chronic schizophrenia' and ..... standard protocol of management to be used by both nursing and medical staff; (if) the authorisation ...
Full Text Available Robert Wilson,1 Antonio Anzueto,2 Marc Miravitlles,3 Pierre Arvis,4 Daniel Haverstock,5 Mila Trajanovic,6 Sanjay Sethi7 1Host Defence Unit, Royal Brompton Hospital, London, UK; 2University of Texas Health Science Center, South Texas Veterans Health Care System, San Antonio, TX, USA; 3Pneumology Department, Hospital Universitari Vall d’Hebron, CIBER de Enfermedades Respiratorias (CIBERES, Barcelona, Spain; 4Bayer HealthCare Pharmaceuticals, Loos, France; 5Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA; 6Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; 7University at Buffalo, Buffalo, NY, USA Background: Acute exacerbations represent a significant burden for patients with moderate-to-severe chronic obstructive pulmonary disease. Each exacerbation episode is frequently associated with a lengthy recovery and impaired quality of life. Prognostic factors for outpatients that may predict poor outcome after treatment with antibiotics recommended in the guidelines, are not fully understood. We aimed to identify pretherapy factors predictive of clinical failure in elderly (≥60 years old outpatients with acute Anthonisen type 1 exacerbations.Trial registration: NCT00656747.Methods: Based on the moxifloxacin in AECOPDs (acute exacerbations of chronic obstructive pulmonary disease trial (MAESTRAL database, this study evaluated pretherapy demographic, clinical, sputum bacteriological factors using multivariate logistic regression analysis, with internal validation by bootstrap replicates, to investigate their possible association with clinical failure at end of therapy (EOT and 8 weeks posttherapy.Results: The analyses found that the independent factors predicting clinical failure at EOT were more frequent exacerbations, increased respiratory rate and lower body temperature at exacerbation, treatment with long-acting anticholinergic drugs, and in vitro bacterial resistance to study drug. The independent factors predicting poor outcome at 8
Alvarado-Esquivel, Cosme; Sánchez-Anguiano, Luis Francisco; Arnaud-Gil, Carlos Alberto; Hernández-Tinoco, Jesús; Molina-Espinoza, Luis Fernando; Rábago-Sánchez, Elizabeth
Little is known about the epidemiology of suicide attempts among psychiatric outpatients in Mexico. This study was aimed to determine the socio-demographic, clinical and behavioral characteristics associated with suicide attempts in psychiatric outpatients in two public hospitals in Durango, Mexico. Two hundred seventy six psychiatric outpatients (154 suicide attempters and 122 patients without suicide attempt history) attended the two public hospitals in Durango City, Mexico were included in this study. Socio-demographic, clinical and behavioral characteristics were obtained retrospectively from all outpatients and compared in relation to the presence or absence of suicide attempt history. Increased prevalence of suicide attempts was associated with mental and behavioral disorders due to psychoactive substance use (F10-19) (P=0.01), schizophrenia, schizotypal and delusional disorders (F20-29) (P=0.02), mood (affective) disorders (F30-39) (Pattempts were associated with young age (OR=1.21, 95% CI: 1.06-1.39; P=0.003), female gender (OR=2.98, 95% CI: 1.55-5.73; P=0.001), urban residence (OR=2.31, 95% CI: 1.17-4.57; P=0.01), memory impairment (OR=1.91, 95% CI: 1.07-3.40; P=0.02), alcohol consumption (OR=2.39, 95% CI: 1.21-4.70; P=0.01), and sexual promiscuity (OR=3.90, 95% CI: 1.74-8.77; Pattempts with socio-demographic, clinical and behavioral characteristics in psychiatric outpatients in Mexico. Results may be useful for an optimal planning of preventive measures against suicide attempts in psychiatric outpatients.
Kuo, Ren-Jieh; Wu, Yung-Hung; Hsu, Tsung-Shin
Taiwan became a World Health Organization-defined aging country in 1993, and it is estimated to become an aged country by 2017, surpassing Japan as the fastest aging country in the world. However, healthcare services in Taiwan need a wide range of improvements to cope with the challenges of population aging. Healthcare failure mode and effects analysis (HFMEA) developed by the Department of Veterans Affairs' National Center for Patient Safety (NCPS) was used to evaluate the inconvenience of outpatient registration process for elderly patients. Also, fuzzy set theory was used along with technique for order preference by similarity to ideal solution (TOPSIS) method in multiple criteria decision making (MCDM) to rank the failure risks in the HFMEA. The top three failure modes ranked by the TOPSIS method were "short consultation time," "possible complications of the checkup or treatment were not told," and "opinions and feelings of patients and relatives were not respected." Based on those failure modes, improvements were proposed and results were feedback to hospitals. A random sample of 40 elderly patients was selected for interview at the outpatient department of a tertiary medical center in Taiwan. Thirty-seven out of the 40 elderly patients (92.5%) agreed with the executive expert team. This meant the improvement proposals were effective. In this study, HFMEA was extended to explore the impacts of geriatric outpatient service process failures on elderly patients. Using fuzzy set theory and the TOPSIS method in multiple criteria decision making to rank the severity of the failure modes, the risk assessment of the geriatric outpatient service process was more objective when analyzed with quantitative data. Copyright © 2012. Published by Elsevier B.V.
Rojas, Julio I; Jeon-Slaughter, Haekyung; Brand, Michael; Koos, Erin
Three impaired health care provider groups (N = 84) (nurses, pharmacists, and providers with prescriptive authority) referred for a substance abuse evaluation at an outpatient-based program were compared on demographic and family factors, substance abuse patterns, and psychiatric symptomology as assessed by the Personality Assessment Inventory. Nurses had the highest rates of family history of addiction, problems with benzodiazepines, and psychiatric comorbidity. Overall, health care professionals endorsed opioids twice as often as alcohol as a preferred substance. Family history of addiction, sex, and psychiatric comorbidity emerged as salient factors among these health care professionals. Clinical implications are examined in light of the current findings.
Päivi Maria Pylvänäinen
Full Text Available AbstractWe were interested in investigating the effects of dance movement therapy (DMT in a psychiatric outpatient clinic with patients diagnosed with depression. DMT aims to engage the patients in physical and verbal exploration of their experiences generated in movement based interaction. The assumption was that DMT, which includes both physical engagement as well as emotional and social exploration, would alleviate the mood and psychiatric symptoms.All adult patients (n = 33 included in the study received treatment as usual (TAU. 21 patients participated in a 12-session DMT group intervention, and the remaining 12 patients chose to take TAU only. The majority of the patients suffered from moderate or severe depression, recurrent and/or chronic type. The effects of the interventions were investigated after the intervention, and at 3-month follow-up. Compared to the TAU, adding DMT seemed to improve the effect of the treatment. The effect of the DMT was observable whether the patient was taking antidepressant medication or not. At follow-up, between group effect sizes (ES were medium in favor for the DMT group (d= 0.60-0.79. In the DMT group, the within ES at the 3 months follow-up varied from 0.62 to 0.82 as compared to TAU 0.15 – 0.37. The results indicated that DMT is beneficial in the treatment of depressed patients.
Pylvänäinen, Päivi M; Muotka, Joona S; Lappalainen, Raimo
We were interested in investigating the effects of dance movement therapy (DMT) in a psychiatric outpatient clinic with patients diagnosed with depression. DMT aims to engage the patients in physical and verbal exploration of their experiences generated in movement based interaction. The assumption was that DMT, which includes both physical engagement as well as emotional and social exploration, would alleviate the mood and psychiatric symptoms. All adult patients (n = 33) included in the study received treatment as usual (TAU). Twenty-one patients participated in a 12-session DMT group intervention, and the remaining 12 patients chose to take TAU only. The majority of the patients suffered from moderate or severe depression, recurrent and/or chronic type. The effects of the interventions were investigated after the intervention, and at 3-month follow-up. Compared to the TAU, adding DMT seemed to improve the effect of the treatment. The effect of the DMT was observable whether the patient was taking antidepressant medication or not. At follow-up, between group effect sizes (ES) were medium in favor for the DMT group (d = 0.60-0.79). In the DMT group, the within ES at the 3 months follow-up varied from 0.62 to 0.82 as compared to TAU 0.15-0.37. The results indicated that DMT is beneficial in the treatment of depressed patients.
Pacitti, Francesca; Maraone, Annalisa; Zazzara, Francesca; Biondi, Massimo; Caredda, Maria
The Night Eating Syndrome (NES) is a disorder characterized by the clinical features of morning anorexia, evening hyperphagia, and insomnia with awakenings followed by nocturnal food ingestion. The core clinical feature appears to be a delay in the circadian timing of food intake. The diagnosis and early treatment of NES may represent an important means of prevention for obesity. Aims. The aim of the present study was to determine the vulnerability to develop NES between a clinical sample of patients with psychiatric disorders and a non clinical sample. We investigated a possible relation between stress and a dysfunctional eating behaviors as NES. Methods. The Night Eating Questionnaire (NEQ) has been administered to 147 psychiatric outpatients and to 531 subjects attending the University of L'Aquila. The NEQ is a questionnaire used to evaluate the prevalence of NES. The sample has been also evaluated through the Stress-related Vulnerability Scale (SVS) to measure both perceived stress and social support. Results. The 8.2% of patients scored above the diagnostic cut-off of the NEQ, compared to the 2.1% in the sample of healthy subjects. The majority of patients who had shown NEQ>25 had a diagnosis of major depressive disorder (MDD). The total scores on the NEQ were strongly associated with the SVS total score and especially with the "lack of social support" subscale. Conclusions. This study shows the increased vulnerability of NES in the sample of psychiatric patients compared to the sample of healthy subjects. The study further confirms the strong association between perceived stress, social support, altered eating behaviors and obesity.
McCurdy, Kathleen; Croxford, Anna
It is well established that patients with mental illness are known to have a high level of morbidity and mortality compared to the general population. This is particularly prominent in long-stay psychiatric patients, such as those in secure settings. The Royal College of Psychiatrists recommends that psychiatrists should promote the physical health of their patients and liaise with other specialties. However, there is evidence that communication between psychiatry and other specialties is poor. A survey was carried out at the North London Forensic Service in June 2014. This looked at the views of clinical staff about the frequency and quality of feedback obtained when inpatients attend outpatient hospital appointments at local general hospitals. This survey highlighted the general perception among staff that feedback is poor, with 68.43% of respondents saying that they were "very unsatisfied" or "unsatisfied" with the level and quality of feedback. Clinical staff felt that many patients who attended hospital outpatient appointments, even when escorted by staff, returned with little or no feedback. This was confirmed by a baseline audit across 3 wards showing that details of the appointment (date, time, hospital, and specialty) were only documented in 54.5% of cases and the content of the appointment documented in even fewer cases. A form was designed by junior doctors that provided a simple framework of 6 questions to be answered at the outpatient clinic about the problem, diagnosis, and further actions needed. This was introduced and its impact assessed with a 3-month and 6-month audit of electronic notes, as well as a follow-up survey after 6 months. The audit showed significant improvement in the quality of feedback about the appointment at both the 3-month and 6-month point. The follow-up survey showed that 70% of respondents were aware of the form and 100% of those who were aware of the form had used it at least once and found it helpful. The general
Hansen, Anne Helen; Høye, Anne
Overall, men are less likely than women to seek health care services for mental health problems, but differences between genders in higher age groups are equivocal. The aim of the current study was to investigate the association between gender and the use of psychiatric outpatient specialist services in Norway, both in a general population and in a subpopulation with self-reported anxiety and/or depression. Using questionnaires from 12,982 participants (30-87 years) in the cross-sectional sixth Tromsø Study (2007-8) we estimated proportions reporting anxiety/depression, and proportions using psychiatric outpatient specialist services in a year. By logistic regressions we studied the association between gender and the use of psychiatric outpatient specialist services. Analyses were adjusted for age, marital status, income, education, self-reported degree of anxiety/depression, and GP visits last year. Analyses were also performed for genders separately. Anxiety/depression was reported by 21.5 % of women and 12.3 % of men in the general population. Visits to psychiatric outpatient services during one year were reported by 4.6 % of women and 3.3 % of men. The general population's probability of a visit was significantly lower among men compared to women in ages 30-49 years (odds ratio [OR] 0.58, confidence interval [CI] 0.39-0.84, p-value [p] = 0.004), whereas men used services slightly more than women in ages 50 years and over (OR 1.36, CI 1.00-1.83, p = 0.047). Among those with anxiety/depression 13.5 % of women and 10.5 % of men visited psychiatric outpatient services in a year. We found no statistically significant gender differences in the use of services in this subgroup. Other factors associated with services use in women with anxiety/depression were higher education, more severe anxiety/depression, and GP visits the last year, whereas in men only a more severe anxiety/depression was associated with psychiatric outpatient visits. Overall, the use of
Bragdon, Laura B; Diefenbach, Gretchen J; Hannan, Scott; Tolin, David F
The Overall Anxiety Severity and Impairment Scale (OASIS) is a brief, transdiagnostic measure used to assess anxiety severity and related interference. The OASIS has demonstrated strong psychometric properties in previous investigations, however, it has yet to be validated using a transdiagnostic clinician-rated measure. We evaluated the factor structure, convergent and discriminant validity, and illness severity cut-scores of the OASIS in a sample of outpatients (N=202). A confirmatory factor analysis indicated an unidimensional structure provided the best fit. The OASIS demonstrated good convergent validity and internal consistency. Using the Clinical Global Impression-Severity Scale (CGI-S), ROC curves showed OASIS scores of 6, 10 and 12 to indicate moderate, marked and severe illness severity, respectively. The OASIS is a unidimensional self-report measure with good convergent validity and data from the current study provide illness severity cut-scores. Copyright © 2016 Elsevier B.V. All rights reserved.
Kachani, Adriana Trejger; Barroso, Lucia Pereira; Brasiliano, Silvia; Cordás, Táki Athanássios; Hochgraf, Patrícia Brunfentrinker
Compare inadequate eating behaviors and their relationship to body checking in three groups: patients with anorexia nervosa (AN), patients with bulimia nervosa (BN) and a control group (C). Eighty three outpatients with eating disorders (ED) and 40 controls completed eating attitudes and body checking questionnaires. The overall relationship between the eating attitude and body checking was statistically significant in all three groups. The worse the eating attitude, the greater the body checking behavior. However, when we look at each group individually, the relationship was only statistically significant in the AN group (r=.354, p=0.020). The lower the desired weight and the worse the eating attitude, the more people check themselves, although in the presence of an ED the relationship between body checking and food restrictions is greater. In patients displaying the AN subgroup, body checking is also related to continued dietary control. Copyright © 2015 Elsevier Ltd. All rights reserved.
Anil Kumar Mysore Nagaraj
Full Text Available Background: Disorders such as depression, anxiety, cognitive and psychotic disorders have a high prevalence among elderly. There is some preliminary evidence that life in old age homes is perceived by inmates as more supportive, though the issue is not well studied. Aim: This project is directed towards studying and comparing the psychiatric morbidity and quality of life of elderly people residing in two unique settings: community and old age homes. Method: It is a cross-sectional study where the elderly subjects, 50 each in both the groups, were selected by simple random sampling technique and assessed on Mini Mental Status Examination (MMSE, Informant Questionnaire on Cognitive Decline in Elderly (IQCODE, Brief Psychiatric Rating Scale (BPRS and Quality of life visual analogue scale. Result: On comparison using suitable statistical analysis, there was no significant difference in the total scores on MMSE, IQCODE and quality of life scale across the groups. Depression was present in 22% of people in the community and 36% of old age home inmates. Psychosis was present in 26% of people in the community and 20% of old age home inmates. Conclusion: The psychiatric morbidity is high in elderly irrespective of the setting in which they live.
Dorard, G; Bungener, C; Phan, O; Edel, Y; Corcos, M; Berthoz, S
The use of illicit substances, in particular cannabis, among French adolescents and young adults has become an important public health concern. A better understanding of the mechanisms involved in pathological substance use is nowadays critical. Psychiatric comorbidities have been previously reported in adult substance abusers but are less documented in adolescents, especially regarding cannabis dependence. We investigated mental health problems in adolescents and young adults, seeking treatment for their problematic cannabis use, comparatively to healthy controls, taking into account the participant's gender and age. Moreover, we explored the relationships between psychiatric diagnosis and substance use modalities. In total, 100 young patients (80 males - mean age 18.2 (SD=2.9; [14 to 25] years old)) with a cannabis dependence (DSM-IV-TR criteria) seeking treatment in an addiction unit, and 82 healthy control subjects (50 males - mean age 18.3 (SD=3.4; [14 to 25] years old)) with no substance misuse diagnostic other than for alcohol, participated in the study. The MINI was administered to evaluate cannabis dependence, and DSM-IV axis I comorbid diagnosis, and a semi-structured interview was used to determine psychoactive substance use. Statistical analyses revealed that 79 % of the patients reported at least one other non-drug or alcohol comorbid diagnosis, versus 30.5 % in the control group (χ 2 =16.83; Ppanic attack disorder (χ 2 =4.15; P<0.042; OR=3.59; OR 95 % CI=[0.98-13.19]), alcohol abuse (χ 2 =47.72; P<0.001; OR=66.27; OR 95 % CI=[8.87-495.11]) and dependence (V=0.230; P=0.001) and generalized anxiety disorder (χ 2 =7.46; P=0.006-OR=3.57; OR 95 % CI=[1.37-9.30]). On the whole, the females (n=20) of our clinical sample presented significantly more comorbid diagnoses than the males (n=80) (95 % versus 75 %; χ 2 =6.25, P=0.011). These significant gender differences were found for life-time eating disorder (V=0.352; P=0.007) and
Hsu, Shang-Wei; Lin, Jin-Ding; Chiang, Po-Huang; Chang, Yu-Chia; Tung, Ho-Jui
This study aims to analyze the ambulatory visit frequency and medical expenditures of the general elderly population versus the elderly with intellectual disabilities in Taiwan, while examining the effects of age, gender, urbanization and copayment status on ambulatory utilization. A cross-sectional study was conducted to analyze data from 103,183…
Gaudiano, Brandon A; Zimmerman, Mark
Attenuated psychosis syndrome (APS) is being proposed for inclusion in Section III of DSM-5 for those impaired by subthreshold psychotic symptoms that are not better accounted for by another diagnosis and not meeting criteria for a psychotic disorder. The rationale is to identify patients who are at high risk for transition to a psychotic disorder in the near future. However, the potential impact of using this new diagnosis in routine clinical practice settings has not been carefully examined. As part of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, a treatment-seeking psychiatric outpatient sample (n = 1,257) recruited from June 1997 to June 2002 completed a self-report measure of psychiatric symptoms and afterward were administered structured clinical interviews. For the current post hoc study, we investigated the prevalence rate of endorsing attenuated psychotic experiences to identify patients who could potentially meet criteria for APS. After the exclusion of those with lifetime DSM-IV psychotic disorders, psychotic experiences remained highly prevalent in the sample (28% reported at least 1 psychotic experience during the past 2 weeks), and rates were similar across all major DSM-IV diagnostic categories. Only 1 patient (0.08%) reported psychotic experiences but did not meet criteria for another current DSM disorder; however, this individual endorsed other nonpsychotic symptoms of greater severity. Psychotic experience endorsement was positively correlated with nearly all other nonpsychotic symptom domains, and multivariate analysis showed that general clinical severity predicted endorsement of psychotic experiences (P values < .001). We could not identify any patients who clearly met criteria for APS alone in our sample. Psychotic experiences appear to be common in outpatients and represent nonspecific indicators of psychopathology. Diagnosing APS in the community could result in high rates of false-positives or high
Lau, Ying Wen; Picco, Louisa; Pang, Shirlene; Jeyagurunathan, Anitha; Satghare, Pratika; Chong, Siow Ann; Subramaniam, Mythily
Studies have suggested that stigma resistance plays an important role in the recovery from mental illness. However, there has been limited research in Asian countries that has examined the benefits of stigma resistance among the mentally ill in Asian populations. Hence, this study aimed to assess the prevalence of stigma resistance and establish the socio-demographic correlates of stigma resistance, as well as its association with internalised stigma and psychosocial outcomes among a multi-ethnic population of 280 outpatients with obsessive compulsive disorder (OCD), schizophrenia, depressive disorders and anxiety disorders in Singapore. Prevalence of stigma resistance measured using the Stigma Resistance subscale of the Internalised Stigma of Mental Illness Scale was 82.9%. ANOVA and logistic regressions were conducted and results revealed that: (i) Stigma resistance was positively associated with being separated/divorced/widowed but negatively associated with depression diagnosis; (ii) Psychosocial outcomes such as self-esteem and psychological health were positively associated with stigma resistance; and (iii) Internalised stigma was negatively associated with stigma resistance. Moving forward, treatments could emphasize on improving the self-esteem and psychological health of patients to increase their stigma resistance for counteracting effects of public and internalised stigma. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.
Full Text Available Objectives. We aimed at examining the differences between depressed psychiatric adolescent outpatients with and without cooccurring alcohol misuse in psychosocial background, clinical characteristics, and treatment received during one-year followup. Furthermore, we investigated factors related to nonattendance at treatment. Materials and Methods. Consecutive 156 adolescent (13–19 years psychiatric outpatients with a unipolar depressive disorder at baseline were interviewed using structured measures at baseline and at 12 months. Alcohol misuse was defined as having an AUDIT score of 8 or more points. The outpatients received “treatment as usual” of clinically defined duration. Results. Among depressive outpatients, poor parental support, parental alcohol use and decreased attendance at treatment associated with alcohol misuse. The severity of alcohol use as measured by AUDIT-score was the strongest factor independently predicting nonattendance at treatment in multivariate analysis. Conclusions. Alcohol misuse indicates family problems, has a deleterious effect on treatment attendance, and should be taken into account when managing treatment for depressive adolescent outpatients.
Matsumoto, Toshihiko; Matsushita, Sachio; Okudaira, Kenichi; Naruse, Nobuya; Cho, Tetsuji; Muto, Takeo; Ashizawa, Takeshi; Konuma, Kyohei; Morita, Nobuaki; Ino, Aro
The present study used a self-reporting questionnaire to compare suicide risk in outpatients being treated for substance use disorder at specialized hospitals to suicide risk in outpatients being treated for depressive disorder at general psychiatric clinics. Although patients in both groups exhibited an equal severity of depression, the patients with drug use disorder had a higher suicide risk than those with depressive disorder. These findings indicate that drug-abusing patients at specialized hospitals may have a severe risk of committing suicide, suggesting that carefully assessing the comorbidity of depression with drug abuse may be required for preventing suicide in drug-abusing patients.
Full Text Available Abstract Background There is an expectation in current heath care policy that family carers are involved in service delivery. This is also the case with compulsory outpatient mental health care, Community Treatment Orders (CTOs that were introduced in England in 2008. No study has systematically investigated family involvement through the CTO process. Method We conducted qualitative interviews with 24 family carers to ascertain their views and experiences of involvement in CTOs. The transcripts were subjected to thematic analysis that incorporated both deductive and inductive elements. Results We found significant variation in both the type and extent of family carer involvement throughout the CTO process (initiation, recall to hospital, renewal, tribunal hearings, discharge. Some were satisfied with their level of involvement while others felt (at least partly excluded or that they wanted to be more involved. Some wanted less involvement than what they had. From the interviews we identified key factors shaping carers' involvement. These included: perceptions of patient preference; concern over the relationship to the patient; carers’ knowledge of the CTO and of the potential for carer involvement; access to and relationships with health professionals; issues of patient confidentiality; opportunities for private discussions, and; health professionals limiting involvement. These factors show that health professionals have many opportunities to facilitate, or hinder, carer involvement. The various roles attributed to carers, such ‘proxy’ for patient decision, ‘gatekeeper’ to services, ‘mother’ or ‘expert carer’, however, conflict with one another and make the overall role unclear. Conclusions There is a need for clarification of the expectations of carers in individual care situations, for carers to be equipped with the information they need to in order to be involved, and for services to find flexible and innovative ways of
Rugkåsa, Jorun; Canvin, Krysia
There is an expectation in current heath care policy that family carers are involved in service delivery. This is also the case with compulsory outpatient mental health care, Community Treatment Orders (CTOs) that were introduced in England in 2008. No study has systematically investigated family involvement through the CTO process. We conducted qualitative interviews with 24 family carers to ascertain their views and experiences of involvement in CTOs. The transcripts were subjected to thematic analysis that incorporated both deductive and inductive elements. We found significant variation in both the type and extent of family carer involvement throughout the CTO process (initiation, recall to hospital, renewal, tribunal hearings, discharge). Some were satisfied with their level of involvement while others felt (at least partly) excluded or that they wanted to be more involved. Some wanted less involvement than what they had. From the interviews we identified key factors shaping carers' involvement. These included: perceptions of patient preference; concern over the relationship to the patient; carers' knowledge of the CTO and of the potential for carer involvement; access to and relationships with health professionals; issues of patient confidentiality; opportunities for private discussions, and; health professionals limiting involvement. These factors show that health professionals have many opportunities to facilitate, or hinder, carer involvement. The various roles attributed to carers, such 'proxy' for patient decision, 'gatekeeper' to services, 'mother' or 'expert carer', however, conflict with one another and make the overall role unclear. There is a need for clarification of the expectations of carers in individual care situations, for carers to be equipped with the information they need to in order to be involved, and for services to find flexible and innovative ways of ensuring continuous, open communication. The introduction of CTOs in England has not
Tatarczuk, Joanna; Galus, Krzysztof; Kozak-Szkopek, Elzbieta; Kowalczyk, Alina
Depression and cognitive disfunctions are the most common psychopathological disorders of older adults. To asses effects of a pharmacological and psychological treatment performed in psychiatric ward on psychic state and functional and cognitive abilities in elderly patients with depression. The study included group of 35 patients with depression (22 women and 13 men) above 65 years old, consecutively admitted to the psychiatric ward. Examination of the psychical, mental and functional abilities was performed at the beginning and end of 4-6 weeks treatment in psychiatric ward, by means of the following scales: Katz activities of daily living (ADL), Lawton instrumental activities of daily living scale (IADL), Folstein mini mental state examination (MMSE), Yesavage Geriatric Depression Scale (GDS). In women, after treatment the average scores in ADL test increased 0.3 point (statistically insignificant); in IADL test--increased 2.6 points (statistically significant); in MMSE test--increased 6 points (statistically significant), in GDS scale--reduced 13.45 points (statistically significant). In men after therapy the mean value of points in ADL test increased 0.4 points (statistically insignificant); in the test of IADL increased 3.5 points (statistically significant); in MMSE test--increased 6.5 points (statistically significant); in the scale of the GDS decreased 13.7 points (statistically highly significant). In elderly patients with depression mental state improved after pharmacological and psychological treatment in psychiatric ward. Improvement of mood in elderly patients treated for depression leads to increased functional and cognitive abilities.
Maria Otilia Cerveira
Full Text Available Abstract General psychiatric symptoms may interfere with the ability of individuals to take care of their health, to get involved with activities and develop social abilities, thereby increasing risk of death. Objective: To evaluate general psychiatric symptoms as predictive factors for mortality in a community elderly cohort in Southern Brazil. Methods: 345 healthy elderly, aged ³60 years, from the catchment area of Hospital de Clinicas de Porto Alegre were followed from 1996. Data for the present study were drawn from the period 1996-2004. General psychiatric symptoms (Self-Reporting Questionnaire - SRQ, depressive symptoms (Montgomery-Asberg depressive rating scale, and Mini Mental State Examination scores at baseline were included in the study. Socio-demographic, medical conditions, and functional capacity were also analyzed. The outcome was vital status at follow-up obtained from family members, hospital records and checked against official death registers. Results: Of the 345 baseline individuals, 246 were followed-up. The global mortality rate over the study period was 36.9% (N=90. Those who deceased during the period were older (73.5±7.5, more dependent overall, and more cognitively impaired than the living elderly (univariate analyses. In the logistic regression, only age (OR=0.93; p=0.003 and functional capacity (OR=0.22; p=0.007 remained significant in the final equation. Conclusion: Psychiatric symptoms presented no association with mortality in the present sample. Older age and functional incapacity were risk factors for mortality.
Fukazawa, Raita; Koyama, Shun-ichi; Kanetaka, Hidekazu; Umahara, Takahiko; Hanyu, Haruo; Iwamoto, Toshihiko
Leg edema, observed on comprehensive geriatric assessment (CGA) of 142 elderly outpatients with a variety of chronic diseases, was studied clinically to clarify its incidence and its associated risk factors. The severity of pitting edema was assessed at 3 points, namely, the pretibial edge, medial malleolus, and the dorsum of the foot. On palpation, edema was graded as 0 to 3 for each point on one leg, the sum of which was used as the edema score. According to the edema score, subjects were divided into 3 groups; the moderate to severe (MS) group, the slight to mild (SM) group, and the group without pitting edema. The MS group was defined as having an edema score of 4 or more or edema of grade 2 or more, while the SM group was defined as having an edema score of 2 to 3 points without edema of grade 2 or more. The status of underlying disease, vascular risks, varicose veins, medications, daily activity, nutrition, total protein (TP), albumin, brain natriuretic peptide (BNP), and the estimated glomerular filtration rate (eGFR) were compared among the 3 groups. There were 36 subjects in the MS group and 19 subjects in the SM group. Diabetes, atrial fibrillation, varicose veins, and polypharmacy were more frequent in the MS group than in the control group. Sedentary life style, house-bound, and gait trouble were significantly more frequent in the MS and SM groups. There were no significant differences in the scores of the Mini-Nutritional Assessment Short Form among the groups, although both the body weight and calf circumference in the MS group were significantly greater than those in the group without pitting edema. Low serum TP, albumin and eGFR were seen in the MS group as well as high BNP levels. Multiple regression analysis revealed diabetes, varicose veins, sedentarism, and hypoalbuminemia as risk factors associated with leg edema (R(2)=0.365, pvaricose veins, sedentarism, and hypoalbuminemia. These findings suggest that advising against a sedentary life style
Mondal, Gargi; Bajaj, Vikrant; Goyal, B L; Mukherjee, Nirmalya
Sleep disorders are frequently associated with psychiatric disorders and can be both cause and effect of the same. To study the prevalence of sleep disorders and the severity of insomnia in psychiatric outpatients. 500 patients were randomly selected using purposive sampling from patients attending a tertiary level mental health care facility were evaluated for the presence of any sleep disorder along with their sleep quality. In patients having insomnia, severity of the same was determined. 83.4% of the population had some type of sleep disorder. Symptoms of insomnia were reported by 78.2% of the population and 29.2% had moderate to severe insomnia. 78.4% of the population had poor sleep quality. Significant difference was noted among the different psychiatric groups when insomnia severity index (ISI) was compared. In multinomial logistic regression, chance of severe insomnia is more if the diagnosis is depression, but less if mania or ocd, compared to psychosis. This study was the first in India to assess the prevalence of sleep disorders in psychiatric outpatients. Our study underscores the importance of careful evaluation of sleep problems for proper management of the patients. Copyright © 2017 Elsevier B.V. All rights reserved.
Silveira, Celeste; Norton, Andreia; Brandão, Isabel; Roma-Torres, António
The mental health of college students has been raising major awareness, due to the increased prevalence and severity of psychiatric disorders in this population. Higher education is associated with significant stressors that contribute to the development of mental health disturbances, and most college students are in the high-risk age group for the emergence of symptoms of major psychiatric disorders. Early diagnosis and treatment of these disorders in college students are important areas of effort, since they pose a high impact at the educational, economic, and social levels. Thus, specifically planned mental health services play a major role in the management of this population, should be specialized and have easy accessibility. The purpose of this study is to describe and characterize the College Students' psychiatric outpatient clinic of the Department of Psychiatry, Hospital de São João.
Nyman-Carlsson, Erika; Engström, Ingemar; Norring, Claes; Nevonen, Lauri
The Eating Disorder Inventory-3 (EDI-3) is designed to assess eating disorder psychopathology and the associated psychological symptoms. The instrument has been revised and has not yet been validated for Swedish conditions in its current form. The aim of this study was to investigate the validity and reliability of this inventory and present national norms for Swedish females. Data from patients with eating disorders (n = 292), psychiatric outpatients (n = 140) and normal controls (n = 648), all females, were used to study the internal consistency, the discriminative ability, and the sensitivity and specificity of the inventory using preliminary cut-offs for each subscale and diagnosis separately. Swedish norms were compared with those from Denmark, USA, Canada, Europe and Australian samples. The reliability was acceptable for all subscales except Asceticism among normal controls. Analysis of variance showed that the EDI-3 discriminates significantly between eating disorders and normal controls. Anorexia nervosa was significantly discriminated from bulimia nervosa and eating disorder not otherwise specified on the Eating Disorder Risk Scales. Swedish patients scored significantly lower than patients from other countries on the majority of the subscales. Drive for Thinness is the second best predictor for an eating disorder. The best predictor for anorexia nervosa was Interoceptive Deficits and Bulimia for the other diagnoses. Conclusions/clinical implications: The EDI-3 is valid for use with Swedish patients as a clinical assessment tool for the treatment planning and evaluation of patients with eating-related problems. However, it still exist some uncertainty regarding its use as a screening tool.
Adamis, D; Ball, C
This study examines the prevalence of physical morbidity in elderly psychiatric inpatients and the possible relationships between major psychiatric disorders (organic mental disorders, schizophrenic and mood disorders) and physical illnesses. The clinical implications of such relationships are discussed. Data were obtained from two old age psychiatry wards over a six month period. Seventy-nine subjects were studied and information was obtained from their medical files. Demographic characteristics, psychiatric diagnosis, number of physical illnesses and number of body systems affected were collected. Analysis of variance (ANOVA) was used to compare the psychiatric groups on continuous outcome data and chi(2) test to compare psychiatric groups on categorical data. Seventy-five per cent of subjects had at least one physical illness. The number of medical illnesses was independent from the psychiatric disorder. Subjects with mood disorders, and especially depression, were more likely to suffer from hypertension, diabetes and cardiovascular illnesses than subjects with schizophrenic or organic disorders. Subjects with organic disorders had the lowest prevalence of endocrine disease and diabetes. It was concluded the link between mood disorders (depression), cardiovascular diseases and hypertension could be of a 'cause/effect' type or are the results of a survivor effect. The high prevalence of physical morbidity has implications for training and continuing professional development of those in Old Age Psychiatry Services. It should also be taken into consideration when the location of services is being decided.
Bhatnagar, K; Frank, J
In our community study of the prevalence of psychiatric disorders among elderly South Asian immigrants from the Indian sub-continent (India, Pakistan and Bangladesh) living in Bradford (UK), we found depression in 20%, dementia in 4% and anxiety neurosis in 4%. Subjects were interviewed at their place of residence by a consultant psychiatrist familiar with their culture and language. The Hindi translation of the community version of the Geriatric Mental State schedule (GMS-A) was also administered. Psychiatrist's ICD-9 diagnosis was compared with GMS-AGECAT computerized diagnosis. We found low-level agreement in dementia cases (kappa 0.33) whereas the agreement in subjects with depression was high (kappa 0.81). In many subjects GMS-A made a diagnosis of dementia not diagnosed as cases by the psychiatrist, who had the benefit of additional history information from carers in this population from a different culture and educational background. These findings are discussed along with suggestions and present limitations of GMS-A in the diagnosis of dementia in cross-cultural research. Larger studies are needed in this population (a) to find out prevalence rates in countries of origin and (b) to investigate the author's (KB) observation of low rates of Alzheimer's type dementia in this population, which may have aetiological significance.
Posttraumatic growth, depressive symptoms, posttraumatic stress symptoms, post-migration stressors and quality of life in multi-traumatized psychiatric outpatients with a refugee background in Norway.
Teodorescu, Dinu-Stefan; Siqveland, Johan; Heir, Trond; Hauff, Edvard; Wentzel-Larsen, Tore; Lien, Lars
Psychiatric outpatients with a refugee background have often been exposed to a variety of potentially traumatizing events, with numerous negative consequences for their mental health and quality of life. However, some patients also report positive personal changes, posttraumatic growth, related to these potentially traumatic events. This study describes posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, post-migration stressors, and their association with quality of life in an outpatient psychiatric population with a refugee background in Norway. Fifty five psychiatric outpatients with a refugee background participated in a cross-sectional study using clinical interviews to measure psychopathology (SCID-PTSD, MINI), and four self-report instruments measuring posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, and quality of life (PTGI-SF, IES-R, HSCL-25-depression scale, and WHOQOL-Bref) as well as measures of social integration, social network and employment status. All patients reported some degree of posttraumatic growth, while only 31% reported greater amounts of growth. Eighty percent of the patients had posttraumatic stress symptoms above the cut-off point, and 93% reported clinical levels of depressive symptoms. Quality of life in the four domains of the WHOQOL-Bref levels were low, well below the threshold for the'life satisfaction' standard proposed by Cummins. A hierarchic regression model including depressive symptoms, posttraumatic stress symptoms, posttraumatic growth, and unemployment explained 56% of the total variance found in the psychological health domain of the WHOQOL-Bref scale. Posttraumatic growth made the strongest contribution to the model, greater than posttraumatic stress symptoms or depressive symptoms. Post-migration stressors like unemployment, weak social network and poor social integration were moderately negatively correlated with posttraumatic growth and quality of life, and positively
Full Text Available Abstract Background Psychiatric outpatients with a refugee background have often been exposed to a variety of potentially traumatizing events, with numerous negative consequences for their mental health and quality of life. However, some patients also report positive personal changes, posttraumatic growth, related to these potentially traumatic events. This study describes posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, post-migration stressors, and their association with quality of life in an outpatient psychiatric population with a refugee background in Norway. Methods Fifty five psychiatric outpatients with a refugee background participated in a cross-sectional study using clinical interviews to measure psychopathology (SCID-PTSD, MINI, and four self-report instruments measuring posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, and quality of life (PTGI-SF, IES-R, HSCL-25-depression scale, and WHOQOL-Bref as well as measures of social integration, social network and employment status. Results All patients reported some degree of posttraumatic growth, while only 31% reported greater amounts of growth. Eighty percent of the patients had posttraumatic stress symptoms above the cut-off point, and 93% reported clinical levels of depressive symptoms. Quality of life in the four domains of the WHOQOL-Bref levels were low, well below the threshold for the’life satisfaction’ standard proposed by Cummins. A hierarchic regression model including depressive symptoms, posttraumatic stress symptoms, posttraumatic growth, and unemployment explained 56% of the total variance found in the psychological health domain of the WHOQOL-Bref scale. Posttraumatic growth made the strongest contribution to the model, greater than posttraumatic stress symptoms or depressive symptoms. Post-migration stressors like unemployment, weak social network and poor social integration were moderately negatively correlated with
Background Psychiatric outpatients with a refugee background have often been exposed to a variety of potentially traumatizing events, with numerous negative consequences for their mental health and quality of life. However, some patients also report positive personal changes, posttraumatic growth, related to these potentially traumatic events. This study describes posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, post-migration stressors, and their association with quality of life in an outpatient psychiatric population with a refugee background in Norway. Methods Fifty five psychiatric outpatients with a refugee background participated in a cross-sectional study using clinical interviews to measure psychopathology (SCID-PTSD, MINI), and four self-report instruments measuring posttraumatic growth, posttraumatic stress symptoms, depressive symptoms, and quality of life (PTGI-SF, IES-R, HSCL-25-depression scale, and WHOQOL-Bref) as well as measures of social integration, social network and employment status. Results All patients reported some degree of posttraumatic growth, while only 31% reported greater amounts of growth. Eighty percent of the patients had posttraumatic stress symptoms above the cut-off point, and 93% reported clinical levels of depressive symptoms. Quality of life in the four domains of the WHOQOL-Bref levels were low, well below the threshold for the’life satisfaction’ standard proposed by Cummins. A hierarchic regression model including depressive symptoms, posttraumatic stress symptoms, posttraumatic growth, and unemployment explained 56% of the total variance found in the psychological health domain of the WHOQOL-Bref scale. Posttraumatic growth made the strongest contribution to the model, greater than posttraumatic stress symptoms or depressive symptoms. Post-migration stressors like unemployment, weak social network and poor social integration were moderately negatively correlated with posttraumatic growth and
Ekeblad, Annika; Falkenström, Fredrik; Andersson, Gerhard; Vestberg, Robert; Holmqvist, Rolf
Interpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) are both evidence-based treatments for major depressive disorder (MDD). Several head-to-head comparisons have been made, mostly in the United States. In this trial, we compared the two treatments in a small-town outpatient psychiatric clinic in Sweden. The patients had failed previous primary care treatment and had extensive Axis-II comorbidity. Outcome measures were reduction of depressive symptoms and attrition rate. Ninety-six psychiatric patients with MDD (DSM-IV) were randomized to 14 sessions of CBT (n = 48) or IPT (n = 48). A noninferiority design was used with the hypothesis that IPT would be noninferior to CBT. A three-point difference on the Beck Depression Inventory-II (BDI-II) was used as noninferiority margin. IPT passed the noninferiority test. In the ITT group, 53.5% (23/43) of the IPT patients and 51.0% (24/47) of the CBT patients were reliably improved, and 20.9% (9/43) and 19.1% (9/47), respectively, were recovered (last BDI score depressed psychiatric patients in a community-based outpatient clinic. CBT had significantly more dropouts than IPT, indicating that CBT may be experienced as too demanding. Since about half the patients did not recover, there is a need for further treatment development for these patients. The study should be considered an effectiveness trial, with strong external validity but some limitations in internal validity. © 2016 Wiley Periodicals, Inc.
Chien, Wai-Tong; Bressington, Daniel
This study aimed to test the effectiveness of a nurse-led structured psychosocial intervention program in Chinese patients with first-onset mental illness. A single-blind, parallel group, randomized controlled trial design was used. The study involved 180 participants with mild to moderate-severe symptoms of psychotic or mood disorders who were newly referred to two psychiatric outpatient clinics in Hong Kong. Patients were randomly assigned to either an eight-session nurse-led psychosocial intervention program (plus usual care) or usual psychiatric outpatient care (both n=90). The primary outcome was psychiatric symptoms. Outcomes were measured at recruitment, one week and 12 months post-intervention. Patients in the psychosocial intervention group reported statistically significant improvements in symptoms compared to treatment as usual. There were also significant improvements in illness insight and perceived quality of life and reduction in length of re-hospitalizations over the 12-month follow-up. The findings provide evidence that the nurse-led psychosocial intervention program resulted in improved health outcomes in Chinese patients with first-onset mental illness. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Bijlsma, A.Y.; Pasma, J.H.; Lambers, D.; Stijntjes, M.; Blauw, G. J.; Meskers, C.G.M.; Maier, A.B.
Objectives: Assessment of the association of muscle characteristics with standing balance is of special interest, as muscles are a target for potential intervention (ie, by strength training). Design: Cross-sectional study. Setting: Geriatric outpatient clinic. Participants: The study included 197
This study aimed to measure patient satisfaction with the care they were receiving; examine patients\\' knowledge of the psychiatric services in general; and identify variables associated with satisfaction.
Aloba, Olutayo; Akinsulore, Adesanmi; Mapayi, Boladale; Oloniniyi, Ibiduniyi; Mosaku, Kolawole; Alimi, Taiwo; Esan, Olufemi
Previous studies from the developed western countries have repeatedly demonstrated that hopelessness positively correlates with an increased risk of suicide in the context of chronic mental disorders such as schizophrenia and affective disorders. Despite this persistently strong association, the construct of hopelessness in terms of its factorial structure and correlates has not been explored among Nigerian psychiatric outpatients. The aim of this present study is to examine the psychometric characteristics of the Yoruba language culturally adapted version of the Beck Hopelessness Scale in a cross-sectional sample of psychiatric outpatients in South-western Nigeria. The participants were 327 Nigerian adult outpatients receiving treatment for schizophrenia, bipolar and depressive disorders, consecutively recruited from the outpatient psychiatric clinics of a university teaching hospital in South-western Nigeria. The outpatients were recruited over a one year period. They completed the Yoruba translated version of the Beck Hopelessness Scale (BHS-Y), a sociodemographic and illness-related questionnaire, the Beck Depression Inventory-II (BDI-II). Their level of functioning was assessed with the Global Assessment of Functioning Scale (GAF), psychopathology was evaluated with the Positive and Negative Syndrome Scale (PANSS) and the level of disability measured with the World Health Organization Disability Assessment Schedule (WHODAS-II). Suicidality and confirmation of the diagnoses of schizophrenia, bipolar and depressive disorders were evaluated with the Mini International Neuropsychiatric Interview (MINI). The construct of hopelessness in terms of factorial structure, reliability, validity and correlates was explored. Exploratory Factor Analysis using Principal Component Analysis with Varimax rotation was used to examine the factorial structure of the BHS-Y. Internal consistency was examined with Cronbach's alpha, and the construct validity of the scale was assessed
De las Cuevas C
Full Text Available Carlos De las Cuevas,1 Mariano Motuca,2 Trino Baptista,3 Jose de Leon4–6 1Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, Canary Islands, Spain; 2Instituto Vilapriño, Center for Studies, Assistance and Research in Neurosciences, Mendoza, Argentina; 3Departament of Physiology, Facultad de Medicina, Universidad de Los Andes, Mérida, Venezuela; 4Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA; 5Psychiatry and Neurosciences Research Group (CTS-549, Institute of Neurosciences, University of Granada, Granada, Spain; 6Biomedical Research Centre in Mental Health Net (CIBERSAM, Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain Background: Cultural differences in attitudes toward psychiatric medications influence medication adherence but transcultural studies are missing. The objective of this study was to investigate how attitudes and beliefs toward psychotropic medications influence treatment adherence in psychiatric outpatients in Spain, Argentina, and Venezuela.Methods: A cross-sectional, cross-cultural psychopharmacology study was designed to assess psychiatric outpatients’ attitudes toward their prescribed medication. Patients completed the Drug Attitude Inventory – 10 Item (DAI-10, the Beliefs about Medicines Questionnaire – Specific Scale (BMQ-Specific, the Sidorkiewicz adherence tool, and sociodemographic and clinical questionnaires. The study included 1,291 adult psychiatric outpatients using 2,308 psychotropic drugs from three Spanish-speaking countries, the Canary Islands (Spain (N=588 patients, Argentina (N=508, and Venezuela (N=195.Results: The univariate analyses showed different mean scores on the DAI-10 and the BMQ – Necessity and Concerns subscales but, on the other hand, the percentages of non-adherent and skeptical patients were relatively similar in three countries. Argentinian patients had a very low level of pharmacophobia
Arnoldi, Ermenegildo; Dieli, Maria; Mangia, Marina; Minetti, Bruno; Labianca, Roberto
Cancer is an age-related disease, and the increase in life expectancy will lead to a progressive increase of cancer cases in the elderly (> or =70 years of age). We have created a group called GONG (Gruppo Oncologico Geriatrico) to apply cancer geriatric assessment in elderly cancer patients, in order to select which of them are eligible for oncological treatment or supportive care only. We applied this model to evaluate 153 patients from March 2004 to August 2005. Our model included three categories of patients: frail (at least one of the following items: Activities of Daily Living scale or =3 comorbidities unrelated to the tumor according to the Charlson Index, performance status or =3 according respectively to Karnofsky and the ECOG scale, > or =1 geriatric syndrome); borderline (patients with multiple comorbidities not affecting performance status or ability in daily activities); non-frail. Applying the aforementioned criteria, we found 30 borderline, 14 frail and 109 non-frail patients. Statistical analysis showed a significant difference in mortality between frail and non-frail patients (P patients. Our model was thus able to identify patients at higher risk of death. These results confirm the importance of cancer geriatric assessment also for the clinical evaluation of oncological patients. Additional randomized studies with a larger number of patients, also in an adjuvant setting, should be performed to confirm the effectiveness of this approach.
Full Text Available Abstract The aging of the population is a worldwide phenomenon, where 60% of elders live in developing areas of the world such as Brazil, regions in which few studies have been carried out. Objectives: The goal of this study was to evaluate the clinical and demographic profile of patients with dementing disorders seen at a specialized outpatient clinic in South Brazil. Methods: A sample of 105 demented patients seen at the Dementia Outpatient Clinic from Hospital de Clínicas de Porto Alegre (HCPA, Brazil between June 2004 and June 2008. Evaluation of patients consisted of medical history, cognitive testing, assessment of functional status (Activities of Daily Living Scale - ADL; Instrumental Activities Daily Living - IADL and application of the Neuropsychiatry Inventory (NPI for behavioral symptoms. Severity of dementia was evaluated based on the CDR scale. All patients underwent laboratory screening tests and brain imaging exams to define etiology of dementia. Results: Of the whole sample, 71% were female. Age was 79±8 years (mean±SD. Educational level was 4±3 years (mean±SD. Sixty-four patients (60% presented the diagnosis of Alzheimer's disease. Of the whole sample, 26.7% were classified as CDR=1, 44% as CDR=2 and 29. 3% as CDR=3. A significant difference on the Mini Mental State Examination (MMSE and functional status scores was observed among the CDR categories (severity. No significant association was found between severity and impairment on memory tests and behavioral symptoms. Conclusions: Alzheimer's disease was the most common etiology, followed by vascular dementia. At diagnosis, most patients presented mild to moderate severity of dementia, independent of cause.
Araos, Pedro; Pedraz, María; Serrano, Antonia; Lucena, Miguel; Barrios, Vicente; García-Marchena, Nuria; Campos-Cloute, Rafael; Ruiz, Juan J; Romero, Pablo; Suárez, Juan; Baixeras, Elena; de la Torre, Rafael; Montesinos, Jorge; Guerri, Consuelo; Rodríguez-Arias, Marta; Miñarro, José; Martínez-Riera, Roser; Torrens, Marta; Chowen, Julie A; Argente, Jesús; Mason, Barbara J; Pavón, Francisco J; Rodríguez de Fonseca, Fernando
The treatment for cocaine use constitutes a clinical challenge because of the lack of appropriate therapies and the high rate of relapse. Recent evidence indicates that the immune system might be involved in the pathogenesis of cocaine addiction and its co-morbid psychiatric disorders. This work examined the plasma pro-inflammatory cytokine and chemokine profile in abstinent cocaine users (n = 82) who sought outpatient cocaine treatment and age/sex/body mass-matched controls (n = 65). Participants were assessed with the diagnostic interview Psychiatric Research Interview for Substance and Mental Diseases according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Tumor necrosis factor-alpha, chemokine (C-C motif) ligand 2/monocyte chemotactic protein-1 and chemokine (C-X-C motif) ligand 12 (CXCL12)/stromal cell-derived factor-1 (SDF-1) were decreased in cocaine users, although all cytokines were identified as predictors of a lifetime pathological use of cocaine. Interleukin-1 beta (IL-1β), chemokine (C-X3-C motif) ligand 1 (CX3CL1)/fractalkine and CXCL12/SDF-1 positively correlated with the cocaine symptom severity when using the DSM-IV-TR criteria for cocaine abuse/dependence. These cytokines allowed the categorization of the outpatients into subgroups according to severity, identifying a subgroup of severe cocaine users (9-11 criteria) with increased prevalence of co-morbid psychiatric disorders [mood (54%), anxiety (32%), psychotic (30%) and personality (60%) disorders]. IL-1β was observed to be increased in users with such psychiatric disorders relative to those users with no diagnosis. In addition to these clinical data, studies in mice demonstrated that plasma IL-1β, CX3CL1 and CXCL12 were also affected after acute and chronic cocaine administration, providing a preclinical model for further research. In conclusion, cocaine exposure modifies the circulating levels of pro-inflammatory mediators. Plasma
Vidal, Raquel; Barrau, Víctor; Casas, Miguel; Caballero-Correa, María; Martínez-Jiménez, Pedro; Ramos-Quiroga, Josep Antoni
The aim of the current study was to assess the prevalence of symptoms of attention deficit/hyperactivity disorder (ADHD) in adolescents and young adults diagnosed with other primary psychiatric disorders, who had not responded to previous treatments. A total of 795 outpatients aged 15 to 24 years were included. The presence of ADHD was studied using DSM-IV criteria and the frequency of symptoms using the 18 item DuPaul ADHD Rating Scale. ADHD (DSM-IV criteria) was present in 48 patients (6%), none of whom had previously received the diagnosis. A total of 260 patients (32.7%) met the criteria for moderate ADHD and between them, severity of primary psychiatric disorder was higher according to the CGI-S (P=.007). Risk factors for moderate ADHD symptoms were the presence of substance use disorders (SUD) (odds ratio=1.543, P=.01) and borderline personality disorders (odds ratio =2.173, p=.0001). Unrecognized ADHD was present in 6% of patients; moreover 32.7% of the sample also presented moderate symptoms of the disorder. Screening for ADHD in young patients with refractory response to primary disorder treatment, mainly those with substance use disorders, conduct and personality disorders is highly advisable, due to the high frequency of ADHD comorbidity in these psychiatric disorders. Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.
Full Text Available Background: The growth in the elderly population means an inevitable increase in general physical health, psychobiological and mental health-related problems. Aim of the study: The present study aims to examine psychiatric morbidity, quality of life, and perceived social support among elderly population. Research design: A cross-sectional community-based study was conducted. People in age group of 60 years and above, who were permanent members of their respective households of Ranga Pukri Para and Dekargaon village in Tezpur, Sonitpur district of Assam, were the sample for the present study. One thousand four hundred and ninety adult populations had been identified as sample frame from the electorate list. One hundred and four people of age 60 years and above had been identified from the list for the study purpose. Random sampling method was used for selection of the sample. Semi-structured socio-demographic datasheet, General Health Questionnaire-12 (GHQ-12, CAGE questionnaire, Multidimensional Scale of Perceived Social Support, and World Health Organization Quality of Life (WHOQOL-BREF scale were administered to the respondents. Results: Based on the GHQ-12 score, it was found that 24% of the respondents showed an indication of mental health problems and from the CAGE score, it indicated that 13% of the respondents were found to be misusing or was in dependence in alcohol. The result from the present study indicated that elderly population was getting more family social support, followed by friends and from significant others. The result indicated that the mean score was low in the domain of social relationships. Environment domain was high followed by physical health and psychological domains of WHOQOL-BREF. Conclusion: In the elderly population, overall health can be influenced by multiple factors, including a person’s physical, psychological, behavioural, and social factors. The mental health professionals can provide resources, services
Zima, Bonnie T.; Hurlburt, Michael S.; Knapp, Penny; Ladd, Heather; Tang, Lingqi; Duan, Naihua; Wallace, Peggy; Rosenblatt, Abram; Landsverk, John; Wells, Kenneth B.
Objective: To describe the documented adherence to quality indicators for the outpatient care of attention-deficit/hyperactivity disorder, conduct disorder, and major depression for children in public mental health clinics and to explore how adherence varies by child and clinic characteristics. Method: A statewide, longitudinal cohort study of 813…
Christine Grützmann Faustino
Full Text Available Objective: To establish the prevalence of potentially inappropriate medications prescribed for elderly patients, to identify the most commonly involved drugs, and to investigate whether age, sex and number of medications were related with the prescription of these drugs. Methods: Prescriptions for 1,800 elderly patients (≥ 60 years were gathered from a database. These prescriptions were written by general physicians at a tertiary level university hospital in the city of Sao Paulo, Brazil, from February to May 2008. Only one prescription per patient was considered. The prescriptions were classified according to sex and age (60-69, 70-79 and ≥ 80. The Beers criteria (2003 version were used to evaluate potentially inappropriate medications. Results: Most of the sample comprised women (66.6% with a mean age of 71.3 years. The mean prevalence of potentially inappropriate medication prescriptions was 37.6%. The 60-69 age group presented the highest prevalence (49.9%. The most frequently prescribed potentially inappropriate medications to women were carisoprodol, amitriptyline, and fluoxetine; amitriptyline, carisoprodol, fluoxetine and clonidine were prescribed more often to men. The female sex (p<0.001; OR=2.0 and number of medications prescribed (p<0.001 were associated with prescription of potentially inappropriate medications. The chance of having a prescription of these drugs was lower among patients aged over 80 years (OR=0.7. The mean number of prescribed medications for both sexes and all age groups was 7.1. The mean number of medications per patient was higher among females (p<0.001; this result was not age-dependent (p=0.285. Conclusion: The prevalence of potentially inappropriate medications was similar to previously reported values in the literature and was correlated with the female sex. The chance of having a potentially inappropriate medication prescription was lower among patients aged over 80 years. The chance of having a
Martínez-Gras, Isabel; Ferre Navarrete, Francisco; Pascual Arriazu, Jesús; Peñas Pascual, José; de Iceta Ruiz de Gauna, Mariano; Fraguas Herráez, David; Rubio Valladolid, Gabriel
The objective of this study was to estimate the current prevalence of psychiatric disorders in cocaine-dependent patients who attend different treatment centres in the Community of Madrid. A prospective multicentre study was used, and a total of 197 cocaine-dependent subjects were assessed. The assessment instrument used for diagnosis was the Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV). The main findings of this study were a high prevalence of psychiatric comorbidity in cocaine-dependent patients seeking treatment (64.0%). The most common Non Substance Use Disorders found were attention-deficit/hyperactivity Disorders (34.5%) and depressive disorders (13.7%). The most common Substance Use Disorder was alcohol dependence (28.4%). Cocaine-dependent patients who had a depressive disorder and were alcohol dependent presented a more severe clinical profile and a higher degree of psychopathology, measured using different assessment tools, than the patients who were only cocaine dependent. These data suggest that the presence of psychiatric comorbidity could constitute a risk factor associated with the severity of cocaine dependence. The clinical heterogeneity found also indicates the need to search for individualised treatments that more specifically fit the needs of this population.
Tubman, Jonathan G; Oshri, Assaf; Taylor, Heather L; Morris, Staci L
The purpose of the current study was to describe the use of a brief maltreatment assessment instrument to classify adolescents receiving alcohol or other drug (AOD) treatment services based on the extensiveness and severity of prior maltreatment. This goal is significant because maltreatment reduces the effectiveness of AOD treatment and is associated significantly with co-occurring patterns of psychiatric symptoms and sexual risk behaviors. Structured interviews were administered to 300 adolescent treatment clients (202 males, 98 females; M = 16.22 years; SD = 1.13 years) to assess childhood maltreatment experiences, past year psychiatric symptoms, and sexual risk behaviors during the past 180 days. Cluster analysis classified adolescents into unique groups via self-reported sexual abuse, physical punishment, and parental neglect/negative home environment. Significant between-cluster differences in psychiatric symptoms and sexual risk behaviors were documented using MANOVA and chi-square analyses. More severe maltreatment profiles were associated with higher scores for psychiatric symptoms and unprotected intercourse. Significant heterogeneity and distinct types within this treatment sample of adolescents supports the adaptation of selected prevention efforts to promote HIV/STI risk reduction.
Shakir, Lana Nabeel; Sulaiman, Karwan Hawez
Background and objectives: Attention deficit hyperactivity disorder is one of the common psychiatric disorder in childhood and it affects on children socially and academically. The aim of this study is to find out the prevalence of Attention deficit hyperactivity disorder among the studied population, describe its association with certain…
Kalra, Gurvinder; Kamath, Ravindra; Subramanyam, Alka; Shah, Henal
Introduction: Sexual dysfunction can occur due to biological problems, relationship problems, lack of proper sexual knowledge or a combination of these. India is often known as the land of Kamasutra. But as far as sexuality research is concerned, there is a paucity of relevant data from India. In view of this, we conducted a study to assess the psychosocial profile of males presenting with sexual dysfunction to psychiatry out-patient department of a tertiary medical hospital. Materials and Me...
Choi, Kang Rok; Kim, Daeho; Jang, Eun Young; Bae, Hwallip; Kim, Seok Hyeon
Traumatic events and adverse stressful experiences are major etiological factors in a wide variety of physical and mental disorders. Developing psychological instruments that can be easily administered and that have good psychometric properties have become an integral part for research and practice. This study investigated the reliability and validity of the Korean version of the Lifetime Stressor Checklist-Revised (LSC-R) in a consecutive sample of psychiatric outpatients. The LSC-R is a 30-item self-reporting questionnaire examining lifetime traumatic and non-traumatic stressors. A final sample of 258 outpatients with anxiety or depressive disorders was recruited at the psychiatric department of a university-affiliated teaching hospital. Self-reported data included the Life Events Checklist (LEC), the Zung Self-Rating Depression and Anxiety Scales, and the Impact of Events Scale-Revised, in addition to the LSC-R. A convenience sample of 50 college students completed the LSC-R on two occasions separated by a three week-interval for test-retest reliability. Mean kappa for temporal stability was high (κ=0.651) and Cronbach alpha was moderate (α=0.724). Convergent validity was excellent with corresponding items on the LEC. Concurrent validity was good for symptoms of post-traumatic stress disorder, depression, and anxiety. An exploratory factor analysis revealed that 11 factors explained 64.3 % of the total variance. This study demonstrated good psychometric properties of the Korean version of the LSC-R, further supporting its use in clinical research and practice with a Korean speaking population.
Mitchell, A J; McGlinchey, J B; Young, D; Chelminski, I; Zimmerman, M
There is uncertainty about the diagnostic significance of specific symptoms of major depressive disorder (MDD). There is also interest in using one or two specific symptoms in the development of brief scales. Our aim was to elucidate the best possible specific symptoms that would assist in ruling in or ruling out a major depressive episode in a psychiatric out-patient setting. A total of 1523 psychiatric out-patients were evaluated in the Methods to Improve Diagnostic Assessment and Services (MIDAS) project. The accuracy and added value of specific symptoms from a comprehensive item bank were compared against the Structured Clinical Interview for DSM-IV (SCID). The prevalence of depression in our sample was 54.4%. In this high prevalence setting the optimum specific symptoms for ruling in MDD were psychomotor retardation, diminished interest/pleasure and indecisiveness. The optimum specific symptoms for ruling out MDD were the absence of depressed mood, the absence of diminished drive and the absence of loss of energy. However, some discriminatory items were relatively uncommon. Correcting for frequency, the most clinically valuable rule-in items were depressed mood, diminished interest/pleasure and diminished drive. The most clinically valuable rule-out items were depressed mood, diminished interest/pleasure and poor concentration. The study supports the use of the questions endorsed by the two-item Patient Health Questionnaire (PHQ-2) with the additional consideration of the item diminished drive as a rule-in test and poor concentration as a rule-out test. The accuracy of these questions may be different in primary care studies where prevalence differs and when they are combined into multi-question tests or algorithmic models.
De Las Cuevas, Carlos; Peñate, Wenceslao; Sanz, Emilio J
Although non-adherence to antidepressant medications is a significant barrier to the successful treatment of depression in clinical practice, few potentially modifiable predictors of poor adherence to antidepressant treatment are known. The aim of this study was to examine the relationship of psychological reactance, health locus of control and the sense of self-efficacy on adherence to treatment regimen among psychiatric outpatients with depression. One hundred and forty-five consecutive psychiatric outpatients suffering from depressive disorders were invited to participate in a cross-sectional study and 119 accepted. Patients completed a series of self-reported questionnaires assessing psychological reactance, health locus of control, self-efficacy, and adherence to prescribed medication in addition to socio-demographic and clinical variables. Logistic regression analyses were performed to determine which factors better correlate to treatment adherence. Age was found to be the best correlate of adherence to prescribed treatment. As regards psychological dimension studied, medication adherence was negatively associated with both cognitive and affective psychological reactance; patients with higher psychological reactance were more likely to be noncompliant than patients showing a low level of psychological reactance. Regarding health locus of control, only the external dimension of doctor-attributed health locus of control was positively associated with medications adherence. No effect on adherence was observed for the self-efficacy scale. Psychological reactance is an important correlate of adherence to treatment in patients with depressive disorders and this needs to be considered when giving clinical advice in order to avoid inducing reactance and thus non-adherence to prescribed treatments. Mental health professionals need to learn about communication techniques and counseling skills that enable them to deal with the psychological reactance of their patients.
Aliyev, Nadir A; Aliyev, Zafar N
Depersonalization disorders (DPDs) are highly prevalent in population. However, the effect of lamotrigine on outpatients with DPD without psychiatric comorbidity has not been studied in a double-blind placebo-controlled design. Eighty patients (all men) were washed out from all medications. Each patient was randomized either to receive lamotrigine (40 patients) for 12 weeks or matched on placebo (40 patients) in a double-blind manner. Eligible participants, in addition to meeting the criteria for DPD from Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, were required to be between 18 and 65 years. Response was defined as a 50% reduction in the Cambridge Depersonalization Scale. Response effects with lamotrigine and placebo were compared by using analysis of variance and χ² tests. Six patients did not return for at least 1 subsequent assessment, and 74 patients dropped out (36 taking lamotrigine and 38 taking placebo) in the valuables study group. Of the 36 lamotrigine-treated participants, 26 responded by 12 weeks versus 6 of the 38 placebo-treated participants (P < 0.001). The most common and problematic adverse effect in the lamotrigine group was rash. The authors believe this to be the first double-blind placebo-controlled randomization study to test the efficacy of lamotrigine in the management of outpatients with DPDs. These need to be replicated in a larger study group.
Hartmann, Ellen; Hartmann, Terje
To examine the impact of Internet-based information about how to simulate being mentally healthy on the Rorschach (Exner, 2003) and the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), 87 psychiatric outpatients completed the tests under 4 conditions: uncoached and Internet-coached outpatients under faking healthy instructions (faking patients and Internet-faking patients) and patients and nonpatients under standard instructions (standard patients and standard nonpatients). On the Rorschach, faking patients and Internet-faking patients did not manage to portray healthy test performance and, like standard patients, revealed a significantly greater number of perceptual and cognitive disturbances than standard nonpatients. Faking patients scored in the psychopathological direction on most variables. Internet-faking patients produced constricted protocols with significantly higher F% (57%) and lower use of provoking and aggressive contents than the other groups. On the MMPI-2, faking patients and Internet-faking patients were able to conceal symptoms and, like standard nonpatients, scored in the normal range on the clinical scales. The validity scale L successfully detected the faking patients and the Internet-faking patients, whereas the F scale only distinguished the Internet-faking patients and K only the faking patients. We conclude that Internet-based information could threaten test validity.
Boričević Maršanić, Vlatka; Aukst Margetić, Branka; Ožanić Bulić, Suzana; Đuretić, Irena; Kniewald, Hrvoje; Jukić, Tatjana; Paradžik, Ljubica
The children of male veterans with combat-related posttraumatic stress disorder (PTSD) are at particularly high risk of emotional and behavioral problems. However, no studies have examined non-suicidal self-injury (NSSI) in this population of youth. To determine the prevalence and psychosocial correlates of lifetime NSSI in a sample of psychiatric outpatient adolescent offspring of Croatian PTSD male veterans. Consecutive outpatient adolescent offspring of Croatian male PTSD veterans, aged 12 to 18 years, were assessed on the Deliberate Self Harm Inventory, the Youth Self-Report, the Family Assessment Device, the Parental Bonding Instrument and the Demographics Questionnaire. Of the whole sample, 52.7% of adolescents reported NSSI at least once during their lifetime. Lifetime NSSI was significantly associated with internalizing symptoms (adjusted odds ratio (OR) = 2.14; 95% confidence interval (CI): 1.04-4.42, p = .040), poor family functioning (adjusted OR = 6.54; 95% CI: 2.02-21.22, p = .002), lower maternal and paternal care (adjusted OR = 0.47; 95% CI: 0.40-0.56, p = .000 and adjusted OR = 0.82; 95% CI: 0.73-0.91, p = .000, respectively) and higher paternal control (adjusted OR = 1.84; 95% CI: 1.59-2.14, p = .000) in multivariate analysis. No association was found between lifetime NSSI and any of the socio-demographic variables. NSSI is a significant clinical problem in outpatient adolescent offspring of PTSD male veterans, which may be influenced by clinical and family factors. Interventions aimed at reducing internalizing symptoms and improving family functioning and parental behaviors are needed in the treatment of adolescent offspring of male PTSD veterans engaging in NSSI. © The Author(s) 2014.
Picco, Louisa; Lau, Ying Wen; Pang, Shirlene; Abdin, Edimansyah; Vaingankar, Janhavi Ajit; Chong, Siow Ann; Subramaniam, Mythily
Objectives To examine whether self-stigma mediates the relationship between perceived stigma and quality of life, self-esteem and general functioning among outpatients with depression, schizophrenia, anxiety and obsessive-compulsive disorder (OCD). Design Cross-sectional survey. Setting Outpatient clinics at a tertiary psychiatric hospital in Singapore. Participants 280 outpatients with a primary clinical diagnosis of either schizophrenia, depression, anxiety or OCD. Methods Data were collected in relation to self-stigma, perceived stigma, self-esteem, functioning and quality of life. In order to examine the mediating role of self-stigma on the relationship between perceived stigma and psychosocial outcomes, bootstrapping mediation analyses were used. Results Mediation analyses revealed that the relationship between perceived stigma and psychosocial outcomes was subject to the effects of self-stigma among the overall sample. Separate mediation analyses were conducted by diagnoses and showed differences in the mediating effects of self-stigma. Among the whole sample and the subsample with OCD, self-stigma mediated the relationship between perceived stigma and all psychosocial outcomes. For those with anxiety, depression and schizophrenia, the mediating effects of self-stigma were present in all relationships except (1) perceived stigma with physical health in the anxiety sample, (2) perceived stigma with social relationships in the depression sample and (3) perceived stigma with physical health in the schizophrenia sample. Conclusions The mediating effects of self-stigma on the relationship between perceived stigma and various psychosocial outcomes are evident and differ across diagnoses. Interventions to address and reduce the effects of self-stigma along with targeted treatments and psychoeducation to assist people with mental illness overcome or better manage self-stigma while providing them the skills to counteract public stigma are needed. PMID:28851803
Pedraz, María; Araos, Pedro; García-Marchena, Nuria; Serrano, Antonia; Romero-Sanchiz, Pablo; Suárez, Juan; Castilla-Ortega, Estela; Mayoral-Cleries, Fermín; Ruiz, Juan Jesús; Pastor, Antoni; Barrios, Vicente; Chowen, Julie A.; Argente, Jesús; Torrens, Marta; de la Torre, Rafael; Rodríguez De Fonseca, Fernando; Pavón, Francisco Javier
There are sex differences in the progression of drug addiction, relapse, and response to therapies. Because biological factors participate in these differences, they should be considered when using biomarkers for addiction. In the current study, we evaluated the sex differences in psychiatric comorbidity and the concentrations of plasma mediators that have been reported to be affected by cocaine. Fifty-five abstinent cocaine-addicted subjects diagnosed with lifetime cocaine use disorders (40 men and 15 women) and 73 healthy controls (48 men and 25 women) were clinically assessed with the diagnostic interview “Psychiatric Research Interview for Substance and Mental Disorders.” Plasma concentrations of chemokines, cytokines, N-acyl-ethanolamines, and 2-acyl-glycerols were analyzed according to history of cocaine addiction and sex, controlling for covariates age and body mass index (BMI). Relationships between these concentrations and variables related to cocaine addiction were also analyzed in addicted subjects. The results showed that the concentrations of chemokine (C-C motif) ligand 2/monocyte chemotactic protein-1 (CCL2/MCP-1) and chemokine (C-X-C motif) ligand 12/stromal cell-derived factor-1 (CXCL12/SDF-1) were only affected by history of cocaine addiction. The plasma concentrations of interleukin 1-beta (IL-1β), IL-6, IL-10, and tumor necrosis factor-alpha (TNFα) were affected by history of cocaine addiction and sex. In fact, whereas cytokine concentrations were higher in control women relative to men, these concentrations were reduced in cocaine-addicted women without changes in addicted men. Regarding fatty acid derivatives, history of cocaine addiction had a main effect on the concentration of each acyl derivative, whereas N-acyl-ethanolamines were increased overall in the cocaine group, 2-acyl-glycerols were decreased. Interestingly, N-palmitoleoyl-ethanolamine (POEA) was only increased in cocaine-addicted women. The covariate BMI had a significant
Kyomen, Helen H; Hennen, John; Gottlieb, Gary L; Wei, Jeanne Y
This study investigated the efficacy and safety of short-term estrogen therapy in decreasing noncognitive signs and symptoms of dementia in demented elderly patients. Sixteen moderately to severely demented elderly patients with aggressive behavioral disturbances were randomly assigned to receive conjugated equine estrogens or placebo in a 4-week clinical trial. Frequency and severity of noncognitive signs and symptoms of dementia, as assessed with the Dementia Signs and Symptoms Scale, were compared between estrogen and placebo groups. Data were analyzed with intent-to-treat and regression modeling methods. Estrogen therapy was associated with a significantly greater improvement on the Dementia Signs and Symptoms Scale total score than placebo. All five Dementia Signs and Symptoms Scale subscale comparisons favored estrogen therapy. No adverse effects were observed. These preliminary data suggest that short-term estrogen therapy may safely decrease the frequency and severity of noncognitive signs and symptoms of dementia in elderly patients.
Verhoeven, W.M.A.; Csepan, R.; Marcelis, C.L.M.; Lefeber, D.J.; Egger, J.I.; Tuinier, S.
OBJECTIVE: Sanfilippo B is a rare autosomal recessive mucopolysaccharidosis (MPS IIIB) caused by a deficiency of N-acetyl-alpha-D-glucosaminidase (NAGLU). METHOD: A mild mentally retarded elderly female patient is described with a slowly progressive dementia who had given birth to a daughter who
Csepán, R.; Verhoeven, W.M.A.; Marcelis, C.L.M.; Lefeber, D.J.; Egger, J.I.M.; Tuinier, S.
Objective: Sanfilippo B is a rare autosomal recessive mucopolysaccharidosis (MPS IIIB) caused by a deficiency of N-acetyl-α-D-glucosaminidase (NAGLU). Method: A mild mentally retarded elderly female patient is described with a slowly progressive dementia who had given birth to a daughter who
Chen, Tzu-Ting; Ko, Chih-Hung; Chen, Shao-Tsu; Yen, Chia-Nan; Su, Po-Wen; Hwang, Tzung-Jeng; Lin, Jin-Jia; Yen, Cheng-Fang
The aim of this study was to examine the correlations between the severity of alprazolam dependence and socio-demographic characteristics, the characteristics of alprazolam use, psychiatric comorbidity, and beliefs toward alprazolam use among long-term alprazolam users in Taiwan. A total of 148 long-term alprazolam users participated in this study. The Chinese version of the Severity of Dependence Scale was used to assess participants' severity of alprazolam dependence in the preceding month. Their socio-demographic characteristics, family function characteristics, dosage of prescribed alprazolam, duration of alprazolam use, alcohol use pattern, pain reliever and cigarette use pattern, severity of depressive symptoms, psychiatric diagnosis, and belief toward alprazolam use were investigated. The results of multiple regression analysis indicated that a longer duration of alprazolam use, severe depressive symptoms, a high level of belief in the necessity of alprazolam treatment, and a high level of concern about the potential adverse consequences of alprazolam use were significantly associated with more severe alprazolam dependence. Doctors should closely monitor the severity of alprazolam dependence among long-term users, especially patients' levels of depression, beliefs in the necessity of alprazolam treatment, and their concerns over the adverse consequences of continued treatment with alprazolam. Copyright © 2014. Published by Elsevier B.V.
Elkington, Katherine S; McKinnon, Karen; Mann, Claudio Gruber; Collins, Pamela Y; Leu, Cheng-Shiun; Wainberg, Milton L
We examined the associations between perceived mental illness stigma and HIV risk and protective behaviors among adults with severe mental illness (SMI) in Rio de Janeiro, Brazil. We measured mental illness stigma across three domains ("Personal Experiences," "Perceived Attractiveness," and "Relationship Discrimination"), and examined the relationship between experiences of stigma in each domain and HIV risk and protective behaviors over the past 3 months in 98 outpatients with SMI. Those who reported greater "Relationship Discrimination" stigma were significantly more likely to be sexually active and to have unprotected sex; they were significantly less likely to report deliberately having fewer partners as a way to protect themselves from HIV. The role of stigma in unprotected sexual behavior should be examined further and considered in any HIV prevention intervention for people with SMI.
Kang, Kyung-Ah; Kim, Shin-Jeong; Kim Ellis, Hyon
The purpose of this study was to identify the differences in suicide risk, meaning in life, and need for life respect among three age groups (young adults, the middle aged, and the elderly) of 540 public hospital outpatients in South Korea. This was a cross-sectional study. Among these 3 age groups, we observed significant differences in suicide risk, meaning in life, and need for life respect according to education level, marital status, living arrangements, type of disease, gender, and monthly income. These findings might contribute to the prevention of suicide in the future and the implementation of better community-based nursing care.
Kalra, Gurvinder; Kamath, Ravindra; Subramanyam, Alka; Shah, Henal
Sexual dysfunction can occur due to biological problems, relationship problems, lack of proper sexual knowledge or a combination of these. India is often known as the land of Kamasutra. But as far as sexuality research is concerned, there is a paucity of relevant data from India. In view of this, we conducted a study to assess the psychosocial profile of males presenting with sexual dysfunction to psychiatry out-patient department of a tertiary medical hospital. Hundred consecutive male patients presenting with sexual dysfunction were screened using Arizona Sexual Experiences Scale for clinical sexual dysfunction and after obtaining their informed consent were included in this study. They were assessed using a semi-structured proforma, Diagnostic and Statistical Manual of Mental Disorders, 4(th) Edition, Text Revision criteria, Mini-International Neuropsychiatric Interview, and Dyadic Adjustment Scale. Majority of our respondents were in the 18-30 years age group and were married. The main source of sex knowledge for 69% of them was peer group. Age of onset of masturbation was 11-13 years for 43% of them. Premature ejaculation was the most common sexual dysfunction seen in the respondents. Marital discord was seen in significantly lesser number of respondents (32.35%) as also major depressive disorder that was seen in only 16%. Premature ejaculation was the most common sexual dysfunction in our sample. Despite the sexual dysfunction, marital discord and depression were seen less commonly in our respondents.
Alagiakrishnan, Kannayiram; Senthilselvan, Ambikaipakan
Chronic kidney disease is a global public health concern. Glomerular filtration rate (GFR) prediction based on serum creatinine is used to assess renal function in the elderly. The Cockcroft-Gault (CG) formula, based on body surface area (CG/BSA formula), and the Modified Diet and Renal Disease formula (MDRD formula) are commonly used in assessing renal function in clinical practice. The objective of this study was to investigate the agreement between the GFR estimate, CG/BSA formula, and the MDRD formula in elderly outpatients. An outpatient chart review was conducted on consecutive elderly patients aged ≥ 65 years over a 9-month period. Data regarding age, gender, cognitive status, clock drawing, weight, height, and serum creatinine were collected. Pearson's correlation coefficient, Bland-Altman plot, and kappa statistics were used for statistical analysis. Of the 170 patients who participated in the study, 71% were cognitively impaired or had dementia. Using the CG/BSA formula, 79% of the patients had stage 3 renal disease (GFRformula. There was a high correlation between the CG/BSA and MDRD formulas (Pearson correlation coefficient, 0.88; P formulas. The diagnosis of having stage 3 chronic kidney disease depended on whether the CG/BSA or MDRD formula was used. A 17% discordance rate (9.61 mL/min) was seen between the MDRD and CG/BSA formulas for estimating GFR, and there was low agreement between the 2 formulas. Further studies are needed to assess which predictive formula is appropriate for elderly patients.
Full Text Available Background/aimsAttention-deficit/hyperactivity disorder (ADHD is often overlooked in adults; moreover, the problem seems to be even more critical in women. In the present, observational screening study, a clinical, particularly adult outpatient population was examined regarding frequency and severity of a likely ADHD, whereby sex differences were of particular interest.Methods224 participants, 146 men and 78 women, were included. Based on data recorded with the self-rating WHO screening instrument Adult ADHD Self-Report Scale (ASRS-v1.1, it was examined how many participants were conspicuous for adult ADHD by exceeding a predefined cutoff value (COV (COV ≥ 4 for ASRS-6, and ≥12 for ASRS-18. To examine frequency distributions, χ2 tests were conducted. For the inferential statistical comparison of means, t-tests for independent samples or Mann–Whitney U tests were calculated.Results34.4% of the sample was screened positive in the ASRS-v1.1 screener short version, ASRS-6, while 17.4% were conspicuous in the symptom checklist, ASRS-18. There were indeed more men screened positive, but the difference in the frequency between the sexes was not statistically significant, indicating a balanced sex ratio. Further, severity of ADHD core symptoms inattention and hyperactivity/impulsivity was examined by comparing ASRS-18 symptom subscale scores. In concordance with the hypothesis, men and women did not differ in severity of symptoms.ConclusionResults indicate that women might be affected by ADHD in a comparable manner as men; this emphasizes the importance for the awareness of ADHD in both sexes in clinical practice.
Robert C. Abrams
Full Text Available Introduction. We describe the design and implementation of a psychiatric collaborative care model in a university-based geriatric primary care practice. Initial results of screening for anxiety and depression are reported. Methods and Materials. Screens for anxiety and depression were administered to practice patients. A mental health team, consisting of a psychiatrist, mental health nurse practitioner, and social worker, identified patients who on review of screening and chart data warranted evaluation or treatment. Referrals for mental health interventions were directed to members of the mental health team, primary care physicians at the practice, or community providers. Results. Subjects (N=1505 comprised 38.2% of the 3940 unique patients seen at the practice during the 4-year study period. 37.1% (N=555 screened positive for depression, 26.9% (N=405 for anxiety, and 322 (21.4% screened positive for both. Any positive score was associated with age (P<0.033, female gender (P<0.006, and a nonsignificant trend toward living alone (P<0.095. 8.87% had suicidal thoughts. Conclusions. Screening captured the most affectively symptomatic patients, including those with suicidal ideation, for intervention. The partnering of mental health professionals and primary care physicians offers a workable model for addressing the scarcity of expertise in geriatric psychiatry.
Narud, Kjersti; Mykletun, Arnstein; Dahl, Alv A
Few studies exist on the outcome of patients with personality disorders (PDs) treated at ordinary outpatient clinics. This study examines the gains of such patients 2 years after treatment start at an outpatient clinic. Three patient groups were sampled: cluster A + B PDs, cluster C PDs and axis I disorders. Fifty-eight patients (53%) were amenable to follow-up, and they did not show less psychopathology than the non-compliers. All patients had structured interviews and filled in questionnaires. Patients in the PDs cluster A + B group showed considerable gains, while that was not found for the PDs cluster C and Axis I disorder groups. Since almost all patients received long-term psychotherapy sometimes combined with antidepressant drugs, the finding that such a treatment mainly shows gains in more severely disturbed PDs patients should be replicated in larger samples at ordinary psychiatric outpatient clinics.
Geller, Jeffrey L; Crandell, Allan E
... is a bildungsroman, a classic coming-of-age progression, although the two primary characters, Elder McLeod and Elder Passos, devise two very different solutions to the developmental question. In the process they are often seen as alienated and anxious as they traverse the anticipated territory of late adolescence, with its sexual energy, long...
Uchida, Hiroyuki; Suzuki, Takefumi; Mamo, David C; Mulsant, Benoit H; Kikuchi, Toshiaki; Takeuchi, Hiroyoshi; Tomita, Masayuki; Watanabe, Koichiro; Yagi, Gohei; Kashima, Haruo
Since the literature on benzodiazepine use in elderly patients with anxiety disorders is limited, a large cross-sectional review of psychotropic prescriptions in 796 patients with neurotic disorders (ICD-10) (age range=11-91 years) was conducted across 30 sites in Japan. Use of benzodiazepine-derivative anxiolytics was approximately 70% in all decades without a group difference. The proportion of subjects who received prescriptions for benzodiazepine-derivative anxiolytics in the absence of antidepressants was higher in older age groups (e.g., 27.7% and 43.2% in the third and sixth decades, respectively). On the other hand, antidepressants were less frequently prescribed in older age groups (e.g., 59.8% and 41.5% in the third and sixth decades, respectively). The very high use of anxiolytics in the elderly, especially in the absence of concomitant antidepressant use, is a cause for concern since they are not a preferred long-term treatment strategy given their adverse effects in the elderly.
Changes in symptom severity, schemas and modes in heterogeneous psychiatric patient groups following short-term schema cognitive-behavioural group therapy: a naturalistic pre-treatment and post-treatment design in an outpatient clinic.
van Vreeswijk, M F; Spinhoven, P; Eurelings-Bontekoe, E H M; Broersen, J
Schema therapy has proven to be an effective treatment for patients with borderline personality disorder. However, little is known of its merits in other psychiatric (personality) disorders. This study investigated whether schema therapy in a group setting (group schema cognitive-behavioural therapy [SCBT-g]) was associated with changes in symptom and schema and mode severity. Furthermore, the aim was to search for baseline predictors and possible mediators of treatment outcome. Sixty-three heterogeneous psychiatric outpatients who attended the SCBT-g were included as participants. In this naturalistic pre-treatment and post-treatment design, data were available on the Symptom Checklist 90, the Schema Questionnaire and the Young-Atkinson Mode Inventory. All outcome measurements showed changes with moderate to high effect sizes, with 53.2% of the patients showing a significant reduction in severity of psychiatric symptoms and schemas and modes. Higher pre-treatment levels of the schema domain Other Directedness predicted greater symptom reduction. Pre-treatment to mid-treatment changes in schema severity predicted subsequent symptom improvement, but change in symptoms and schemas proved to be strongly correlated. In this naturalistic study, SCBT-g was associated with reduced symptom and schema and mode severity in more than half of the psychiatric outpatients. Furthermore, the results suggest that changes in schemas and symptomatology mutually reinforce each other. Over 50% of ambulatory patients show clinical improvement after treatment in a short-term schema therapy group. Other Directedness seems to be a predictor of schema group therapy success. More randomized controlled trial studies and prediction and mediation studies on (short-term) schema group therapy are sorely needed. Copyright © 2012 John Wiley & Sons, Ltd.
A. Schene; A. Smit; A. Kaasenbrood; B. van Meijel; G. Hutschemaekers; Bauke van Koekkoek
In psychiatric care professionals perceive some patients as ‘difficult’, especially patients with long-term non-psychotic disorders. For these patients few evidence-based treatments exist. An intervention program, Interpersonal Community Psychiatric Treatment (ICPT), was developed by the authors. It
A. Smit; A. Schene; A. Kaasenbrood; G. Hutschemaekers; prof Berno van Meijel; B. Koekkoek
In psychiatric care professionals perceive some patients as 'difficult', especially patients with long-term non-psychotic disorders. For these patients few evidence-based treatments exist. An intervention program, Interpersonal Community Psychiatric Treatment (ICPT), was developed by the authors. It
Koekkoek, B.W.; Meijel, B.K.G. van; Schene, A.H.; Smit, A.; Kaasenbrood, A.J.A.; Hutschemaekers, G.J.M.
Background: In psychiatric care professionals perceive some patients as 'difficult', especially patients with long-term non-psychotic disorders. For these patients few evidence-based treatments exist. An intervention program, Interpersonal Community Psychiatric Treatment (ICPT), was developed by the
Grey, I.; Al-Saihati, B. A.; Al-Haddad, M.; McClean, B.
Background: Relatively little information is available regarding the use of psychiatric services by individuals with intellectual disability (ID) in Arab countries. The current study aimed to identify (1) the reasons for referral; (2) demographic characteristics of individuals referred; (3) previous contact with child psychiatric services; (4)…
The paper describes the current provision of psychiatric services in Algeria - in particular, in-patient and out-patient facilities, child psychiatry and human resources. Education, training, associations and research in the field of mental health are also briefly presented. The challenges that must dealt with to improve psychiatric care and to comply with international standards are listed, by way of conclusion.
Arroyo, Pedro; Gutiérrez-Robledo, Luis Miguel
...´s milk and dairy products intake in adults, with emphasis on the elderly. The role of milk and dairy products as part of the regular diet, as well as their contribution to a healthy diet for the aged population is described...
Palic, Sabina; Kappel, Michelle; Nielsen, Monica
BACKGROUND: Currently, the mental health issues of traumatized refugees are mainly documented in terms of posttraumatic stress disorder, depression, and anxiety. Importantly, there are no reports of the level of psychiatric disability in treatment seeking traumatized refugees resettled in the West...... and social domains. The rate of pre- to post-treatment improvement on the HoNOS was smaller for the traumatized refugees than it was for the psychiatric inpatients. CONCLUSIONS: The level, and the versatile profile, of psychiatric disability on the HoNOS point to complex bio-psycho-social problems...... in resettled treatment seeking traumatized refugees. Thus, a broader assessment of symptoms and better cooperation between psychiatric, health care, and social systems is necessary in order to meet the treatment needs of this group....
Periodontal diseases are associated with systemic health and health behaviors; the purpose of this study was to investigate periodontal health status and its association with systemic health and health behaviors in the elderly. Data was collected from 300 random Case Western Reserve University (CWRU) dental school patient charts, aged 65 or higher. A modified WHO form was used to collect the date on: periodontal conditions using the community periodontal index (CPI), demographics, systemic health and certain health behaviors. Community periodontal index collected data for six sextants. Descriptive tests and bivariate analytic tests, Chi-square test and computation of odds ratio, investigated any association between certain periodontal conditions and demographic as well as systemic health attributes. In the study cohort, the average age was 73.7 ± 6.8 years. Moderate periodontitis (38.9%) was the most prevalent periodontal health condition, while severe periodontitis was the least prevalent periodontal health (6.1%). Nearly 30% of the cohort had healthy periodontium. Only insurance status was associated with healthy periodontium (p periodontitis was the most prevalent among the studied subjects. A positive association was found with the insurance status of the subjects and the healthy periodontium. No association was found between periodontal disease and smoking, alcohol consumption, diabetes and cardiovascular disease.
Bouchra, Oneib; Maria, Sabir; Abderazak, Ouanass
The bipolar disorder is often misdiagnosed in particular among outpatients with recurrent depression. Indeed, this work confirmed that the unrecognised bipolar disorder is common among depressed outpatients, which were younger, unemployed, single or divorced with a low socio-economic level. These socio-demographics data gives us an idea about the disability experienced by the unknown bipolar patients. Also, we demonstrate that the under-diagnosis bipolar disorder was associated with the earliest onset age of a depressive episode and it was more prevalent in depressed patients with suicidal ideation and suicide attempts. These factors should be taken into account when we screen for the unknowm bipolar disorder, especially type II to improve the early diagnosis and the quality of life of these patients. PMID:28979648
Bouchra, Oneib; Maria, Sabir; Abderazak, Ouanass
The bipolar disorder is often misdiagnosed in particular among outpatients with recurrent depression. Indeed, this work confirmed that the unrecognised bipolar disorder is common among depressed outpatients, which were younger, unemployed, single or divorced with a low socio-economic level. These socio-demographics data gives us an idea about the disability experienced by the unknown bipolar patients. Also, we demonstrate that the under-diagnosis bipolar disorder was associated with the earliest onset age of a depressive episode and it was more prevalent in depressed patients with suicidal ideation and suicide attempts. These factors should be taken into account when we screen for the unknowm bipolar disorder, especially type II to improve the early diagnosis and the quality of life of these patients.
Full Text Available Introduction: Over the last five decades, general hospital psychiatric units (GHPUs have become important mental health service setups in India. The present study reports on the changing clinical profile of the patients attending the GHPUs over the last five decades. Methodology: A total of 500 subjects, attending a GHPU were recruited prospectively for the study. The subjects were assessed using a semistructured proforma. A comparison was made with similar studies conducted in GHPU settings over the last five decades. Results: In the present study, neurotic, stress-related and somatoform disorders formed the commonest diagnostic group (33% followed by psychotic disorders (17% and mood disorders (15%. The diagnostic distribution is broadly similar to the studies done at different times in the last 5 decades, though there were lesser number of patients with mental retardation and organic brain syndrome. About 15% of the subjects did not have a psychiatric diagnosis. Conclusion: GHPUs in India attend to a broad range of patients with psychiatric disorders.
Adaptation and initial validation of the Patient Health Questionnaire - 9 (PHQ-9) and the Generalized Anxiety Disorder - 7 Questionnaire (GAD-7) in an Arabic speaking Lebanese psychiatric outpatient sample.
Sawaya, Helen; Atoui, Mia; Hamadeh, Aya; Zeinoun, Pia; Nahas, Ziad
The Patient Health Questionnaire - 9 (PHQ-9) and Generalized Anxiety Disorder - 7 (GAD-7) are short screening measures used in medical and community settings to assess depression and anxiety severity. The aim of this study is to translate the screening tools into Arabic and evaluate their psychometric properties in an Arabic-speaking Lebanese psychiatric outpatient sample. The patients completed the questionnaires, among others, prior to being evaluated by a clinical psychiatrist or psychologist. The scales' internal consistency and factor structure were measured and convergent and discriminant validity were established by comparing the scores with clinical diagnoses and the Psychiatric Diagnostic Screening Questionnaire - MDD subset (PDSQ - MDD). Results showed that the PHQ-9 and GAD-7 are reliable screening tools for depression and anxiety and their factor structures replicated those reported in the literature. Sensitivity and specificity analyses showed that the PHQ-9 is sensitive but not specific at capturing depressive symptoms when compared to clinician diagnoses whereas the GAD-7 was neither sensitive nor specific at capturing anxiety symptoms. The implications of these findings are discussed in reference to the scales themselves and the cultural specificity of the Lebanese population. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Wang, A G
A comprehensive psychiatric service was established in 1969 in the Faroe Islands. This service was created as a department of a general hospital. The spheres covered by this department, operating in the midst of the community were: acute and chronic patients, a liaison-psychiatric service......, and an outpatient service. The number of chronic patients has not decreased, due to an influx of unruly senile patients. The close proximity of the service to the community has increased the pressure with regard to the care of such patients. Other services, such as outpatient treatment of alcoholics and neurotics...
Wang, A G
, and an outpatient service. The number of chronic patients has not decreased, due to an influx of unruly senile patients. The close proximity of the service to the community has increased the pressure with regard to the care of such patients. Other services, such as outpatient treatment of alcoholics and neurotics......A comprehensive psychiatric service was established in 1969 in the Faroe Islands. This service was created as a department of a general hospital. The spheres covered by this department, operating in the midst of the community were: acute and chronic patients, a liaison-psychiatric service...
Transtornos de ansiedade: um estudo de prevalência e comorbidade com tabagismo em um ambulatório de psiquiatria Anxiety disorders: a study of the prevalence and comorbidity with smoking in a psychiatric outpatient clinic
Cristina Lunardi Munaretti
Full Text Available OBJETIVOS: Este estudo tem por objetivo investigar a presença de transtornos de ansiedade e tabagismo entre pacientes atendidos em um ambulatório de psiquiatria. MÉTODOS: Realizou-se um estudo transversal em um ambulatório de psiquiatria em Porto Alegre, no qual se aplicou SCID-I em 84 pacientes, para examinar a ocorrência de transtornos de ansiedade e dependência à nicotina; também se utilizou o Teste de Fagerström para identificar o grau de dependência nicotínica. Excluíram-se pacientes com esquizofrenia, outros transtornos psicóticos e retardo mental. RESULTADOS: Verificou-se freqüência de 75% para os transtornos de ansiedade, sendo mais freqüentes fobia específica e transtorno de ansiedade generalizada (TAG com 26,2% cada um. Tabagistas representaram 21,43% da amostra, e a maior parte destes obteve escore leve para o grau de dependência. Constatou-se associação entre ter TAG e ser tabagista, e a chance dos pacientes com TAG fumarem é 5,2 vezes em relação aos que não têm esse transtorno de ansiedade. CONCLUSÕES: Os transtornos de ansiedade têm uma freqüência elevada entre pacientes ambulatoriais, sendo importante sua identificação. A freqüência de tabagismo entre pacientes com transtorno de ansiedade é alta, apresentando importante associação com TAG, e por isso deve também ser foco de atenção no tratamento desses pacientes.OBJETIVES: This study was aimed at investigating the presence of anxiety disorders and tobacco use among psychiatric outpatients. METHODS: A transversal study was carried out in which SCID-I was administered to 84 psychiatric outpatients in Porto Alegre, in order to determine the occurrence of anxiety disorders and nicotine dependence; in addition, Fagerström's test was used to identify the degree of nicotine dependence. Exclusion criteria were having a diagnosis of schizophrenia or presenting other psychotic disorders and mental retardation. RESULTS: Anxiety disorders were found in
Shivakumar, Prafulla; Sadanand, Shilpa; Bharath, Srikala; Girish, N; Philip, Mariamma; Varghese, Mathew
Psychological distress in the elderly with various illness conditions often goes unrecognized. Since psychological distress is treatable, it is important to recognize it at the earliest to enhance recovery. This is an interim analysis of screening data of the elderly seeking health care in a hospital in India, with a focus on the 12-item General Health Questionnaire (GHQ-12), a screening instrument for psychological distress and a rationale for a higher cutoff score in help seeking elderly. A retrospective analysis of screening data of psychological distress using GHQ-12 in the elderly seeking care for neuropsychiatric conditions was carried out. Traditionally, ≥2 is considered positive for distress by GHQ-12. Receiver Operating Characteristic (ROC) curve was used to define new cutoff points for psychological distress. At ≥2, 2443 (50%) of the elderly screened were recognized to be psychologically distressed. Using an ROC and optimum sensitivity and specificity measures, a cutoff score of ≥4 was observed to detect 30% of the elderly who had diagnosable mental health disorders. Female sex, illiteracy, and multiple co-morbidities were the factors that were associated with higher cutoff scores on GHQ-12 proposed here and psychiatric morbidity thereof. There is greater psychological distress among the elderly seeking health care. Hence, it is important to screen them and identify those at higher risk. Using a higher cutoff score with a standardized instrument like GHQ-12 indicated that it was statistically valid to identify those elderly with higher distress in a busy out-patient setting.
Munk-Olsen, Trine; Maegbaek, M L; Johannsen, B M
and childbirth, which suggests differences in the underlying etiology. We further speculate varying treatment incidence and prevalence in pregnancy vs postpartum may indicate that the current Diagnostic and Statistical Manual of Mental Disorders-5 peripartum specifier not adequately describes at-risk periods......Perinatal psychiatric episodes comprise various disorders and symptom severity, which are diagnosed and treated in multiple treatment settings. To date, no studies have quantified the incidence and prevalence of perinatal psychiatric episodes treated in primary and secondary care, which we aimed...... psychiatric facilities, 2.5 births were followed by an episode treated at outpatient psychiatric facility and 12 births by GP-provided pharmacological treatment. We interpret our results the following way: treated severe and moderate psychiatric disorders have different risk patterns in relation to pregnancy...
Impaired mobility, depressed mood, cognitive impairment and polypharmacy are independently associated with disability in older cancer outpatients: The prospective Physical Frailty in Elderly Cancer patients (PF-EC) cohort study.
Pamoukdjian, Frederic; Aparicio, Thomas; Zelek, Laurent; Boubaya, Marouane; Caillet, Philippe; François, Veronique; de Decker, Laure; Lévy, Vincent; Sebbane, Georges; Paillaud, Elena
To assess the prevalence of disability and the oncologic factors associated with disability in older outpatients with cancer. The Physical Frailty in Elderly Cancer patients (PF-EC) study (France) is a prospective bicentric observational cohort study. Two hundred and ninety outpatients with cancer were included. A cross-sectional analysis of oncologic factors and geriatric variables associated with disability that were collected using a comprehensive geriatric assessment (CGA) was conducted. Disability was defined as impairment in activities of daily living (ADL) and/or instrumental activities of daily living (IADL), simplified to four items. Univariate and multivariate logistic models of disabled patients were performed. The three final multivariate models were compared using the area under the receiver operating characteristic curve (AUC/ROC) of the logistic model. The mean age was 80.6years, and 51% of the patients were women with various types of cancer. The prevalence of disability was 67.6%. No oncologic factors (cancer site, cancer extension) were associated with disability. Impaired mobility, poor functional status, depressive mood, cognitive impairment and polypharmacy were independently associated with disability (PDisability was highly prevalent in older cancer outpatients before cancer treatment but was not associated with oncologic factors. Impaired mobility, depressed mood, cognitive impairment and polypharmacy were the geriatric variables significantly and independently associated with disability. Identifying these factors prior to cancer treatment could enable the implementation of corrective actions to improve patient autonomy before treatment and during follow-up. Copyright © 2017 Elsevier Ltd. All rights reserved.
Full Text Available Wadih Rhondali,1 Gilles Freyer,2 Virginie Adam,3 Marilène Filbet,4 Martine Derzelle,5 Gaelle Abgrall-Barbry,6 Sophie Bourcelot,7 Jean-Louis Machavoine,8 Muriel Chomat-Neyraud,9 Olivier Gisserot,10 Rémi Largillier,11 Annick Le Rol,12 Frank Priou,13 Pierre Saltel,14 Claire Falandry15 1Clinique Mon Repos, Clinea, Marseille, France; 2Medical Oncology Unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Benite, France; 3Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre-lès-Nancy, France; 4Palliative Unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Benite, France; 5Institut Jean Godinot, Reims, France; 6Tenon Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; 7Centre Léon Bérard, Lyon, France; 8Centre François Baclesse, Caen, France; 9Centre Hospitalier de la région d’Annecy, Pringy, France; 10Hôpital d’Instruction des Armées Sainte-Anne, Toulon, France; 11Centre Azuréen de Cancérologie, Mougins, France; 12Medical Oncology, Hôpital Perpétuel Secours, Levallois-Perret, France; 13Medical Oncology, Centre Hospitalier Départemental Les Oudairies, La Roche-sur-Yon, France; 14Supportive Care Department, Centre Léon Bérard, Lyon, France; 15Geriatrics and Oncology Unit, Centre Hospitalier Lyon Sud, Université Lyon 1, Pierre-Bénite, France Background: Depression, a major outcome in cancer patients, is often evaluated by physicians relying on their clinical impressions rather than patient self-report. Our aim was to assess agreement between patient self-reported depression, oncologist assessment (OA, and psychiatric clinical interview (PCI in elderly patients with advanced ovarian cancer (AOC.Methods: This analysis was a secondary endpoint of the Elderly Women AOC Trial 3 (EWOT3, designed to assess the impact of geriatric covariates, notably depression, on survival in patients older than 70 years of age. Depression was assessed using the Geriatric Depression Scale-30 (GDS, the Hospital
Full Text Available Abstract Objective To evaluate the overall long-term effectiveness of aripiprazole in patients with schizophrenia in a general psychiatric practice setting in Taiwan. Methods This was a prospective, open-label, multicenter, post-market surveillance study in Taiwanese patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV diagnosis of schizophrenia or schizoaffective disorder requiring a switch in antipsychotic medication because current medication was not well tolerated and/or clinical symptoms were not well controlled. Eligible patients were titrated to aripiprazole (5-30 mg/day over a 12-week switching phase, during which their previous medication was discontinued. Patients could then enter a 52-week, long-term treatment phase. Aripiprazole was flexibly dosed (5-30 mg/day at the discretion of the treating physicians. Efficacy was assessed using the Clinical Global Impression scale Improvement (CGI-I score, the Clinical Global Impression scale Severity (CGI-S score, The Brief Psychiatry Rating Scale (BPRS, and the Quality of Life (QOL scale, as well as Preference of Medicine (POM ratings by patients and caregivers. Safety and tolerability were also assessed. Results A total of 245 patients were enrolled and switched from their prior antipsychotic medications, and 153 patients entered the 52-week extension phase. In all, 79 patients (32.2% completed the study. At week 64, the mean CGI-I score was 3.10 and 64.6% of patients who showed response. Compared to baseline, scores of CGI-S, QOL, and BPRS after 64 weeks of treatment also showed significant improvements. At week 12, 65.4% of subjects and 58.9% of caregivers rated aripiprazole as better than the prestudy medication on the POM. The most frequently reported adverse events (AEs were headache, auditory hallucinations and insomnia. A total of 13 patients (5.3% discontinued treatment due to AEs. No statistically significant changes were noted with respect to
Krystal, Andrew D; Durrence, H Heith; Scharf, Martin; Jochelson, Philip; Rogowski, Roberta; Ludington, Elizabeth; Roth, Thomas
to evaluate the efficacy and safety of doxepin 1 mg and 3 mg in elderly subjects with chronic primary insomnia. the study was a randomized, double-blind, parallel-group, placebo-controlled trial. Subjects meeting DSM-IV-TR criteria for primary insomnia were randomized to 12 weeks of nightly treatment with doxepin (DXP) 1 mg (n = 77) or 3 mg (n = 82), or placebo (PBO; n = 81). Efficacy was assessed using polysomnography (PSG), patient reports, and clinician ratings. Objective efficacy data are reported for Nights (N) 1, 29, and 85; subjective efficacy data during Weeks 1, 4, and 12; and Clinical Global Impression (CGI) scale and Patient Global Impression (PGI) scale data after Weeks 2, 4, and 12 of treatment. Safety assessments were conducted throughout the study. DXP 3 mg led to significant improvement versus PBO on N1 in wake time after sleep onset (WASO; P treatment groups. There were no significant next-day residual effects; additionally, there were no reports of memory impairment, complex sleep behaviors, anticholinergic effects, weight gain, or increased appetite. DXP 1 mg and 3 mg administered nightly to elderly chronic insomnia patients for 12 weeks resulted in significant and sustained improvements in most endpoints. These improvements were not accompanied by evidence of next-day residual sedation or other significant adverse effects. DXP also demonstrated improvements in both patient- and physician-based ratings of global insomnia outcome. The efficacy of DXP at the doses used in this study is noteworthy with respect to sleep maintenance and early morning awakenings given that these are the primary sleep complaints of the elderly. This study, the longest placebo-controlled, double-blind, polysomnographic trial of nightly pharmacotherapy for insomnia in the elderly, provides the best evidence to date of the sustained efficacy and safety of an insomnia medication in older adults.
Erlangsen, Annette; Mortensen, Preben Bo; Vach, Werner
BACKGROUND: Very old people have higher suicide rates than the younger elderly population. Psychiatric disorders are known to have a strong association with suicide among elderly people. AIMS: To analyse the analyse the suicide risk associated with psychiatric hospitalisation among the very old......: The association between suicide and psychiatric hospitalisation is much weaker for the very old than for the old. Psychiatric disorders among very old people may be interacting with other disorders, may be underdiagnosed or treated in other healthcare settings....
Larsen, Tina Gram; Valbak, Lone; Perto, Gurli; Reinert, Kjeld
In Denmark the number of forensic psychiatric patients is increasing. The objective of this study was to explore whether the increased number of forensic psychiatric patients has been reflected in the use of psychiatric inpatient facilities. Furthermore, we wanted to investigate differences in the treatment of various diagnostic groups of forensic patients and of forensic and non-forensic patients with schizophrenia. Information about admissions and outpatient contact was extracted from the Danish Psychiatric Central Research Register for all Danish patients sentenced to psychiatric treatment in the period 1994-2003. Furthermore, a group of first-admission forensic patients suffering from schizophrenia was compared to a control group of first-admission non-forensic patients with schizophrenia, matched for sex, age and time of admission. The number of forensic psychiatric patients increased markedly in the period 1994-2003; at the same time, the use of inpatient facilities for this group of patients did not increase to a similar degree but actually decreased. Forensic patients in the group F20-F29 spent more time in hospital than did forensic patients with affective disorders and personality disorders. Forensic psychiatric patients with schizophrenia had significantly longer periods of hospitalization than did non-forensic patients with schizophrenia. Forensic psychiatric patients' use of psychiatric inpatient facilities during the last 10 years did not increase to the extent expected relative to the increasing number of forensic psychiatric patients. This raises the question of whether these patients are receiving necessary and sufficient treatment.
Wang, A G
of senile psychoses. The total increase amounts to 2.4 times the admission rates of psychiatric cases to the General Hospital and 4.4 times the admission rates to the Psychiatric Hospital in Nykøbing in the last years prior to the start of the local service. The outpatient department has grown steadily...
Full Text Available OBJETIVO: Este estudo teve como objetivo verificar a relação entre o bem-estar subjetivo, independência funcional e desempenho de membros inferiores (força muscular, velocidade de marcha e equilíbrio de idosos em seguimento ambulatorial, em relação ao sexo e a grupos etários. MÉTODOS: Foram avaliados 125 idosos de ambos os sexos com idade mínima de 60 anos, atendidos em um ambulatório de geriatria. Os instrumentos utilizados foram: 1 Medida da Independência Funcional (MIF para avaliar a dependência funcional; 2 Short Physical Performance Battery (SPPB para medir o desempenho físico; 3 Bem-Estar Subjetivo (BES: questões sobre a saúde e satisfação com a vida. RESULTADOS: A amostra utilizada foi de conveniência, com predomínio do sexo feminino, que apresentou maior comprometimento funcional. As correlações do bem-estar subjetivo com o teste de desempenho não demonstraram diferenças entre os sexos, contudo os idosos mais velhos apresentaram maior nível de satisfação que os idosos mais jovens. A saúde percebida também foi mais satisfatória entre os idosos mais velhos. Entretanto, a saúde percebida comparada mostrou melhores resultados nos idosos com moderado a bom desempenho físico. CONCLUSÃO: Os resultados sugerem que indivíduos mais velhos apresentam maior satisfação com a vida e melhor saúde percebida. Além disso, o bom desempenho físico foi uma variável de relevância para melhor saúde percebida quando comparada a outras pessoas.OBJECTIVE: The aim of this study was to investigate the relationship between subjective well-being, functional independence and lower-limb performance (muscle strength, gait velocity and balance among elderly people undergoing outpatient follow-up, stratified by sex and age groups. METHODS: We evaluated 125 elderly people, aged 60 years and over, who received care at a geriatric outpatient clinic. The instruments used were: 1 Functional Independence Measure (FIM to evaluate
psychiatric facilities in Denmark: an outpatient psychiatric long-term treatment clinic and a closed psychiatric ward. The applied methods are participant observation, interviews with patients and professionals and analysis of documents. Employing discursive and narrative approaches, the aim of the project...
Aydin, Zeynep Dilek; Ersoy, Ismail Hakki; Baştürk, Abdülkadir; Kutlucan, Ali; Göksu, Sema Sezgin; Güngör, Gökhan; Tamer, Mehmet Numan
Influence of sun exposure and physical activity on cognition has not been evaluated simultaneously. We aimed to evaluate predictors of clock drawing test (CDT) performance on n=125 patients attending an internal medicine outpatient clinic. Interview data was gathered on sociodemographic, health-related and lifestyle factors referring to the last year. Factors associated with obtaining a score >0 and a full score (10/10) were analyzed by univariate (UVA) and multivariate (MVA) logistic regression analyses. Mean age of the participants was 72 ± 5, 58% were women and 17% were illiterate. Mean CDT score was 4.70 ± 2.27, 61.6% scored >0 and 21.6% scored 10/10. Both duration of walking and summer sun exposure predicted a CDT score >0 in UVA. However only summer sun exposure was an independent predictor (odds ratio=OR=1.73, 95% confidence interval=CI=1.16-2.57). Other factors independently associated with obtaining a score >0 were education level (OR=2.70, 95%CI=1.77-4.12) and cerebrovascular disease (CVD) history (OR=0.08, 95%CI=0.008-0.78). Factors independently associated with obtaining a full score were weight (OR=1.05, 95%CI=1.00-1.10), education level (OR=2.04, 95%CI=1.38-3.00) and visiting the clinic alone (OR=3.92, 95%CI=1.354-11.39). Our study shows that CDT can be utilized to unravel the lifestyle factors associated with cognitive function. To our knowledge, this is the first study to suggest an association between sun exposure and cognition. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Javier Fernández Eito
Full Text Available El progresivo envejecimiento de la población española conlleva un aumento de la atención sanitaria, por los servicios de urgencias extrahospitalarias (SUE, a este grupo de edad. El objetivo de este trabajo es evidenciar la importancia de realizar una valoración global del anciano en el contexto domiciliario y comunitario, que contemple tanto los aspectos físicos como los psicosociales y ambientales de la persona en situación de urgencia. Para ello, se desarrolla un caso clínico, que se apoya en la evidencia científica, para determinar la actuación más adecuada que mejore las intervenciones de los servicios de urgencias extrahospitalarias. El análisis del caso se estructura en tres apartados: la valoración de enfermería, el registro de los datos y la transmisión de la información a otros equipos de salud. Como conclusión, se identifica la necesidad de valorar y registrar datos sobre el estado físico y fisiológico del anciano al mismo tiempo que se recoge información sobre su contexto familiar, comunitario o ambiental, para proporcionar unos cuidados integrales y de calidad. Asimismo, se recomienda el desarrollo de herramientas de valoración geriátrica específicas para utilizar en situaciones de urgencias extrahospitalarias.The progressive aging of the Spanish population leads to increased health care for Outpatient Emergency Services (EUS, in this age group. The aim of this paper is to highlight the importance of an overall assessment of the elderly in the household and community context, which involves both the physical and psychosocial in the emergency environmental. To do this, we develop a clinical case, which is based on scientific evidence, to determine the most appropriate action to improve interventions in emergency services. The case analysis is divided into three sections: nursing assessment, data recording and transmission of information to other health teams. In conclusion, it identifies the need to assess and
Bachrach, Nathan; Croon, Marcel; Bekker, Marrie
In the current study we investigated the relationship of sex and autonomy-connectedness with internalizing and externalizing personality disorder symptoms (PDS), coping and axis-I pathology in older age. A path model was tested which was based on neo-analytical object relation, attachment- and primary-personality theory, among 100 clinical and 106 non-clinical elderly. In line with our model, autonomy-connectedness (self-awareness and capacity of managing new situations) was strongly associated to internalizing PDS in both groups. In both groups, neither sex nor autonomy-connectedness predicted externalizing PDS. Sex, internalizing as well as externalizing PDS and reactive defensive coping were associated to axis-I psychopathology. We conclude that sex and autonomy-connectedness were, similarly as in adult populations, associated to internalizing PDS and axis-I pathology. Treatment of elderly with internalizing PDS and axis-I psychopathology should therefore focus on enhancing autonomy-connectedness.
Parkar, Shubhangi R
This paper highlights the mental health needs of the elderly. It tackles the issues of their institutionalisation and community care. Rapid urbanisation in Indian society throws up special problems in elderly care. There is great evidence of a raise in morbidity, mortality, hospitalisation and loss of functional status related to common mental disorders in the elderly patients. Overlap of depression and anxiety is very common with up to almost half of the elderly patients reporting significant depressive and anxiety symptoms. Also, depression is the most common psychiatric disorder in late life. Growth in the elderly population means a direct increase in age related diseases such as dementia and poor mental health outcomes such as depression, anxiety, suicide and serious constraints on the quality of life among elderly individuals. The need to identify new and unmet problem areas and develop efficient therapeutic outcomes for this special population is stressed.
M.M.Y. de Klerk; J.M. Timmermans
Report on the Elderly 1998 describes various aspects of the living circumstances of the elderly: the labour market position, financial situation, housing circumstances, health and uptake of health care. Extensive attention is also devoted to the scale and consequences of psychiatric disorders
Full Text Available The size of the elderly population is expected to increase dramatically in the next decades worldwide, also in Turkey. In accordance with these demographic changes, psychiatric disorders in late life, including suicide becomes much important. Elderly suicide is a very serious public health problem. Suicide rates in both males and females generally increase with age. However, the pattern is different in every nation. Suicidal behaviour in old age exists as a spectrum ranging from death wishes to completed suicide. Risk factors for suicide in old age are male sex, lower socioeconomic status, social isolation, having personality traits like hopelessness and dependency on others etc., the presence of psychiatric and physical disorders and previous suicidal behaviour. The most common cause for elderly suicide, as for all suicides, is untreated depression. Thus, elderly depression needs to be recognized and treated. The treatment of depressive disorder and other psychiatric diorders in late life, counselling in crisis situations and prevention of social isolation in elderly people are the major points for the prevention of suicide in old age. In this review article is to investigate the relationship between elderly and suicidal behavior. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(3.000: 294-309
Moltke, Katinka; Høegh, Erica B; Sæbye, Ditte
BACKGROUND: Since the first publication of the psychiatric emergency units (PEUs) in Copenhagen 1985, outpatient facilities have undergone considerable changes. Our aim is to examine how these changes have influenced the activities in the PEUs in the same catchment area. METHODS: We conducted...... reduced the number of visits in the PEUs considerably. The results have shown a change of diagnostic distribution and more severe conditions requiring acute admissions for emergency treatment. Close collaboration with the patients' families, GPs, social authorities and specialized psychiatric outpatient...
Erlangsen, Annette; Mortensen, Preben Bo; Vach, Werner
BACKGROUND: Very old people have higher suicide rates than the younger elderly population. Psychiatric disorders are known to have a strong association with suicide among elderly people. AIMS: To analyse the analyse the suicide risk associated with psychiatric hospitalisation among the very old......: The association between suicide and psychiatric hospitalisation is much weaker for the very old than for the old. Psychiatric disorders among very old people may be interacting with other disorders, may be underdiagnosed or treated in other healthcare settings....
Martone, Christine A; Mulvey, Edward P; Yang, Suzanne; Nemoianu, Andrei; Shugarman, Ryan; Soliman, Layla
The authors examined the rate of mental disorders in an unselected sample of homicide defendants in a U.S. jurisdiction, seeking to identify psychiatric factors associated with offense characteristics and court outcomes. Defendants charged with homicide in a U.S. urban county between 2001 and 2005 received a psychiatric evaluation after arrest. Demographic, historical, and psychiatric variables as well as offense characteristics and legal outcomes were described. Bivariate analyses examined differences by age group and by race, and logistic models examined predictors of multiple victims, firearm use, guilty plea, and guilty verdict. Fifty-eight percent of the sample had at least one axis I or II diagnosis, most often a substance use disorder (47%). Axis I or II diagnoses were more common (78%) among defendants over age 40. Although 37% of the sample had prior psychiatric treatment, only 8% of the defendants with diagnosed axis I disorders had outpatient treatment during the 3 months preceding the homicide; African Americans were less likely than non-African Americans to be in treatment. African American males were more likely to use a firearm and to have a male victim. In exploratory analyses, psychiatric factors did not predict multiple victims, firearm use in the crime, or a guilty verdict. Rates of axis I disorders were lower than reported in previous studies. Few homicide defendants were in psychiatric treatment at the time of the crime, suggesting limited opportunities for prevention by mental health providers.
Purpose: To determine the prescribing patterns and occurrence of potentially inappropriate medications (PIM) among elderly outpatients visiting a tertiary hospital in Nigeria. Methods: A retrospective study was carried out among elderly subjects (age 60 years) who were issued prescriptions in the outpatients department of ...
Background: Gender is a predictor of prevalence of psychiatric morbidity. The present study was to examine gender difference, prevalence and pattern of psychiatric morbidity among attendees of a general outpatient clinic in a tertiary hospital in sokoto, Nigeria. Methods: A total of 267,000 patients attended the general ...
OSVALDO P. ALMEIDA
Full Text Available Pacientes portadores de quadros demenciais frequentemente apresentam uma série de sintomas neuropsiquiátricos que incluem distúrbios do humor, delírios, alucinações, sintomas vegetativos e alterações da atividade psicomotora. Este estudo foi desenhado com o objetivo de investigar a prevalência de morbidade psiquiátrica entre os pacientes com o diagnóstico clínico de demência (ICD-10 atendidos na clínica de memória da Santa Casa de São Paulo entre fevereiro de 1997 e maio de 1998. O estado mental e cognitivo dos pacientes foram avaliados com uma versão ampliada do SRQ-20 e o MMSE respectivamente. Quarenta e cinco porcento dos 75 pacientes disponíveis para análise apresentavam escores iguais ou maiores do que 8 no SRQ-20, indicando a presença de morbidade psiquiátrica significativa. Sintomas característicos de depressão foram relatados por 69,3% dos indivíduos da amostra. Ideação persecutória e alucinações auditivas foram descritas por 20,0% e 16,0% dos idosos avaliados. Oito pacientes (10,7% descreveram a presença de ideação suicida 3/4 todos apresentavam sintomatologia depressiva. Pacientes com escores no SRQ-20 3 8 ou com ideação suicida eram significativamente mais jovens. Aqueles que relatavam alucinações auditivas apresentavam escores significativamente mais baixos no MMSE. Não se observou diferença significativa entre os sexos quanto à frequência dos sintomas investigados. O exame do estado mental deve ser parte integrante da avaliação do paciente com demência. A detecção e tratamento desses sintomas pode contribuir para diminuir o sofrimento do paciente e o estresse de seus cuidadores.Subjects with dementia often display an array of neuropsychiatric symptoms that include disorders of mood, delusions, hallucinations, vegetative symptoms and psychomotor abnormalities. The present study was designed to investigate the prevalence of psychiatric morbidity amongst patients with the clinical diagnosis
Full Text Available Case: A shy, depressed 30 year old male discussed his frequent ego-syntonic indoor prostitution consumption in small peer groups. Several distinctive non-sexual functions of this paid sex habit were identified. Design and method: The patient had 40 hourly psychiatric sessions in the private practice setting over 14 months. The Arizona Sexual Experience Scale was applied to compare the subjective appraisal of both paid sex and sex in a relationship. The informal Social Atom elucidates social preferences and the Operationalized Psychodynamic Diagnostic-procedure was applied to describe a dominant relationship pattern. Results: The paid sex consumption functioned as a proud male life style choice to reinforce the patients fragile identity. The effect on self esteem was a release similar to his favorite past-time of kick-boxing. With paid sex asserted as a group ritual, it was practiced even with frequent erectile dysfunction and when sex with a stable romantic partner was more enjoyable and satisfying. The therapeutic attitude of the female psychiatrist, with her own ethical values, is put in to context with two opposing theories about prostitution: the ‘Sex-Work-model’ and the ‘Oppression-model’. The therapist’s reaction to the patients’ information was seen as a starting point to understanding the intrapsychic function of paid sex as a coping mechanism against depressive feelings. Conclusions: Exploring and understanding prostitution consumption patterns in young men can benefit the treatment of psychiatric disorders in the private practice setting. It is the psychiatrists task to investigate the patients hidden motives behind paid sex use to help patients achieve a greater inner and relational freedom.
Sullivan, Patrick F; Agrawal, Arpana; Bulik, Cynthia M
into biologically, clinically, and therapeutically meaningful insights. The emerging findings suggest that we are entering a phase of accelerated genetic discovery for multiple psychiatric disorders. These findings are likely to elucidate the genetic portions of these truly complex traits, and this knowledge can...... then be mined for its relevance for improved therapeutics and its impact on psychiatric practice within a precision medicine framework. [AJP at 175: Remembering Our Past As We Envision Our Future November 1946: The Genetic Theory of Schizophrenia Franz Kallmann's influential twin study of schizophrenia in 691...
Sørensen, Ann Lykkegaard; Mainz, Jan; Nielsen, Lars Peter
Background : Potential inappropiate prescribing (IP) is associated with higher mortality, morbidity and risk of hospitalization. Potential IP has only been investigated in elderly populations and never in a psychiatric setting or a general population. Registered nurses are the healthprofessionals...
Canuto, Alessandra; Meiler-Mititelu, Corina; Herrmann, François R; Delaloye, Christophe; Giannakopoulos, Panteleimon; Weber, Kerstin
Although previous studies suggested that psychiatric day hospital care is a valuable alternative to inpatient treatment, its effectiveness for elderly patients is disputed. Small number of cases, poor definition of the psychotherapeutic setting, and absence of systematic assessment at different time points may explain the observed discrepancies. We performed an assessment of a psychiatric day hospital treatment combining individual and group psychotherapy in a series of 122 elderly depressed outpatients. The Geriatric Depression Scale, Short Form Survey, as well as a Therapeutic Community Assessment Scale and Group Evaluation Scale were repeated at admission, 3, 6, 12 months and discharge. The day hospital program was based on psychotherapeutic treatment combining individual and group settings. All patients presented with major depression or a depressive episode of bipolar disease. Variables included severity of depressive symptoms, quality of life, adhesion to therapeutic community treatment and progress in groups of psychotherapy, art-therapy, and psychomotricity. There was a significant reduction of depressive symptoms, and improvement in mental quality of life across all time points studied. Adhesion to therapeutic community increased from admission to discharge. This was also the case for the progress in group therapy for all three groups used, yet the evolution of this parameter at intermediate time points was highly variable. Neither demographic characteristics, nor pharmacological treatment or presence of stressful life events predicted the clinical improvement. Psychotherapeutic care program in day hospitals may improve clinical status and quality of life in elderly depressed patients.
E. M. Kutyrev
Full Text Available With the development of technologies, and discovery of new methods of diagnostics and treatment of diseases, a shift of the disease towards chronic disease is observed. Growth in prosperity will increase average life expectancy and mean age of population. Year after year, the elderly sector grows, with several chronic diseases per person. This is especially true for St. Petersburg, where 25 % of the populations of over working age. Thus, the demand for specialized medical care, particularly outpatient, will increase. Given that outpatient care is more profitable than hospital care, particular attention should be paid to its organization and expansion (increase in area, number of personnel, logistics, and so on. The article attempts to analyze changes in the volume of specialized outpatient medical care delivered at the outpatient Advisory Department of St. Petersburg state establishment of healthcare Mariinsky hospital in the period from 2008 through 2013.
Full Text Available The authors surveyed the clinical data and reviewed the literature on the pain management in elderly patients. The conclusion was made that chronic pain in older age is neglected and analgesia is often insufficient. Data for pharmacokinetic and pharmacodynamic characteristics of widely used analgesic drugs are summarized. The authors provide practical guidelines for pain management of elderly people in outpatients departments.
Bouman, Yvonne H. A.; de Ruiter, Corine; Schene, Aart H.
PURPOSE: The majority of patients treated at forensic psychiatric outpatient facilities suffer from personality disorders, especially Cluster B disorders. Life events have been shown to influence subjective well-being, severity of psychopathology and delinquent behaviour of patients with different
Korczak, Dieter; Huber, Beate; Steinhauser, Gerlinde; Dietl, Markus
-patient pulmonary rehabilitation. Regarding the best frequency of training units per week or the duration and the content of a unit further research is needed. Final results for the ideal length of an in-patient rehabilitation are still missing. None of the studies deals with the analysis of the different treatment forms of a COPD which are frequently defined by an alteration of in-patient and out-patient treatments and participation in sports clubs or self-help groups. There are some other limitations of the studies. The results concerning self-management programmes are not distinct. (Self-) Selection leads to high drop-out rates. Many studies have only small sample sizes. Confounder and long-time effects are seldom researched, relevant economic evaluations do not exist The improvement of health related quality of life is primarily obtained by an improved disease management than by an improvement of a medical parameter. Out-patient pulmonary rehabilitation is as effective as in-patient pulmonary rehabilitation. But there is a critical shortage of out-patient pulmonary rehabilitation supply in Germany. Domains for further research are the evaluation of models for integrated care, the length, frequency and content of training programmes, psychiatric assessments and the cost-effectiveness of out-patient pulmonary rehabilitation.
Hoogeboom, T.J.; Dronkers, J.J.; Ende, C.H.M. van den; Oosting, E.; Meeteren, N.L.U. van
Objective: To evaluate the feasibility and preliminary effectiveness of therapeutic exercise before total hip replacement in frail elderly. Design: A single-blind, randomized clinical pilot trial. Setting: Outpatient physiotherapy department. Subjects: Frail elderly with hip osteoarthritis awaiting
Effect of pharmaceutical care intervention on blood pressure of elderly outpatients with hypertension Efeito de intervenções de atenção farmacêutica na pressão arterial de pacientes idosos com hipertensão
Divaldo Pereira de Lyra Júnior
Full Text Available The purpose of this study was to evaluate the effect of pharmacist intervention on the prevention and solution of drug therapy-problems (DTP, Body Mass Index (BMI, and blood pressure control in elderly outpatients with hypertension. The instruments were applied to 30 elderly outpatients assisted at the pharmacy of a primary health care unit in Ribeirão Preto (SP, Brazil. The group of patients received follow-up during a period of 12 months. It was observed that Pharmaceutical Care intervention optimized the medication use; reduced symptoms caused by drug therapy and improved the elderly patients' health conditions. The Pharmaceutical Care intervention influenced the care given to elderly people as well as the achievement of positive health outcomes. After this study, the researcher gave training about practice of Pharmaceutical Care to 38 dispensing pharmacists from the Public Health-System of Ribeirão Preto. Nowadays, these pharmacists are perpetuating the practice introduced in the region.O objetivo deste estudo foi avaliar o efeito das intervenções farmacêuticas na prevenção e solução de problemas relacionados à farmacoterapia, ao índice de massa corporal e ao controle da pressão arterial de um grupo de pacientes idosos portadores de hipertensão arterial. O grupo de 30 pacientes assistidos na farmácia de uma unidade básica de saúde, em Ribeirão Preto (SP, Brasil, foi acompanhado por 12 meses. No estudo foi observado que as intervenções do programa de Atenção Farmacêutica otimizaram o uso dos medicamentos, reduziram os problemas de saúde causados pelos medicamentos e melhoraram as condições de saúde dos pacientes. As intervenções influenciaram tanto no cuidado prestado aos idosos como na obtenção de resultados de saúde positivos. Depois deste estudo, o pesquisador ministrou um curso de capacitação sobre a prática da Atenção Farmacêutica para 38 farmacêuticos da Secretaria Municipal de Saúde de Ribeir
Hoffmann, P; Tiggemann, H G
Psychiatric care has gradually been shifting in Germany from its original inpatient basis to outpatient and complementary treatment. This shift of emphasis resulted in a transfer of psychiatry-political responsibility to communal bodies and hence also to communal public health services. Sociopsychiatric service ranks high in communal psychiatric care setups, since it promotes cooperation and helps to coordinate efforts in individual cases in respect of focal points on which such care is centered. For the future, an expert commission has suggested that the various institutions actively engaged in community psychiatric care should team up in each region. This applies in particular to mobile services visiting the patients in their homes, and to the offices providing contracts to sociopsychiatric services of public health offices. Despite positive outlooks there are also quite a few negative aspects of present-day practice. One of them is poor definition of tasks and functions of communal sociopsychiatric services, whereas another one are the unsatisfactory quantitative and qualitative means at their disposal. It is also too often overlooked that psychiatric patients and disabled persons are entitled to compensation insurance payments to promote their rehabilitation, as provided for by individual legislation in the various German laender. To tap these sources sufficiently well, sociopsychiatric services must be better equipped in every respect. The professional competence of social workers and physicians, as well as of the relevant staff, must be safeguarded by continuing education and specialist training measures.
Mattoo, Khurshid A.; Garg, Rishabh; Kumar, Shalabh
Context: This study is a continuation of the earlier studies and has been extended to investigate the potential forensic markers of elder abuse. Aims: To determine the prevalence of elder abuse in various outpatient departments (OPDs). To study the associated parameters related to the abuser and the abused. To determine the existence of potential forensic markers of elder abuse. Settings and Design: The subjects were randomly selected from the medical and the dental OPDs of the university. Materials and Methods: Eight hundred and thirty two elderly subjects in the age range 40-60 years were interviewed using a questionnaire to determine the existence of elder abuse. The subjects were investigated and examined for weight, nutrition and hydration, vital signs, habits, existing visual and auditory capabilities, medications, disclosure of wills/deeds, signs of depression, and documented cleanliness. The mini-mental state examination, the Geriatric Depression Scale, the Clock drawing test, and the Brief Psychiatric Rating Scale were used to determine the potential forensic markers. Statistical Analysis Used: Mean values in percentage were determined by dividing the number of determined subjects by the total number of subjects for that parameter. Results: About 37% in medical and 41% in dental OPDs were found to have suffered from abuse, mostly in the age group 60-70 years. Females received more abuse and a combination of son and daughter-in-law constituted most abusers. Various potential markers of elder abuse and neglect investigated among the elder abuse victims included depression (89%), signs of improper feeding (83%), changes in personal hygiene (69%), need for medical/dental treatment (78%), medication misuse (67%), changes in wills/deeds (26%), decubiti (10%), bruises (17%), skin tears (27%), and confusion (23%). Conclusions: Elder abuse exists in one or more forms in both medical and dental OPDs among both males and females in all age groups. PMID:26816460
Hjorthøj, Carsten Rygaard; Madsen, Trine; Agerbo, Esben
PURPOSE: Knowledge of the epidemiology of suicide is a necessary prerequisite of suicide prevention. We aimed to conduct a nationwide study investigating suicide risk in relation to level of psychiatric treatment. METHODS: Nationwide nested case-control study comparing individuals who died from...... suicide between 1996 and 2009 to age-, sex-, and year-matched controls. Psychiatric treatment in the previous year was graded as "no treatment," "medicated," "outpatient contact," "psychiatric emergency room contact," or "admitted to psychiatric hospital." RESULTS: There were 2,429 cases and 50...
Okkels, Niels; Mogensen, Rasmus Beyer; Crean, Lea Catherine
BACKGROUND: Despite concerns about rising treatment of psychiatric patients with psychotropic medications and declining treatment with psychotherapy, actual treatment profiles of psychiatric patients are largely unknown. AIMS: To describe patterns in the treatment of patients in a large psychiatric...... university hospital department. METHODS: A descriptive mapping of treatment of in- and outpatients in a psychiatric department at Aarhus University Hospital Risskov, Denmark. Information was collected by healthcare staff using a 25-item survey form. The p-value was calculated with a chi-squared test and p...
Oyffe, Igor; Melamed, Yuval
Much has been written about involuntary outpatient treatment, both in Israel and abroad. Since the amendment of the law in Israel in 1991, there is an option for compulsory outpatient treatment that is Less confining than hospitalization. Research has noted its efficacy in avoiding exacerbation of the mental state, repeat hospitalizations and involvement in dangerous activities among patients with low compliance to treatment. In practice, there is no mechanism for implementation or enforcement. Thus, the main difficulty noted by Spinzy and Krieger, is the lack of tools to supervise involuntary outpatient treatment, thereby making it difficult to implement the law of involuntary outpatient treatment ordered by the regional psychiatrist. In addition, the court interpreted the law in a manner that prevents taking measures against the patient who does not comply with compulsory outpatient treatment unless his condition is so severe that it requires court ordered hospitalization. The issue becomes more problematic with court ordered compulsory outpatient treatment. In the United States there is Assisted Outpatient Treatment (AOT) in 42 states. The criteria include dangerousness to the environment, harm to self, or severe inability to care for one's self. AOT helps prevent hospitalizations and improves the outcome of treatment. According to "Kendra's Law" in the United States, the Court detaiLs the biological and psychosocial treatment programs in the court order recommendations: The recommendations include: create uniformity, determine a mechanism of action, assign skilled manpower to implement compulsory outpatient treatment, establish a plan for compulsory outpatient treatment, and create a legal mechanism to supervise patients in court ordered outpatient treatment. In conclusion, determining a mechanism for intervention, implementation and supervision of compulsory outpatient treatment is first and foremost in the best interest of: the patient, who does not want his
O'Connor, Stephen S.; Jobes, David A.; Comtois, Katherine Anne; Atkins, David C.; Janis, Karin; Chessen, Chloe E.; Landes, Sara J.
The purpose of this study was to identify outpatients who experience entrenched suicidal ideation following inpatient psychiatric hospitalization. Our findings suggest that the use of a suicidal ambivalence index score was helpful at discriminating those who reported significantly greater ratings of suicidal ideation across a 1-year period of…
Full Text Available Abstract Background Substance use disorders seem to be an under considered health problem amongst the elderly. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST, was developed by the World Health Organization to detect substance use disorders. The present study evaluates the psychometric properties of the French version of ASSIST in a sample of elderly people attending geriatric outpatient facilities (primary care or psychiatric facilities. Methods One hundred persons older than 65 years were recruited from clients attending a geriatric policlinic day care centre and from geriatric psychiatric facilities. Measures included ASSIST, Addiction Severity Index (ASI, Mini-International Neuropsychiatric Interview (MINI-Plus, Alcohol Use Disorders Identification Test (AUDIT, Revised Fagerstrom Tolerance Questionnaire-Smoking (RTQ and MiniMental State(MMS. Results Concurrent validity was established with significant correlations between ASSIST scores, scores from ASI, AUDIT, RTQ, and significantly higher ASSIST scores for patients with a MINI-Plus diagnosis of abuse or dependence. The ASSIST questionnaire was found to have high internal consistency for the total substance involvement along with specific substance involvement as assessed by Cronbach’s α, ranging from 0.66, to 0.89 . Conclusions The findings demonstrate that ASSIST is a valid screening test for identifying substance use disorders in elderly.
Knabb, Joshua J; Vogt, Ronald G
In this study, we examined Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon, 2009) characteristics in an Old Order Amish outpatient sample (n = 166), with a comparison group of Old Order Amish who were not receiving mental health treatment at the time of testing (n = 80). We also graphically compared the 2 Amish groups to a non-Amish psychiatric sample in the literature. Consistent with our hypotheses, the Old Order Amish outpatients scored significantly higher than the Old Order Amish comparison group on the majority of MCMI-III scales, with mostly medium effect sizes, suggesting that the MCMI-III is a useful personality instrument in discriminating between Old Order Amish clinical and nonclinical groups. In addition, the Amish outpatients scored similar to a non-Amish psychiatric sample in the literature on most personality scales. Future MCMI-III studies with the Amish are needed to replicate and generalize our findings.
Rummans, T A; Smith, G E; Lin, S C; Waring, S C; Kokmen, E
To further investigate the relationship between psychiatric disorders and dementia in elderly patients, the authors drew a population-based, age-stratified random sample from residents of Rochester, Minnesota, age 65 and older. A trained paramedic completed a 90-minute screening interview, including the Symptom Checklist-90, Mini-Mental State Exam, and Auditory-Verbal Learning Test. Persons failing the screens were interviewed by a psychiatrist and a neurologist. DSM-III-R diagnoses were assigned for dementia and other psychiatric disorders. Of 201 participants, 37 were evaluated further by both neurologist and psychiatrist. One received a psychiatric diagnosis alone. Dementia alone was present in four people. Concurrent psychiatric diagnoses and dementia were found in 17 subjects. Much of the psychopathology found in older persons occurs in people with cognitive impairment. Current diagnostic nosology may not be able to capture the interrelatedness of psychiatric syndromes and cognitive impairment in elderly patients.
Conclusion: This study employed nationally representative data in the detection of patterns in outpatient care utilization by elderly individuals in Taiwan. Medical care providers and policymakers should be fully aware of the complex patterns unique to older patients. The results of this study could be used as a benchmark with which to assess the impact of future medical care policy on elderly people.
Pang, Wendy W; Schrier, Stanley L
There have been several large-scale epidemiologic studies, including the National Health and Nutrition Examination Survey III (NHANES III), which have described the prevalence and impact of anemia in the elderly. The information derived has been critically important. However, given the large number of patients surveyed, these reports necessarily relied substantially on the laboratory-based screening evaluations. There are now two recent reports describing the cause of anemia in elderly outpatients, and although the numbers are smaller than the large scale surveys, they constitute comprehensive hematologic evaluations with therapeutic interventions and clinical follow-up. The purpose of this review is to compare these different analyses. There are distinct differences and similarities in the two types of studies, which are derived from patients seen in hematology clinics. Despite comprehensive hematologic evaluation, the puzzling entity of unexplained anemia of the elderly is confirmed and found to account for 30-46% of patients. NHANES III classified iron-deficiency anemia with other nutritional anemias, a classification that might be correct in the developing third world, but in North America and Western Europe, iron deficiency is more often caused by blood loss and the cause must be sought and dealt with. The myelodysplastic syndromes are an important cause of anemia in the elderly, with a prevalence of at least 4%. Large-scale screening studies of anemia in the elderly are of great importance, and when complemented by comprehensive hematologic evaluations, provide a more accurate picture of the clinical situation.
Niimura, Hidehito; Nemoto, Takahiro; Sakuma, Kei; Mizuno, Masafumi
Recently, patients with schizophrenia have been progressively aging in a way similar to that of the general population. In Japan, community mental health care has become more active in the context of the policy of promoting the discharge of patients from psychiatric hospitals. Patients with chronic schizophrenia who have been discharged are already approaching old age. "Successful aging" may be a key concept in their community-based psychiatric care. Successful aging does not emphasize a loss of youth, but focuses on gains and growth achieved with aging. In the Sasagawa Project, 78 patients with schizophrenia were gradually transferred from a psychiatric hospital to a community dwelling. Eight years have passed since the project began. Elder patients (>60 years old) showed stable psychiatric symptoms and were rarely readmitted to the psychiatric ward. They were, however, more often readmitted to hospital due to physical disease (for example, lifestyle-related disease or fracture) than were middle -aged patients (aging, but they are not sufficiently prepared for old age. In the mental health care of aging psychiatric patients, it is necessary to not only control psychiatric symptoms, but also promote and improve their quality of life by maintaining their ability to continue living in the community (for example, by supporting their preparations for old age).
Our report describes the evolution of the outpatients' psychiatry in Lausanne. Here is mentioned the constant increase of consultations for new and former cases, and it is statistically shown that this augmentation is not only the result of the increasing population in the "Vaud District" (Canton de Vaud) but rather the consequence of the increasing number of patients with deeper investigations and treatments. It is true that the psychotherapeutic training was the most important in our outpatients' department, but the coming of psychotropic drugs has changed the treatment in certain cases and has developed mixed treatments. The creation of the Psycho-Social Center in the Psychiatric outpatients' department was the beginning of the social action in the institution, with the creation of an emergency department, consultations at the patients' home and treatment made by a team including doctors-outpatients' nurses-social assistants. We have checked that for many outpatients, very often in hard or psycho-reactive situations, there was no opposition between pharmaco-therapy or psychotherapy. So pharmaco-therapy and psychotherapy are often used separately or together in the outpatients' department through individual analytic psychotherapies, group or brief psychotherapies, relaxation, emergency treatments with perfusion of psychotropic and neuroleptic drugs.
U.S. Department of Health & Human Services — Use of medical imaging - national data. These measures give you information about hospitals' use of medical imaging tests for outpatients. Examples of medical...
U.S. Department of Health & Human Services — Use of medical imaging - provider data. These measures give you information about hospitals' use of medical imaging tests for outpatients. Examples of medical...
U.S. Department of Health & Human Services — Use of medical imaging - state data. These measures give you information about hospitals' use of medical imaging tests for outpatients. Examples of medical imaging...
Bert, Jack M; Hooper, Jessica; Moen, Sam
Outpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. With current pressures on arthroplasty surgeons and their associated institutions to reduce costs per episode of care, it is important to define the steps and challenges associated with establishing an outpatient arthroplasty program. Several studies have outlined techniques of selecting patients suitable for this type of postoperative pathway. With emerging concerns about patients who undergo outpatient arthroplasty being at increased risk of medical complications, which may lessen projected cost savings, it is important to identify value-based strategies to optimize patient recovery after OTJA. This article reviews digital techniques for patient selection and data collection, operating room efficiency systems, and provides a summary of methods to build and maintain value in outpatient total joint replacement within the framework of bundled payment reimbursement.
Varma, Sannidhya; Sareen, Himanshu; Trivedi, J K
With improvement in medical services in the last few years, there has been a constant rise in the geriatric population throughout the world, more so in the developing countries. The elderly are highly prone to develop psychiatric disorders, probably because of age related changes in the brain, concomitant physical disorders, as well as increased stress in later life. Psychiatric disorders in this population may have a different presentation than in other groups and some of psychopathologies might be mistaken for normal age related changes by an unwary clinician. Therefore the need of the day is to train psychiatrists and physicians to better recognize and manage mental disorders in this age group.
Aim:The aim of this study was to find out if the frequency of dream recall among neuropsychiatric patients on psychotropic drugs was significantly different from that of healthy individuals. Methods: The study was done on 53 neuropsychiatric patients with different diagnoses who were on medication and 144 healthy ...
This paper addresses price elasticity of demand (PED) in a region where most patients make payments for consultations out of pocket. PED is a measure of the responsiveness of the quantity demanded of goods or services to changes in price. The study was done in the context of an outpatient psychiatric clinic in a sub -Saharan African country. The study was performed at the University College Hospital (UCH), Ibadan, Nigeria. Aggregate data were collected on weekly clinic attendance over a 24-month period October 2008 - September 2010 representing 12 months before, to 12months after a 67% increase in price of outpatient psychiatric consultation. The average weekly clinic attendance prior to the increase was compared to the average clinic attendance after the price increase. Arc-PED for consultation was also estimated. Clinic attendance dropped immediately and significantly in the weeks following the price increase. There was a 34.4% reduction in average weekly clinic attendance. Arc-PED for psychiatric consultation was -0.85. In comparison to reported PED on health care goods and services, this study finds a relatively high PED in psychiatric consultation following an increase in price of user fees of psychiatric consultation.
Elderly Suicide Fact Sheet Based on 2012 Data (2014) Overview • The elderly (ages 65 and older) made up 13. ... population; they accounted for 16.37% of all suicides in the US. • The rate of suicides for ...
Estudo multicêntrico de idosos atendidos em ambulatórios de cardiologia e geriatria de instituições brasileiras Multicenter study of elderly patients in outpatient clinics of cardiology and geriatric brazilian institutions
Cláudia F. Gravina Taddei
Full Text Available OBJETIVO: Avaliar aspectos epidemiológicos, clínicos e terapêuticos de idosos com doenças cardiovasculares (DCV, no Brasil. MÉTODOS: Idosos com DCV, atendidos em 36 serviços de Cardiologia e Geriatria do Brasil, foram investigados através de questionário aplicado aos que tinham consulta marcada para o período analisado (um mês. RESULTADOS: Estudados 2196 idosos de 65 a 96 anos, sendo 60% mulheres e analisados os fatores de risco: sedentarismo (74%, pressão arterial (PA elevada (53%, LDL colesterol aumentado (33%, colesterol total aumentado (30%, obesidade (30%, HDL-colesterol diminuído (15%, diabetes (13% e tabagismo (6%. Observou-se maior prevalência nas mulheres, com três ou mais fatores de risco. O principal motivo de consulta foi a PA elevada (48%. Teste ergométrico e cinecoronariografia, foram mais solicitados para os homens. Os diagnósticos mais comuns foram hipertensão arterial sistêmica (HAS (67% e insuficiência coronária (ICo (29%. Os medicamentos mais utilizados foram diuréticos (42%. CONCLUSÃO: Foi observada alta prevalência de fatores de risco (93%, principalmente nas mulheres; sedentarismo, como fator de risco mais freqüente, aumentando de prevalência com a idade; HAS, como principal motivo de consulta e diagnóstico; menor investigação e diagnóstico de ICo em mulheres; diuréticos, como os fármacos mais freqüentemente prescritos; insuficiência cardíaca como principal doença associada a internação (31% e atendimento de emergência (10%.PURPOSE: To evaluate epidemiological, clinical and therapeutic aspects of elderly patients with cardiovascular disease in Brazil. METHODS: Elderly patients with cardiovascular disease treated in 36 centers of cardiology and geriatrics were investigated through a questionnaire applied to those who had an appointment during the analyzed period . RESULTS: 2196 elderly patients ranging from 65 to 96 years of age were analyzed, 60% of which were females. The main risk
Objective: This paper addresses price elasticity of demand (PED) in a region where most patients make payments for consultations out of pocket. PED is a measure of the responsiveness of the quantity demanded of goods or services to changes in price. The study was done in the context of an outpatient psychiatric clinic in ...
Zuardi, Antonio Waldo; Ishara, Sergio; Bandeira, Marina
Purpose: The authors compared the levels of job burden and stress in psychiatry residents with those of other healthcare professionals at inpatient and outpatient psychiatric hospitals in a medium-sized Brazilian city. Method: In this study, the levels of job burden and stress of 136 healthcare workers and 36 psychiatry residents from six various…
Objectives. This study examined the quality of referrals to secondary-level outpatient psychiatric services rendered by the. Department of Psychiatry, University of the Free State. Referral letters were evaluated according to specific quality criteria. Aspects that would enable secondary-level doctors to make informed decisions ...
Sabine C Meijwaard
Full Text Available Crime victimisation is a serious problem in psychiatric patients. However, research has focused on patients with severe mental illness and few studies exist that address victimisation in other outpatient groups, such as patients with depression. Due to large differences in methodology of the studies that address crime victimisation, a comparison of prevalence between psychiatric diagnostic groups is hard to make. Objectives of this study were to determine and compare one-year prevalence of violent and non-violent criminal victimisation among outpatients from different diagnostic psychiatric groups and to examine prevalence differences with the general population.Criminal victimisation prevalence was measured in 300 outpatients living in Amsterdam, The Netherlands. Face-to-face interviews were conducted with outpatients with depressive disorder (n = 102, substance use disorder (SUD, n = 106 and severe mental illness (SMI, n = 92 using a National Crime Victimisation Survey, and compared with a matched general population sample (n = 10865.Of all outpatients, 61% reported experiencing some kind of victimisation over the past year; 33% reported violent victimisation (3.5 times more than the general population and 36% reported property crimes (1.2 times more than the general population. Outpatients with depression (67% and SUD (76% were victimised more often than SMI outpatients (39%. Younger age and hostile behaviour were associated with violent victimisation, while being male and living alone were associated with non-violent victimisation. Moreover, SUD was associated with both violent and non-violent victimisation.Outpatients with depression, SUD, and SMI are at increased risk of victimisation compared to the general population. Furthermore, our results indicate that victimisation of violent and non-violent crimes is more common in outpatients with depression and SUD than in outpatients with SMI living independently in the community.
The future of psychiatric community care in Japan requires a medical team for outpatient care to offer support and take responsibility for a region; respecting human rights and supporting high risk patients who have concluded a long-period of hospitalized or repeated involuntary commitment, and for people who suffer from social withdraws over a long period of time. There are over 3,000 private psychiatric outpatient clinics in Japan. Over 400 of them are multifunctional psychiatric outpatient clinics that provide daycare services and outreach activities. In the future, if systematized those clinics entrusted by an administrative organ with performing as a "community mental health center". Multifunctional vertical integration of psychiatric care is possible in Japan to create a catchment area with 24 hours phone service and continued free access.
Lindqvist, D.; Epel, E.S.; Mellon, S.H.; Penninx, B.W.; Revesz, D.; Verhoeven, J.E.; Reus, V.I.; Lin, J.; Mahan, L.; Hough, C.M.; Rosser, R.; Bersani, F.S.; Blackburn, E.H.; Wolkowitz, O.M.
Many psychiatric illnesses are associated with early mortality and with an increased risk of developing physical diseases that are more typically seen in the elderly. Moreover, certain psychiatric illnesses may be associated with accelerated cellular aging, evidenced by shortened leukocyte telomere
Krystal, Andrew D.
SYNOPSIS Psychiatric disorders and sleep are related in important ways. In contrast to the longstanding view of this relationship which viewed sleep problems as symptoms of psychiatric disorders, there is growing experimental evidence that the relationship between psychiatric disorders and sleep is complex and includes bi-directional causation. In this article we provide the evidence that supports this point of view, reviewing the data on the sleep disturbances seen in patients with psychiatric disorders but also reviewing the data on the impact of sleep disturbances on psychiatric conditions. Although much has been learned about the psychiatric disorders-sleep relationship, additional research is needed to better understand these relationships. This work promises to improve our ability to understand both of these phenomena and to allow us to better treat the many patients with sleep disorders and with psychiatric disorders. PMID:23099143
month period and screened for general psychiatric morbidity, anxiety and depression using the SRQ-20 and HAD scales respectively. The male:female ratio of the group was 2.1:1 with a mean age of 57.3 years. The elderly population constituted ...
Menecier, Pascal; Fernandez, Lydia
Addictive behavior still persists among the elderly, mainly concerning substance abuse, such as alcohol, tobacco or psychotropic drugs and addictive practices such as gambling. Illegal substances or cyber-addictions appear much less often. The environment (place of residence or care) and/or economic factors may influence behavior and practices. The incidence of somatic illness or psychiatric disorders, such as cognitive impairment among the elderly patients, complicates even further the presentation of addictive disorders and their treatment. The age factor does not seem to lessen the suffering felt by the patient and care is required in an equal manner for all ages. Prevention (maintenance of personal autonomy and quality of life throughout the ageing process) plays an essential role along with the offer of care. The lack of scientific data such as the absence of validation for adult care among the elderly, leave wide scope for epidemiological, clinical and theoretical research. Copyright © 2012 Elsevier Masson SAS. All rights reserved.
Full Text Available Epidemiological and clinical studies have shown a positive correlation between smoking and psychiatric disorders. To investigate the prevalence of cigarette smoking, 277 psychiatric outpatients with anxiety or depressive disorders (DSM-IV answered a self-evaluation questionnaire about smoking behavior and were compared with a group of 68 control subjects. The diagnoses (N = 262 were: 30.2% (N = 79 major depressive disorder, 23.3% (N = 61 panic disorder, 15.6% (N = 41 social anxiety disorder, 7.3% (N = 19 other anxiety disorders, and 23.7% (N = 62 comorbidity disorders. Among them, 26.3% (N = 69 were smokers, 23.7% (N = 62 were former smokers and 50.0% (N = 131 were nonsmokers. The prevalence of nicotine dependence among the smokers was 59.0% (DSM-IV. The frequency of cigarette smoking did not show any significant difference among the five classes of diagnosis. The social anxiety disorder patients were the heaviest smokers (75.0%, with more unsuccessful attempts to stop smoking (89.0%. The frequency of former smokers was significantly higher among older subjects and nonsmokers were significantly younger (chi² = 9.13, d.f. = 2, P = 0.01. Our data present some clinical implications suggesting that in our psychiatric outpatient sample with anxiety disorder, major depression and comorbidity (anxiety disorder and major depression, the frequency of cigarette smoking did not differ from the frequency found in the control group or in general population studies. Some specific features of our population (outpatients, anxiety and depressive disorders might be responsible for these results.
Moltke, Katinka; Høegh, Erica B; Sæbye, Ditte; Larsen, Peter Lindorff; Reff, Kasper Thybo; Knop, Joachim
Since the first publication of the psychiatric emergency units (PEUs) in Copenhagen 1985, outpatient facilities have undergone considerable changes. Our aim is to examine how these changes have influenced the activities in the PEUs in the same catchment area. We conducted a follow-up study to describe this development in the past 27 years by comparing 1985 variables with same measures in 2012. A random sample of all visits every 10 days in 2012 to three PEUs in Copenhagen were registered and compared with data collected, using the same study design in 1985. The number of visits has decreased significantly from 367 visits/year/10,000 inhabitants in 1985 to 225 in 2012. Apart from a considerable number (15.6%) of visitors with non-Danish background, the demographic variables have not changed significantly since 1985. Compared with 1985, the diagnostic distribution among the 2012 visitors shows an increased frequency of affective disorders and neurotic and stress disorders, while schizophrenia spectrum and personality disorders show almost the same frequencies in 1985 and 2012. Rates of alcoholism and organic mental disorders show a minor reduction during the 27-year follow-up period. In 1985, 20.7% of the visits ended up without any referrals, compared with 4.8% in 2012. The rate of acute admissions into a psychiatric ward was 60.8% in 2012 compared with 35.65% in 1985. The extension of the psychiatric outpatients' facilities since 1985 has reduced the number of visits in the PEUs considerably. The results have shown a change of diagnostic distribution and more severe conditions requiring acute admissions for emergency treatment. Close collaboration with the patients' families, GPs, social authorities and specialized psychiatric outpatient clinics is emphasized.
Kessing, Lars Vedel; Hansen, Hanne Vibe; Hvenegaard, Anne
BACKGROUND: Little is known about whether treatment in a specialised out-patient mood disorder clinic improves long-term prognosis for patients discharged from initial psychiatric hospital admissions for bipolar disorder. AIMS: To assess the effect of treatment in a specialised out-patient mood...... randomised to treatment in a specialised out-patient mood disorder clinic or standard care (ClinicalTrials.gov: NCT00253071). The primary outcome measure was readmission to hospital, which was obtained from the Danish Psychiatric Central Register. RESULTS: A total of 158 patients with mania/bipolar disorder...... were included. The rate of readmission to hospital was significantly decreased for patients treated in the mood disorder clinic compared with standard treatment (unadjusted hazard ratio 0.60, 95% CI 0.37-0.97, P = 0.034). Patients treated in the mood disorder clinic more often used a mood stabiliser...
Barghadouch, Amina; Kristiansen, Maria; Jervelund, Signe Smith
Purpose: Studies show a high level of mental health problems among refugee children. This study examined whether a subset of refugee children living in Denmark accessed psychiatric healthcare services more than those born in the country. Methods: This study compared 24,427 refugee children from...... and psychiatrists in private practice. Results: Between 1 January 1996 and 30 June 2012, 3.5 % of the refugee children accessed psychiatric healthcare services compared to 7.7 % of the Danish-born children. The rate ratio of having any first-time psychiatric contact was 0.42 (95 % CI 0.40–0.45) among refugee boys...... and 0.35 (95 % CI 0.33–0.37) among refugee girls, compared to Danish-born children. Figures were similar for those accessing private psychologists or psychiatrists, emergency room, inpatient and outpatient services. Conclusions: Refugee children used fewer psychiatric healthcare services than Danish...
Meade, Christina S; Sikkema, Kathleen J
Persons with severe mental illness (SMI) are disproportionately affected by HIV/AIDS. This study examined multivariate correlates of sexual risk among 152 adults with SMI receiving outpatient psychiatric treatment. Structured interviews assessed psychiatric, psychosocial, and behavioral risk factors. The majority was sexually active (65%), and many reported unprotected intercourse (73%), multiple partners (45%), and sex trading (21%) in the past year. Logistic regression models found that sexual behaviors were differentially associated with non-psychotic disorder, psychiatric symptoms, substance abuse, childhood sexual abuse, romantic partnership, and social support (all ps < .05). Findings underscore the need for targeted HIV prevention interventions that address psychiatric and psychosocial risk factors.
Hannallah, R S
Successful anesthetic management of children undergoing outpatient surgery requires that the surgeon and anesthesiologist be actively involved in all aspects of management. Guidelines should be established in consultation with the surgeons, nurses, and administrators to ensure proper selection and preoperative preparation of patients. The psychological evaluation and preparation of children, and the use of pharmacologic premedication when indicated, will ensure a pleasant experience for all involved. The anesthesiologist should choose a specific anesthetic agent and a technique that are appropriate for each individual child. Use of "routine" induction techniques is rarely, if ever, appropriate. Early ambulation and discharge are very desirable in outpatients. Long-acting drugs and techniques that are associated with excessive drowsiness or nausea and vomiting should not be utilized. Special attention must be paid to the analgesic requirements of the child. Regional blocks should be used whenever possible to supplement "light" general anesthesia and to limit the need for narcotics during recovery. Specific criteria for discharge ensure the safety and protection of the child and staff.
Jansson, Susanne; Fridlund, Bengt
A therapeutic alliance with a continuing collaboration between a patient and psychiatric staff is a resource for helping patients cope with the demands of coercive legislation. Knowledge exists describing coercion in inpatient care while the knowledge regarding the perceptions of creating a therapeutic alliance with patients on Community Treatment Orders (CTO) among psychiatric staff is scarce. To describe perceptions among psychiatric staff of creating a therapeutic alliance with patients on CTOs, an exploratory design using a phenomenographic method was employed. Thirteen semi-structured audio-taped interviews were conducted with psychiatric staff responsible for patients on CTOs. The staff worked in five different outpatient clinics and the interviews were conducted at their workplaces. The analysis resulted in in four metaphors: the persevering psychiatric staff, the learning psychiatric staff, the participating psychiatric staff, and the motivating psychiatric staff. Patients on CTOs were more time-consuming for psychiatric staff in care and treatment. Long-term planning is required in which the creation of a therapeutic alliance entails the patient gradually gaining greater self-awareness and wanting to visit the outpatient clinic. The professional-patient relationship is essential and if a therapeutic alliance is not created, the patient's continued care and treatment in the community is vulnerable.
Full Text Available The criminological literature underscores that criminal offences committed by senior citizens are directly related to their age and entering a new stage of life. In elder offenders, we may observe a distinctive pattern in the development of their criminal activities, the structure of crime, gender-specific criminal offences, their previous criminal records and their social status. The former criminological studies on the elderly population have most frequently focused on examining the senior citizens' fear of crime and their victimization within the family; the studies on criminal offences committed by the elderly seem to be rather scarce. The prior research into the criminal activity of elder offenders has largely addressed the needs and difficulties encountered by elderly inmates, particularly in case they were sentenced to long-term imprisonment and subject to strict parole rules. Some researchers have also extended criticism on the lack of special correctional facilities specifically designed for elder inmates. In general, crime rate drops with aging. In developed countries, there is a constant increase of elder population as opposed to the marked decrease of younger population. Yet, the percentage of convicted offenders among the persons over the age of 55 is still significantly lesser as compared to the percentage of younger convicts. Namely, different issues pertaining to 'elder people behind bars' have eventually become the subject matter of interest of criminologists and penologists, public administration authorities and international organizations advocating the observance of human rights. The incarcerated men and women face many physical and psychological problems which are generally encountered by all people at large but usually at a later age, when they are at least 10 years older than the inmates. Violence, anxiety and distress caused by the immediate prison environment, separation from their friends and families, and the awareness
Lapid, Maria I; Prom, Maria C; Burton, M Caroline; McAlpine, Donald E; Sutor, Bruce; Rummans, Teresa A
Eating disorders in the elderly are often overlooked. When they occur, significant morbidity and mortality result. In this study we review all existing literature on eating disorders in the elderly and provide practical guidelines for clinicians in recognizing and managing eating disorders in the elderly. A literature search using Medline, PubMed, Web of Knowledge, and PsychINFO revealed 48 published cases of eating disorders in people over the age of 50 years. The mean age was 68.6 years (range 50-94), and the majority (88%) of cases were females. The majority (81%) of cases had anorexia nervosa, and 10% had bulimia nervosa. Late onset eating disorders were more common (69%) than early onset. Comorbid psychiatric conditions existed in 60%, most commonly major depression. Management with a combination of behavioral and pharmacologic interventions was most successful, although only 42% were treated successfully. Mortality was high (21%) secondary to the eating disorder and its complications. Eating disorders do occur in the elderly and should be included in the differential diagnosis of unexplained weight loss in the elderly.
Full Text Available Psychiatric disorders are common in women during their childbearing years. Special considerations are needed when psychotic disorders present during pregnancy. Early identification and treatment of psychiatric disorders in pregnancy can prevent morbidity in pregnancy and in postpartum with the concomitant risks to mother and baby. Nevertheless, diagnosis of psychiatric illnesses during pregnancy is made more difficult by the overlap between symptoms of the disorders and symptoms of pregnancy. In majority of cases both psychotherapy and pharmacotherapy should be considered. However, psychiatric disorders in pregnancy are often under treated because of concerns about potential harmful effects of medication. This paper reviews findings about the presentation and course of major psychiatric disorders during pregnancy.
Full Text Available The etiology of these dermatological diseases is entirely psychiatric origin. These patients show overconcern to their skin or self inflicted dermatoses unconsciously instead of facing with their real problems. In this group, delusions, dermatitis artefacta, trichotillomania, body dysmorphic disorder can be seen. They use denial as defence mechanism to their real psychiatric problems and prefer to apply dermatology instead of psychiatry. Dermatologist should be very careful before asking psychiatric consultation. Denial mechanism help patients to overcome agressive impulses like suicide or prevent further psychiatric damage like psychosis. Dermatologist should see these patients with short and frequent intervals with a good empathic approach. This will help to progress a powerful patient doctor relationship which will lead to a psychiatric evaluation.
Chaudhary, Shyam Chand; Nanda, Satyan; Tripathi, Adarsh; Sawlani, Kamal Kumar; Gupta, Kamlesh Kumar; Himanshu, D; Verma, Ajay Kumar
Psychiatric disorders, especially anxiety and depression have been reported to have an increased prevalence in chronic obstructive pulmonary disease (COPD) patients, but there is a paucity of data from India. Aim of our study is to study the frequency of psychiatric comorbidities in COPD patients and their correlation with severity of COPD, as per global initiative for obstructive lung disease guidelines. This study was conducted in outpatient department of a tertiary care hospital (King George's Medical University). A total of 74 COPD patients were included in this study and compared with 74 controls. The diagnosis and severity of COPD were assessed by spirometry. Psychiatric comorbidities were assessed using the Mini International Neuropsychiatric Interview questionnaire. The frequency of psychiatric comorbidities was significantly higher (P < 0.05) in COPD patients (28.4%) as compared to controls (2.7%). As regards to severity, the frequency was significantly increased in severe and very severe COPD. The frequency of psychiatric comorbidities in COPD patients increased significantly with the increase in duration of symptoms being present in 67% of patients with duration of symptoms more than 10 years and only 23% of patients with duration of symptoms ≤5 years. The frequency of psychiatric comorbidities is increased in COPD patients as compared to controls. We recommend that all patients with COPD should be screened for psychiatric comorbidity, if any.
Molendijk, M.L.; Bamelis, L.; van Emmerik, A.A.P.; Arntz, A.; Haringsma, R.; Spinhoven, P.
In a recent study, Rude, Gortner, and Pennebaker (2004) found word use to be related to depression and vulnerability to depression in the essays of college students. We sought to replicate and extend these findings in a clinical sample. Written essays of 304 psychiatric outpatients with a
Vulink, N. C. C.; Rosenberg, A.; Plooij, J. M.; Koole, R.; Bergé, S. J.; Denys, D.
Body dysmorphic disorder (BDD) is a severe psychiatric disease with delusions about defects in appearance for which patients seek surgical help. This is the first European study to determine the half-year prevalence of BDD in a maxillofacial outpatient clinic. A total of 160 patients with
Vulink, N.C.; Rosenberg, A.; Plooij, J.M.; Koole, R.A.; Berge, S.J.; Denys, D.
Body dysmorphic disorder (BDD) is a severe psychiatric disease with delusions about defects in appearance for which patients seek surgical help. This is the first European study to determine the half-year prevalence of BDD in a maxillofacial outpatient clinic. A total of 160 patients with
Kessels, R.P.C.; Ruis, C.; Kappelle, L.J.
OBJECTIVES: To examine the effect of self-reported depressive symptoms on memory function in a non-psychiatric, non-litigation outpatient sample and to identify which memory tests may be most susceptible for depression-related decline. METHODS: Self-reported depressive symptoms were measured by the
Poirier, Marie-France; Canceil, Olivier; Baylé, Franck; Millet, Bruno; Bourdel, Marie-Chantal; Moatti, Cécile; Olié, Jean-Pierre; Attar-Lévy, Dominique
Compelling evidence that tobacco-smoking is a form of drug addiction exists. The aim of this study is to determine the following: (1) prevalence of tobacco-smoking and of nicotine dependence in French psychiatric patients; (2) rates and patterns of tobacco smoking and of nicotine dependence according to diagnosis; (3) relationship between current smoking status and antipsychotic medications; and (4) relationship between cigarette smoking and neurological side effects induced by neuroleptics. A population of 711 psychiatric in- and outpatients was assessed using: (1) a detailed smoking self-questionnaire for smoking history and nicotine dependence; and (2) a questionnaire for staff covering treatments and DSMIII-R diagnoses. Data were analyzed using chi2 analysis of variance (ANOVA) tests (one factor) for quantitative comparisons between groups of patients, and analysis of covariance (ANCOVA) test with age covariate was performed for age-dependent variables. Prevalence of smoking in the population of psychiatric patients was significantly higher than in the French general population. Diagnoses among current smokers were mainly substance-related disorder and schizophrenia. The authors established correlations between prevalence of smoking and age, sex, marital and socioeconomic status, alcohol use, coffee consumption and other psychoactive substance use or abuse. The authors did not find relationship between smoking prevalence and institutionalization. Neuroleptic neurological side effects were significantly fewer among smokers compared to nonsmokers. However, the rate of smokers was significantly higher in psychiatric patients receiving neuroleptic drugs. Nicotine abuse in psychiatric patients, and especially in schizophrenic patients, could support the hypothesis that smoking is consistent with self-medication.
Avaliação de fragilidade, funcionalidade e medo de cair em idosos atendidos em um serviço ambulatorial de geriatria e gerontologia Assessment of frailty, functionality and fear of falling in elderly assisted at an outpatient gerontologic and geriatric clinic
Silvia Lanziotti Azevedo da Silva
Full Text Available A síndrome da fragilidade é uma condição associada ao envelhecimento, com desfechos de saúde nos idosos como quedas, medo de cair e incapacidade. Os objetivos deste estudo foram determinar a freqüência de fragilidade e verificar a existência de correlação desta com quedas, medo de cair e funcionalidade, em 30 idosos (média de 75,7±7,6 anos cadastrados em um serviço interdisciplinar de Geriatria e Gerontologia. Foram avaliados quanto à fragilidade, por características sugeridas pela literatura, e quanto aos desfechos quedas, funcionalidade e medo de cair. A análise descritiva identificou 20% de idosos frágeis, 46,7% pré-frágeis e 33,3% não-frágeis. Foram encontradas diferenças significativas entre os grupos frágeis e pré-frágeis e frágeis e não-frágeis em relação à funcionalidade mensurada pela escala de Lawton (p=0,000 e medo de cair, avaliada pela escala internacional de eficácia de quedas (FES-I, na sigla em inglês. Foi encontrada correlação significativa e moderada entre a pontuação na FES-I e o número de quedas; e correlação significativa, moderada e inversa, entre as pontuações da FES-I e de Lawton. A freqüência de fragilidade foi maior na amostra do estudo do que a encontrada em estudos prévios; e foram encontradas diferenças significativas entre os grupos de idosos, de acordo com as características de fragilidade, indicando que os mais frágeis apresentavam maior incapacidade para atividades de vida diária e mais medo de cair.The frailty syndrome is a condition associated to age-related vulnerability, bearing health outcomes such as falls, fear of falling, and disability. The purposes of this study were to determine frequency of frailty and to search for correlations between frailty and falls, fear of falling, and functionality, in a group of 30 elderly (mean age 75.7±7.6 registered at a geriatric outpatient clinic. They were assessed as to frailty according to features suggested by
Gokce Nur Say
Full Text Available Oxytocin is a neuropeptide that plays critical role in mother-infant bonding, pair bonding and prosocial behaviors. Several neuropsychiatric disorders such as autism, schizophrenia, affective disorders, anxiety disorders, attention deficit/hyperactivity disorder, alcohol/substance addiction, aggression, suicide, eating disorders and personality disorders show abnormalities of oxytocin system. These findings have given rise to the studies searching therapeutic use of oxytocin for psychi-atric disorders. The studies of oxytocin interventions in psychiatric disorders yielded potentially promising findings. This paper reviews the role of oxytocin in emotions, behavior and its effects in psychiatric disorders. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(2: 102-113
Strandholm, Thea; Kiviruusu, Olli; Karlsson, Linnea; Pankakoski, Maiju; Pelkonen, Mirjami; Marttunen, Mauri
We investigated stability and change in personality disorder (PD) symptoms and whether depression severity, comorbid clinical psychiatric disorders, and social support predict changes in personality pathology among adolescent outpatients. The 1-year outcome of PD symptoms among consecutive adolescent psychiatric outpatients with depressive disorders (N = 189) was investigated with symptom count of depression, comorbid psychiatric disorders, and perceived social support as predictors. An overall decrease in PD symptoms in most PD categories was observed. Decreases in depression severity and in number of comorbid diagnoses correlated positively with decreases in PD symptoms of most PD categories. Social support from close friends predicted a decrease in schizotypal and narcissistic, whereas support from family predicted a decrease in paranoid symptoms. Our results suggest that among depressed adolescent outpatients, PD symptoms are relatively unstable, changes co-occuring with changes/improvement in overall psychopathology. Social support seems a possibly effective point for intervention efforts regarding positive outcome of PD symptoms.
The behavioral view that depression results from inadequate, ineffective and/or insufficient reinforcers was explored. Since the depressed person does not act in a manner open to positive reinforcement by others, he suffers ongoing and deepening depression. The task of the therapist is to improve behavior, especially social skills, so that the…
U.S. Department of Health & Human Services — The Outpatient Utilization and Payment Public Use File (Outpatient PUF) presents information on common outpatient services provided to Medicare fee-for-service...
Dekker, Jack; Peen, Jaap; Koelen, Jurrijn; Smit, Filip; Schoevers, Robert
Epidemiological studies over the last decade have supplied growing evidence of an association between urbanization and the prevalence of psychiatric disorders. Our aim was to examine the link between levels of urbanization and 12-month prevalence rates of psychiatric disorders in a nationwide German population study, controlling for other known risk factors such as gender, social class, marital status and the interaction variables of these factors with urbanization. The Munich Composite International Diagnostic Interview (M-CIDI) was used to assess the prevalence of mental disorders (DSM-IV) in a representative sample of the German population (N = 4181, age: 18-65). The sample contains five levels of urbanization based on residence location. The epidemiological study was commissioned by the German Ministry of Research, Education and Science (BMBF) and approved by the relevant Institutional Review Board and ethics committee. Written informed consent was obtained for both surveys (core survey and Mental Health Supplement). Subjects did not get any financial compensation for their study participation. Higher levels of urbanization were linked to higher 12-month prevalence rates for almost all major psychiatric disorders (with the exception of substance abuse and psychotic disorders). The weighted prevalence percentages were highest in the most urbanized category. Alongside urbanization, female gender, lower social class and being unmarried were generally found to be associated with higher levels of psychopathology. The impact of urbanization on mental health was about equal (for almost all major psychiatric disorders) in young people and elderly people, men and women, and in married and single people. Only people from a low social class in the most urbanized settings had more somatoform disorders, and unmarried people in the most urbanized settings had more anxiety disorders. Psychiatric disorders are more prevalent among the inhabitants of more urbanized areas
Full Text Available Abstract Background Epidemiological studies over the last decade have supplied growing evidence of an association between urbanization and the prevalence of psychiatric disorders. Our aim was to examine the link between levels of urbanization and 12-month prevalence rates of psychiatric disorders in a nationwide German population study, controlling for other known risk factors such as gender, social class, marital status and the interaction variables of these factors with urbanization. Methods The Munich Composite International Diagnostic Interview (M-CIDI was used to assess the prevalence of mental disorders (DSM-IV in a representative sample of the German population (N = 4181, age: 18–65. The sample contains five levels of urbanization based on residence location. The epidemiological study was commissioned by the German Ministry of Research, Education and Science (BMBF and approved by the relevant Institutional Review Board and ethics committee. Written informed consent was obtained for both surveys (core survey and Mental Health Supplement. Subjects did not get any financial compensation for their study participation. Results Higher levels of urbanization were linked to higher 12-month prevalence rates for almost all major psychiatric disorders (with the exception of substance abuse and psychotic disorders. The weighted prevalence percentages were highest in the most urbanized category. Alongside urbanization, female gender, lower social class and being unmarried were generally found to be associated with higher levels of psychopathology. The impact of urbanization on mental health was about equal (for almost all major psychiatric disorders in young people and elderly people, men and women, and in married and single people. Only people from a low social class in the most urbanized settings had more somatoform disorders, and unmarried people in the most urbanized settings had more anxiety disorders. Conclusion Psychiatric disorders are more
Each year, health care costs for managing chronically ill patients increase as the life expectancy of Americans continues to grow. To handle this situation, many hospitals, doctors practices, and home care providers are turning to disease management, a system of coordinated health care interventions and communications, to improve outpatient care. By participating in daily monitoring programs, patients with congestive heart failure, chronic obstructive pulmonary disease, diabetes, and other chronic conditions requiring significant self-care are facing fewer emergency situations and hospitalizations. Cybernet Medical, a division of Ann Arbor, Michigan-based Cybernet Systems Corporation, is using the latest communications technology to augment the ways health care professionals monitor and assess patients with chronic diseases, while at the same time simplifying the patients interaction with technology. Cybernet s newest commercial product for this purpose evolved from research funded by NASA, the National Institute of Mental Health, and the Advanced Research Projects Agency. The research focused on the physiological assessment of astronauts and soldiers, human performance evaluation, and human-computer interaction. Cybernet Medical's MedStar Disease Management Data Collection System is an affordable, widely deployable solution for improving in-home-patient chronic disease management. The system's battery-powered and portable interface device collects physiological data from off-the-shelf instruments.
... Guide - Table of Contents Facts For Families Guide - View by Topic Chinese Facts for Families Guide ... Psychiatric Evaluation No. 52; Updated October 2017 Evaluation by a child and adolescent psychiatrist is appropriate for any child or adolescent ...
Lewis-Fernández, Roberto; Aggarwal, Neil Krishan
Since the publication of DSM-IV in 1994, a number of components related to psychiatric diagnosis have come under criticism for their inaccuracies and inadequacies. Neurobiologists and anthropologists have particularly criticized the rigidity of DSM-IV diagnostic criteria that appear to exclude whole classes of alternate illness presentations as well as the lack of attention in contemporary psychiatric nosology to the role of contextual factors in the emergence and characteristics of psychopat...
Brandt, Frans; Thvilum, Marianne; Pedersen, Dorthe Almind
Thyroid hormones are essential for the normal development of the fetal brain, while hyperthyroidism in adults is associated with mood symptoms and reduced quality of life. We aimed to investigate the association and temporal relation between hyperthyroidism and psychiatric morbidity.......Thyroid hormones are essential for the normal development of the fetal brain, while hyperthyroidism in adults is associated with mood symptoms and reduced quality of life. We aimed to investigate the association and temporal relation between hyperthyroidism and psychiatric morbidity....
Shantna Kumari; Inderjeet Banerjee; G Majhi; Suprakash Chaudhury; Amool R Singh; A N Verma
Background: Self-stigma of people with mental illness is a major obstacle to recovery, limiting opportunities and undermining self-esteem. Aim: The aim of this study is to compare felt stigma and self-esteem in psychiatric patients receiving treatment from hospital outdoor clinic or from Community Outreach Program (COP). Materials and Methods: This cross-sectional study was conducted on psychiatric patients who were on outpatient treatment for at least 6 months, but had never been hospitalize...
Sutton, Eliza L
Sleep issues are common in people with psychiatric disorders, and the interaction is complex. Sleep disorders, particularly insomnia, can precede and predispose to psychiatric disorders, can be comorbid with and exacerbate psychiatric disorders, and can occur as part of psychiatric disorders. Sleep disorders can mimic psychiatric disorders or result from medication given for psychiatric disorders. Impairment of sleep and of mental health may be different manifestations of the same underlying neurobiological processes. For the primary care physician, key tools include recognition of potential sleep effects of psychiatric medications and familiarity with treatment approaches for insomnia in depression and anxiety. Copyright © 2014 Elsevier Inc. All rights reserved.
Silverstone, Peter H; Salsali, Mahnaz
Background The objective of the current study was to determine the prevalence and the degree of lowered self-esteem across the spectrum of psychiatric disorders. Method The present study was carried out on a consecutive sample of 1,190 individuals attending an open-access psychiatric outpatient clinic. There were 957 psychiatric patients, 182 cases with conditions not attributable to a mental disorder, and 51 control subjects. Patients were diagnosed according to DSM III-R diagnostic criteria following detailed assessments. At screening, individuals completed two questionnaires to measure self-esteem, the Rosenberg self-esteem scale and the Janis and Field Social Adequacy scale. Statistical analyses were performed on the scores of the two self-esteem scales. Results The results of the present study demonstrate that all psychiatric patients suffer some degree of lowered self-esteem. Furthermore, the degree to which self-esteem was lowered differed among various diagnostic groups. Self-esteem was lowest in patients with major depressive disorder, eating disorders, and substance abuse. Also, there is evidence of cumulative effects of psychiatric disorders on self-esteem. Patients who had comorbid diagnoses, particularly when one of the diagnoses was depressive disorders, tended to show lower self-esteem. Conclusions Based on both the previous literature, and the results from the current study, we propose that there is a vicious cycle between low self-esteem and onset of psychiatric disorders. Thus, low self-esteem increases the susceptibility for development of psychiatric disorders, and the presence of a psychiatric disorder, in turn, lowers self-esteem. Our findings suggest that this effect is more pronounced with certain psychiatric disorders, such as major depression and eating disorders. PMID:12620127
Silverstone, Peter H; Salsali, Mahnaz
BACKGROUND: The objective of the current study was to determine the prevalence and the degree of lowered self-esteem across the spectrum of psychiatric disorders. METHOD: The present study was carried out on a consecutive sample of 1,190 individuals attending an open-access psychiatric outpatient clinic. There were 957 psychiatric patients, 182 cases with conditions not attributable to a mental disorder, and 51 control subjects. Patients were diagnosed according to DSM III-R diagnostic criteria following detailed assessments. At screening, individuals completed two questionnaires to measure self-esteem, the Rosenberg self-esteem scale and the Janis and Field Social Adequacy scale. Statistical analyses were performed on the scores of the two self-esteem scales. RESULTS: The results of the present study demonstrate that all psychiatric patients suffer some degree of lowered self-esteem. Furthermore, the degree to which self-esteem was lowered differed among various diagnostic groups. Self-esteem was lowest in patients with major depressive disorder, eating disorders, and substance abuse. Also, there is evidence of cumulative effects of psychiatric disorders on self-esteem. Patients who had comorbid diagnoses, particularly when one of the diagnoses was depressive disorders, tended to show lower self-esteem. CONCLUSIONS: Based on both the previous literature, and the results from the current study, we propose that there is a vicious cycle between low self-esteem and onset of psychiatric disorders. Thus, low self-esteem increases the susceptibility for development of psychiatric disorders, and the presence of a psychiatric disorder, in turn, lowers self-esteem. Our findings suggest that this effect is more pronounced with certain psychiatric disorders, such as major depression and eating disorders.
of mortality are attained in out-patient as well as in in-patient pulmonary rehabilitation. Regarding the best frequency of training units per week or the duration and the content of a unit further research is needed. Final results for the ideal length of an in-patient rehabilitation are still missing. None of the studies deals with the analysis of the different treatment forms of a COPD which are frequently defined by an alteration of in-patient and out-patient treatments and participation in sports clubs or self-help groups. There are some other limitations of the studies. The results concerning self-management programmes are not distinct. (Self- Selection leads to high drop-out rates. Many studies have only small sample sizes. Confounder and long-time effects are seldom researched, relevant economic evaluations do not exist The improvement of health related quality of life is primarily obtained by an improved disease management than by an improvement of a medical parameter. Conclusion: Out-patient pulmonary rehabilitation is as effective as in-patient pulmonary rehabilitation. But there is a critical shortage of out-patient pulmonary rehabilitation supply in Germany. Domains for further research are the evaluation of models for integrated care, the length, frequency and content of training programmes, psychiatric assessments and the cost-effectiveness of out-patient pulmonary rehabilitation.
Emiroğlu, Fatma Neslihan Inal; Kurul, Semra; Akay, Aynur; Miral, Süha; Dirik, Eray
Neurologic symptoms such as headache, vertigo, dizziness, and fainting can create a diagnostic problem in pediatric neurology practice because they are also the most common presenting symptoms of psychiatric disorders. Children, especially adolescents, who are often admitted with such autonomic symptoms, are frequently misdiagnosed. In this study, we aimed to investigate the psychiatric morbidity and comorbidity rate in children and adolescents presenting with neurologic symptoms such as headache, vertigo, and syncope. We investigated 31 children who presented with these symptoms. All children were evaluated for their medical history and had a physical and neurologic examination. We attempted to rule out a possible organic etiology. All patients received a complete laboratory examination (blood count, electroencephalography), pediatric cardiology and otorhinolaryngology consultations, and a caloric test. All patients were assessed according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria. The majority of the patients (93.5%) received a psychiatric diagnosis according to the DSM-IV criteria. Most of these patients were adolescents and female. Psychosocial stressors such as academic problems, familial dysfunction, parental psychopathology, and child sexual abuse were associated with somatic symptoms. The results of this study demonstrated the importance of differential diagnosis and psychiatric comorbidity in a pediatric neurologic outpatient population. Treatment should be directed at biopsychosocial integrity, and a multidisciplinary treatment approach should be applied.
Orui, Masatsugu; Hirokawa, Seiko; Akazawa, Masato; Tachimori, Hisateru; Kawano, Kenji; Mori, Takao; Akita, Hiroya; Takeshima, Tadashi
Although factors related to suicide are complicated, mental health disorders are an important risk factor. It is anticipated that suicide prevention measures will be implemented from the perspective of improved psychiatric medicine. No national-scale study has been carried out in Japan on the state of psychiatric medicine and its influence on suicide since 2000. Moreover, many efforts not intended for suicide prevention have been shown to be effective for this purpose. Here, we conducted surveys to obtain basic data on suicide prevention and improvements in mental health care among 1,728 psychiatric hospitals and clinics in Japan in 2010. The incidence of suicide in psychiatric hospitals and clinics from January to December 2009 was estimated to be 100.5 for outpatients and 154.5 for inpatients per 100,000 patients. Regarding the duration from consultation to suicide, 87% of outpatients committed suicide less than one month following their last consultation. Moreover, approximately two-thirds of patients had undergone consultations for more than one year. A number of suicides in psychiatric hospitals and clinics occurred while patients were continuously undergoing treatment. Efforts shown to be effective in suicide prevention included risk assessment with multiple medical staff (i.e., doctors and nurses), a 24-hour crisis line, and a follow-up system for discontinued outpatients. We expect that the results of this survey will aid in the implementation of effective suicide prevention in psychiatric medicine.
Andersen, Klaus Ejner; Clausen, N
Complications in out-patient gastroscopy were evaluated retrospectively in 995 examinations performed in 625 patients. At the examination seven complications were registered in the gastroscopy record. Two complications: perforation of the stomach and cardiac arrhythmia, required hospitalisation...
Memórias de idosos aposentados de um hospital psiquiátrico catarinense (1951-1971 Memorias del trabajo de ancianos jubilados de un hospital psiquiátrico (1951-1971 Memoirs of work retirees elderly from a psychiatric hospital (1951-1971
Ana Maria Espíndola Koerich
ía, hoy ancianos, tuvieron un papel fundamental en la asistencia de enfermería prestada a la clientela internada.This is a qualitative study of socio-historical approach that aimed to historicize the daily lives of nursing workers, elderly nowadays, in a psychiatric hospital in Santa Catarina state in the period between 1951 and 1971. Data were collected through semistructured interviews with six nursing staff using the method of oral history. The memory was used as the theoretical framework and the data were categorized on content analysis. The results showed the knowledge and practices of nursing staff, working conditions and relationships between professionals in the health care team. The results showed that the situation experienced by workers in this institution was congruent with the situation of Brazilian nursing, especially in psychiatric hospitals asylums. Moreover, these nursing workers, elderly people today, had a key role in nursing care to patients admitted.
Roy, P-M; Moumneh, T; Penaloza, A; Sanchez, O
Despite clear potential benefits of outpatient care, most patients suffering from pulmonary embolism (PE) are currently hospitalized due to the fear of possible adverse events. Nevertheless, some teams have increased or envisage to increase outpatient treatment or early discharge. We performed a narrative systematic review of studies published on this topic. We identified three meta-analyses and 23 studies, which involved 3671 patients managed at home (n=3036) or discharged early (n=535). Two main different approaches were applied to select patients eligible for outpatient in recent prospective studies, one based on a list of pragmatic criteria as the HESTIA rule, the other adding severity criteria (i.e. risk of death) as the Pulmonary Embolism Severity Criteria (PESI) or simplified PESI. In all these studies, a specific follow-up was performed for patients managed at home involving a dedicated team. The overall early (i.e. between 1 to 3 months) complication rate was low, Outpatient management appears to be feasible and safe for many patients with PE. In the coming years, outpatient treatment may be considered as the first line management for hemodynamically stable PE patients, subject to the respect of simple eligibility criteria and on the condition that a specific procedure for outpatient care is developed in advance. Copyright © 2017 Elsevier Ltd. All rights reserved.
The elderly population size is increasing worldwide due to falling birth rates and increasing life expectancy. It has been hypothesized that as the elderly dependency ratio (the ratio of those over the age of 65 years to those under 65) increases, there will be fewer younger people available to care for older people and this, in turn, will increase the burden on younger carers with increased levels of psychiatric morbidity leading to an increase in general population suicide rates. A cross-national study examining the relationship between elderly dependency ratios and general population suicide rates was conducted using data from the World Health Organization and the United Nations websites. The main findings were of a significant and independent positive correlation between elderly dependency ratios and general population suicide rates in both genders. The contribution of cross-national differences in psychiatric morbidity in younger carers on general population suicide rates requires further study. The prevalence of psychiatric morbidity in younger carers of older people should be examined by: (i) cross-national studies using standardized measures of psychiatric morbidity that are education-free, culture-fair and language-fair; and (ii) within-country longitudinal studies with changing elderly dependency ratios over time.
Full Text Available Infertility can be defined as a crisis with cultural, religious, and class related aspects, which coexists with medical, psychiatric, psychological, and social problems. Relation between psychiatric and psychological factors stem from a mutual interaction of both. Family is an important institution in maintaining human existence and raising individuals in line with society's expectations. Fertility and reproduction are seen as universal functions unique to women with raising children as the expected result of the family institution. Incidence of infertility has increased recently and can become a life crisis for a couple. Even though not being able to have a child affects both sexes emotionally, women feel greater amounts of stress, pressure, anxiety, and depression.Consequences of infertility arise from short and long-term devastating effects on both individual's physical and mental health, and marital system. Many studies focus on infertility related psychological and psychiatric disorders (depression, anxiety, grief, marital conflict, gender differences, relation between the causes of infertility and psychopathology, the effects of psychiatric evaluation and intervention -when necessaryon the course of infertility treatment, pregnancy rates, and childbirth. The most important underlying causes of high levels of stress and anxiety that infertile women experience are the loss of maternity, reproduction, sense of self, and genetic continuity. In this review article is to investigate the relationship between medically unexplained symptoms and psychiatric symptoms. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000: 165-185
Joginder Pal Attri
Full Text Available Many patients with psychiatric illnesses are prescribed long-term drug treatment, and the anaesthesiologist must be aware of potential interactions with anaesthetic agents. Psychotropic drugs often given in combination with each other or with other non-psychiatric drugs generally exert profound effects on the central and peripheral neurotransmitter and ionic mechanisms. Hence, prior intake of these drugs is an important consideration in the management of the patient about to undergo anaesthesia and surgery. This article highlights the effects of anaesthetics on patients taking antipsychotics, tricyclic antidepressants, monoamine oxidase inhibitors and lithium carbonate. The risk that should be considered in the perioperative period are the extent of surgery, the patient′s physical state, anaesthesia, the direct and indirect effects of psychotropics, risk of withdrawal symptoms and risk of psychiatric recurrence and relapse.
Helene Daae-Qvale Holmemo
Full Text Available AbstractBackgroundPatients with severe mental disorders have increased mortality, and cardiovascular disease (CVD accounts for a large part. Physical inactivity and low aerobic fitness have been recognized as significant risk factors for CVD. In this study, we investigated the differences in aerobic fitness and physical activity between in- and outpatients with severe mental disorders. Method and subjectsFifty in- and outpatients from a regional psychiatric department were included. The patients filled in a questionnaire on physical activity and completed a clinical examination. An estimation of aerobic fitness was calculated for each patient, using gender, age, waist circumference, resting heart rate and physical activity level as variables.ResultsInpatients had lower estimated aerobic fitness than outpatients (VO₂peak 42 vs 50 mL•kg-1•min-1, p<0.001. Compared to population data matched for age and gender, inpatients had lower aerobic fitness, while outpatients were not different from the population average.ConclusionInpatients at a psychiatric department had lower estimated aerobic fitness than outpatients, and a lower aerobic fitness compared to the general population. Our findings suggest that inpatients with severe mental disorders should be considered a high risk group for CVD.
van der Put, C.E.; Asscher, J.J.; Stams, G.J.J.M.; van der Laan, P.H.; Breuk, R.; Jongman, E.; Doreleijers, T.
The aim of this study was to examine the effect of treatment characteristics on recidivism in a forensic youth-psychiatric outpatient clinic. The treatment offered comprised functional family therapy (FFT), individual cognitive behavioural therapy (CBT), or CBT in combination with parent training.
Hornsveld, R.H.J.; Muris, P.; Kraaimaat, F.W.; Meesters, C.
The psychometric properties of a Dutch version of Buss and Perry's Aggression Questionnaire (AQ) were examined in a sample of violent forensic psychiatric inpatients and outpatients and a sample of secondary vocational students. The internal consistency, interitem correlations, and item-scale
Full Text Available Objectives: Daily hours" by the word means times. Leisure is the concept of comfort, rest, relation and free of any working situations. And technically; it consists of times and opportunity that have reminded after daily job and performance of any types of activity. Sociologists leisure has anew conceptuality in compare to do believe society in which such phenomenon can't be considered as classical unemployment, as was in the past. Methods & Materials: This research is about needs in elderlies' leisure times. This research shows that all leisure programs are sum of nearly all complete practical programs in domination of adult's leisure times. A performed with careful planning and programming and multifactorial rather than expansion of accomplishment's are beneficial is our country. We distributed special research questionnaires as accidental mode among adults, in general parks of qzvin province. We assessed archive information by use of unparametric statistics of expansion. In addition, we used piraloon coefficient of correlation too. Results: According to achieve result of research among elderlies' leisure programs which consist of" film showing", sport and art programs which have allocated extended portion for their own. Elderlies' views about sport were very positive. Exercise of sport has been considered as effective to their heath and their soul and society cultural promotions. Conclusion: All keeping centers of elderlies have t.v, radio and other facilities for showing video-films which consist of sports, also complete installation of sports, arts used as human drives, were very useful in optimizing elderlies' leisure times objectives.
Dec 3, 2002 ... Impairment and disability assessment on psychiatric grounds has always been subjective, controversial ... informed medical advisors doing their disability assessments. Many of these advisors have expressed ..... that will empower the affected employee and that is non- stigma- tising. In order to do so it is ...
Hvidhjelm, Jacob; Sestoft, Dorte; Skovgaard, Lene Theil
Health care workers are often exposed to violence and aggression in psychiatric settings. Short-term risk assessments, such as the Brøset Violence Checklist (BVC), are strong predictors of such aggression and may enable staff to take preventive measures against aggression. This study evaluated wh...
their caregivers in South Africa. The heritability of the majority of the psychiatric disorders is ... linkage analyses in a cohort of Bantu-speaking black South. Africans.17-22 Areas of implied linkage to schizophrenia ... one of the studies of a Bantu-speaking schizophrenia cohort. Table I. Glossary of genetic terminology. Allele.
Baldaçara,Leonardo; Borgio,João Guilherme Fiorani; Lacerda,Acioly Luiz Tavares de; Jackowski,Andrea Parolin
OBJECTIVE: The objective of this update article is to report structural and functional neuroimaging studies exploring the potential role of cerebellum in the pathophysiology of psychiatric disorders. METHOD: A non-systematic literature review was conducted by means of Medline using the following terms as a parameter: "cerebellum", "cerebellar vermis", "schizophrenia", "bipolar disorder", "depression", "anxiety disorders", "dementia" and "attention deficit hyperactivity disorder". The electron...
Introduction: Empowerment refers to patient skills that allow them to become primary decision-makers in control of daily self-management of health problems. As important the concept as it is, particularly for elders with chronic diseases, few available instruments have been validated for use with Spanish speaking people. Objective: Translate and adapt the Health Empowerment Scale (HES) for a Spanish-speaking older adults sample and perform its psychometric validation. Methods: The HES was adapted based on the Diabetes Empowerment Scale-Short Form. Where "diabetes" was mentioned in the original tool, it was replaced with "health" terms to cover all kinds of conditions that could affect health empowerment. Statistical and Psychometric Analyses were conducted on 648 urban-dwelling seniors. Results: The HES had an acceptable internal consistency with a Cronbach's α of 0.89. The convergent validity was supported by significant Pearson's Coefficient correlations between the HES total and item scores and the General Self Efficacy Scale (r= 0.77), Swedish Rheumatic Disease Empowerment Scale (r= 0.69) and Making Decisions Empowerment Scale (r= 0.70). Construct validity was evaluated using item analysis, half-split test and corrected item to total correlation coefficients; with good internal consistency (α> 0.8). The content validity was supported by Scale and Item Content Validity Index of 0.98 and 1.0, respectively. Conclusions: HES had acceptable face validity and reliability coefficients; which added to its ease administration and users' unbiased comprehension, could set it as a suitable tool in evaluating elder's outpatient empowerment-based medical education programs. PMID:25767307
Akkaya-Kalayci, Türkan; Popow, Christian; Waldhör, Thomas; Winkler, Dietmar; Özlü-Erkilic, Zeliha
The conditions of children and adolescents with migration background receiving emergency psychiatric care in Europe are not well known. Migrants usually attend regular psychiatric care less frequently than the autochthonous population. We therefore speculated that, being undertreated, they would be overrepresented among psychiatric emergency care patients. We retrospectively analyzed the records of 1093 minors aged 4‑18 years treated during a period of three years at the psychiatric emergency outpatient clinic of the Department of Child and Adolescent Psychiatry at the Medical University of Vienna. More minors with migration background than natives consulted our emergency clinic. Most frequent reasons for referral were suicide attempts by Turkish patients, acute stress disorder in Serbian/Croatian/Bosnian and in Austrian patients. Psychiatric diagnoses like eating and personality disorders were mostly diagnosed in natives. We found gender specific differences between the groups. The reasons for these differences possibly relate to deficits of adequate mental health-care in Austria, to intercultural and intrafamiliar conflicts related to acculturation distress in the migrant population. Prospective longitudinal studies focusing on the utilization of mental health care by the migrant children and the impact of the migration background on their mental health are needed for improving adequate culture-sensitive mental-health care for this population.
Liu, Xiaoqin; Agerbo, Esben; Ingstrup, Katja G
in children, defined as first day of inpatient or outpatient treatment for psychiatric disorders. Hazard ratios of psychiatric disorders were estimated using Cox regression models.Results Overall, psychiatric disorders were diagnosed in 32 400 children. The adjusted 15 year cumulative incidence of psychiatric......Objective To investigate the association between in utero exposure to antidepressants and risk of psychiatric disorders.Design Population based cohort study.Setting Danish national registers.Participants 905 383 liveborn singletons born during 1998-2012 in Denmark and followed from birth until July...... disorders was 8.0% (95% confidence interval 7.9% to 8.2%) in the unexposed group, 11.5% (10.3% to 12.9%) in the antidepressant discontinuation group, 13.6% (11.3% to 16.3%) in the continuation group, and 14.5% (10.5% to 19.8%) in the new user group. The antidepressant continuation group had an increased...
Barazzetti, Lidiane; Pattussi, Marcos Pascoal; Garcez, Anderson da Silva; Mendes, Karina Giane; Theodoro, Heloísa; Paniz, Vera Maria Vieira; Olinto, Maria Teresa Anselmo
This study investigated the association between minor psychiatric disorders and menopause symptoms and their associated factors. A cross-sectional study was conducted with 615 women aged 40 to 65 years treated in a public menopause and gynecological outpatient clinic in the South Region of Brazil. Minor psychiatric disorders were assessed using the Self-Reporting Questionnaire (SRQ-20) and menopause symptoms using the Menopause Rating Scale. Score for menopause symptoms was categorized into three levels of symptoms: mild, moderate, and severe. Multivariate analyses used ordinal logistic regression. The prevalence of mild, moderate, and severe menopause symptoms was 34.1% (95% CI 30.3-37.9), 29.6% (95% CI 25.8-33.1), and 36.3% (95% CI 32.4-40.0), respectively. The overall prevalence of minor psychiatric disorders was 66.6% (95% CI 62.8-70.3). After adjustment, the odds ratio (OR) of the occurrence of menopause symptoms were approximately eight times higher in women relating minor psychiatric disorders compared with those without such disorders (OR = 7.76; 95% CI 5.27-11.44). The following factors were also associated with the menopause symptoms: women older than 50 years, living with a partner, lower educational level, smokers, larger number of pregnancies, obese, and those using psychotropic and/or postmenopause medication. The minor psychiatric disorders exhibited strong association with the presence of menopause symptoms independently of sociodemographic, behavioral, and reproductive factors, and of use of psychotropic medication.
Urrila, Anna S; Karlsson, Linnea; Kiviruusu, Olli; Pelkonen, Mirjami; Strandholm, Thea; Marttunen, Mauri
The objective of our study was to examine the prevalence rates of different sleep complaints among adolescent outpatients with major depressive disorder (MDD). Further, we examined whether depressed adolescents with and without different sleep disturbances differ in terms of severity of depression, the presence of comorbid psychiatric disorders, and the symptom profile of depression. A total of 166 Finnish adolescent psychiatric outpatients (age 13-19; mean 16.5 years old; 17.5% boys) diagnosed with unipolar MDD (as defined by DSM-IV criteria) were included in the study. Their sleep complaints were assessed with self-rating scales and clinical research interviews. The prevalence rate of subjective sleep complaints in adolescents with MDD was high: 83% of the adolescents experienced significantly disturbed sleep. The most common types of sleep complaints were nonrestorative sleep (69%) and insomnia (51%). The presence of sleep disturbances was associated with severity of depression: Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI) total sum scores were highest in adolescents with multiple sleep disturbances and lowest in adolescents with no sleep problems. Adolescents with multiple sleep disturbances differed most from adolescents with no or minor sleep disturbances in terms of thoughts about death, suicidal thoughts, and anhedonia. These findings suggest a close link between sleep disturbances and the severity of depression in adolescent outpatients with MDD. In particular, the link between sleep disturbances and thoughts about death and suicidal thoughts calls for attention to sleep problems among depressed adolescents in clinical settings. Copyright © 2012 Elsevier B.V. All rights reserved.
Kurki, M; Koivunen, M; Anttila, M; Hätönen, H; Välimäki, M
Internet has become increasingly common in adolescents' daily lives and also in health care. However, there is still need to explore how nurses perceive its use as a part of adolescents' treatment. This explorative qualitative study aim was to explore how nurses perceive the usefulness of Internet in adolescents' outpatient care in mental health. The data were collected among nurses (n=12) working in two psychiatric adolescent outpatient clinics in university central hospitals in Finland. The data were collected in focus group interviews and analysed using inductive content analysis. The analysis showed that Internet use could promote the care process of adolescents with depression by supporting their self-reflection and self-management, enhancing nurses' understanding of adolescents' daily lives and facilitating nurse-adolescent interaction. Disadvantages identified among nurses were fear of role changes in the nurse-adolescent interaction, changes in the intervention, when Internet might be a third party in the face-to-face interaction and negative effects of Internet on adolescents. Facilitators in the use of Internet were nurses' positive attitude to Internet, knowledge and experiences of Internet usage. Nurses' negative attitude to Internet and lack of training and instructions were seen as barriers in promoting the successful utilization of Internet among adolescents with depression in outpatient care. © 2010 Blackwell Publishing.
Boks Marco PM
Full Text Available Abstract Background The Psychiatric Case Register Middle Netherlands (PCR-MN registers the mental healthcare consumption of over Dutch 760,000 inhabitants in the centre of the Netherlands. In 2010 the follow-up period was over ten years. In this paper we describe the content, aims and research potential of this case register. Description All mental healthcare institutions in the middle-western part of the province of Utrecht participate in the PCR-MN case register. All in- and out-patients treated in these institutions have been included in the database from the period 2000 to 2010. Diagnosis according to DSM-IV on axis I to IV, visits to in- and out-patient clinics and basic demographics are recorded. A major advantage of this register is the possibility to link patients anonymously from the PCR-MN cohort to other databases to analyze relationships with determinants and outcomes, such as somatic healthcare consumption, mortality, and demographics, which further increases the research potential Conclusions The PCR-MN database has a large potential for scientific research because of its size, duration of follow-up and ability to link with additional databases, and is accessible for academic researchers.
Soldo, B J; Agree, E M
The older population in the US has grown twice as fast as the rest of the population in the last 20 years. This growth is expected to accelerate early in the next century as the large baby boom cohorts move through middle age and become elderly. Today, about 1 in 8 Americans is 65 years of age or older. By 2030, 1 out of every 4 persons will be in older person. Substantial improvements in life expectancy at all ages, particularly at extreme old age, mean that not only will there be a greater proportion of elderly in the population, but the more will be the "oldest-old," over 85. By 2050, they will be more than 1/4 of the population. As people live longer, many are active and healthy well past retirement. However, many individuals living into their 80s have to cope with chronic disabilities affecting their capacity to perform day-to-day activities. Modern medicine has made great inroads against mortality from such illnesses as heart disease and stroke, but has not eliminated all the effects of these diseases. As the population ages, the issues of health care funding and availability, particularly long-term care, increase in importance. Contrary to widespread belief, the elderly are not abandoned by their families to nursing home care. The vast majority--95%--live in the community. Those needing assistance generally receive help from family and friends. This has created a tremendous demand for federal subsidies to support community-based long-term care services. 1/4 of the federal budget is now spent on the elderly--$270 billion in 1986. Medicaid and Medicare are among the government's success stories, but these programs are threatened by their very success. Economists estimate that government expenditures are 3 times greater for the elderly than for children, raising the issue of "intergenerational equity"--how to balance the amount of care society provides to those who have already contributed with what is provided to those who will contribute in the future. The
Sar, Vedat; Koyuncu, Ahmet; Ozturk, Erdinc; Yargic, L Ilhan; Kundakci, Turgut; Yazici, Ahmet; Kuskonmaz, Ekrem; Aksüt, Didem
The aim of this study was to determine the prevalence of dissociative disorders among emergency psychiatric admissions. Forty-three of the 97 consecutive outpatients admitted to the psychiatric emergency unit of a university hospital were screened using the Dissociative Experiences Scale (DES). Seventeen (39.5% of the 43 evaluated) patients with a DES score above 25.0 were then interviewed with the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for Dissociative Disorders. Fifteen emergency unit patients (34.9% of the 43 evaluated participants) were diagnosed as having a dissociative disorder. Six (14.0%) patients had dissociative identity disorder, 6 (14.0%) had dissociative disorder not otherwise specified, and 3 (7.0%) had dissociative amnesia. The average DES score of dissociative patients was 43.7. A majority of them had comorbid major depression, somatization disorder, and borderline personality disorder. Most of the patients with dissociative disorder reported auditory hallucinations, symptoms associated with psychogenic amnesia, flashback experiences, and childhood abuse and/or neglect. Dissociative disorders constitute one of the diagnostic groups with high relevance in emergency psychiatry.
Dec 18, 1971 ... over-supplied with hospital beds and nursing staff that we can afford such luxuries? Must we insist on ... femoral, inguinal and umbilical), breast segmental excision, fissurotomy or polypectomy, node biopsy, ... neck and many other conditions requiring surgical inter- vention (on outpatients)'. What about our ...
Dr. Jon Mark Hirshon, Associate Professor of Emergency Medicine at the University of Maryland School of Medicine, discusses Clostridium difficile infection in outpatients. Created: 11/7/2011 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Date Released: 11/21/2011.
Newnham, Elizabeth A; Hooke, Geoff R; Page, Andrew C
To date, the monitoring of patient progress using standardized assessments has been neglected in hospital-based psychiatric care. Findings in outpatient psychotherapy have demonstrated clinically significant benefits for providing feedback to the sizeable minority of patients who were otherwise unlikely to experience positive outcome (Lambert, 2007). However, a similar system for presenting feedback on patient progress has not yet been assessed for group therapy within psychiatric inpatient settings. The current study aimed to develop and evaluate the effectiveness of a feedback system suitable for use in psychiatric services. In a nonrandomized trial, 1308 consecutive inpatients and day patients, whose diagnoses were primarily depressive and anxiety disorders, completed the World Health Organization's Wellbeing Index (WHO-5) routinely during a ten-day cognitive behavioral therapy group. The first cohort (n=461) received treatment as usual. The second cohort (n=439) completed monitoring measures without feedback, and for patients in the third cohort (n=408), feedback on progress was provided to both clinicians and patients midway through the treatment period. Feedback was effective in reducing depressive symptoms (F(1,649)=6.29, p.05). The current findings may be generalized to patient samples that exhibit largely depressive disorders, however rigorous follow-up is warranted. Similar to outpatient settings, feedback appears to be beneficial for improving symptom outcomes but further time may be required for wellbeing to be affected. Copyright © 2010 Elsevier B.V. All rights reserved.
Full Text Available Inadequate glycemic control in patients with diabetes is known to be associated with psychiatric disorders such as depression, anxiety disorder, and cognitive impairment. However, dissociative syndrome has not been reported so far. Here we are reporting a case of repeated dissociative fugue associated with hyperglycemia, in an elderly with type II diabetes. Possible neurobiological mechanism has been discussed.
Sarró Alvarez, S
Rheumatic fibromyalgia, also known as fibrositis or myofascial pain, is a common syndrome whose diagnoses, founded mainly on physical examination, usually delays due to symptom unspecificity, amount of complementary tests requested and intercourse with psychiatric disorders. Psychyatrists and psychologists get often involved in fibromyalgia treatment. Its proper knowledge prevents not only physicians and patients' psychological discourage but also development of depression and mental health expenses, as well as allows designing a treatment plan according to the main symptoms which may offer improvement chances to fibromyalgia patients. This article intends to offer an up-to-date and complete information about this entity, focused on psychiatric aspects, to better identify and manage such a puzzling disease.
Aguiar, Inês Guerra; Barroso, Cláudia; Moreira, Filipa; Fonseca, Maria da Luz; Mendes, Patrícia; Pangaio, Nuno; Miranda, Vânia; Fernandes, Graça
Introduction: The Infancy and Early Childhood Psychiatric Outpatient Clinic at the Oporto Hospital Centre’s Department of Child and Adolescent Psychiatry opened in 2007. Our aim is to characterize the first consultations between June 2012 and June 2013.Methods: Review of clinical files and collection of demographic and medical data; diagnostic evaluation according to the Diagnostic Classification of Mental Health and Development Disorders of Infancy and Early Childhood: Revised Edition; stati...
Hall, Allison; Ofei-Tenkorang, Nana Ama; Machan, Jason T.; Gordon, Catherine M
Background Individuals with restrictive eating disorders present with co-morbid psychiatric disorders and many attempt to control symptoms using strenuous exercises that increase caloric expenditure. Yoga offers a safe avenue for the engagement in physical activity while providing an outlet for disease-associated symptoms. This study sought to examine use of yoga practice in an outpatient setting and its impact on anxiety, depression and body image disturbance in adolescents with eating disor...
Kok, Rob M.; Nolen, Willem A.; Heeren, Thea J.
Background The majority of the trials in the elderly are outpatient trials which excluded psychotic patients and patients with common comorbid physical disorders. Consequently information is lacking about the more complex cases of elderly depressed patients, as found in inpatient wards. Objective To
Lewis-Fernández, Roberto; Aggarwal, Neil Krishan
Since the publication of DSM-IV in 1994, neurobiologists and anthropologists have criticized the rigidity of its diagnostic criteria that appear to exclude whole classes of alternate illness presentations, as well as the lack of attention in contemporary psychiatric nosology to the role of contextual factors in the emergence and characteristics of psychopathology. Experts in culture and mental health have responded to these criticisms by revising the very process of diagnosis for DSM-5. Specifically, the DSM-5 Cultural Issues Subgroup has recommended that concepts of culture be included more prominently in several areas: an introductory chapter on Cultural Aspects of Psychiatric Diagnosis - composed of a conceptual introduction, a revised Outline for Cultural Formulation, a Cultural Formulation Interview that operationalizes this Outline, and a glossary on cultural concepts of distress - as well as material directly related to culture that is incorporated into the description of each disorder. This chapter surveys these recommendations to demonstrate how culture and context interact with psychiatric diagnosis at multiple levels. A greater appreciation of the interplay between culture, context, and biology can help clinicians improve diagnostic and treatment planning. Copyright © 2013 APA*
U.S. Department of Health & Human Services — This release contains the Basic Stand Alone (BSA) Outpatient Procedures Public Use Files (PUF) with information from Medicare outpatient claims. The CMS BSA...
U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Limited Data Set This file contains select claim level data and is derived from 2010 hospital outpatient PPS...
Park, Subin; Kim, Chang Yoon; Hong, Jin Pyo
Compared with the general population, adolescent psychiatric patients are subject to premature death from all causes, but suicide-specific mortality rates in this population have not been carefully investigated. Therefore, we examined the high mortality due to unnatural causes, particularly suicide, using standardized mortality ratios (SMRs) relative to sex, diagnosis, and type of psychiatric service. A total of 3,029 patients aged 10-19 years presented to the outpatient clinic of a general hospital in Seoul, Korea, or were admitted to that hospital for psychiatric disorders from January 1995 to December 2006. Unnatural causes mortality risk and suicide mortality risk in these patients were compared with those in sex- and age-matched subjects from the general Korean population. The SMR for unnatural causes was 4.6, and for suicide it was 7.8. Female subjects, the young, and inpatients had the highest risks for unnatural causes of death or suicide. Among the different diagnostic groups, patients with psychotic disorders, affective disorders, and personality disorders had significantly increased SMRs for unnatural causes, and those with psychotic disorders, affective disorders, and disruptive behavioral disorders had significantly increased SMRs for suicide. The risks of unnatural death and suicide are high in adolescent psychiatric inpatients in Korea, but not as high in adolescent outpatients. Effective preventative measures are required to reduce suicide mortality in adolescent psychiatric patients, particularly female patients admitted for general psychiatric care. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Hazif-Thomas, Cyril; Thomas, Philippe
Empathy is one of the qualities which enable caregivers to develop high quality care. The circumstances of professional practice such as pressure and lack of time can see this quality pushed to one side. The risk of burnout is all the greater as empathy alone does not protect caregivers from submitting themselves to their hierarchy. Compassion, on the other hand, enables caregivers to actively take on their responsibilities. Copyright © 2015. Published by Elsevier Masson SAS.
Full Text Available Objectives: To explore the relationship between white matter hyperintensities (WMH and the prevalence and course of depressive symptoms in mild Alzheimer’s disease (AD and Lewy body dementia. Design: This is a prospective cohort study conducted in secondary care outpatient clinics in western Norway. Subjects: The study population consisted of 77 elderly people with mild dementia diagnosed according to standardised criteria. Methods: Structured clinical interviews and physical, neurological, psychiatric, and neuropsychological examinations were performed and routine blood tests were taken. Depression was assessed using the depression subitem of the Neuropsychiatric Inventory and the Montgomery-Åsberg Depression Rating Scale (MADRS. A standardised protocol for magnetic resonance imaging scan was used, and the volumes of WMH were quantified using an automated method, followed by manual editing. Results: The volumes of total and frontal deep WMH were significantly and positively correlated with baseline severity of depressive symptoms, and depressed patients had significantly higher volumes of total and frontal deep WMH than non-depressed patients. Higher volumes of WMH were also associated with having a high MADRS score and incident and persistent depression at follow-up. After adjustment for potential confounders, frontal deep WMH, in addition to prior depression and non-AD dementia, were still significantly associated with baseline depressive symptoms (p = 0.015, OR 3.703, 95% CI 1.294–10.593. Similar results emerged for total WMH. Conclusion: In elderly people with mild dementia, volumes of WMH, in particular frontal deep WMH, were positively correlated with baseline severity of depressive symptoms, and seemed to be associated with persistent and incident depression at follow-up. Further studies of the mechanisms that determine the course of depression in mild dementia are needed.
Rice, Danielle; Janzen, Shannon; McIntyre, Amanda; Vermeer, Julianne; Britt, Eileen; Teasell, Robert
Few studies have considered the effectiveness of outpatient rehabilitation programs for stroke patients. The objective of this study was to assess the effectiveness of a hospital-based interdisciplinary outpatient stroke rehabilitation program with respect to physical functioning, mobility, and balance. The Comprehensive Outpatient Rehabilitation Program provides a hospital-based interdisciplinary approach to stroke rehabilitation in Southwestern Ontario. Outcome measures from physiotherapy and occupational therapy sessions were available at intake and discharge from the program. A series of paired sample t-tests were performed to assess patient changes between time points for each outcome measure. A total of 271 patients met the inclusion criteria for analysis (56.1% male; mean age = 62.9 ± 13.9 years). Significant improvements were found between admission and discharge for the Functional Independence Measure, grip strength, Chedoke-McMaster Stroke Assessment, two-minute walk test, maximum walk test, Timed Up and Go, Berg Balance Scale, and one-legged stance (P stroke. A hospital-based, stroke-specific rehabilitation program should be considered when patients continue to experience deficits after inpatient rehabilitation. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Full Text Available Background: Self-stigma of people with mental illness is a major obstacle to recovery, limiting opportunities and undermining self-esteem. Aim: The aim of this study is to compare felt stigma and self-esteem in psychiatric patients receiving treatment from hospital outdoor clinic or from Community Outreach Program (COP. Materials and Methods: This cross-sectional study was conducted on psychiatric patients who were on outpatient treatment for at least 6 months, but had never been hospitalized. The study sample included 130 patients receiving outdoor treatment from a Psychiatric Hospital and a matched group of 140 patients receiving treatment from COP of the same hospital. Demographic and clinical details of the patients were recorded on a specially designed proforma. Modified felt stigma scale and Rosenberg self-esteem scale were used to assess stigma and self-esteem, respectively. Results: On the modified felt stigma scale, the mean (±standard deviation [SD] score of psychiatric hospital outpatients (31.89 ± 6.51 was significantly higher than the scores of patients attending COP (29.20 ± 6.80. On Rosenberg self-esteem scale, mean (±SD scores of patients with psychosis (17.98 ± 1.69 was significantly lower compared to scores of patients with epilepsy (21.83 ± 1.60. There was no significant correlation between stigma and self-esteem. Conclusion: As psychiatric hospital outpatients have significantly more self-stigma when compared to patients attending community outreach camps, the availability of more community outreach camps along with educating people about psychiatric illnesses may help in lowering stigma of psychiatric disorders.
Wang, Yu-Chun; Lin, Yu-Kai
This study evaluated the risk of outpatient visits for respiratory diseases, asthma, and chronic airway obstruction not elsewhere classified (CAO) associated with ambient temperatures and extreme temperature events from 2000 to 2008 in Taiwan. Based on geographical and socioeconomics characteristics, this study divided the whole island into seven areas. A distributed lag non-linear model was used to estimate the area-disease-specific cumulative relative risk (RR), and random-effect meta-analysis was used to estimate the pooled RR of outpatient visits, from lag 0 to lag 7 days, associated with daily temperature, and added effects of prolonged extreme heat and cold for population of all ages, the elderly and younger than 65 years. Pooled analyses showed that younger population had higher outpatient visits for exposing to low temperature of 18 °C, with cumulative 8-day RRs of 1.36 (95 % confidence interval (CI) 1.31-1.42) for respiratory diseases, 1.10 (95 % CI 1.03-1.18) for asthma, and 1.12 (95 % CI 1.02-1.22) for CAO. The elderly was more vulnerable to high temperature of 30 °C with the cumulative 8-day RR of 1.08 (95 % CI 1.03-1.13) for CAO. Elevated outpatient visits for all respiratory diseases and asthma were associated with extreme heat lasting for 6 to 8 days. On the contrary, the extreme cold lasting more than 8 days had significant negative association with outpatient visits of all respiratory diseases. In summary, elderly patients of respiratory diseases and CAO are vulnerable to high temperature. Cold temperature is associated with all types of respiratory diseases for younger patients.
Desrosiers, Alethea; Blokhina, Elena; Krupitsky, Evgeny; Zvartau, Edwin; Schottenfeld, Richard; Chawarski, Marek
The Russian Federation is experiencing a very high rate of HIV infection among people who inject drugs (PWID). However, few studies have explored characteristics of people with co-occurring opioid use disorders and HIV, including psychiatric symptom presentations and how these symptoms might relate to quality of life. The current study therefore explored a.) differences in baseline psychiatric symptoms among HIV+ and HIV- individuals with opioid use disorder seeking naltrexone treatment at two treatment centers in Saint Petersburg, Russia and b.) associations between psychiatric symptom constellations and quality of life. Participants were 328 adults enrolling in a randomized clinical trial evaluating outpatient treatments combining naltrexone with different drug counseling models. Psychiatric symptoms and quality of life were assessed using the Brief Symptom Inventory and The World Health Organization Quality of Life-BREF, respectively. Approximately 60% of participants were HIV+. Those who were HIV+ scored significantly higher on BSI anxiety, depression, psychoticism, somatization, paranoid ideation, phobic anxiety, obsessive-compulsive, and GSI indexes (all p<0.05) than those HIV-. A K-means cluster analysis identified three distinct psychiatric symptom profiles; the proportion of HIV+ was significantly greater and quality of life indicators were significantly lower in the cluster with the highest psychiatric symptom levels. Higher levels of psychiatric symptoms and lower quality of life indicators among HIV+ (compared to HIV-) individuals injecting drugs support the potential importance of combining interventions that target improving psychiatric symptoms with drug treatment, particularly for HIV+ patients. Copyright © 2017 Elsevier B.V. All rights reserved.
Raghavendra B Nayak
Full Text Available Context: One percent of the population in India is homeless (destitutes which include beggars, commercial sex workers, homeless mentally ill, elderly women with dependent children, street children, and persons with disability. Psychiatric disorders are generally seen to be common among homeless individuals. The data are limited regarding psychiatric morbidity and its prevalence in this populace in Indian context. Aim: The aim was to study the prevalence of psychiatric morbidity among the inmates of a center for destitutes. Settings and Design: Cross-sectional study. Materials and Methods: The study included all the residents (n = 50 of a center of destitutes. Psychiatric evaluation was done by qualified practicing psychiatrist. Brief Psychiatric Rating Scale and Global Assessment of Functioning instruments were used to assess the severity of psychiatric symptoms and general functioning of the individuals with mental disorders. Statistical Analysis Used: SPSS version 13 was used for statistical analysis. Results: All residents (n = 50 of center of destitutes were evaluated for psychiatric co-morbidity. 42 (84% inmates were suffering from psychiatric disorders. Most common psychiatric disorder among them was psychotic disorders in 19 (38%, followed by affective disorders, mainly depression in 16 (32%, somatoform disorders in 5 (10%, and anxiety disorders in 2 (4%. No significant gender differences were noted (P = 0.335. Substance abuse was present in 22 (44% of the inmates. A significant negative correlation between psychiatric symptoms and functioning of the subject was seen, (P < 0.001. Conclusion: Psychiatric disorders and in particular substance abuse, are common among the homeless people who stay in the center of destitutes. Psychiatric disorders are likely to be the cause significant functional impairment.
Boerman, Remco; Cohen, Dan; Schulte, Peter F J; Nugter, Annet
Several studies show an association between schizophrenia and low levels of vitamin D. To date, there are only few studies about the prevalence of vitamin D deficiency in patients with bipolar disorder. We hypothesized that vitamin D deficiency is less common among patients with bipolar disorder than among patients with schizophrenia or schizoaffective disorder. A second hypothesis is that vitamin D deficiency is more prevalent among patients with schizophrenia, schizoaffective disorder, or bipolar disorders than among the general Dutch population.Most studies have been conducted with hospitalized patients; in this study, we only included outpatients. All outpatients of a center for bipolar disorders and all outpatients of 3 flexible assertive community treatment teams were asked to participate in this cross-sectional study. We included 118 patients with bipolar disorder and 202 patients with schizophrenia or schizoaffective disorder. Vitamin D levels were deficient in 30.3% (95% confidence interval, 25.5-35.6) of the cases. The type of psychiatric disorder was not a predictor of vitamin D deficiency. The absolute difference in risk of deficiency between the study population and the Dutch Caucasian population was 23.8% (95% confidence interval, 18.3%-29.3%). In this study, vitamin D deficiency was 4.7 times more common among outpatients with bipolar disorder, schizophrenia, or schizoaffective disorder than among the Dutch general population.Given the high prevalence of vitamin D deficiency, we believe that outpatients with bipolar disorder, schizophrenia, or schizoaffective disorder should be considered at risk of having low levels of vitamin D. Annual measurement of vitamin D levels in psychiatric outpatients with these disorders seems to be justified to maintain bone health, muscle strength, and to prevent osteoporosis.
Pereira De Godoy, J M; Amador Franco Brigidio, P; Buzato, E; Fátima Guerreiro De Godoy, M
The aim of this paper was to report on a novel approach to the intensive outpatient treatment of elephantiasis of an underprivileged population. Prospective, random study, the diagnosis of lymphedema was clinical and the inclusion of patients was by order of arrival in the treatment center where all were invited to participate in the study. Intensive outpatient therapy was performed for 6 to 8 hours daily over a period of four weeks. Eleven legs with grade III elephantiasis of 8 patients were evaluated in a random prospective study. Three patients were men and five were women with ages ranging between 28 and 66 years old. Treatment included mechanical lymph drainage using the RAGodoy® apparatus for a period of 6 to 8 hours daily and the Godoy & Godoy cervical stimulation technique for 20 minutes per day, both associated to the use of a home-made medical compression stocking using a low-stretch cotton-polyester material. Additionally, manual lymph drainage using the Godoy & Godoy technique was performed for one hour. Perimetry was used to compare measurements made before and after treatment, of the three points of the limb with the largest circumferences. The paired t-test was utilized for statistical analysis with an alpha error greater than 5% (P-value treatment program (P-value=0.001). Intensive outpatient treatment is an option for all types of lymphedema with large volumetric reductions being possible in a short period when treating elephantiasis.
Laupland Kevin B
Full Text Available Abstract Background Blood cultures are a gold standard specific test for diagnosing many infections. However, the low yield may limit their usefulness, particularly in low-risk populations. This study was conducted to assess the utility of blood cultures drawn from ambulatory outpatients. Methods Blood cultures drawn at community-based collection sites in the Calgary Health Region (population 1 million in 2001 and 2002 were included in this study. These patients were analyzed by linkages to acute care health care databases for utilization of acute care facilities within 2 weeks of blood culture draw. Results 3102 sets of cultures were drawn from 1732 ambulatory outpatients (annual rate = 89.4 per 100,000 population. Significant isolates were identified from 73 (2.4% sets of cultures from 51 patients, including Escherichia coli in 18 (35% and seven (14% each of Staphylococcus aureus and Streptococcus pneumoniae. Compared to patients with negative cultures, those with positive cultures were older (mean 49.6 vs. 40.1 years, p Conclusion Blood cultures drawn in outpatient settings are uncommonly positive, but may define patients for increased intensity of therapy. Strategies to reduce utilization without excluding patients with positive cultures need to be developed for this patient population.
Sederer, L I; Eisen, S V; Dill, D; Grob, M C; Gougeon, M L; Mirin, S M
A fixed-prepayment system (case-based reimbursement) for patients initially requiring hospital-level care was evaluated for one year through an arrangement between a private nonprofit psychiatric hospital and a self-insured company desiring to provide psychiatric services to its employees. This clinical and financial experiment offered a means of containing costs while monitoring quality of care. A two-group, case-control study was undertaken of treatment outcomes at discharge, patient satisfaction with hospital care, and service use and costs during the program's first year. Compared with costs for patients in the control group, costs for those in the program were lower per patient and per admission; cumulative costs for patients requiring rehospitalization were also lower. However, costs for outpatient services for patients in the program were not calculated. Treatment outcomes and patients' satisfaction with hospital care were comparable for the two groups.
Holi, M M; Sammallahti, P R; Aalberg, V A
To examine the relation between psychiatric symptoms and defense mechanisms, we administered two questionnaires, the Symptom Check-list 90 (SCL-90) and the Defense Style Questionnaire (DSQ) to 122 psychiatric out-patients and to a community sample of 337 subjects. Using regression analysis, we found that 51.8% of the variation in subject's Global Severity Index value could be explained by his defense style. Of the three defense styles, the immature style explained most of the variation in the symptoms. We found little overall evidence for specific connections between particular defenses and symptoms. Projection and dissociation were central in most of the symptom dimensions. We compared patients and controls with the same level of general symptom severity and found that patients used significantly more devaluation and splitting, and controls used significantly more altruism and idealization. Whether defenses predispose to certain symptomatology or are one of its aspects is discussed.
Baldonado, Analiza; Hawk, Ofelia; Ormiston, Thomas; Nelson, Danielle
Patients who are high risk high cost (HRHC), those with severe or multiple medical issues, and the chronically ill elderly are major drivers of rising health care costs.1 The HRHC patients with complex health conditions and functional limitations may likely go to emergency rooms and hospitals, need more supportive services, and use long-term care facilities.2 As a result, these patient populations are vulnerable to fragmented care and "falling through the cracks".2 A large county health and hospital system in California, USA introduced evidence-based interventions in accordance with the Triple AIM3 focused on patient-centered health care, prevention, health maintenance, and safe transitions across the care continuum. The pilot program embedded a Transitional Care Manager (TCM) within an outpatient Family Medicine clinic to proactively assist HRHC patients with outreach assistance, problem-solving and facilitating smooth transitions of care. This initiative is supported by a collaborative team that included physicians, nurses, specialists, health educator, and pharmacist. The initial 50 patients showed a decrease in Emergency Department (ED) encounters (pre-vs post intervention: 33 vs 17) and hospital admissions (pre-vs post intervention: 32 vs 11), improved patient outcomes, and cost saving. As an example, one patient had 1 ED visit and 5 hospital admission with total charges of $217,355.75 in the 6 months' pre-intervention with no recurrence of ED or hospital admissions in the 6 months of TCM enrollment. The preliminary findings showed improvement of patient-centered outcomes, quality of care, and resource utilization however more data is required.
Hsu, Wen-Chin; Hsu, Yi-Ping
Taiwan has one of the fastest growing aging populations in the world, which makes the effective allocation of scarce medical resources a key issue. This paper investigates patterns in the use of outpatient services by elderly individuals in Taiwan under the National Health Insurance (NHI) program. We assembled a random sample from the NHI Research Database in Taiwan, comprising 50% of all claims made for elderly people (65 years old) in 2010 (n 1,239,836 beneficiaries) including 14 variables. In 2010, individuals aged 65 years or older comprised 10.74% of the population of Taiwan, and accounted for 11.39% of all physician and outpatient visits. The rate of medical care visits was 28.54 ± 21.23 (Standard deviation) times per person per annum, with a higher rate for women, those in the 80-84 age group, low-income beneficiaries, and the inhabitants of offshore islands. The three most frequent diagnoses for elderly patients were hypertension, diabetes, and acute upper respiratory infections. The mean insured medical costs per person per annum were US Dollars 1,132, with higher expenses for men, those in the 80-84 age group, and those inhabiting urban areas. This study employed nationally representative data in the detection of patterns in outpatient care utilization by elderly individuals in Taiwan. Medical care providers and policymakers should be fully aware of the complex patterns unique to older patients. The results of this study could be used as a benchmark with which to assess the impact of future medical care policy on elderly people. Copyright © 2015. Published by Elsevier B.V.
Gurpegui, Manuel; Jurado, Dolores
The psychiatric consequences of induced abortion continue to be the object of controversy. The reactions of women when they became aware of conception are very variable. Pregnancy, whether initially intended or unintended, may provoke stress; and miscarriage may bring about feelings of loss and grief reaction. Therefore, induced abortion, with its emotional implications (of relief, shame and guilt) not surprisingly is a stressful adverse life event. METHODOLOGICAL CONSIDERATIONS: There is agreement among researchers on the need to compare the mental health outcomes (or the psychiatric complications) with appropriate groups, including women with unintended pregnancies ending in live births and women with miscarriages. There is also agreement on the need to control for the potential confounding effects of multiple variables: demographic, contextual, personal development, previous or current traumatic experiences, and mental health prior to the obstetric event. Any psychiatric outcome is multi-factorial in origin and the impact of life events depend on how they are perceived, the psychological defence mechanisms (unconscious to a great extent) and the coping style. The fact of voluntarily aborting has an undeniable ethical dimension in which facts and values are interwoven. No research study has found that induced abortion is associated with a better mental health outcome, although the results of some studies are interpreted as or Some general population studies point out significant associations with alcohol or illegal drug dependence, mood disorders (including depression) and some anxiety disorders. Some of these associations have been confirmed, and nuanced, by longitudinal prospective studies which support causal relationships. With the available data, it is advisable to devote efforts to the mental health care of women who have had an induced abortion. Reasons of the woman's mental health by no means can be invoked, on empirical bases, for inducing an abortion.
Reid, Jennifer G; Gitlin, Michael J; Altshuler, Lori L
Owing to the prevalence of medication side effects and treatment resistance, prescribers often consider off-label uses of US Food and Drug Administration (FDA)-approved agents for the treatment of persistent symptoms. The authors review the available literature on the FDA-approved and non-FDA-approved uses of lamotrigine in adults with psychiatric disorders. We used PubMed, MEDLINE, and a hand search of relevant literature to find studies published between 1990 and 2012 and available in English language. The following keywords were searched: lamotrigine, psychiatric, mood disorders, depression, personality disorders, anxiety, schizophrenia, side effects, and rash. Data were selected from 29 randomized controlled trials (RCTs). When RCTs were not available, open-label trials (6), retrospective case reviews (10), and case series (4) were summarized. We extracted results of monotherapy and augmentation trials of lamotrigine on primary and secondary outcome measures. Lamotrigine is generally well tolerated, with the best evidence for the maintenance treatment of bipolar disorder, particularly in prevention of depressive episodes. In acute bipolar depression, meta-analyses suggested a modest benefit, especially for more severely depressed subjects, with switch rates similar to placebo. In unipolar depression, double-blind RCTs noted benefit on subsets of symptoms and improved response in more severely depressed subjects. Data are limited but promising in borderline personality disorder. Use of lamotrigine in schizophrenia and anxiety disorders has little supportive evidence. Lamotrigine is recommended in bipolar maintenance when depression is prominent. It also has a role in treating acute bipolar depression and unipolar depression, though the latter warrants more research. Data are too limited in other psychiatric disorders to recommend its use at this time. © Copyright 2013 Physicians Postgraduate Press, Inc.
Full Text Available INTRODUCTION Parricide is defined as a murder of parents by their children; the patricide is murder of father, while matricide is murder of mother. This entity is classified as homicide, but it differs in the fact that victims are parents and the killers are their children. Mostly, it is associated with psychiatric morbidity. OBJECTIVE To describe sociodemographic and psychopathological characteristics of parricide committers and to analyze circumstances of parricide and psychiatric morbidity in order to achieve better recognition and prevention of risks. METHOD This retrospective study included all homicide autopsy records (1991-2005 performed at the Institute of Forensic Medicine, Medical School, University of Belgrade. For further analyses, all parricide records were selected out. The study analyzed all available parameters, which concerned parricide committers, victims and the act itself. Methods of descriptive statistics were used. RESULTS Between 1991 and 2005, there were 948 cases of homicide; of these, 3.5% were parricides. The committers of parricide were on average 31.2±11.9 years old, 87.8% were males, 60.6% with psychiatric symptoms most commonly with schizophrenia, alcohol dependence, personality disorder etc. Victims were on average 63.7±11.9 years old, 54.5% males, and 21.2% had a diagnosed mental illness. CONCLUSION Parricide is a rare kind of homicide accounting for 3% of all homicides. Committers are mostly unemployed males in early adulthood who have mental disorder. The phenomenon of parricide deserves a detailed analysis of the committer (individual bio-psycho-social profile and the environ- mental factors (family, closely related circumstances to enable a precise prediction of the act and prevention of the fatal outcome, which logically imposes the need of further studies.
Brust, J S; Ford, C V; Rimoin, D L
Sixteen adult dwarfs - 11 with achondroplasia and 5 with hypopituitarism - were studied by means of psychiatric interviews and psychological tests. There were no significant differences between the two groups; in general, the subjects had achieved a satisfactory life adjustment despite the stress of having bodies uniquely different from those of the general population. They had secure identities as "little people" and successfully used coping mechanisms such as a sense of humor and a pleasant interpersonal style. Male dwarfs tended to experience more emotional distress than female dwarfs.
Fredriksson, Lennart; Lindström, Unni A
The aim of this study was to increase and deepen the understanding of how psychiatric patients in conversations with nurses narrate their experience of suffering. Data were obtained in the years 2001-2002 by audio recording of 20 individual caring conversations between eight patients and three psychiatric nurses at a psychiatric outpatient unit in Sweden. Before the data were gathered the study was approved by a local research ethics committee. The methodology is inspired by the hermeneutics of Paul Ricoeur. The data is given a naïve reading which is followed by two structural analyses which explain the text. Finally, the structural analyses and the pre-understanding are confronted in a critical reflection. In the patients' narratives, suffering was at first concealed under a façade that helps the patient to cope with suffering and with shame. As they moved along to a turning point, something happened that made them able to risk everything, i.e. their very selves, but also gave them the possibility of regaining vital parts of themselves that where lost when the façade was constructed. As they took the suffering upon themselves, they grew to be fully visible as human beings and healing was possible as a re-establishment of the interpersonal bridge. This not only meant that the sufferer became open for relationships with others or an abstract other, but also that an opening in the relationship with themselves occurred. If psychiatric patients are allowed to narrate freely they develop different plot structures, which can either hide or reveal suffering. Patients who could establish an answer to the why-question of suffering could also interpret their suffering in a way that enabled growth and reconciliation. In order to do so, they had to abandon the shelter of the façade and confront suffering and shame. This turning point opened them up to life-sustaining relationships with themselves as well as with abstract and concrete others.
Green, A H; Kaplan, M S
To assess psychiatric impairment and childhood victimization experiences in female child molesters. Eleven incarcerated female child molesters were compared to 11 women imprisoned for nonsexual offenses as to their psychiatric diagnoses based on interviews with the Structured Clinical Interview for DSM-III-R, Outpatient Version (SCID-OP), the SCID II for Personality Disorders, and the Harvard-Upjohn Post-Traumatic Stress Disorder (PTSD) Interview. A family and sexual history with a description of childhood victimization experiences was also obtained by using the Wyatt Sexual History Questionnaire. The majority of the subjects in each group exhibited major depression, alcohol/substance abuse, and PTSD, but the sexual offenders demonstrated more psychiatric impairment on the Global Assessment of Functioning Scale on the SCID-OP. The sexual offenders demonstrated a higher incidence of childhood physical and sexual abuse within the family than the comparison group, and these victimization experiences were more severe and more frequently associated with PTSD. The sexual offenders and the comparison women described negative relationships with parents and caretakers, and with spouses or boyfriends. However, the sexual offenders perceived their parents as more abusive, while the comparison women regarded their parents as more neglecting. Incarcerated female child molesters exhibited greater psychiatric impairment and more intrafamilial physical and sexual abuse than a comparison group of women imprisoned for nonsexual offenses.
Dybdal, Daniel; Tolstrup, Janne S; Sildorf, Stine M
of psychiatric disorders as well as the effects of age at onset and duration of type 1 diabetes on the risk of subsequently developing psychiatric morbidities. RESULTS: An increased risk of being diagnosed with mood disorders and anxiety, dissociative, eating, stress-related and somatoform disorders was observed......AIMS/HYPOTHESIS: The aim of this study was to investigate psychiatric morbidity following childhood onset of type 1 diabetes. METHODS: In a matched, population-based cohort study based on Danish national registers, we identified children and adolescents who had been diagnosed as an in......- or outpatient with type 1 diabetes before the age of 18, and afterwards diagnosed with a psychiatric disorder (n = 5084). Control individuals were matched according to sex and date of birth (n = 35,588). The Cox proportional hazards model was used to assess associations between type 1 diabetes and the incidence...
Baldaçara, Leonardo; Borgio, João Guilherme Fiorani; Lacerda, Acioly Luiz Tavares de; Jackowski, Andrea Parolin
The objective of this update article is to report structural and functional neuroimaging studies exploring the potential role of cerebellum in the pathophysiology of psychiatric disorders. A non-systematic literature review was conducted by means of Medline using the following terms as a parameter: "cerebellum", "cerebellar vermis", "schizophrenia", "bipolar disorder", "depression", "anxiety disorders", "dementia" and "attention deficit hyperactivity disorder". The electronic search was done up to April 2008. Structural and functional cerebellar abnormalities have been reported in many psychiatric disorders, namely schizophrenia, bipolar disorder, major depressive disorder, anxiety disorders, dementia and attention deficit hyperactivity disorder. Structural magnetic resonance imaging studies have reported smaller total cerebellar and vermal volumes in schizophrenia, mood disorders and attention deficit hyperactivity disorder. Functional magnetic resonance imaging studies using cognitive paradigms have shown alterations in cerebellar activity in schizophrenia, anxiety disorders and attention deficit hyperactivity disorder. In dementia, the cerebellum is affected in later stages of the disease. Contrasting with early theories, cerebellum appears to play a major role in different brain functions other than balance and motor control, including emotional regulation and cognition. Future studies are clearly needed to further elucidate the role of cerebellum in both normal and pathological behavior, mood regulation, and cognitive functioning.
Schaffrath, Jonas; Schmitz-Buhl, Mario; Gün, Ali Kemal; Gouzoulis-Mayfrank, Euphrosyne
Medical and psychological care of refugees is among the most important current challenges in German health politics. Work with patients from this heterogeneous group who have often faced severe stress before, during and after their migration is currently based on a thin data foundation. Based on introductory information on current knowledge concerning psychiatric morbidity of refugees this article presents the psychiatric care of refugees at LVR Clinics Cologne - a psychiatric specialty hospital situated in North Rhine-Westphalia, Germany. A sample of 239 cases of refugee patients who were referred to in- and outpatient departments of the LVR Clinics Cologne between April 2015 and March 2016 are evaluated in respect of diagnoses, admission modalities and socio-demographic variables. The majority of principal diagnoses (40.2%) belong to the group of stress-related and somatoform disorders (F4 in ICD-10). Mood disorders (F3 in ICD-10) represented 31.0%, followed by mental and behavioral disorders due to psychoactive substance use (F1 in ICD-10) with 15.1%. Posttraumatic Stress Disorder (PTSD) was the most prevalent diagnose (13.0%). Among the 29 countries of the patients' origin Afghanistan (10,0%), Serbia (9.6%) and Kosovo (8.8%) were the most abundant. The diagnoses and the high rate of acute psychiatric events reflect the massive psychological pressure of the patients. The important role of interpreters and mediators specialized in language and integration in the treatment process is emphasized. © Georg Thieme Verlag KG Stuttgart · New York.
Ekblad, Mikael; Lehtonen, Liisa; Korkeila, Jyrki; Gissler, Mika
Maternal smoking during pregnancy has been associated with an increased risk for psychiatric morbidity. We further studied this with Finnish siblings to control for genetic/familial factors. From the Finnish Medical Birth Register, sibling pairs were selected as the first two children born 1987-1995 to the same mother (n = 150 168 pairs), along with information on maternal smoking (no smoking/smoking). Information on the children's psychiatric diagnoses related to outpatient care visits (1998-2013) and inpatient care (1987-2013), and the mothers' psychiatric morbidity (1969-2013) was derived from the Finnish Hospital Discharge Register. The first pair analysis compared siblings of mothers who only smoked in the first pregnancy (Quitters, 4.7%) and mothers who smoked in both pregnancies (Smokers, 9.6%); the second analysis included mothers who smoked only in the second pregnancy (Starters, 3.3%) and mothers who did not smoke in either pregnancy (Nonsmokers, 77.5%). Smoking information was missing for 5.0% of pairs. Psychiatric morbidity of the siblings and mother was included in the statistical analyses. The risk of psychiatric diagnoses was significantly lower for the second child of quitters (adjusted OR 0.77, 95% CI 0.72-0.83) compared to the risk among smokers. A higher risk for psychiatric diagnoses was found for the second child of starters (1.39, 1.30-1.49) compared to the risk among nonsmokers. The effect of smoking was more robust for externalizing diagnoses. Maternal smoking was independently associated with a higher risk for psychiatric morbidity in children, even when controlling thoroughly for genetic and familial factors. Maternal smoking during pregnancy has an independent effect on the risk of psychiatric morbidity in children, even after controlling for non-measurable genetic/familial factors by using a sibling pair design. The effect of maternal smoking was robust for externalizing diagnoses. Maternal smoking during pregnancy had an effect on
before sleep, vivid recall of personal experiences, and physical reactions (e . g., anxiety, and nausea) to observed violence on television...preliminary data. Psycological Reports, 65(2), 691·698. Nash, M. R . (1992) . Hypnosis, psychopathology, and psychological regression. In Fronun, E
Rahim, Twana Abdulrahman; Saeed, Banaz Adnan; Farhan, Hafidh Muhammed; Aziz, Rosh Rauf
Indigenous healing is commonly practiced in Middle East. Little is known about trends of indigenous therapies among patients with psychiatric disorders in Iraq. To determine and compare rates and predictors of indigenous healings by individuals with psychiatric disorders, and the practiced rituals among Arabic and Kurdish ethnicities in Iraq, patients aged 18 year and older attending outpatients in Erbil and Najaf were assessed for their prior contacts with indigenous healers. About 48.9 % had indigenous healer's consultations before visiting their psychiatrists; the figure was three times higher among Arabs than Kurds. Higher consultation rate was detected among younger and less formally educated patients. Fourteen types of religious therapeutic rituals have been practiced. Indigenous healing is widespread in Iraq. It is more common among Arabs, younger and less educated people with psychiatric disorders. Participants consider indigenous healing for their psychiatric more than non-psychiatric disorders.
Frequent disconfirmation behaviors have been documented in psychiatric clients. Individuals who demonstrate maladaptive patterns of disconfirmation can learn to understand and modify this dysfunctional sequence. Through one to one interactions and group discussions, psychiatric nurses can help clients learn more positive communication behaviors. This accomplishment will positively affect the client's interpersonal responsiveness and self-esteem.
van Loo, Hanna; Romeijn, Johannes
The frequent occurrence of comorbidity has brought about an extensive theoretical debate in psychiatry. Why are the rates of psychiatric comorbidity so high and what are their implications for the ontological and epistemological status of comorbid psychiatric diseases? Current explanations focus
Singh, Delar K.
This paper focuses on college students with psychiatric disabilities. It defines and discusses various psychiatric conditions such as mood disorders, anxiety disorders, eating disorders, and personality disorders. It concludes with accommodations that a college professor can make to help these students succeed in higher education. (Contains 1…
Jagt-Jelsma, W. van der; Vries-Schot, M.R. de; Jong, R. de; Hartman, C.A.; Verhulst, F.C.; Klip, H.; Deurzen, P.A. van; Buitelaar, J.K.
BACKGROUND: This study investigated the association between the religiosity of parents and pre-adolescents, and pre-adolescents' psychiatric problems. METHOD: In a clinic-referred cohort of 543 pre-adolescents at least once referred to a mental health outpatient clinic mental health problems were
van der Jagt-Jelsma, W.; de Vries-Schot, M. R.; de Jong, Rint; Hartman, C. A.; Verhulst, F. C.; Klip, H.; van Deurzen, P. A. M.; Buitelaar, J. K.
Background: This study investigated the association between the religiosity of parents and pre-adolescents, and pre-adolescents' psychiatric problems. Method: In a clinic-referred cohort of 543 pre-adolescents at least once referred to a mental health outpatient clinic mental health problems were
Green, Sheryl M.; Bieling, Peter J.
Mindfulness-based interventions (e.g., MBSR; Kabat-Zinn, 1990; MBCT; Segal, Williams, & Teasdale, 2002) have demonstrated effectiveness in a number of distinct clinical populations. However, few studies have evaluated MBCT within a heterogeneous group of psychiatric adult outpatients. This study examined whether a wider variety of patients…
Christensen, Bruce K.; Girard, Todd A.; Bagby, R. Michael
An eight-subtest short form (SF8) of the Wechsler Adult Intelligence Scale, Third Edition (WAIS-III), maintaining equal representation of each index factor, was developed for use with psychiatric populations. Data were collected from a mixed inpatient/outpatient sample (99 men and 101 women) referred for neuropsychological assessment. Psychometric…
Gelfand, Yaroslav; Kaplitt, Michael G
Gene therapy has become of increasing interest in clinical neurosurgery with the completion of numerous clinical trials for Parkinson disease, Alzheimer disease, and pediatric genetic disorders. With improved understanding of the dysfunctional circuitry mediating various psychiatric disorders, deep brain stimulation for refractory psychiatric diseases is being increasingly explored in human patients. These factors are likely to facilitate development of gene therapy for psychiatric diseases. Because delivery of gene therapy agents would require the same surgical techniques currently being employed for deep brain stimulation, neurosurgeons are likely to lead the development of this field, as has occurred in other areas of clinical gene therapy for neurologic disorders. We review the current state of gene therapy for psychiatric disorders and focus specifically on particular areas of promising research that may translate into human trials for depression, drug addiction, obsessive-compulsive disorder, and schizophrenia. Issues that are relatively unique to psychiatric gene therapy are also discussed. Copyright © 2013. Published by Elsevier Inc.
Bartak, Anna; Andrea, Helene; Spreeuwenberg, Marieke D; Ziegler, Uli M; Dekker, Jack; Rossum, Bert V; Hamers, Elisabeth F M; Scholte, Wubbo; Aerts, Janneke; Busschbach, Jan J V; Verheul, Roel; Stijnen, Theo; Emmelkamp, Paul M G
For patients with cluster B personality disorders there is no consensus regarding the optimal treatment setting. The aim of this study was to compare the effectiveness of different psychotherapeutic settings for patients with cluster B personality disorders, i.e. outpatient, day hospital, and inpatient treatment. The study was conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherlands, with a sample of 207 patients with a DSM-IV-TR axis II cluster B diagnosis. Patients were assigned to 3 different settings of psychotherapeutic treatment and effectiveness was assessed at 18 months after baseline. An intention-to-treat analysis was conducted for psychiatric symptoms (Brief Symptom Inventory), psychosocial functioning (Outcome Questionnaire-45), and quality of life (EQ-5D), using multilevel statistical modelling. As the study was non-randomised, the propensity score method was used to control for initial differences. Patients in all 3 settings improved significantly in terms of psychiatric symptoms, social and interpersonal functioning, and quality of life 18 months after baseline. The inpatient group showed the largest improvements. The comparison of outpatient and inpatient treatment regarding psychiatric symptoms showed a marginally significant result (p = 0.057) in favour of inpatient treatment. Patients with cluster B personality disorders improved in all investigated treatment settings, with a trend towards larger improvements of psychiatric symptoms in the inpatient setting compared to the outpatient setting. Specialised inpatient treatment should be considered as a valuable treatment option for cluster B personality disorders, both in research and in clinical practice. Copyright © 2010 S. Karger AG, Basel.
Frederiksen, Julie Elisabeth Nordgaard; Sass, Louis A; Parnas, Josef
that are historically rooted in logical positivism and behaviorism. These theoretical approaches marked decisively the so-called "operational revolution in psychiatry" leading to the creation of DSM-III. This paper attempts to examine the theoretical assumptions that underlie the use of a fully structured psychiatric...... person), actionable format, used for classification, treatment, and research. Our central thesis is that psychiatry targets the phenomena of consciousness, which, unlike somatic symptoms and signs, cannot be grasped on the analogy with material thing-like objects. We claim that in order to perform...... faithful distinctions in this particular domain, we need a more adequate approach, that is, an approach that is guided by phenomenologically informed considerations. Our theoretical discussion draws upon clinical examples derived from structured and semi-structured interviews. We conclude that fully...
Luciane Loss Jardim
Full Text Available This article describes the intriguing case of a young female patient first seen in the emergency room and then followed up at the psychiatric outpatient facility of the General Hospital at UNICAMP, Brazil. The cooperation that ensued between psychiatrists and a psychoanalyst to reach a psychopathological diagnosis is also presented here. The differential diagnosis is discussed within a psychiatric framework and then contributions from listening to the patient's free associations related to the clarification of her psychopathology are described. The clinical collaboration between psychiatry and psychoanalysis proved effective in this case as a clinical method for approaching the patient.
Robles Bayón, A; Gude Sampedro, F
Behavioural and psychiatric symptoms (BPS) are frequent in neurological patients, contribute to disability, and decrease quality of life. We recorded BPS prevalence and type, as well as any associations with specific diagnoses, brain regions, and treatments, in consecutive outpatients examined in a cognitive neurology clinic. A retrospective analysis of 843 consecutive patients was performed, including a review of BPS, diagnosis, sensory impairment, lesion topography (neuroimaging), and treatment. The total sample was considered, and the cognitive impairment (CI) group (n=607) was compared to the non-CI group. BPS was present in 59.9% of the patients (61.3% in the CI group, 56.4% in the non-CI group). One BPS was present in 31.1%, two in 17.4%, and three or more in 11.4%. BPS, especially depression and anxiety, are more frequent in women than in men. Psychotic and behavioural symptoms predominate in subjects aged 65 and older, and anxiety in those younger than 65. Psychotic symptoms appear more often in patients with sensory impairment. Psychotic and behavioural symptoms are more prevalent in patients with degenerative dementia; depression and anxiety in those who suffer a psychiatric disease or adverse effects of substances; emotional lability in individuals with a metabolic or hormonal disorder; hypochondria in those with a pain syndrome; and irritability in subjects with chronic hypoxia. Behavioural symptoms are more frequent in patients with anomalies in the frontal or right temporal or parietal lobes, and antipsychotics constitute the first line of treatment. Leaving standard treatments aside, associations were observed between dysthymia and opioid analgesics, betahistine and statins, and between psychotic symptoms and levodopa, piracetam, and vasodilators. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.
Uhlmann, C; Flammer, E; Pfiffner, C; Grempler, J; Längle, G; Eschweiler, G-W; Spießl, H; Steinert, T
In the S3 treatment guidelines psychotherapy is recommended in all psychological disorders. Therefore, outpatient or inpatient psychotherapy should be recommended by therapists in most cases. On the other hand, it is well known that waiting periods for psychotherapeutic treatment are considerable, which raises the question how the recommendation for psychotherapy is presented in psychiatric hospitals in Germany. The article deals with the question of how frequent the recommendation of psychotherapeutic treatment is made after psychiatric inpatient stay or day care, and if there are differences between hospitals and patient groups. In four psychiatric hospitals in southern Germany the frequency of recommendation for psychotherapy in psychiatric patients was registered and compared to the number of all patients treated in the equivalent time. For this purpose, we analyzed data of the basic documentation in the four participating hospitals. Overall, 9.6 % of the patients received a recommendation of psychotherapeutic treatment. In the psychiatric university hospital a subsequent psychotherapeutic treatment was recommended somewhat more often. Differences between hospitals were present but marginal. Over all participating hospitals, psychotherapy was recommended markedly less frequently in patients with an F2 diagnosis in comparison with patients with F3 or F4 diagnoses. Psychotherapeutic treatment after psychiatric inpatient stay is recommended cautiously. Probably therapists anticipate the fact that the growing demand for psychotherapeutic treatment in general reduces the chances for persons after psychiatric inpatient treatment.
Lindor, Rachel A; Campbell, Ronna L; Pines, Jesse M; Melin, Gabrielle J; Schipper, Agnes M; Goyal, Deepi G; Sadosty, Annie T
Emergency department (ED) care for patients with psychiatric complaints has become increasingly challenging given recent nationwide declines in available inpatient psychiatric beds. This creates pressure to manage psychiatric patients in the ED or as outpatients and may place providers and institutions at risk for liability under the Emergency Medical Treatment and Labor Act (EMTALA). We describe the patient characteristics, disposition, and legal outcomes of EMTALA cases involving patients with psychiatric complaints. Jury verdicts, settlements, and other litigation involving alleged EMTALA violations related to psychiatric patients between the law's enactment in 1986 and the end of 2012 were collected from 3 legal databases (Westlaw, Lexis, and Bloomberg Law). Details about the patient characteristics, disposition, and reasons for litigation were independently abstracted by 2 trained reviewers onto a standardized data form. Thirty-three relevant cases were identified. Two cases were decided in favor of the plaintiffs, 4 cases were settled, 10 cases had an unknown outcome, and 17 were decided in favor of the defendant institutions. Most patients in these 33 cases were men, had past psychiatric diagnoses, were not evaluated by a psychiatrist, and eventually committed or attempted suicide. The most frequently successful defense used by institutions was to demonstrate that their providers used a standard screening examination and did not detect an emergency medical condition that required stabilization. Lawsuits involving alleged EMTALA violations in the care of ED patients with psychiatric complaints are uncommon and rarely successful. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
Kassira, Wrood; Namias, Nicholas
The leading etiologies of pediatric burns are scald, thermal, and electrical injuries. The initial management of burns involves assessment of burn depth and total body surface area (TBSA) affected, a history, and physical examination. Calculation of percent of TBSA affected is an important determinant of the necessity for hospitalization versus outpatient management. Only second- and third-degree burns are included in the calculation. The criteria for outpatient management vary based on the center experience and resources. One such set of criteria in an experienced burn center includes burn affecting less than 15% TBSA, therefore not requiring fluid resuscitation; the ability to take in oral fluids, excluding serious perioral burns; no airway involvement or aspiration of hot liquid; no abuse; and dependable family able to transport the patient for clinic appointments. Once the child is ready to reenter school, the physician must discuss with the family and school staff any needs and expectations for the child, including wound care. Social reintegration can be difficult. Educating the teachers and staff of the child's appearance may help prepare the students.
Kraemer, K L; Conigliaro, J; Saitz, R
The alcohol withdrawal syndrome is common in elderly individuals who are alcohol dependent and who decrease or stop their alcohol intake. While there have been few clinical studies to directly support or refute the hypothesis that withdrawal symptom severity, delirium and seizures increase with advancing age, several observational studies suggest that adverse functional and cognitive complications during alcohol withdrawal do occur more frequently in elderly patients. Most elderly patients with alcohol withdrawal symptoms should be considered for admission to an inpatient setting for supportive care and management. However, elderly patients with adequate social support and without significant withdrawal symptoms at presentation, comorbid illness or past history of complicated withdrawal may be suitable for outpatient management. Although over 100 drugs have been described for alcohol withdrawal treatment, there have been no studies assessing the efficacy of these drugs specifically in elderly patients. Studies in younger patients support benzodiazepines as the most efficacious therapy for reducing withdrawal symptoms and the incidence of delirium and seizure. While short-acting benzodiazepines, such as oxazepam and lorazepam, may be appropriate for elderly patients given the risk for excessive sedation from long-acting benzodiazepines, they may be less effective in preventing seizures and more prone to produce discontinuation symptoms if not tapered properly. To ensure appropriate benzodiazepine treatment, dose and frequency should be individualised with frequent monitoring, and based on validated alcohol withdrawal severity measures. Selected patients who have a history of severe or complicated withdrawal symptoms may benefit from a fixed schedule of benzodiazepine provided that medication is held for sedation. beta-Blockers, clonidine, carbamazepine and haloperidol may be used as adjunctive agents to treat symptoms not controlled by benzodiazepines. Lastly, the
Ladouceur, Robert; Sylvain, Caroline; Sévigny, Serge; Poirier, Lynda; Brisson, Laurent; Dias, Carlos; Dufour, Claudie; Pilote, Pierrette
Several researchers and clinicians have questioned the advantages and disadvantages of inpatient and outpatient treatment for people suffering from pathological gambling. This study compares the characteristics of pathological gamblers seeking inpatient and outpatient treatment. A total of 233 pathological gamblers (inpatients = 134, outpatients = 99) participated in the study. Results show that inpatients have more severe gambling problems than those receiving outpatient services. Similar results were obtained on most other related variables such as anxiety, depression, alcohol consumption, and comorbidity. These results are discussed in terms of the costs and benefits of these two treatment modalities.
Parkar, Shubhangi R
... of functional status related to common mental disorders in the elderly patients. Overlap of depression and anxiety is very common with up to almost half of the elderly patients reporting significant depressive and anxiety symptoms...
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Vinkers, David J; de Beurs, Edwin; Barendregt, Marko; Rinne, Thomas; Hoek, H Wijbrand
Black and ethnic minorities (BME) are disproportionally represented in western prisons and forensic psychiatric facilities. The authors wished to determine whether patient-related or services-related factors account for this overrepresentation. This study examined the relationship among the assessments of psychological accountability for a crime, treatment recommendations, and ethnicity among persons accused of a crime and suspected of having a mental disorder. We examined all 21,857 pre-trial psychiatric reports requested by Dutch courts between 2000 and 2006. Ethnicity was classified as Dutch native (n=15,004), Black and minority ethnic (BME) groups (n=6202), and Whites from other western countries (n=638). Accountability assessments and treatment recommendations were compared using chi-square tests and logistic regression models, adjusted for demographic, psychiatric, and judiciary characteristics. Among BME and Whites from other western countries, accountability for the crimes committed was more often judged to be at the extreme ends of the spectrum, that is, "fully responsible" or "not responsible." Compulsory admission to a psychiatric hospital was more frequently recommended for BME persons (OR: 1.38, 95% CI: 1.16-1.64) and Whites from other western countries (OR: 1.54, 95% CI: 1.05-2.27), but not admission to a penitentiary hospital or use of medication. The compulsory admission findings are largely explained by a higher prevalence of psychotic disorders in BME persons (19.8%) and Whites from other western countries (19.3%) as compared to Dutch natives (9.2%). Outpatient treatment was less often recommended for BME persons (OR: 0.81, 95% CI: 0.76-0.87) and Whites from other western countries (OR: 0.83, 95% CI: 0.70-0.99) than for Dutch natives. Both patient-related and services-related factors play a role in the increased admission of BME groups and Whites from other western countries to psychiatric hospitals.
Kroska, Amy; Harkness, Sarah K; Brown, Ryan P; Thomas, Lauren S
We examine a key modified labeling theory proposition-that a psychiatric label increases vulnerability to competence-based criticism and rejection-within task- and collectively oriented dyads comprised of same-sex individuals with equivalent education. Drawing on empirical work that approximates these conditions, we expect the proposition to hold only among men. We also expect education, operationalized with college class standing, to moderate the effects of gender by reducing men's and increasing women's criticism and rejection. But, we also expect the effect of education to weaken when men work with a psychiatric patient. As predicted, men reject suggestions from teammates with a psychiatric history more frequently than they reject suggestions from other teammates, while women's resistance to influence is unaffected by their teammate's psychiatric status. Men also rate psychiatric patient teammates as less powerful but no lower in status than other teammates, while women's teammate assessments are unaffected by their teammate's psychiatric status. Also as predicted, education reduces men's resistance to influence when their teammate has no psychiatric history. Education also increases men's ratings of their teammate's power, as predicted, but has no effect on women's resistance to influence or teammate ratings. We discuss the implications of these findings for the modified labeling theory of mental illness and status characteristics theory. Copyright © 2015 Elsevier Inc. All rights reserved.
Kahana, Eva; Midlarsky, Elizabeth
The elderly have generally been portrayed as needy recipients of services; only recently has attention been paid to their contributory role. To explore the nature and characteristics of helping behavior among urban elderly, 117 residents of senior citizens' housing sites in Detroit completed the Altruism Scale for the Elderly and a second measure…
Full Text Available Abstract: In the last century, advances in medical care and longevity have resulting in an increase in the elderly population, and the world and Turkey populations have become older. In parallel with the aging population, problems seen in old people have been increasing. Burn, one of these problems, causes more serious injuries and high level of mortality in people aged 65 years and over compared to the general population. Reduction in sensory/cognitive functions, slowing reflexes, limited movements and accompanying situations (chronic diseases, alcoholism, used medication, neurological and psychiatric disorders which are due to physiology of elderly people increase the burn incidence and the severity of burn. In addition, these factors could also raise the ventilation requirement, complications and hospitalization period in burnt patients. Despite the recent developmetns in burn treatment and care, burn is still a serious health problem for elderly people. As the majority of the burn injuries are preventable, the essential point of burn administration in elderly people should be related to the prevention of burn incidence. [TAF Prev Med Bull 2011; 10(2.000: 251-254
Chaturvedi, Santosh K; Desai, Geetha; Shaligram, Deepika
The prevalence--and type--of dissociative disorders is considered to vary across cultures and over time. The aim of the study was to examine patterns of dissociative disorders among subjects attending psychiatric services over a period of 10 years. The sample consisted of both inpatients and outpatients attending a psychiatric hospital between 1999 and 2008. Information of those subjects diagnosed to have dissociative disorders was reviewed. A semi-structured proforma was used to collect information about demographic details and diagnosis. A total of 893 patients had been diagnosed with dissociative disorder over the past decade: 591 (66%) were outpatients and 302 (34%) were inpatients. The proportion of patients diagnosed with dissociative disorders ranged between 1.5 and 15.0 per 1,000 for outpatients and between 1.5 and 11.6 per 1,000 for inpatients. The majority of patients were diagnosed with dissociative motor disorder (43.3% outpatients, 37.7% inpatients), followed by dissociative convulsions (23% outpatients, 27.8% inpatients). Female preponderance was seen across all sub-types of dissociative disorder except dissociative fugue. Dissociative disorders are still commonly diagnosed in both inpatient and outpatient settings. Dissociative motor disorders and dissociative convulsions are the most common disorders. Unlike in the West, dissociative identity disorders were rarely diagnosed; instead, possession states were commonly seen in the Indian population, indicating cross-cultural disparity.
Mariana Inés Ybarra
Full Text Available OBJECTIVE: To investigate the prevalence of psychiatric disorders in patients with myasthenia gravis (MG. METHOD: Forty-one patients with MG answered to a structured psychiatric interview (MINI-Plus. RESULTS: Eleven (26.1% patients were diagnosed with a depressive disorder and 19 (46.3% were diagnosed with an anxiety disorder. Patients with dysthymia were older (p=0.029 and had longer disease duration (p=0.006. Patients with social phobia also had longer disease duration (p=0.039. CONCLUSION: Psychiatric disorders in MG are common, especially depressive and anxiety disorders.
Full Text Available The cerebellum has been considered for a long time to play a role solely in motor coordination. However, studies over the past two decades have shown that the cerebellum also plays a key role in many motor, cognitive, and emotional processes. In addition, studies have also shown that the cerebellum is implicated in many psychiatric disorders including attention deficit hyperactivity disorder, autism spectrum disorders, schizophrenia, bipolar disorder, major depressive disorder and anxiety disorders. In this review, we discuss existing studies reporting cerebellar dysfunction in various psychiatric disorders. We will also discuss future directions for studies linking the cerebellum to psychiatric disorders.
Sikorski, Claudia; Glaesmer, Heide
This article addresses the usage of qualitative methods in psychiatric research and presents the qualitative approach in more detail. Recent original empirical work of a German psychiatric journal was systematically reviewed. Methods used to collect and analyse the information are detailed. One third of the articles used a solely qualitative research design. One further article applied a combination of quantitative and qualitative approaches. Three kinds of the qualitative interviews were used (in depth, narrative and problem-focussed interview). Additionally, focus groups (group discussions) and qualitative content analysis were applied by studies. Qualitative approaches are an integral part of psychiatric research. Further work should assure to use adequate sampling strategies.
Jaite, Charlotte; Hoffmann, Falk; Glaeske, Gerd; Bachmann, Christian J
This study aimed at investigating the prevalence, psychiatric comorbidity and outpatient treatment in a sample of German children and adolescents with eating disorders (EDs). Data of a large German statutory health insurance company were analysed and outpatients aged between 10 and 21 years with an ED diagnosis in 2009 were identified. Of 248,558 insured children and adolescents, 1,404 patients (79.9 % females, mean age: 16.7; SD: 3.3 years) matched the inclusion criteria. The large majority of patients with anorexia nervosa (AN) and bulimia nervosa (BN) were females (94.7 and 92.7 %), on which we focus in the following analyses. The prevalence in females was 0.28 % (AN) and 0.20 % (BN). Psychiatric comorbidity was diagnosed in 59.8 % (AN) and 64.1 % (BN) of patients, respectively. Most patients were treated with psychotherapy (AN: 75.7 %, BN: 78.5 %), 16.4 % (AN) and 20.2 % (BN) of our patients received pharmacotherapy with either antidepressants or antipsychotics. 23.5 % (AN) and 21.1 % (BN) received no treatment with psychotherapy, antidepressants or antipsychotics. This naturalistic study suggests that in young ED outpatients, EDs seem to be underdiagnosed and treatment does not necessarily comply with current guidelines. Therefore, dissemination of state-of-the-art knowledge on diagnosis and treatment in children and adolescents with EDs constitutes an important educational goal.
Struch, Naomi; Levav, Itzhak; Shereshevsky, Yechiel; Baidani-Auerbach, Alona; Lachman, Max; Daniel, Noga; Zehavi, Tali
Mental health-related stigma causes suffering and interferes with care and social inclusion. This study explored stigma as experienced by mental health service users. Particular attention is given to their use of coping mechanisms. Interviews were held with 167 adults undergoing outpatient psychiatric treatment; two-thirds of them had previously been hospitalized. Examples of frequency of stigma-related situations included the following: Over half of service users expect people to refuse to have a person with a mental disorder as a co-worker or neighbor, or to engage in other types of social contact. A sizeable group acknowledged that they feared or had experienced rejection. A third of respondents reported they feared or had experienced inappropriate treatment by their doctor. Service users utilize several coping mechanisms to deal with stigma, among them: education, withdrawal, secrecy, and positive distinctiveness. Although we studied a convenience sample of service users, our findings provide sufficient basis to suggest different types of intervention, i.e., to address stigma in the course of treatment in the specialist settings, to promote the establishment of mutual support groups, and to raise family physicians' awareness with regard to the stigma that may be present when caring for persons with mental disorders.
Restek-Petrović, Branka; Mihanović, Mate; Grah, Majda; Molnar, Sven; Bogović, Anamarija; Agius, Mark; Kezić, Slobodanka; Grošić, Vladimir; Mayer, Nina; Svrdlin, Pero; Dominis, Vesna; Goršić, Lada; Kamerman, Nenad; Pavlović, Irena; Švagelj, Ana
The Early intervention program for the first episodes of psychotic disorders (RIPEPP) at the Psychiatric Hospital “Sveti Ivan“ in Zagreb encompasses patients hospitalized due to various psychoses (acute psychotic disorder, schizophrenia, schizoaffective and delusional disorder, bipolar affective disorder with psychotic symptoms) in the “critical period“ of illness, i.e. within five years after the occurrence of the first symptoms. The RIPEPP Program consists of an in- and out-patient...
Konzag, T A; Rübler, D; Bloching, M; Bandemer-Greulich, U; Fikentscher, E; Frommer, J
Counselling is a basic psychological intervention for chronic tinnitus the effectiveness of which has not yet been evaluated. The therapeutic effect of counselling was compared to that of a self-help manual. Outcome was analysed for tinnitus disability, tendency to become chronic, and accompanying psychiatric disorders. A total of 75 tinnitus outpatients were randomly assigned to group counselling (n=35) and self-help (n=40). Tinnitus disability, general psychological disturbances, depression, anxiety, coping and illness beliefs were measured using questionnaires (TQ, SCL-90-R, BDI, BAI, FKV, KKG) administered before and after treatment and at a 6-month follow-up. Psychiatric disorders (DSM-IV) were assessed using the CIDI. Counselling and the self-help manual had a significant effect on tinnitus disability, showing most profit for participants with a high level of tinnitus distress. The significant reduction in tinnitus distress was maintained at the 6-month follow-up. There was, however, no difference between the two treatment-groups. Effect-sizes for patients with DSM-IV-diagnoses were smaller. For tinnitus outpatients without psychiatric comorbidity, self-help manuals can be an effective first treatment.
Esper, Larissa Horta; Corradi-Webster, Clarissa Mendonça; Carvalho, Ana Maria Pimenta; Furtado, Erikson Felipe
Quantitative and descriptive study aimed to identify sociodemographic and clinical characteristics of women undergoing outpatient treatment for alcohol abuse. Data were collected from medical records of women with alcohol-related disorders who were treated at a psychiatric outpatient service We performed a reading and descriptive analysis of such data. The sample was composed of 27 medical records, the average age of women was 50 years, mostly married (59.6%), not working (70.4%) with incomplete primary education (70.4%), with an alcoholic family (81.5%) and other psychiatric diagnoses (70.3%). Losses physical, social and emotional was the most common symptoms resulting from alcohol withdrawal syndrome (66.7%), family conflicts (72%) and "sadness" (79.2%). Family violence was recorded in 11 records (40.7%). There was low education, unemployment, psychiatric comorbidities and the presence of other family members with alcohol abuse as common characteristics. We emphasize the importance of professional knowledge about the peculiarities of female alcoholism for health activities more effective.
Carey, Kathleen; Montez-Rath, Maria E; Rosen, Amy K; Christiansen, Cindy L; Loveland, Susan; Ettner, Susan L
To examine how service accessibility measured by geographic distance affects service sector choices for veterans who are dually eligible for veterans affairs (VA) and Medicare services and who are diagnosed with mental health and/or substance abuse (MH/SA) disorders. Primary VA data sources were the Patient Treatment (acute care), Extended Care (long-term care), and Outpatient Clinic files. VA cost data were obtained from (1) inpatient and outpatient cost files developed by the VA Health Economics and Resource Center and (2) outpatient VA Decision Support System files. Medicare data sources were the denominator, Medicare Provider Analysis Review (MEDPAR), Provider-of-Service, Outpatient Standard Analytic and Physician/Supplier Standard Analytic files. Additional sources included the Area Resource File and Census Bureau data. We identified dually eligible veterans who had either an inpatient or outpatient MH/SA diagnosis in the VA system during fiscal year (FY)'99. We then estimated one- and two-part regression models to explain the effects of geographic distance on both VA and Medicare total and MH/SA costs. Results provide evidence for substitution between the VA and Medicare, demonstrating that poorer geographic access to VA inpatient and outpatient clinics decreased VA expenditures but increased Medicare expenditures, while poorer access to Medicare-certified general and psychiatric hospitals decreased Medicare expenditures but increased VA expenditures. As geographic distance to VA medical facility increases, Medicare plays an increasingly important role in providing mental health services to veterans.
Polimeni, Giovanni; Cutroneo, Paola; Gallo, Adele; Gallo, Salvatore; Spina, Edoardo; Caputi, Achille P
To report the case of a patient who developed marked anxiety associated with episodes of panic attacks after starting rabeprazole therapy. An otherwise healthy 55-year-old woman was prescribed rabeprazole 20 mg/day administered in the morning for persistent symptoms of dyspepsia. Ten days later, she presented with a 7 day history of marked anxiety associated with panic attacks, night terror (pavor nocturnus), episodic mental confusion, and attention deficit. Within 2 days of discontinuing rabeprazole, the patient recovered completely from the neuropsychiatric manifestations. Subsequent esomeprazole therapy did not cause psychiatric symptoms. Rabeprazole-induced hypergastrinemia may have played a role in this neuropsychiatric adverse reaction. Several lines of evidence have indicated that gastrin-releasing peptide, whose release is mediated by proton pump inhibitor (PPI)-induced secretion of gastrin, is involved in regulating aspects of behavior that might be altered in disorders such as anxiety, depression, and dementia. The fact that rabeprazole has the highest capacity of inducing gastrin increase compared with other PPIs might explain why our patient's panic symptoms disappeared after switching to esomeprazole. Based on the Naranjo probability scale, rabeprazole was the probable cause of the adverse reaction. Specific studies are needed to investigate the potential role of PPI-induced hypergastrinemia in neuropsychiatric adverse reactions.
Ünlü, Çagdas; Gunadi, Patrick M.; Gerhards, Michael F.; Boermeester, Marja A.; Vrouenraets, Bart C.
Traditionally, treatment of acute diverticulitis has mostly been based on inpatient care. The question arises whether these patients can be treated on an outpatient basis as the admissions for diverticular disease have been shown to be increasing every year. We studied whether outpatient treatment
Mioton, Lauren M; Buck, Donald W; Rambachan, Aksharananda; Ver Halen, Jon; Dumanian, Gregory A; Kim, John Y S
Hospital readmissions have become a topic of focus for quality care measures and cost-reduction efforts. However, no comparative multi-institutional data on plastic surgery outpatient readmission rates currently exist. The authors endeavored to investigate hospital readmission rates and predictors of readmission following outpatient plastic surgery. The 2011 National Surgical Quality Improvement Program database was reviewed for all outpatient procedures. Unplanned readmission rates were calculated for all 10 tracked surgical specialties (i.e., general, thoracic, vascular, cardiac, orthopedics, otolaryngology, plastics, gynecology, urology, and neurosurgery). Multivariate logistic regression models were used to determine predictors of readmission for plastic surgery. A total of 7005 outpatient plastic surgery procedures were isolated. Outpatient plastic surgery had a low associated readmission rate (1.94 percent) compared with other specialties. Seventy-five patients were readmitted with a complication. Multivariate regression analysis revealed obesity (body mass index ≥ 30), wound infection within 30 days of the index surgery, and American Society of Anesthesiologists class 3 or 4 physical status as significant predictors for unplanned readmission. Unplanned readmission after outpatient plastic surgery is infrequent and compares favorably to rates of readmission among other specialties. Obesity, wound infection within 30 days of the index operation, and American Society of Anesthesiologists class 3 or 4 physical status are independent predictors of readmission. As procedures continue to transition into outpatient settings and the drive to improve patient care persists, these findings will serve to optimize outpatient surgery use.
Full Text Available BACKGROUND: Mounting evidence suggests a link between low zinc levels and depression. There is, however, little knowledge about zinc levels in older persons with other psychiatric diagnoses. Therefore, we explore the zinc status of elderly patients suffering from a wide range of psychiatric disorders. METHODS: Clinical data and blood samples for zinc analyzes were collected from 100 psychogeriatric patients over 64 of age. Psychiatric and cognitive symptoms were assessed using the Montgomery and Aasberg Depression Rating Scale, the Cornell Scale for Depression in Dementia, the Mini-Mental State Examination, the Clockdrawing Test, clinical interviews and a review of medical records. In addition, a diagnostic interview was conducted using the Mini International Neuropsychiatric Interview instrument. The prevalence of zinc deficiency in patients with depression was compared with the prevalence in patients without depression, and the prevalence in a control group of 882 older persons sampled from a population study. RESULTS: There was a significant difference in zinc deficiency prevalence between the control group (14.4% and the patient group (41.0% (χ(2 = 44.81, df = 1, p<0.001. In a logistic model with relevant predictors, zinc deficiency was positively associated with gender and with serum albumin level. The prevalence of zinc deficiency in the patient group was significantly higher in patients without depression (i.e. with other diagnoses than in patients with depression as a main diagnosis or comorbid depression (χ(2 = 4.36, df = 1, p = 0.037. CONCLUSIONS: Zinc deficiency is quite common among psychogeriatric patients and appears to be even more prominent in patients suffering from other psychiatric disorders than depression. LIMITATIONS: This study does not provide a clear answer as to whether the observed differences represent a causal relationship between zinc deficiency and psychiatric symptoms. The blood sample collection time points
Patel, Shaun R; Aronson, Joshua P; Sheth, Sameer A; Eskandar, Emad N
Lesion procedures for psychiatric indications have a history that spans more than a century. This review provides a brief history of psychiatric surgery and addresses the most recent literature on lesion surgery for the treatment of anxiety and mood disorders. Relevant data described in publications from the early 1900 s through the modern era regarding lesion procedures for psychiatric indications, both historical and current use, are reported. The early procedures of Burkhardt, Moniz, and Freeman are reviewed, followed by descriptions of the more refined techniques of Leksell, Knight, Foltz, White, and Kelly. The application of lesion procedures to obsessive-compulsive disorder, mood disorders, and addiction are discussed. Lesioning procedures have informed modern deep brain stimulation targets. Recent lesioning studies demonstrate the efficacy and durability of these procedures in severely disabled patients. Judicious application of these techniques should continue for appropriately selected patients with severe, refractory psychiatric disorders. Copyright © 2013. Published by Elsevier Inc.
J Gordon Millichap
Full Text Available The prevalence of teacher-rated tic behaviors in 3006 school children, from preschool to adolescence, was determined in a study of comorbid psychiatric symptoms at State University of New York, Stony Brook, NY.
J Gordon Millichap
The prevalence of teacher-rated tic behaviors in 3006 school children, from preschool to adolescence, was determined in a study of comorbid psychiatric symptoms at State University of New York, Stony Brook, NY.
Öster, Caisa; Bäckström, Susan; Lantz, Ingrid; Ramklint, Mia
In the education of professionals in psychiatry, one challenge is to provide clinical placements with opportunities for students to interact and have direct contact with patients. The aim of this study was to explore Swedish psychiatric patients' perspectives on student participation in their care. In a cross-sectional survey design, 655 adult psychiatric patients at a university hospital completed questionnaires. These questionnaires included statements about student involvement, student gender, attitudes towards student participation as well as two open-ended questions. Data were analyzed quantitatively and qualitatively. The majority of the patients were comfortable with student participation. There were no differences between patients in wards compared to outpatients but patients who previously had students involved in their care reported higher comfort levels and a more positive attitude. Female patients were less comfortable with male students and very young students. Patients stressed the importance of being informed about the opportunity to refuse student participation. More detailed information given before the consultation as well as the importance of the student showing a professional attitude was conditions that could enable more patients to endorse student participation. The psychiatric patients' overall positive attitudes are in line with previous findings from other specialties and countries. The results support both altruistic motives and experience of personal gains by student involvement. More detailed information given beforehand would enable more patients to consider student participation.
Nation-wide German Counseling Review regarding psychiatry in 1975 yielded a reasonable reform of psychiatric care in Germany. Especially outpatient and complementary caring concepts promoted the integration of psychiatric patients in their communities. However, this development was paralled by an increase of involuntary hospitalisations in Northrine-Westphalia. Within ten years involuntary hospitalisations doubled in some communities. These findings contrast with recent concepts of a complex community psychiatry with improved caring according to humanitarian principles and those of non-violence. These specific settings must be taken into consideration in developing community psychiatry. The report presents the activity of the working group concerning community psychiatry in Northrine-Westphalia. During its annual meetings a standardised and valid documentation concerning hospitalisation procedures in the communities as a means of quality control was discussed repeatedly. Taking into consideration the data of this survey the complex mechanisms leading to an increase of involuntary hospitalisations becomes understandable. Health reporting on a community level on the topic of involuntary hospitalisations is an important tool for discussion of its complex psychosocial and administrative mechanisms. Discussion about standard procedures in psychiatric emergency care service will thus be enabled.
Testa, A; Giannuzzi, R; Sollazzo, F; Petrongolo, L; Bernardini, L; Dain, S
In this Part II psychiatric disorders coexisting with organic diseases are discussed. "Comorbidity phenomenon" defines the not univocal interrelation between medical illnesses and psychiatric disorders, each other negatively influencing morbidity and mortality. Most severe psychiatric disorders, such as schizophrenia, bipolar disorder and depression, show increased prevalence of cardiovascular disease, related to poverty, use of psychotropic medication, and higher rate of preventable risk factors such as smoking, addiction, poor diet and lack of exercise. Moreover, psychiatric and organic disorders can develop together in different conditions of toxic substance and prescription drug use or abuse, especially in the emergency setting population. Different combinations with mutual interaction of psychiatric disorders and substance use disorders are defined by the so called "dual diagnosis". The hypotheses that attempt to explain the psychiatric disorders and substance abuse relationship are examined: (1) common risk factors; (2) psychiatric disorders precipitated by substance use; (3) psychiatric disorders precipitating substance use (self-medication hypothesis); and (4) synergistic interaction. Diagnostic and therapeutic difficulty concerning the problem of dual diagnosis, and legal implications, are also discussed. Substance induced psychiatric and organic symptoms can occur both in the intoxication and withdrawal state. Since ancient history, humans selected indigene psychotropic plants for recreational, medicinal, doping or spiritual purpose. After the isolation of active principles or their chemical synthesis, higher blood concentrations reached predispose to substance use, abuse and dependence. Abuse substances have specific molecular targets and very different acute mechanisms of action, mainly involving dopaminergic and serotoninergic systems, but finally converging on the brain's reward pathways, increasing dopamine in nucleus accumbens. The most common
Full Text Available Objective: Quality of life (QOL assessment has been employed increasingly to evaluate outcome among patients with chronic medical conditions. Such assessment could be adversely affected by psychiatric disorders, co existing with such a medical condition. Method: A cross sectional study of 251 out-patients with diabetes mellitus was done at a Nigerian University Teaching Hospital using the Composite Diagnostic Interview (CIDI for psychiatric assessment and the World Health Organisation Quality of Life brief version (WHOQOL-BREF to evaluate the QOL. Results: Fifty (20% of the 251 respondents met the ICD-10 criteria for definite psychiatric diagnosis. Depression accounted for 9.6% while twenty-six (10.4% had anxiety disorder. Of the 35 respondents who performed poorly on the overall quality of life, 17(48.57% had psychiatric diagnosis; 9 were depressed and 8 had anxiety disorder. 39 (15.5% scored poor on the physical health domain. 21(53.8% of the 39 respondents with poor score had psychiatric diagnosis: 13 had depression while 8 had anxiety disorder. On domain 1 (physical health, 51 (20.3% scored poor. Twenty-eight (54.9% of the poor scorers had psychiatric diagnosis, 20 were depressed while 8 had anxiety. 51 (20.3% scored poor on psychological domain (domain 2 twenty-eight (54.9% of the poor scorers had psychiatric diagnosis, 20 of which were depressed while 8 had anxiety. 34 (13.5% scored poor on social relations (domain 3. 19 (55.9% of those who scored poor had psychiatric disorder and the diagnosis was depression. Conclusions: Physicians need to increase their surveillance of psychiatric co-morbidity in diabetes mellitus and collaborate with psychiatrists for a more effective liaison to improve the quality of life of patients with diabetes.
Full Text Available BACKGROUND: Psychiatric manifestations after occurrence of epilepsy have often been noted. However, the association between newly diagnosed epilepsy and psychiatric disorders afterward is not completely understood. We conducted two longitudinal cohorts for patients with and without epilepsy to investigate the risk factors and hazard ratios of developing psychiatric disorders after patients were newly diagnosed with epilepsy. METHODS: We identified 938 patients with a new diagnosis of epilepsy and 518,748 participants without epilepsy from the National Health Insurance Research Database in 2000-2002 and tracked them until 2008. We compared the incidence of developing psychiatric disorders between the two cohorts, evaluated risk factors and measured the associated hazard ratios (HRs and 95% confidence intervals (CIs of developing psychiatric disorders. FINDINGS: The incidences of psychiatric disorders for people with and without epilepsy were 94.1 and 22.6 per 1000 person-years, respectively. After adjusting the covariates, the epilepsy cohort showed the highest risks in mental retardation (HR 31.5, 95% CI 18.9 to 52.4, bipolar disorder (HR 23.5, 95% CI 11.4 to 48.3 and alcohol or drug psychosis (HR 18.8, 95% CI 11.1 to 31.8 among psychiatric complications developed after newly diagnosed epilepsy. The risk increased with epileptic general seizure and frequency of outpatient visits for epilepsy, as well as with emergency room visits and hospitalizations for epilepsy, and with older age. Chronologically, the highest risk occurred in the first year after epilepsy diagnosis (HR 11.4, 95% CI 9.88 to 13.2. CONCLUSION: Various psychiatric disorders were demonstrated after newly diagnosed epilepsy and closely related to general seizure and use of medical services for epilepsy. This shows a need for integrated psychiatric care for patients newly diagnosed with epilepsy, especially in the first year.
Stotland, Nada L
Approximately one third of the women in the United States have an abortion during their lives. In the year 2008, 1.21 million abortions were performed in the United States (Jones and Koolstra, Perspect Sex Reprod Health 43:41-50, 2011). The psychiatric outcomes of abortion are scientifically well established (Adler et al., Science 248:41-43, 1990). Despite assertions to the contrary, there is no evidence that abortion causes psychiatric problems (Dagg, Am J Psychiatry 148:578-585, 1991). Those studies that report psychiatric sequelae suffer from severe methodological defects (Lagakos, N Engl J Med 354:1667-1669, 2006). Methodologically sound studies have demonstrated that there is a very low incidence of frank psychiatric illness after an abortion; women experience a wide variety of feelings over time, including, for some, transient sadness and grieving. However, the circumstances that lead a woman to terminate a pregnancy, including previous and/or ongoing psychiatric illness, are independently stressful and increase the likelihood of psychiatric illness over the already high baseline incidence and prevalence of mood and anxiety disorders among women of childbearing age. For optimal psychological outcomes, women, including adolescents, need to make autonomous and supported decisions about problem pregnancies. Clinicians can help patients facing these decisions and those who are working through feelings about having had abortions in the past.
Old men are overrepresented in the whole of all suicides. In contrast, only very few elderly men find their way to specialised treatment facilities. Elderly accept psychotherapy more rarely than younger persons. Therefore presentations on the psychodynamics of suicidality in old men are rare and mostly casuistical. By means of a stepwise reconstructable qualitative case comparison of five randomly chosen elderly suicidal men with ideal types of suicidal (younger) men concerning biography, suicidal symptoms and transference, psychodynamic hypothesis of suicidality in elderly men are developed. All patients came into psychotherapy in a specialised academic out-patient clinic for psychodynamic treatment of acute and chronic suicidality. The five elderly suicidal men predominantly were living in long-term, conflictuous sexual relationships and also had ambivalent relationships to their children. Suicidality in old age refers to lifelong existing intrapsychic conflicts, concerning (male) identity, self-esteem and a core conflict between fusion and separation wishes. The body gets a central role in suicidal experiences, being a defensive instance modified by age and/or physical illness, which brings up to consciousness aggressive and envious impulses, but also feelings of emptiness and insecurity, which have to be warded off again by projection into the body. In transference relationships there are on the one hand the regular transference, on the other hand an age specific turned around transference, with their counter transference reactions. The chosen methodological approach serves the systematic finding of hypotheses with a higher degree in evidence than hypotheses generated from single case studies. Georg Thieme Verlag KG Stuttgart - New York.
Full Text Available Collaborative care models for treatment of depression and anxiety disorders in primary care have been shown to be effective. The aim of this study was to investigate at the municipal level to what extent investment in mental health personnel at primary care health centres in the study area is reflected in the costs and use of secondary psychiatric services. Furthermore, we analysed whether the service provision and use of secondary psychiatric care correlates with the socioeconomic indicators of need. We found significant variation in the amount of mental health personnel provided at the health centres, uncorrelated with the indicators of need nor with the costs of secondary psychiatric care. The amount of mental health nurses at the health centres correlated inversely with the number of secondary psychiatric outpatient visits, whereas its relation to inpatient days and admission was positive. The costs of secondary psychiatric care correlated with level of psychiatric morbidity and socioeconomic indicators of need. The results suggest that when aiming at equal access of care and cost-efficiency, the primary and secondary care should be organized and planned with integrative collaboration.
Vadlin, Sofia; Åslund, Cecilia; Hellström, Charlotta; Nilsson, Kent W
The aim of the present study was to investigate associations between problematic gaming and psychiatric symptoms among adolescents. Data from adolescents in the SALVe cohort, including adolescents in Västmanland who were born in 1997 and 1999 (N=1868; 1034 girls), and data from consecutive adolescent psychiatric outpatients in Västmanland (N=242; 169 girls) were analyzed. Adolescents self-rated on the Gaming Addiction Identification Test (GAIT), Adult ADHD Self-Report Scale Adolescent version (ASRS-A), Depression Self-Rating Scale Adolescent version (DSRS-A), Spence Children's Anxiety Scale (SCAS), and psychotic-like experiences (PLEs). Multivariable logistic regression analyses were performed, and adjusted for sex, age, study population, school bullying, family maltreatment, and interactions by sex, with two-way interactions between psychiatric measurements. Boys had higher self-rated problematic gaming in both samples, whereas girls self-rated higher in all psychiatric domains. Boys had more than eight times the probability, odds ratio (OR), of having problematic gaming. Symptoms of ADHD, depression and anxiety were associated with ORs of 2.43 (95% CI 1.44-4.11), 2.47 (95% CI 1.44-4.25), and 2.06 (95% CI 1.27-3.33), respectively, in relation to coexisting problematic gaming. Problematic gaming was associated with psychiatric symptoms in adolescents; when problematic gaming is considered, the probability of coexisting psychiatric symptoms should also be considered, and vice versa. Copyright © 2016 Elsevier Ltd. All rights reserved.
Kalb, Luther G; Stuart, Elizabeth A; Vasa, Roma A
This study examined differences in the rates of psychiatric-related emergency department visits among adolescents with autism spectrum disorder, adolescents with attention deficit hyperactivity disorder, and adolescents without autism spectrum disorder or attention deficit hyperactivity disorder. Additional outcomes included emergency department recidivism, probability of psychiatric hospitalization after the emergency department visit, and receipt of outpatient mental health services before and after the emergency department visit. Data came from privately insured adolescents, aged 12-17 years, with autism spectrum disorder (N = 46,323), attention deficit hyperactivity disorder (N = 408,066), and neither diagnosis (N = 2,330,332), enrolled in the 2010-2013 MarketScan Commercial Claims Database. Adolescents with autism spectrum disorder had an increased rate of psychiatric emergency department visits compared to adolescents with attention deficit hyperactivity disorder (IRR = 2.0, 95% confidence interval: 1.9, 2.1) and adolescents with neither diagnosis (IRR = 9.9, 95% confidence interval: 9.4, 10.4). Compared to the other groups, adolescents with autism spectrum disorder also had an increased probability of emergency department recidivism, psychiatric hospitalization after the emergency department visit, and receipt of outpatient care before and after the visit (all p < 0.001). Further research is required to understand whether these findings extend to youth with other neurodevelopmental disorders, particularly those who are publicly insured.
Gammelmark, Carina; Jensen, Signe Ow; Plessen, Kerstin J
OBJECTIVE: Is an increased focus on eating disorders during the past few decades reflected by increasing occurrence in the psychiatric health service system. METHOD: All first-time diagnoses of eating disorders identified in the Danish Central Psychiatric Research Register 1970-2008 constitute...... the present research database. Age-standardized rates per 100,000 inhabitants were calculated and autoregressive models were fitted for males and females separately as well as for in- and outpatients. RESULTS: The incidence of eating disorders diagnosed in Danish psychiatric secondary healthcare has increased...... considerably during a nearly 40-year period of observation both within the general category of eating disorders and also specifically for anorexia nervosa. The steepest increase is seen within females aged 15-19 years, where the highest incidences are also found. Anorexia nervosa constitutes the vast majority...
Brown, Matthew; Coffee, Tammy; Adenuga, Paul; Yowler, Charles J
The literature surrounding pediatric burns has focused on inpatient management. The goal of this study is to characterize the population of burned children treated as outpatients and assess outcomes validating this method of burn care. A retrospective review of 953 patients treated the burn clinic and burn unit of a tertiary care center. Patient age, burn etiology, burn characteristics, burn mechanism, and referral pattern were recorded. The type of wound care and incidence of outcomes including subsequent hospital admission, infection, scarring, and surgery served as the primary outcome data. Eight hundred and thirty children were treated as outpatients with a mean time of 1.8 days for the evaluation of burn injury in our clinic. Scalds accounted for 53% of the burn mechanism, with burns to the hand/wrist being the most frequent area involved. The mean percentage of TBSA was 1.4% for the outpatient cohort and 8% for the inpatient cohort. Burns in the outpatient cohort healed with a mean time of 13.4 days. In the outpatient cohort, nine (1%) patients had subsequent admissions and three (0.4%) patients had concern for infection. Eight patients from the outpatient cohort were treated with excision and grafting. The vast majority of pediatric burns are small, although they may often involve more critical areas such as the face and hand. Outpatient wound care is an effective treatment strategy which results in low rates of complications and should become the standard of care for children with appropriate burn size and home support.
Perlis, Roy H.; Uher, Rudolf; Ostacher, Michael; Goldberg, Joseph F.; Trivedi, Madhukar H.; Rush, A. John; Fava, Maurizio
Context It has been suggested that patients with major depressive disorder (MDD) who display pretreatment features suggestive of bipolar disorder or bipolar spectrum features might have poorer treatment outcomes. Objective To assess the association between bipolar spectrum features and antidepressant treatment outcome in MDD. Design Open treatment followed by sequential randomized controlled trials. Setting Primary and specialty psychiatric outpatient centers in the United States. Participants Male and female outpatients aged 18 to 75 years with a DSM-IV diagnosis of nonpsychotic MDD who participated in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Interventions Open treatment with citalopram followed by up to 3 sequential next-step treatments. Main Outcome Measures Number of treatment levels required to reach protocol-defined remission, as well as failure to return for the postbaseline visit, loss to follow-up, and psychiatric adverse events. For this secondary analysis, putative bipolar spectrum features, including items on the mania and psychosis subscales of the Psychiatric Diagnosis Screening Questionnaire, were examined for association with treatment outcomes. Results Of the 4041 subjects who entered the study, 1198 (30.0%) endorsed at least 1 item on the psychosis scale and 1524 (38.1%) described at least 1 recent manic-like/hypomaniclike symptom. Irritability and psychotic-like symptoms at entry were significantly associated with poorer outcomes across up to 4 treatment levels, as were shorter episodes and some neurovegetative symptoms of depression. However, other indicators of bipolar diathesis including recent maniclike symptoms and family history of bipolar disorder as well as summary measures of bipolar spectrum features were not associated with treatment resistance. Conclusion Self-reported psychoticlike symptoms were common in a community sample of outpatients with MDD and strongly associated with poorer outcomes. Overall
Perlis, Roy H; Uher, Rudolf; Ostacher, Michael; Goldberg, Joseph F; Trivedi, Madhukar H; Rush, A John; Fava, Maurizio
It has been suggested that patients with major depressive disorder (MDD) who display pretreatment features suggestive of bipolar disorder or bipolar spectrum features might have poorer treatment outcomes. To assess the association between bipolar spectrum features and antidepressant treatment outcome in MDD. Open treatment followed by sequential randomized controlled trials. Primary and specialty psychiatric outpatient centers in the United States. Male and female outpatients aged 18 to 75 years with a DSM-IV diagnosis of nonpsychotic MDD who participated in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Open treatment with citalopram followed by up to 3 sequential next-step treatments. Number of treatment levels required to reach protocol-defined remission, as well as failure to return for the postbaseline visit, loss to follow-up, and psychiatric adverse events. For this secondary analysis, putative bipolar spectrum features, including items on the mania and psychosis subscales of the Psychiatric Diagnosis Screening Questionnaire, were examined for association with treatment outcomes. Of the 4041 subjects who entered the study, 1198 (30.0%) endorsed at least 1 item on the psychosis scale and 1524 (38.1%) described at least 1 recent maniclike/hypomaniclike symptom. Irritability and psychoticlike symptoms at entry were significantly associated with poorer outcomes across up to 4 treatment levels, as were shorter episodes and some neurovegetative symptoms of depression. However, other indicators of bipolar diathesis including recent maniclike symptoms and family history of bipolar disorder as well as summary measures of bipolar spectrum features were not associated with treatment resistance. Self-reported psychoticlike symptoms were common in a community sample of outpatients with MDD and strongly associated with poorer outcomes. Overall, the data do not support the hypothesis that unrecognized bipolar spectrum illness contributes
Paramita Sengupta; Anoop I Benjamin
Background: Depression, the most common psychiatric disorder among the elderly, is not yet perceived as an important health problem in India, where few population-based studies have addressed this problem. Objectives: To estimate the prevalence of depression and identify the associated risk factors in the elderly population. Materials and Methods: 3038 consenting elderly (>60 years old) rural and urban residents of both sexes from the field practice areas were interviewed and examined in a cr...
Hoyt, Tim; Barry, David; Kwon, So Heui; Capron, Claire; De Guzman, Noriko; Gilligan, James; Edwards-Stewart, Amanda
Recent U.S. Army policy has established intensive outpatient programs at several installations as part of a comprehensive behavioral health system of care. This study presents retrospective program evaluation data from a case series without randomization or a control group at 1 recently established intensive outpatient program for active duty service members at a joint military installation. Out of 240 patients referred to the program at 1 installation, 200 enrolled in treatment. Of these, 169 completed treatment in a Skills & Resiliency Track (n = 97), Trauma Track (n = 34), or both (Combined Track; n = 38). Patients completed measures of posttraumatic stress symptoms and general distress throughout program enrollment. First year preliminary results show significant decreases in distress for those in the Skills & Resiliency and Combined groups. Trauma group patients showed significant decreases in posttraumatic stress symptoms. Patients in the Skills & Resiliency and Combined groups showed significant decreases in rates of psychiatric hospitalization. These results show potential for treating high-risk or treatment-resistant patients in a half-day intensive outpatient program. Lessons learned and recommendations for establishing intensive outpatient programming for the military are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Priscila Freitas Ramos
Full Text Available Psychiatric hospitalization is controversial, especially when there is no consent of the subject. Even in contemporary times, compulsory psychiatric hospitalization (IPC, is considered as a specific sector protective measure against the violation of elderly people’s rights. This paper identifies, based on court proceedings, how IPCs are done in a midsize city in the state of São Paulo. We used the documentary analysis of civil cases prosecutors, in the light of public health policies, of the mental health and of the Federal Constitution. The protection of the elderly is established via removal of the offender from his home. Actions by the Network of Guaranteed Inter-sectorial Care in the current public policies, previous to the IPC, were not identified.
Observational study of outpatients with schizophrenia in the Middle East and Africa — 3- and 6-month efficacy and safety results. The Intercontinental Schizophrenia Outpatient Health Outcomes Study.
Full Text Available Background: The comorbidity of substance abuse and mental disorder is known to exist and may cause many diagnostic, prognostic, and management difficulties. Indian data are sparse in this area. Objectives: The aim of the study was to identify the prevalence and pattern of substance abuse in psychiatric outpatients and to examine the relation between demographic variables and drug abuse pattern. Materials and Methods: Medical records of the patients attending psychiatry outpatient clinic at a tertiary care general hospital over a 3-month period were reviewed. Information was obtained from medical chart and Drug Abuse Monitoring Scale pro forma about substance abuse. Psychiatric diagnosis made by a qualified psychiatrist according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition diagnostic criteria, as recorded in the case record form, was used. Observation: The results revealed that 50.8% (half of all psychiatry outpatients were using one or more substances including tobacco in the last month prior to registration (1 month prevalence and 28.35% were using substances at any time in their life prior to the last month (lifetime prevalence. Male patients had 6 to 8 times higher substance abuse than female patients. Tobacco and alcohol were found to be the most common substances of abuse, followed by cannabis. Part-time and full-time employed male patients consumed more alcohol and tobacco than unemployed patients. Conclusions: Substance abuse was common among mentally ill outpatients and could be the cause of various health hazards and hence requires due attention.
Full Text Available Hee Ryung Wang, Young Sup Woo, Tae-Youn Jun, Won-Myong Bahk Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea Objective: This study aimed to examine the sociodemographic and disease-related variables associated with the premature discontinuation of psychiatric outpatient treatment after discharge among patients with noncombat-related posttraumatic stress disorder. Methods: We retrospectively reviewed the medical records of patients who were discharged with a diagnosis of posttraumatic stress disorder. Results: Fifty-five percent of subjects (57/104 prematurely discontinued outpatient treatment within 6 months of discharge. Comparing sociodemographic variables between the 6-month non-follow-up group and 6-month follow-up group, there were no variables that differed between the two groups. However, comparing disease-related variables, the 6-month follow-up group showed a longer hospitalization duration and higher Global Assessment of Function score at discharge. The logistic regression analysis showed that a shorter duration of hospitalization predicted premature discontinuation of outpatient treatment within 6 months of discharge. Conclusion: The duration of psychiatric hospitalization for posttraumatic stress disorder appeared to influence the premature discontinuation of outpatient treatment after discharge. Keywords: posttraumatic stress disorder, discontinuation, compliance, predictor
青木, 正治; 熊本, 悦明
Clinical statistical studies on hematuria were performed in outpatients who were seen at our Department, during the 7-year period from 1974 through 1980. Of the 11,574 outpatients studied, the total number of outpatients with hematuria 1,705; macroscopic hematuria was found in 446 cases (3.9%) and microscopic hematuria was in 1,259 cases (10.9%). The most frequent cause of macroscopic hematuria was malignant urinary tumors and that of microscopic hematuria was urinary tract infections. Macros...
Marcos Hirata Soares
Full Text Available Background There are several parameters that must be included in the evaluation psychosocial rehabilitation. Objectives To describe and correlate the degree of stress of family members who live with schizophrenic and bipolar disorder patients, their satisfaction with mental health services and the level of daily living skills of the patient. Method Cross-sectional and correlational study, from 2012 to 2013, with a sample of 100 caregivers. The Family Satisfaction with Mental Health Services Rating Scale (SATIS-BR, the Independent Living Skills Survey (ILSS-BR, and the General Health Questionnaire (GHQ-12 were used. Data were analyzed using SPSS v.21, with the Mann-Whitney test, Jonckheere-Terpstra test, and Pearson’s, Spearman’s and Partial correlations, and a significance level α = 0.05. Results The score for the SATIS-BR scale was 4.28, 1.59 for the ILSS, and 7.39 for the GHQ-12. The value of the Pearson correlation coefficient between the SATIS-BR and ILSS was r = -0.27, and r = -0.23 between the GHQ-12 and SATIS-BR. The Spearman’s correlation coefficient between Education and the GHQ-12 was r = -0.24 and there was a negative linear trend between stress and the level of education (JT = -2.54, p < 0:01. Discussion The caregivers presented a very high level of psychological distress, therefore, it is critical that mental health services perform more effective psychosocial rehabilitation actions.
Biegel, Gina M.; Brown, Kirk Warren; Shapiro, Shauna L.; Schubert, Christine M.
Research has shown that mindfulness-based treatment interventions may be effective for a range of mental and physical health disorders in adult populations, but little is known about the effectiveness of such interventions for treating adolescent conditions. The present randomized clinical trial was designed to assess the effect of the…
Catherine A. Martin
Full Text Available The objective of this study was to evaluate the relationship between caffeine use, other drug use, and psychopathology in adolescents, using self-report measures. The study group consisted of 132 adolescents (average age 14.01 ± 2.06 years, 52% female, 19% African American, 5% other categories, 76% Caucasian. Most (47% were recruited from a child psychiatry clinic with emphasis on youth with disruptive disorders, with 35% from an adolescent pediatric clinic with emphasis on prevention of risk-taking behavior and 18% from a pediatric clinic for families with limited resources. Subjects were consecutively recruited before or after regular clinic visits. Consent was obtained from parents and assent from the youth. High caffeine consumption was associated with daily cigarette use; aggressive behavior; conduct, attention deficit/hyperactivity, and social problems; and increased somatic complaints in adolescents.
Høy, Bente; Hall, E.O.C.; Wagner, L.
This study shows how care providers in hospital practice perceive the elderly patient's dignity as a core value in health promoting care towards the elderly. Fifteen focus group interviews were conducted with care providers who told about their nursing practice experience. The interviews were...... analysed using a phenomenological hermeneutical approach. The results disclose that when caring for the elderly patient's health potential, care providers saw dignity as the core value of health. Dignity was found to capture three themes: autonomy, identity, and worthiness. These themes reflect...... the principles of nursing practice, protecting, enhancing and promoting the elderly patient's health potential. It is suggested that these themes of dignity provide a frame of reference in elder care; they shape the understanding of when health issues become a concern for health-promoting care for the elderly...
Bullying is a complex phenomenon moderated not only by the personal characteristics and behavioral traits of the individual but also by family rearing practices, as well as by situational factors such as the frequency and type of bullying. The phenomenon is also affected by group processes among the individuals present during the event. Bullying is a distressing experience that is often continuous over years and predicts both concurrent and future psychiatric symptoms and disorders, even in adulthood. At young ages, attention-deficit hyperactivity disorder and depression, as well as anxiety, are prevalent concurrently with bullying among the children involved. Later in young adulthood, male victims are at risk for anxiety, male bullies for personality disorders, and male bully-victims for both personality disorders and anxiety, and the risk is especially increased if the child is disturbed when involved in bullying at school age. Rarely does any single behavior predict future problems as clearly as bullying does, and additional assessment of psychiatric problems is always warranted, if the child is involved in bullying as a bully, victim or bully-victim. Based on our current knowledge, school-based interventions regulating the behavior of the child, increasing pro-social skills and promoting peer relationships are recommended for those without concurrent psychiatric disturbance, but those displaying psychiatric symptoms and disorders should be referred for psychiatric consultation and intervention.
Full Text Available Introduction: Severe Psychiatricillness is accompanied by gross disturbances in patient's occupational role. This study presents a comparative picture of work performance before and after psychiatric hospitalization. Method: Subjects comprised 440 psychiatric admitters from Noor Medical center - Isfahan - Iran, who were followed from November 1999 to November 2000. Their work adjustment was measured by means of Weiss man's index. Data were computer analyzed using SPSS by running paired t- student and ANOVA. Results: Majority of the patients (53 % were without permanent sources of income before psychiatric hospitalization, about 12 percent of those who were working prior to hospitalization lost their job after being discharged from hospital. Better work adjustment before hospitalization was positively correlated with better work adjustment after discharge for working patients (r =0/66. Working ability of the patients after discharge was lesser than before the attack f9r patients with regular and irregular job (P < 001. Discussion: Job loss or poor working ability after psychiatric admission reported by several researchers and has bean confirmed in this study as well. These observatoins have been discussed in view of the current socio economic problems in the society and nature of psychiatric disturbances.
Ameri, Fereshteh; Vazifeshenas, Naser; Haghparast, Abbas
The growing elderly population calls mental health professionals to take measures concerning the treatment of the elderly mental disorders. Today in developed countries, bibliotherapy is used for the treatment of the most prevalent psychiatric disorders. Therefore, this study aimed to investigate the effects of audio book on the elderly mental health of Retirement Center of Shahid Beheshti University of Medical Sciences. This experimental study was conducted on 60 elderly people participated in 8 audio book presentation sessions, and their mental health aspects were evaluated through mental health questionnaire (SCL-90-R). Data were analyzed using SPSS 24. Data analysis revealed that the mean difference of pretest and posttest of control group is less than 5.0, so no significant difference was observed in their mental health, but this difference was significant in the experimental group (more than 5.0). Therefore, a significant improvement in mental health and its dimensions have observed in elderly people participated in audio book sessions. This therapeutic intervention was effective on mental health dimensions of paranoid ideation, psychosis, phobia, aggression, depression, interpersonal sensitivity, anxiety, obsessive-compulsive and somatic complaints. Considering the fact that our population is moving toward aging, the obtained results could be useful for policy makers and health and social planners to improve the health status of the elderly.
Khawaled, Razek; Bauer, Arie; Rosca, Paola; Helman, Dafna; Shai, Uzi; Grinshpoon, Alexander; Ponizovsky, Alexander M
In 2005 the Forensic Psychiatry Department of Mental Health Services at the Ministry of Health launched a pilot project: the Community Emergency Psychiatric Service (CEPS). The purpose was to offer community-based emergency response to acute psychiatric conditions during after-hours periods, including Saturdays and holidays. The project was implemented in the Tel Aviv, Central and Southern districts. Advertisements were posted in mass circulating newspapers announcing the launching of the new program for the general public in the participating districts. The public was invited to call the hotline of the medical emergency service, Magen David Adom (MDA), in the event of psychiatric distress or emergency. MDA personnel were instructed to give the callers a telephone number of an on-call psychiatrist. The Ministry of Health engaged a pool of seven licensed psychiatrists to be available on-call one per shift. The psychiatrists offered crisis intervention over the phone or house visits when necessary. Data were obtained from the Tel Aviv, Central and Southern Districts. The results show that there were 1,472 calls between May 2005 and June 2006. In 198 cases (13.5%) clients were referred for treatment and follow-up to local outpatient clinics, while in 116 of the cases (7.8%) a home visit by the on-call psychiatrist was carried out, resulting in 50 voluntary and 16 involuntary hospitalizations. An examination of records of calls received by the on-call psychiatrists (N=97) during August 2006 suggests that most callers fit the following profile: female, ranging in age 19-35, unmarried, with diagnosis of schizophrenia, with no previous psychiatric hospitalizations, and presenting no danger to herself or others. A limited response team, comprised of one on-call psychiatrist per shift, can provide a viable service for psychiatric emergencies in a population center of approximately 2.7 million. The findings also suggest that such a service may increase the number of
Sansone, Randy A; Butler, Melissa; Dakroub, Hassan; Pole, Michele
The relationship between borderline personality symptomatology and employment disability has undergone limited study. Four previous studies indicate a possible relationship, but each has its own inherent limitations. In the present study, we examined this relationship among 94 internal medicine outpatients. Using a sample of convenience, we administered 2 self-report measures for borderline personality (the Personality Diagnostic Questionnaire-4th Edition, which is based on DSM criteria, and the Self-Harm Inventory, which correlates with scores on the Diagnostic Interview for Borderlines) and inquired about the lifetime presence and length of either psychiatric or medical disability. The study was active from February 2003 through January 2005. There was a significant and positive correlation between scores on both borderline personality measures and the length of psychiatric disability for women (r = .33, r = .36, p = .05); however, no significant relationship was found between scores on either measure for borderline personality and the length of either psychiatric or medical disability for men. These findings suggest that, in contrast to men, there may be a relationship between borderline personality symptomatology and psychiatric disability only among women (i.e., there may be a gender difference). We discuss the possible implications of these results.
Jennum, Poul; Thorstensen, Eva Wiberg; Pickering, Line
OBJECTIVES: The objective of the study was to evaluate the morbidities and mortality in a national group of middle-aged and elderly narcolepsy patients before and after the first diagnosis of the condition. METHODS: From the Danish National Patient Registry (NPR), 1174 patients (45.1% males) aged....... In the NPR, all morbidities are grouped into major WHO classes. RESULTS: Middle-aged and elderly patients had more health contacts before and after their narcolepsy diagnosis with respect to several disease domains: infections, neoplasm, endocrine/metabolic diseases/diabetes, mental/psychiatric, neurological.......002) among those aged 60+ years. CONCLUSION: There are higher rates of morbidity in several disease domains before and after a diagnosis of narcolepsy. Elderly narcolepsy patients have higher mortality rates....
U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Partial Hospitalization Program LDS This file contains select claim level data and is derived from 2010 claims...
The intercontinental schizophrenia outpatient health outcomes (IC-SOHO) study: baseline clinical and functional characteristics and antipsychotic use patterns in the North Africa and Middle Eastern (AMEA) region: original article.
Sitvast, J E; Widdershoven, G A M; Abma, T A
The purpose of this article is to illustrate moral learning in persons with a psychiatric disability who participated in a nursing intervention, called the photo-instrument. This intervention is a form of hermeneutic photography. The findings are based on a multiple case study of 42 patients and additional interviews with eight of them. Photo groups were organized within three settings of psychiatric services: ambulatory as well as clinical, all situated in the Netherlands. Data were analysed according to hermeneutic and semiotic principles. Two cases are presented. Findings show that voice and face are concepts that help to identify elements of moral learning in the rehabilitation process of persons with a psychiatric disability. During the process patients become more aware of their responsibilities towards themselves and others.
Guffanti, Guia; Gaudi, Simona; Fallon, James H; Sobell, Janet; Potkin, Steven G; Pato, Carlos; Macciardi, Fabio
Transposable Elements (TEs) or transposons are low-complexity elements (e.g., LINEs, SINEs, SVAs, and HERVs) that make up to two-thirds of the human genome. There is mounting evidence that TEs play an essential role in genomic architecture and regulation related to both normal function and disease states. Recently, the identification of active TEs in several different human brain regions suggests that TEs play a role in normal brain development and adult physiology and quite possibly in psychiatric disorders. TEs have been implicated in hemophilia, neurofibromatosis, and cancer. With the advent of next-generation whole-genome sequencing approaches, our understanding of the relationship between TEs and psychiatric disorders will greatly improve. We will review the biology of TEs and early evidence for TE involvement in psychiatric disorders. © 2014 Wiley Periodicals, Inc.
Amy Y. Zhang
Full Text Available This study investigated the ICD-9 diagnostic rates of depressive and anxiety disorders, including major depression, neurotic depression, adjustment disorder with depressed mood, depressive disorder NOS (not elsewhere classified, and anxiety states, among elderly Medicare beneficiaries (age ≥ 65 who received a colorectal cancer diagnosis between 1998 and 2002 in U.S. The Seer-Medicare data, representing 14–25% of the U.S. population, was used to examine ICD-9 diagnostic rates of depressive and anxiety disorders among 56,182 colorectal cancer outpatients and 265,382 noncancer outpatients, respectively. The findings show that the ICD-9 diagnoses ranged from 1.5% to 1.8% for depressive disorders and 0.8% to 1.2% for anxiety states in the colorectal cancer outpatients, and from 2% to 2.5% for depressive disorders and 1.1% to 1.5% for anxiety states in the noncancer outpatients over five years. More than 70% of colorectal cancer outpatients with a depressive diagnosis were diagnosed for depressive disorder NOS. The findings suggest that the difficulty in recognizing depressive symptoms in colorectal cancer patients may contribute in part to the low ICD-9 diagnostic rates of depressive disorders. They call for research attention to the investigation of depressive symptoms for improving the recognition and treatment in this patient population.
Uchida, Hiroyuki; Suzuki, Takefumi; Mamo, David C; Mulsant, Benoit H; Tsunoda, Kenichi; Takeuchi, Hiroyoshi; Kikuchi, Toshiaki; Nakajima, Shinichiro; Nomura, Kensuke; Tomita, Masayuki; Watanabe, Koichiro; Kashima, Haruo
Data on benzodiazepine use in mood disorders are still limited, especially among seniors. A cross-sectional review of psychotropic prescriptions in 948 outpatients with mood disorders (405 male; mean +/- SD age, 52 +/- 17 years; age range, 16- 91 years) was conducted in Japan. The use of benzodiazepine-derivative anxiolytics was approximately 60% in all decades, including older patients, without a group difference. The frequent use of benzodiazepines is a cause for concern because they are not preferred treatment, given their well-known adverse effects especially in the elderly.
Full Text Available Dermatological drugs, mostly corticosteroids and isotretinoin, cause different psychiatric adverse effects. During steroid therapy, a wide range of psychiatric conditions, from minor clinical symptoms like insomnia and anxiety to serious psychiatric syndromes like psychosis and delirium might be seen. In medical literature, a causal connection is usually suggested between “isotretinoin”, which is used for treatment of acne vulgaris and depression and suicide attempts. However, there are no statistically significant double-blind randomized studies that support this connection. Clinicians must know patient’s psychiatric history before using any dermatological treatment known as causing psychiatric adverse effects, and psychiatric consultation should be established whenever necessary.
Ünlü, Çagdas; Gunadi, Patrick M; Gerhards, Michael F; Boermeester, Marja A; Vrouenraets, Bart C
Traditionally, treatment of acute diverticulitis has mostly been based on inpatient care. The question arises whether these patients can be treated on an outpatient basis as the admissions for diverticular disease have been shown to be increasing every year. We studied whether outpatient treatment of acute uncomplicated diverticulitis is feasible and safe, and which patients could benefit from outpatient care. A retrospective cohort study was carried out in two teaching hospitals using hospital registry codes for diverticulitis. All patients diagnosed with acute uncomplicated diverticulitis between January 2004 and January 2012, confirmed by imaging or colonoscopy, were included. Exclusion criteria were patients with recurrent diverticulitis, complicated diverticulitis (Hinchey stages 2, 3, and 4), and right-sided diverticulitis. Inpatient care was compared with outpatient care. Primary outcome was admission for outpatient care and the complication rate in both groups. Multivariate analysis was carried out to identify potential factors for inpatient care. Of 627 patients with diverticulitis, a total of 312 consecutive patients were identified with primary uncomplicated diverticulitis of the sigmoid colon; 194 patients had been treated as inpatients and 118 patients primarily as outpatients. In this last group, 91.5% had been treated successfully without diverticulitis-related complications or the need for hospital admission during a mean follow-up period of 48 months. Despite inherent patient selection in a retrospective cohort, ambulatory treatment of patients presenting with uncomplicated acute diverticulitis seems feasible and safe. In mildly ill and younger patients, hospital admission can be avoided.
Erlangsen, Annette; Zarit, Steven H; Tu, Xin
characteristics. RESULTS: Affective disorders were found to be associated with an almost twofold higher risk of suicide among psychiatric inpatients than other types of disorders (95% confidence interval [CI]: 1.5-2.6). Patients with dementia had a significantly lower risk ratio of 0.2 (95% CI: 0......OBJECTIVE: Older adults have elevated suicide rates, especially in the presence of a psychiatric disorder, yet not much is known about predictors for suicide within this high-risk group. The current study examines the characteristics associated with suicide among older adults who are admitted...
Manhica, H; Almquist, Y; Rostila, M; Hjern, A
To investigate the patterns of use of different forms of psychiatric care in refugees who settled in Sweden as teenagers. Cox proportional hazards models were used to estimate the use of different forms of psychiatric care from 2009 to 2012 in a population of 35 457 refugees, aged from 20 to 36, who had settled in Sweden as teenagers between 1989 and 2004. These findings were compared with 1.26 million peers from the same birth cohorts in the general Swedish population. Unaccompanied and accompanied refugees were more likely to experience compulsory admission to a psychiatric hospital compared with the native Swedish population, with hazard ratios (HRs) of 2.76 (1.86-4.10) and 1.89 (1.53-2.34), respectively, as well as psychiatric inpatient care, with HRs of 1.62 (1.34-1.94) and 1.37 (1.25-1.50). Outpatient care visits by the young refugees were similar to the native Swedish population. The longer the refugees had residency in Sweden, the more they used outpatient psychiatric care. Refugees born in the Horn of Africa and Iran were most likely to undergo compulsory admission, with HRs of 3.98 (2.12-7.46) and 3.07 (1.52-6.19), respectively. They were also the groups who were most likely to receive inpatient care, with HRs of 1.55 (1.17-2.06) and 1.84 (1.37-2.47), respectively. Our results also indicated that the use of psychiatric care services increased with the level of education in the refugee population, while the opposite was true for the native Swedish population. In fact, the risks of compulsory admissions were particularly higher among refugees who had received a secondary education, compared with native Swedish residents, with HRs of 4.72 (3.06-7.29) for unaccompanied refugees and 2.04 (1.51-2.73) for accompanied refugees. Young refugees received more psychiatric inpatient care than the native Swedish population, with the highest rates seen in refugees who were not accompanied by their parents. The discrepancy between the use of inpatient and outpatient care
Williams, A J; Prematalake, J K; Palmer, R L
A double-blind controlled trial was conducted of emepronium bromide against placebo in elderly mentally ill patients in hospital with urinary incontinence. No significant difference was found between 200 mg emepronium bromide 3-times daily and placebo in treating day-time or nocturnal urinary incontinence for patients suffering from chronic organic brain syndrome or from chronic functional psychiatric illness.
Epstein, Leon J.
It is important that the clinician who treats older patients be aware that depression is the psychiatric symptom often encountered in the elderly and that it is as distressing in this age group as it is in younger persons. It often is reversible with prompt and appropriate treatment. (Author)
Alkan, Ali; Yaşar, Arzu; Karcı, Ebru; Köksoy, Elif Berna; Ürün, Muslih; Şenler, Filiz Çay; Ürün, Yüksel; Tuncay, Gülseren; Ergün, Hakan; Akbulut, Hakan
Due to more comorbidities, polypharmacy is common in elderly patients and drug interactions are inevitable. It is also challenging to treat an elderly patient with a diagnosis of cancer. Prevalence and clinical impacts of drug interactions and using potentially inappropriate medications (PIMs) have been studied in geriatric patients. However, these are not well defined in oncology practice. The purpose of this study is to define the prevalence of PIMs and severe drug interactions (SDIs) in elderly cancer patients and investigate the factors associated with them. Patients more than 65 years of age in both inpatient and outpatient clinics were evaluated. Patient, disease characteristics, and medications used were collected by self reports and medical records. Drug interactions were checked with Lexicomp® and PIM was defined with 2012 update of Beers criteria. Severe drug interactions are defined with category D or X DIs. Logistic regression was used to compute odds ratios (ORs) and 95 % confidence intervals (CIs) for the association between SDIs, PIMs, and clinical parameters. Four hundered and forty-five elderly patients (286 outpatient, 159 inpatient), with a median age of 70 (65-89) were evaluated. SDIs were present in 156 (35.1 %) of patients, 81 (28.3 %), and 75 (47.2 %) for outpatient and inpatients, respectively (p patients, 40 (14.2 %), and 77(48.4 %) for outpatient and inpatients, respectively (p cancer were associated with severe DIs. Polypharmacy, inpatient status, and bad performance score (ECOG 3-4) were associated with PIMs. Nearly one third of the elderly cancer patients are exposed to severe drug interactions and PIMs. Clinicians dealing with elderly cancer patients should be more cautious when prescribing/ planning drugs to this group of patients. More strategies should be developed in this group of patients to minimize the medications prescribed and prevent severe DIs.
Full Text Available Objective: The aim of this study was to evaluate the type, severity and progression of psychiatric pathologies in a sample of 372 outpatients (age range 18–65 years referred by their primary general practitioners (GPs to an Urgent Referral Team (URT based in a psychiatric hospital in Aberdeen, Scotland. This team offers immediate appointments (1- to 7-day delays for rapid assessments and early interventions to the outpatients referred by their primary family doctors.Method: One-sample t-test and z statistic were used for data analysis. From the total population, a convenience sample of 40 people was selected and assessed to evaluate whether follow-up appointments after the first visit could reduce the severity of suicidal ideation, depression and anxiety in the outpatients seen by the URT. A two-sample t-test and a Wilcoxon signed-rank test were used to assess the variations in the scores during the follow-up visits.Results: We found a statistically significant prevalence of depressive disorders, comorbid with anxiety at first presentation in people who were females, white, never married, living with a partner, not studying and not in paid employment. The common presentation of borderline personality disorder and dysthymia in this population underscores its vulnerability to major socioeconomic challenges.Conclusion: The data confirmed the impact that primary care cooperation with psychiatric hospitals can have on the psychiatric system, and as a reflection, on the population’s mental health and well-being. In fact, active cooperation and early diagnosis and intervention will help detect cases at risk in the general population and reduce admissions into hospitals.
Marsh, Patrick J; Odlaug, Brian L; Thomarios, Nick; Davis, Andrew A; Buchanan, Stephanie N; Meyer, Craig S; Grant, Jon E
The goal of the present study was to examine the prevalence of paraphilias in an adult inpatient psychiatric population. One hundred twelve consecutive, voluntarily admitted, adult male psychiatric inpatients were administered the Structured Clinical Interview for DSM-IV, Sexual Disorders Module, Male Version, to assess the rates of DSM-IV paraphilias. Fifteen patients (13.4%) reported symptoms consistent with at least one lifetime DSM-IV paraphilia. The most common paraphilias were voyeurism (n = 9 [8.0%]), exhibitionism (n = 6 [5.4%]), and sexual masochism (n = 3 [2.7%]). Patients who screened positive for a paraphilia had significantly more psychiatric hospitalizations (P = .006) and, on a trend level, were more likely to have attempted suicide. In addition, patients with paraphilias were significantly more likely to report having been sexually abused than patients without a paraphilia (P = paraphilia. Paraphilias appear to be more common in adult male psychiatric inpatients than previously estimated. The study also demonstrated that these disorders were not screened for by the treating physician and thus may go untreated. Further, larger-scale studies are necessary in order to further examine the rates of these disorders in the general population.
Tsuang, D W; Faraone, S V; Tsuang, M T
Like other medical conditions, some psychiatric disorders are inherited, whereas others are not. Human genetics research is moving at a rapid pace. Genes for over 450 genetic disorders have been cloned and many disease-causing mutations have also been identified. The explosion of this new knowledge has created many new exciting opportunities in the diagnosis of these heritable disorders. The rapid pace of gene discovery will aid the identification of susceptibility genes for psychiatric disorders. Indeed, we can look forward to answers to many clinical and research questions. These are some of the gifts that the expanding field of human genetics research will continue to bring to medical science. However, as genetic tests for the detection of psychiatric disorders become available, many ethical, legal, and social implications will need to be considered. In this article, we review the principles of genetic counseling for psychiatric disorders, as well as the social and ethical dilemmas that genetic testing may bring. Although medical and scientific advances may bring many gifts, we should approach this new knowledge with caution, as one of the gifts may be a Pandora's box.
Sitvast, J.E.; Widdershoven, G.G.A.M.; Abma, T.A.
The purpose of this article is to illustrate moral learning in persons with a psychiatric disability who participated in a nursing intervention, called the photo-instrument. This intervention is a form of hermeneutic photography. The findings are based on a multiple case study of 42 patients and
Apr 23, 1983 ... those with psychiatric disorder; severe reactive depression was found in 27,5% and 50% were considered to have personality disorders sufficient to be identified as pathological. Such assessments were based on a record of longstanding neurotic or habitually maladaptive behaviour characterized by ...
identification of early symptoms of relapse, application of immediate and appropriate measures, and adequate record-keeping by health institutions are ... hospitalization, resulting from the policy of de-institutionalization in. Nigeria has led to ..... adolescent psychiatric care Aust N Z ] Psychiatry 2005; 39: 600-606. 3. vaett C.
Mookhoek, E.J.; Meijs, V.M.M.; Loonen, A.J.M.; Leufkens, H.G.M.
Introduction: We report on dyspeptic complaints among patients hospitalized in the long-stay ward of a general psychiatric hospital. Methods: A representative sample of the patients was interviewed using a structured questionnaire. Results: Eighty percent of the patients reported one or more
Maerevoet, M; Sattar, L; Bron, D; Gulbis, B; Pepersack, T
Anaemia is a problem that affects almost 10% over 65 years and 20% over 85 years. There is no physiological anaemia in the elderly. Any anaemia expresses the existence of a pathological process, regardless of its severity. Anaemia in the elderly is always associated with a poor prognosis that is in terms of mortality, morbidity and risk of fragility. The diagnostic approach to anemia in the elderly is the same as in younger individual. There are many causes of anaemia; anaemia balance is a complex diagnostic process. Most anaemias are due to a deficiency, chronic inflammation or comorbidity. However, in the elderly, the etiology of anaemia is often multifactorial. In a number of cases remain unexplained anaemia. In a number of cases, anemia remain unexplained. Treatment of anaemia is the treatment of the cause, but specific therapeutic aspects to the elderly should be considered, as among other martial substitution or use of erythropoietin (EPO).
Schlenger, William E; Mulvaney-Day, Norah; Williams, Christianna S; Kulka, Richard A; Corry, Nida H; Mauch, Danna; Nagler, Caryn F; Ho, Chia-Lin; Marmar, Charles R
The primary goal of this analysis was to assess whether recent use of outpatient services for general medical concerns by Vietnam veterans varies according to level of posttraumatic stress disorder (PTSD) symptomatology over time. Another goal was to determine whether PTSD symptomatology was associated with veterans' reports of discussing behavioral health issues as part of a general medical visit. Self-reported service use data and measures of PTSD were from a nationally representative sample of 848 male and female Vietnam theater veterans (individuals who were deployed to the Vietnam theater of operations) who participated in the National Vietnam Veterans Longitudinal Study, a 25-year follow-up of a cohort of veterans originally interviewed from 1984-1988 as part of the National Vietnam Veterans Readjustment Study. Four categories of PTSD symptomatology course over 25 years were defined, and logistic regression models were used to assess their relationship with recent use of outpatient general medical services. Male and female theater veterans with high or increasing PTSD symptomatology over the period were more likely than those with low symptomatology to report recent VA outpatient visits. Males in the increasing and high categories were also more likely to discuss behavioral health issues at general medical visits. Vietnam veterans with high and increasing PTSD symptomatology over time were likely to use VA outpatient general health services. Attention to stressors of the aging process and to persistence of PTSD symptoms is important for Vietnam veterans, as is addressing PTSD with other psychiatric and medical comorbidities within the context of outpatient general medical care.
Watson, Judith M; Fayter, Debra; Mdege, Noreen; Stirk, Lisa; Sowden, Amanda J; Godfrey, Christine
Research evidence indicates a high prevalence of substance abuse among patients presenting in general hospital settings. Such misuse of alcohol and illicit drugs has a major impact on population health and on costs to health services and to society at large. This review aimed to identify the interventions for alcohol or illicit drug misuse problems that have been evaluated for hospital outpatient populations. Thirteen electronic databases including MEDLINE, EMBASE and PsycInfo were searched for published and unpublished studies in any language up to August 2011. Reference lists of included studies and reviews were also hand-searched. We included randomised and controlled clinical trials of any intervention for adult participants identified as having alcohol and/or drug problems presenting to hospital outpatient settings other than addiction or psychiatric units. Participants could be attending hospital for any reason other than treatment for substance abuse. A narrative synthesis was conducted. There is some evidence to suggest that interventions based on motivational techniques might be effective in treatment of alcohol misuse in oral-maxillofacial clinics but not in general outpatient departments. The evidence is insufficient to allow any conclusions to be derived on the effectiveness of interventions in the treatment of drug misuse and combined alcohol-drug misuse in outpatient settings. Further research is needed to investigate interventions for alcohol and drug misuse in outpatient settings. Additionally, problems remain in terms of study quality. Procedures to ensure the rigour of a study were often poorly reported. © 2013 Australasian Professional Society on Alcohol and other Drugs.
Kokai, Masahiro [Hyogo Coll. of Medicine, Nishinomiya (Japan); Soejima, Toshinori; Wang, Shangdong; Shinfuku, Naotaka
This review focuses on the mental and psychological effects of medical radiation exposure, the nuclear accident at Three Mile Island, the Chernobyl disaster, atomic bomb explosions at Nagasaki and Hiroshima, and accidents at nuclear power plants and nuclear waste plants. Studies have shown that anxiety about the adverse effects of radiation in medicine (such as infertility, carcinogenicity, and genotoxicity) and fear for exposure has caused psychiatric disorders. Several studies on the mental health effects of the nuclear accident at Three Mile Island were conducted, and the results indicated that psychiatric distress persisted for a certain period of time, particularly in pregnant women and women who have children, even when no evidence of substantial of radiation exposure is seen clinically. The psychological consequences of the Chernobyl disaster have been investigated continuously, and various problems, e.g., acute stress reaction, neurosis, and psychosis, have been identified, although no physical damage due to the radiation or PTSD have been reported. By contrast, PTSD has been seen in survivors of the Nagasaki and Hiroshima nuclear explosions. A study in Ohio, (United States), which has a nuclear waste plant, investigated PTSD in people living near the plant and found that the symptom level was mild. In general, the most common symptoms among people with mental and psychological disorders due to radiation exposure are depression and anxiety, with many people having associated somatoform disorders, and some people complain of PTSD. Vague anxiety and fear of sequelae, regardless of the exposure dose, appears to cause such psychiatric disorders. Although it is rare for psychiatrists to see such cases of psychiatric disorders due to radiation exposure, their number may increase as psychiatric services become more widely available. (K.H.)
Fawzi, Mounir H; Said, Nagwa S; Fawzi, Maggie M; Kira, Ibrahim A; Fawzi, Mohab M; Abdel-Moety, Hanaa
To evaluate the relationship between psychiatric referral acceptance for fluoxetine treatment and glycemic control in type 2 diabetes mellitus (T2DM) Egyptian patients with depression. Patients with T2DM who attended the diabetes outpatients clinic at Zagazig University Hospital, Egypt, between May 2013 and April 2015 and who scored ≥20 on screening with the Major Depression Inventory (MDI) (n=196) were offered a psychiatric referral for fluoxetine treatment and monitoring. Decliners (56.1%) received time/attention matched care via diabetologist visits (attentional controls). Fluoxetine patients and controls were compared at the time of the offer (T1) and 8weeks later (T2). Factors that significantly correlated with glycemic control were used in a linear regression analysis as the independent variables. Eighty-six patients (43.9%) accepted psychiatric referral. Most of them (97.7%) remained throughout the study adherent to fluoxetine (mean daily dose=31.9mg). At T2, these patients, in comparison to controls, showed a reduction from baseline in MDI, fasting plasma glucose and glycosylated hemoglobin (HbA1c) levels (P for all comparisons adherence to antidiabetics, psychiatric referral acceptance and Internalized Stigma of Mental Illness (ISMI) and MDI scores. In T2DM patients with depression, psychiatric referral acceptance for fluoxetine treatment is a significant predictor of both depression and glycemic control improvements. Copyright © 2016 Elsevier Inc. All rights reserved.
Mellesdal, L; Kroken, R A; Lutro, O; Wentzel-Larsen, T; Kjelby, E; Oedegaard, K J; Jørgensen, H A; Mehlum, L
Few studies have examined rate and predictors of self-harm in discharged psychiatric patients. To investigate the rate, coding, timing, predictors and characteristics of self-harm induced somatic admission after discharge from psychiatric acute admission. Cohort study of 2827 unselected patients consecutively admitted to a psychiatric acute ward during three years. Mean observation period was 2.3 years. Combined register linkage and manual data examination. Cox regression was used to investigate covariates for time to somatic admission due to self-harm, with covariates changing during follow-up entered time dependently. During the observation period, 10.5% of the patients had 792 somatic self-harm admissions. Strongest risk factors were psychiatric admission due to non-suicidal self-harm, suicide attempt and suicide ideation. The risk was increased throughout the first year of follow-up, during readmission, with increasing outpatient consultations and in patients diagnosed with recurrent depression, personality disorders, substance use disorders and anxiety/stress-related disorders. Only 49% of the somatic self-harm admissions were given hospital self-harm diagnosis. Self-harm induced somatic admissions were highly prevalent during the first year after discharge from acute psychiatric admission. Underdiagnosing of self-harm in relation to somatic self-harm admissions may cause incorrect follow-up treatments and unreliable register data. Copyright © 2013 Elsevier Masson SAS. All rights reserved.
Bhatia, M S; Srivastava, S; Gautam, P; Saha, R; Kaur, J
Intellectual disability in a child places great stress on a family and caregiver and this leads to significant socio-occupational dysfunction and impaired quality of life for caregivers. This study aimed to assess socio-demographic characteristics, burden, and psychiatric morbidity of the caregivers of persons with intellectual disability, as well as to determine the variables that correlated with burden and psychiatric morbidity. An observational study was carried out in an outpatient psychiatric unit of a tertiary care teaching hospital in India from October 2014 to April 2015. A total of 100 caregivers of intellectually impaired individuals were assessed for burden and psychiatric morbidity. In all, 39% of the caregivers had a high burden score, 46% perceived mild-to-moderate burden severity, and 15% perceived no to mild burden. Mild-to-moderate depressive symptoms were present in 23% and 16% had severe-to-extremely severe depressive symptoms. Mild-to-moderate anxiety symptoms were evident in 19% of caregivers and a further 19% had severe-to-extremely severe anxiety symptoms. Routine assessment of burden and psychiatric morbidity in the caregiver will help to reduce their burden and thus help them care for their children more appropriately and efficiently.
Nordholm, Dorte; Nielsen, Bent
The aim of the present study was firstly to describe the characteristics of alcoholic outpatients (A) suffering from co-morbid personality disorder (PD) of either the cluster B (A+PDB) or cluster C (A+PDC) type. Secondly, to investigate the effect of various kinds of treatment to be able to single...... of the Addiction Severity Index. A+PDC had significantly more serious medical problems than A-PD, while the A+PDB group had significantly more employment, drug use and social problems than the A-PD. As for psychiatric status, A-PD had significantly different scores compared with A+PDB and A+PDC. A+PDB were younger...... and had a longer history of alcohol abuse than A-PD and A+PDC. After treatment there was no significance between the patients with and without PD concerning alcohol outcome and psychosocial outcome. The significance of co-morbid PD for the prognosis of alcohol abusers may be overestimated. Our results...
Listernick, R; Zieserl, E; Davis, A T
Twenty-nine dehydrated, well-nourished infants, who were 3 to 24 months of age and had acute gastroenteritis, were enrolled in a prospective randomized study that compared the safety, efficacy, and costs of oral vs intravenous rehydration. The study was designed to assess the use of a holding room in the emergency room for the outpatient rehydration of dehydrated infants. The oral solution that was used contained 60 mEq/L of sodium, 20 mEq/L of potassium, 50 mEq/L of chloride, 30 mEq/L of citrate, 20 g/L of glucose, and 5 g/L of fructose. Thirteen of 15 patients were successfully rehydrated orally as outpatients; two patients, who were subsequently discovered to have urinary tract infections, required hospitalization due to persistent vomiting. Orally rehydrated outpatients spent a mean of 10.7 hours in the holding room, as compared with intravenously rehydrated inpatients, who were hospitalized for a mean of 103.2 hours. Outpatient oral rehydration therapy was significantly less costly than inpatient intravenous therapy (+272.78 vs +2,299.50). Our results indicate that oral rehydration is a safe and cost-effective means of treating dehydrated children in an outpatient setting in the United States. The use of a holding room for observation in the emergency room can markedly decrease health care costs and unnecessary hospitalizations.
Sansoni, Diana; D'Angelo, Tonino; Passamonti, Mauro; Tarulli, Sabrina; Olori, Maria Patrizia; Viviani, Giancarlo
Data regarding the observance of infection control practices in ambulatory healthcare settings is scarce. This type of data is important since the health care system has evolved in such a way that hospital stays are now briefer and there is an increased provision of healthcare in outpatient settings, such as day surgery, day hospital and ambulatory care services. Studies have shown that transmission of infectious diseases in outpatient health care settings is often associated with lack of, or insufficient adherence to, evidence-based preventive measures. Outpatients have less risk factors for nosocomial infections than inpatients, nevertheless, some high risk settings include physicians' waiting rooms (airborne and droplet transmission) and outpatient settings in which invasive procedures are performed. Preventive strategies consist in verifying the adherence to infection control guidelines (this should be done by specifically trained personnel), developing disinfection and sterilization protocols for medical devices (that are comparable to those used in hospitals), training of healthcare personnel, and development of efficacy-based infection control protocols for outpatient settings.
-reported compliance increased during hospital stay. Conclusion Results confirm the widespread use of antipsychotics and the increasing trend in atypical drugs prescription, in both psychiatric in- and outpatients.
Sugai, Takuro; Suzuki, Yutaro; Yamazaki, Manabu; Shimoda, Kazutaka; Mori, Takao; Ozeki, Yuji; Matsuda, Hiroshi; Sugawara, Norio; Yasui-Furukori, Norio; Minami, Yoshitake; Okamoto, Kurefu; Sagae, Toyoaki; Someya, Toshiyuki
Patients with schizophrenia have significantly shorter life expectancy than the general population, and a problem they commonly face is an unhealthy lifestyle, which can lead to obesity and metabolic syndrome. There is a very clear need to determine the prevalence of obesity, hypertension, hyperlipidemia, and diabetes mellitus which are components of metabolic syndrome in patients with schizophrenia, but there has been a paucity of large-scale studies examining this situation in Japan. The aim of our study was to address this need. We conducted a large-scale investigation of the prevalence of obesity, hypertension, hyperlipidemia, and diabetes mellitus using a questionnaire in 520 outpatient facilities and 247 inpatient facilities of the Japan Psychiatric Hospitals Association between January 2012 and July 2013. There were 7,655 outpatients and 15,461 inpatients with schizophrenia. The outpatients had significantly higher prevalence of obesity, hypertension, hypertriglyceridemia, hyper-LDL cholesterolemia, and diabetes mellitus than the inpatients. The prevalence of hypo-HDL cholesterolemia was higher in inpatients than outpatients. Age-specific analysis showed the prevalence of obesity, hypertension, hypertriglyceridemia, hyper-LDL cholesterolemia, and diabetes mellitus among outpatients to be 2- to 3-fold higher than among inpatients. In individuals aged ≥60 years, the prevalence of obesity and DM among outpatients was about 3-fold higher than among inpatients. Japanese outpatients with schizophrenia were more likely to have physical risk such as obesity, hypertension, hyperlipidemia, and diabetes mellitus than inpatients. The physical risk to patients with schizophrenia may be affected by environmental parameters, such as type of care. The physical risk to Japanese patients with schizophrenia demands greater attention.
van Veen, S C; Batelaan, N M; Wesseldijk, L W; Rozeboom, J; Middeldorp, C M
Psychiatric disorders run in families. To bridge the gap between child and youth psychiatry and adult psychiatry, GGZ inGeest has started screening parents of new registered children for psychopathology - and if indicated - offers parents treatment in the same department as their children. To examine the feasibility and usefulness of this procedure, to investigate how many parents agree to screening, further diagnostics and treatment, and to find out how many parents have in fact suffered from recent psychiatric problems. Prior to the children's first appointment, the parents were asked to complete a questionnaire, the Adult Self Report (ASR), about their own problems. If these scores were (sub)clinical, parents were invited to participate in a telephonic interview. This consisted of the Composite International Diagnostic Interview (CIDI) and Conners' Adult ADHD Rating Scales (CAARS). If the results indicate psychopathology, further psychiatric assessment and, if necessary, treatment is offered. The first response was 55.7% and, if indicated, most of the parents agreed on further diagnostics. On the ASR 2 out of 5 mothers (42.1%) and 1 out of 5 fathers (21.8%) reported problems that could point to a psychiatric disorder. According to the ASR, within this high-risk group 37% of the mothers met the criteria for an axis I diagnosis (less than one month earlier) compared to 70.6% of the fathers. A mood disorder was the primary diagnosis for women, whereas men most often suffered from an anxiety disorder. In total, 19.1% of the parents screened were suffering from recent psychopathology and 75% of this group agreed to receive mental health care (treatment at the family outpatient clinic or referred to another clinic). Implementation of the family outpatient clinic scheme is feasible. However, further efforts are needed in order to reach a larger group of parents, particularly fathers. The family outpatient clinic is useful because parents who suffer from psychopathology
Bjørnholdt, K. T.; Mønsted, P. N.; Søballe, Kjeld
Background Dexamethasone has analgesic properties when given intravenously before surgery, but the optimal dose has not been determined. We hypothesised that a dose of 40 mg dexamethasone would improve analgesia after outpatient shoulder surgery compared with 8 mg. Methods A randomised, double......-blind, placebo-controlled clinical trial was conducted at Horsens Regional Hospital, Denmark. Patients scheduled for arthroscopic subacromial decompression and/or acromioclavicular joint resection as an outpatient procedure (n = 101) were randomised to receive intravenous dexamethasone 40 mg (D40), 8 mg (D8...... a dose–response relationship, increasing the dexamethasone dose from 8 to 40 mg did not improve analgesia significantly after outpatient shoulder surgery....
Birket-Smith, M.; Rasmussen, A.
The objective of the study was to compare the frequency of mental disorders in cardiology outpatients to the number of patients with psychological problems identified by cardiologists. In a cardiology outpatient service, 103 consecutive patients were asked to participate in the study. Of these 86...... were included and screened for mental disorder with the Primary Care Evaluation of Mental Disorders (PRIME-MD), Structured Clinical Interview for DSM-IV (SCID) psychosis screening, the Clock Drawing Test, and the WHO-5 Well-being Index. The cardiologists were asked to rate the severity of somatic......, were frequent in cardiology outpatients. Even in cases where the cardiologists identified psychological problems, the diagnosis had no consequence, as none of the patients was offered relevant treatment Udgivelsesdato: 2008...
Gammelmark, Carina; Jensen, Signe O W; Plessen, Kerstin J; Skadhede, Søren; Larsen, Janne Tidselbak; Munk-Jørgensen, Povl
Is an increased focus on eating disorders during the past few decades reflected by increasing occurrence in the psychiatric health service system. All first-time diagnoses of eating disorders identified in the Danish Central Psychiatric Research Register 1970-2008 constitute the present research database. Age-standardized rates per 100,000 inhabitants were calculated and autoregressive models were fitted for males and females separately as well as for in- and outpatients. The incidence of eating disorders diagnosed in Danish psychiatric secondary healthcare has increased considerably during a nearly 40-year period of observation both within the general category of eating disorders and also specifically for anorexia nervosa. The steepest increase is seen within females aged 15-19 years, where the highest incidences are also found. Anorexia nervosa constitutes the vast majority of all eating disorders. Throughout the time interval investigated, the number of males, however, is negligible compared to females. Most patients are seen in outpatient services, increasing towards recent years. However, the number of patients being treated as inpatients has increased linearly through the entire four decenniums investigated. Changes in registration principles, public awareness and higher acceptance of mental disorders in the public is the most obvious explanation for the incidence increase of anorexia nervosa and other eating disorders. This study does not answer whether there has been an increase in true incidence in the population. © The Royal Australian and New Zealand College of Psychiatrists 2015.
Piñeiro-Dieguez, Benjamín; Balanzá-Martínez, Vicent; García-García, Pilar; Soler-López, Begoña
The CAT (Comorbilidad en Adultos con TDAH) study aimed to quantify and characterize the psychiatric comorbidity at the time of diagnosis of ADHD in adult outpatients. Cross-sectional, multicenter, observational register of adults with ADHD diagnosed for the first time. In this large sample of adult ADHD (n = 367), psychiatric comorbidities were present in 66.2% of the sample, and were more prevalent in males and in the hyperactive-impulsive and combined subtypes. The most common comorbidities were substance use disorders (39.2%), anxiety disorders (23%), and mood disorders (18.1%). In all, 88.8% patients were prescribed pharmacological treatment for ADHD (in 93.4% of cases, modified release methylphenidate capsules 50:50). A high proportion of psychiatric comorbidity was observed when adult outpatients received a first-time diagnosis of ADHD. The systematic registering of patients and comorbidities in clinical practice may help to better understand and manage the prognostic determinants in adult ADHD. © The Author(s) 2014.
Full Text Available BACKGROUND: Growth in elderly population has led to an increase in age related diseases and mainly depression which is affecting the quality of life. Depression is more prevalent amongst elderly individuals with medical illnesses and emerging public health problem leading to increased morbidity and disability worldwide. AIMS AND OBJE CTIVES: To assess the prevalence of occult depression in elderly patients with chronic co - morbid medical conditions. MATERIALS AND METHODS: It was a cross - sectional study conducted in tertiary hospital. Total 100 elderly patients with underlying chronic me dical illnesses were included. Depression in study population was assessed by geriatric depression scale and analyzed. RESULT: Out of 100 patients 23(23% had depression. Females 12/39(30.76% were affected more than males 11/61 (18.03%. Depression was mo re prevalent among patients with 3 or more co - morbid conditions (45.4% as compared to <3 (11.9%. CONCLUSION: Elderly patients with multiple chronic medical illnesses may have associated occult depression. Screening of these patients for depression couple d with appropriate psychiatric referral should be an integral part of Geriatric service
Nicolaï, D; Farcet, A; Molines, C; Delalande, G; Retornaz, F
Tetanus is a serious disease, which could be potentially lethal. All cases are observed in patients inadequately immunized. The immunochromatographic tests (including Tetanos quick Stick(®) [TQS]) have demonstrated their efficiency in emergency setting. The aim of our study was to assess the usefulness of these tests in elderly outpatients seen in ambulatory settings. This prospective study included patients aged 65 years and over who presented to the outpatients' clinic of the Gerontologic Departmental Center (Marseille). A TQS and a self-administered questionnaire to assess risk factors for tetanus were performed. One hundred and twenty-two patients were studied. The prevalence of positive TQS was 66%. Patients have an average of 2.5 risk factors for tetanus. Negative TQS was observed in 35% of patients who had seen their general practitioner for a wound during the previous year. Elderly patients accumulate several risk factors regardless of age and lifestyle. While physicians are familiar with the vaccine recommendations, they are often faced with the difficulty of assessing patient's status based only on the patient's interview, which is frequently not reliable. The implementation of immunochromatographic tests in general practice could help physicians in the management of patients at risk for tetanus. Copyright © 2014 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.
Full Text Available Abuse and neglect are preventable societal problems that influence elderly individuals physically, spiritually and socially. Elder abuse is neglected for many years and is a growing problem all over the world. The aim of this article is to review the evaluation of elderly individuals who are exposed to abuse and neglect with systematic detailed history and physical examination and to describe individual, familial, and social measures that should be taken to prevent these abuses. [Archives Medical Review Journal 2013; 22(3.000: 393-407
WAINBERG, MILTON; Pala, Andrea Norcini; Cournos, Francine; McKinnon, Karen
ABSTRACT Objective We evaluated the psychometric properties of a new instrument “Mental Illness Sexual Stigma Questionnaire” (MISS-Q). Methods We interviewed 641 sexually active adults (ages 18-80) attending public outpatient psychiatric clinics in Rio de Janeiro about their stigma experiences. Results Nine factors were extracted through exploratory factor analysis (EFA) and labeled: ‘individual discrimination by others’; ‘staff willingness to talk about sexuality’; ‘staff and family pr...
Full Text Available Background: Epicrania fugax (EF is a rare newly described primary headache characterized by paroxysms of unilateral pain radiating across one hemicranium. Aim: We aimed to describe 10 new cases of EF and assess the psychiatric comorbidity. Materials and Methods: Cases of EF were identified from patients attending the neurology outpatient department of a tertiary level referral and teaching hospital by the first author during a period extending from January 1, 2015 to April 31, 2017. Case ascertainment was done as per ICHD 3 beta criteria from among patients presenting with complaints of headache after detailed history and clinical examination. Clinical and demographic features were noted and patients were subjected to Mini Neuropsychiatric Interview to screen for psychiatric comorbidity followed by Becks Anxiety/Depression Inventory. Results: A total of 10 subjects were obtained during the study period, 4 males, and 6 females. Mean age of subjects was 45.3 years (standard deviation-10. Seventy percent had anteroposterior, and 30% had posteroanterior radiation of pain. The most common character of pain was stabbing (50% followed by electrical (40% and pressing (10%. None of the subjects had autonomic symptoms or focal symptoms in the scalp while 30% subjects had hyperesthesia in the affected area of the scalp.Six subjects (60% patients had episodic course while 40% had chronic course. Sixty percent had comorbid anxiety while one (10% had comorbid depression. A significant relation was obtained between duration of disease and occurrence of anxiety as well as Becks Anxiety Inventory scores while there was no correlation with attack duration. There was also a nonsignificant correlation between visual analog score and occurrence of anxiety symptoms. Conclusions: Our study conclusively proves the existence of EF as a rare, distinct primary headache syndrome in our study population. It has a significant psychiatric comorbidity consisting of 60% of
David, D; Mellman, T A; Mendoza, L M; Kulick-Bell, R; Ironson, G; Schneiderman, N
The nature of psychiatric morbidity in previously non-ill subjects from the area most affected by Hurricane Andrew was investigated at 6-12 months posthurricane. Preliminary associations of morbidity with personal and event-related risk factors were also determined. Fifty one percent (31/61) met criteria for a new-onset disorder, including posttraumatic stress disorder (PTSD) in 36%, major depression (MD) in 30%, and other anxiety disorders in 20%. Thirty four subjects (56%) had significant symptoms persisting beyond 6 months. Having sustained "severe damage" was the risk factor most strongly associated with outcome. Our data underscore the range of psychiatric morbidity related to a natural disaster, and suggest a relationship to chronic stressors.
Benyamina, Amine; Bouchez, Jacques; Rahioui, Hassan; Reynaud, Michel
The practitioner is very frequently confronted by emergencies in drug-addicted patients also having psychiatric symptomatology. In this article the authors will address emergencies related to alcohol (notably intoxication, pre-DTs and the encephalopathies); emergencies related to cannabis (notably intoxication, psychotic states and panic attacks); and emergencies related to other psycho-active substances (overdoses, drug-withdrawal, psychiatric complications related to cocaine or amphetamines). In the domain of drug addiction, as in psychiatry, the practitioner must give as much importance to the organisation of the long-term healthcare plan for the drug addict, ulterior to the management of the immediate emergency. For example, whereas 90% of subjects presenting to the emergency department for acute alcoholic intoxication have a pathological consumption of alcohol (abuse or dependance), management of the alcoholism is proposed in only 2% of them.
Chanen, Andrew M; Jackson, Henry J; McGorry, Patrick D; Allot, Kelly A; Clarkson, Verity; Yuen, Hok Pan
The 2-year stability of categorical and dimensional personality disorder (PD) in an older adolescent psychiatric outpatient sample was examined. One hundred and one 15-18-year-old participants were assessed using the Structured Clinical Interview for DSM Axis II Disorders (SCID-II) at baseline and 97 were re-interviewed, face-to-face, at 2 years. Of those with a categorical PD diagnosis at baseline, 74% still met criteria for a PD at follow-up, with marked gender differences (83% of females and 56% of males). Kappa for specific PDs was low for all except antisocial. Rank order and mean level dimensional stability ranged from high (antisocial, schizoid) to moderate (borderline, histrionic, schizotypal) to low (other PDs), with no decline in PD scores over the 2 years. There was no substantial influence upon stability of dimensional PD from the presence of Axis I disorder at baseline or from outpatient or inpatient treatment. However, categorical PD endured in 100% of those receiving inpatient care. The study supports that, in late teenage outpatients, the 2-year stability of the global category of PD is high and the stability of dimensionally rated PD appears to be similar to that found in young adults in a variety of settings, especially for some cluster A and B PDs. Diagnosis and early intervention appears to be justified in this age group.
Eskelinen, Saana; Sailas, Eila; Joutsenniemi, Kaisla; Holi, Matti; Koskela, Tuomas H; Suvisaari, Jaana
Despite the abundant literature on physical comorbidity, the full range of the concurrent somatic healthcare needs among individuals with schizophrenia has rarely been studied. This observational study aimed to assess the distressing somatic symptoms and needs for physical health interventions in outpatients with schizophrenia, and factors predicting those needs. A structured, comprehensive health examination was carried out, including a visit to a nurse and a general practitioner on 275 outpatients with schizophrenia. The required interventions were classified by type of disease. Logistic regression was used to assess the influence of sociodemographic factors, lifestyle, functional limitations, factors related to psychiatric disorder, and healthcare use on the need for interventions. In total, 44.9% of the patients (mean age 44.9 years) reported somatic symptoms affecting daily life; 87.6% needed specific interventions for a disease or condition, most commonly for cardiovascular, dermatological, dental, ophthalmological, and gastrointestinal conditions, and for altered glucose homeostasis. Smoking and obesity predicted significantly a need of any intervention, but the predictors varied in each disease category. Strikingly, use of general practitioner services during the previous year did not reduce the need for interventions. Health examinations for outpatients with schizophrenia revealed numerous physical healthcare needs. The health examinations for patients with schizophrenia should contain a medical history taking and a physical examination, in addition to basic measurements and laboratory tests. Prevention and treatment of obesity and smoking should be given priority in order to diminish somatic comorbidities in schizophrenia.
Marcos, L R
The author describes common dysfunctions in public psychiatric organizations according to the model of bureaucracy articulated by Max Weber. Dysfunctions are divided into the categories of goal displacement, outside interference, unclear authority structure and hierarchy, and informal relations in the work place. The author emphasizes the bureaucratic nature of public psychiatry and the need for mental health professionals to understand the dysfunctions of the organizations in which they work, including the impact of these dysfunctions on the provision of quality care.
A review of the literature regarding psychiatric thoughts in ancient India is attempted. Besides interesting reading, many of the concepts are still relevant and can be used in day-to-day practice especially towards healthy and happy living. Certain concepts are surprisingly contemporary and valid today. They can be used in psychotherapy and counselling and for promoting mental health. However, the description and classification of mental illness is not in tune with modern psychiatry.
Mehmet Emin Demirkol
Full Text Available Despite developments in treatment options there is no significant increase in treatment adherence ratios. Inadherence in psychiatric disorders is higher than the other diseases. Loss of insight, drugs' side effects, sociodemographic features, personality traits are major factors affecting the treatment adherence. Determining and overcoming these factors for each disorder will help to improve adherence and reduce the treatment costs and hospitalization. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(1: 85-93
A review of the literature regarding psychiatric thoughts in ancient India is attempted. Besides interesting reading, many of the concepts are still relevant and can be used in day-to-day practice especially towards healthy and happy living. Certain concepts are surprisingly contemporary and valid today. They can be used in psychotherapy and counselling and for promoting mental health. However, the description and classification of mental illness is not in tune with modern psychiatry.
A review of the literature regarding psychiatric thoughts in ancient India is attempted. Besides interesting reading, many of the concepts are still relevant and can be used in day-to-day practice especially towards healthy and happy living. Certain concepts are surprisingly contemporary and valid today. They can be used in psychotherapy and counselling and for promoting mental health. However, the description and classification of mental illness is not in tune with modern psychiatry. PMID:25838724
Ali Firoozabadi; Nooshin Reza Alizadeh
Dissociative disorders are conditions that involve disruptions of memory, awareness, identity, or perception. Data collected in diverse geographic locations underline the consistency in clinical symptoms of dissociative disorders. In this cross-sectional descriptive study, prevalence of dissociative experiences has been screened in hospitalized patients in psychiatric wards of Shiraz University of Medical Sciences in Iran. One hundred and sixty patients in two hospitals entered the study. Our...
Eskelinen, Saana; Sailas, Eila; Joutsenniemi, Kaisla; Holi, Matti; Suvisaari, Jaana
Schizophrenia patients are in danger of developing metabolic syndrome (MetS) and its outcomes type 2 diabetes and cardiovascular disease. Antipsychotic treatment and adverse lifestyle increase the burden of metabolic problems in schizophrenia, but little is known about the role of patients' current psychiatric problems and living arrangements in MetS. This study aims to evaluate correlations between MetS, severity of psychiatric symptoms, living arrangements, health behaviour and antipsychotic medication in outpatients with schizophrenia spectrum disorders. A general practitioner and psychiatric nurses performed a comprehensive health examination for all consenting patients with schizophrenia spectrum disorders treated in a psychosis outpatient clinic. Examination comprised of an interview, a questionnaire, measurements, laboratory tests and a general clinical examination. Diagnosis of MetS was made according to International Diabetes Federation (IDF) definition. Correlations were calculated and logistic regression analysis performed with SAS. 276 patients (men n = 152, mean age ± standard deviation = 44.9 ± 12.6 years) participated in the study; 58.7% (n = 162) of them had MetS according to the IDF definition. Clozapine use doubled the risk of MetS (OR = 2.04, 95% CI 1.09-3.82, P = 0.03), whereas self-reported regular physical activity decreased the risk significantly (OR = 0.32, 95% CI 0.18-0.57, P physical activity was associated with decreased risk of MetS. Promotion of a physically active lifestyle should be one of the targets in treatment of schizophrenia, especially in patients using clozapine.
Patrícia M. Guimarães
Full Text Available Objective: To evaluate psychiatric comorbidities in outpatients receiving care for HIV and Chagas disease at Instituto de Pesquisa Clínica Evandro Chagas (IPEC, Fundação Oswaldo Cruz (Fiocruz, Rio de Janeiro, Brazil. Methods: Cross-sectional study with a consecutive sample of 125 patients referred to an outpatient psychiatric clinic from February to December 2010. The Mini International Neuropsychiatric Interview (MINI was used. Factors associated with more frequent mental disorders were estimated by odds ratios (OR with 95% confidence intervals (95%CI by multiple logistic regression. Results: Seventy-six (60.8% patients with HIV, 40 (32% patients with Chagas disease, and nine (7.2% patients with human T-lymphotropic virus were interviewed. The majority were women (64%, with up to 8 years of formal education (56%, and unemployed (81.6%. The median age was 49 years. Suicide risk (n=71 (56%, agoraphobia (n=65 (52%, major depressive episode (n=56 (44.8%, and alcohol/drug abuse (n=43 (34.4% predominated, the latter being directly associated with lower family income (OR = 2.64; 95%CI 1.03-6.75 and HIV infection (OR = 5.24; 95%CI 1.56-17.61. Suicide risk was associated with non-white skin color (OR = 2.21; 95%CI 1.03-4.75, unemployment (OR = 2.72; 95%CI 1.01-7.34, and diagnosis of major depression (OR = 3.34; 95%CI 1.54-7.44. Conclusion: Measures targeting adverse socioeconomic conditions and psychiatric and psychological monitoring and care should be encouraged in this population, considering the association with abuse of alcohol/other psychoactive drugs and suicide risk.
Yen, Yung-Chieh; Huang, Chih-Kuan; Tai, Chi-Ming
Purpose of review Bariatric surgery has been consistently shown to be effective in long-term marked weight loss and in bringing significant improvement to medical comorbidities such as metabolic syndrome. Empirical data suggest a high prevalence of psychiatric disorders among bariatric surgery candidates. In this review, we focus on the studies published recently with a high impact on our understanding of the role of psychiatry in bariatric surgery. Recent findings This article reviews the specific psychopathologies before surgery, changes in psychopathologies after surgery, suicide risk related to bariatric surgery, factors associated with weight loss, and recommendations for presurgical and postsurgical assessment and management. Research indicates a decrease in certain psychiatric symptoms after weight loss with bariatric surgery. However, the risk of suicide and unsuccessful weight loss in some bariatric surgery patients make monitoring following surgery as important as careful assessment and management before surgery. Specific considerations for youth and older populations and future potential research foci are discussed. Summary Recent publications suggest new directions for psychiatric evaluation and interventions for bariatric surgery patients. Future research on outcomes of specific populations, effectiveness of psychopharmacotherapy, and underlying pathophysiology are warranted for the advancement of treating bariatric surgery patients. PMID:25036421
Putkonen, Hanna; Holi, Matti; Kaltiala-Heino, Riittakerttu; Korkeila, Jyrki; Eronen, Markku
This study examined Finnish psychiatric trainees' views on their education. This was a survey study of nationwide data on Finnish psychiatric trainees in 2001. The quality of training was considered at least moderate by 84% of the respondents. Training on epidemiology, on taking history and status, and on psychopharmacology was considered the best. Quality was rated bad for training in leadership and administration, and educating the community. Research was done by 20%, and a personal clinical supervisor was appointed to 52% of the respondents. Offensive treatment had been experienced by 49% of the trainees in this study. Generally, studies of training also reflect strengths and weaknesses of the profession. Based on our results, it seems especially that training in leadership and in educating the community need to be improved; both of these are quintessential skills to survive in the struggle for economic and human resources. Furthermore, treatment of the trainees could still be better; attention should be paid to supervision of all trainees. Moreover, research must become more attractive. Psychiatry can be developed by the development of psychiatric training.
Domenico Lorenzo Urso
Full Text Available Bronchial asthma is a common problem with enormous medical and economics impacts. It is an inflammatory disease of the airways associated with intermittent episodes of bronchospasm. Asthma is not uncommon in the elderly patients. Prevalence of asthma is similar in older and younger adults. Asthma in the elderly patient is underdiagnosed because of false perceptions by both patient and physician. The high incidence of comorbid conditions in the elderly patient makes the diagnosis and management more difficult. Correct diagnosis is demonstrated with spirometry. The goals of asthma treatment are to achieve and maintain control of symptoms and to prevent development of irreversible airflow limitation. Asthma drugs are preferably inhaled because this route minimizes systemic absorption and, thus, improves the ratio of the therapeutic benefit to the potential side-effects in elderly patients.
Full Text Available Management of anticoagulation in elderly patients represents a particularly challenging issue. Indeed, this patient population is at high thromboembolic risk, but also at high hemorrhagic risk. Assessment of the benefit-risk balance of anticoagulation is the key point when decisions are made about introducing and/or continuing such treatments in the individual elderly patient. In order to maximise the safety of anticoagulation in the elderly, some specific considerations need to be taken into account, including renal insufficiency, modified pharmacodynamics of anticoagulants, especially vitamin K antagonists, and the presence of multiple comorbidities and concomitant medications. New anticoagulants could greatly simplify and possibly increase the safety of anticoagulation in the elderly in the near future.
Leung, Ka Chun; Mui, Carlo; Chiu, Wing Yan; Ng, Yuk Yiu; Chen, Matthew H. Y.; Ho, Pui Hung; Kwok, Chun Pong; Lam, Suki S. M.; Wong, Chun Yip; Wong, Kit Yee; Pang, Herbert H.
This randomized controlled trial aimed to test the effectiveness of brief face-to-face patient education in increasing influenza vaccination rate among elderly in the community. Recruitment and intervention were conducted at two general outpatient clinics in Hong Kong. 529 eligible patients were randomly assigned to intervention or control group…
Isaac, Lisa M.; And Others
Assessed multiple aspects of cognitive performance, medication planning ability, and medication compliance in 20 elderly outpatients. Findings suggest that aspects of attention/concentration, visual and verbal memory, and motor function which are untapped by simple mental status assessment are related to medication access, planning, and compliance…
Watanabe, Minoru; Yasuoka, Masaya
Economically developed countries are confronting the aging of society. Especially, their respective shares of elderly people among the total population in Japan are highest in the world. Moreover, the labor participation rates of older people in Japan are higher than in other OECD countries. Several reasons underlie the increased labor participation of older people in Japan. One reason is the subsidy for the labor supply of elderly people. This paper presents an examination of how this subsid...
Chen, Shih-Han; Chen, Yi-Chun; Chen, Tzeng-Ji; Ma, Hsu
The aim of the study is to understand the incidence of burns among outpatients and inpatients of Taiwan in 2010. Characteristics of the burned patients were also studied in terms of gender, age, burn sites, burn degree, reconstructive surgical treatment, as well as which specialty and medical facility they are treated in. Burned patients were identified from the 1,000,000-person cohort dataset sampled from the Taiwan National Health Insurance database. Ones who had been hospitalized with discharge diagnoses related to burns were categorized as inpatients and others who had only ambulatory visits and emergency room visits were classified as outpatients. 7630 burn-injury patients were found, presenting an annual incidence of burns as 670.8/10(5) in males (n=3303) and 852.5/10(5) in females (n=4327). Only 3.4% (156 males and 107 females) of them were hospitalized. Higher incidence of burns were found in females and young children, while males and the elderly tended to have more severe burns, based on high-degree burns, admission rate, and incidence of hospitalizations for burns. This is a population-based study demonstrating the epidemiology of burns among outpatients and inpatients in Taiwan, leading us closer to the reality of burns treated in different settings of medical facilities. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.
Vale Francisco A.C.
Full Text Available We describe clinical and socio-demographic features of patients with dementia attended in a tertiary outpatient clinic during a three years period (56.9% of the total attendance. Most of them were men, white, from the local community, urban district. Nobody had a job at the moment, two thirds of them got social welfare benefit. They lived with their family, the caregiver being the spouse or a daughter. The education level was very low, a quarter of them being illiterate. They were referred mostly from the public health care service, by neurologists or psychiatrists due to cognitive disorders. Family history as well as individual history of previous neurological/psychiatric disorders were frequent, especially alcoholism, stroke, head trauma and dementia. The neurological exam showed abnormalities in two thirds of cases, chiefly extra-pyramidal and pyramidal signs. Alzheimer's disease was the most frequent cause, followed by cerebrovascular disorder; alcoholism and normal pressure hydrocephalus were also frequent causes. Most patients presented concomitant non-etiological neurological/psychiatric disorders, mainly alcoholism and depression, and non-neurological/psychiatric diseases, predominantly hypertension, cardiopathy and diabetes. Most patients had been referred under medication, frequently politherapy, including psychotropics.
Vukcević, Natasa Perković; Ercegović, Gordana Vuković; Segrt, Zoran; Djordjević, Snezana; Stosić, Jasmina Jović
Benzodiazepines are among the most frequently ingested drugs in self-poisonings. Elderly may be at greater risk compared with younger individuals due to impaired metabolism and increased sensitivity to benzodiazepines. The aim of this study was to assess toxicity of benzodiazepines in elderly attempted suicide. A retrospective study of consecutive presentations to hospital after self-poisoning with benzodiazepines was done. Collected data consisted of patient's characteristics (age, gender), benzodiazepine ingested with its blood concentrations at admission, clinical findings including vital signs and Glasgow coma score, routine blood chemistry, complications of poisoning, details of management, length of hospital stay and outcome. According the age, patients are classified as young (15-40-year old), middle aged (41-65-year old) and elderly (older than 65). During a 2-year observational period 387 patients were admitted because of pure benzodiazepine poisoning. The most frequently ingested drug was bromazepam, the second was diazepam. The incidence of coma was significantly higher, and the length of hospital stay significantly longer in elderly. Respiratory failure and aspiration pneumonia occurred more frequently in old age. Also, flumazenil was more frequently required in the group of elderly patients. Massive benzodiazepines overdose in elderly may be associated with a significant morbidity, including deep coma with aspiration pneumonia, respiratory failure, and even death. Flumazenil is indicated more often to reduce CNS depression and prevent complications of prolonged unconsciousness, but supportive treatment and proper airway management of comatose patients is the mainstay of the treatment of acute benzodiazepine poisoning.
Full Text Available Elderly people are the largest and continuously fastest growing population among patients with epilepsy. Elderly patients with epilepsy are very different from other age groups in many respects and clinicians shouldn’t treat them in the same way as younger adults. Accurate diagnosis of epilepsy in the elderly is much more difficult and atypical manifestations and misdiagnoses are certainly not the exception. Syncope is probably the most important differential diagnosis. High clinical suspicion and proper investigation are the best tools for prompt diagnosis. Etiologies of late-onset epilepsy are mainly symptomatic and cerebrovascular diseases are the most common causes in this age group, followed by degenerative diseases such as Alzheimer’s disease. It is appropriate to consider starting antiepileptic drug (AED treatment at the first-ever seizure in elderly patients who have remote symptomatic causes such as stroke and dementia. According to the high recurrence rate of seizure and the good response to AEDs in elderly patients, the proper choice from various AEDs for seizure control is very important. Decision-making for AED choice depends on many different factors, including pharmacological properties, efficacy, tolerability from side effects, drug interactions, and medical comorbidities. The newer AEDs with lesser adverse effects and fewer drug interactions appear to be reasonable treatment options for elderly patients. However, more evidence from clinical trials in this specific age group is warranted.
phrenia Outpatient Health Outcomes (IC-SOHO) Study: ... sirable effect of an intervention, whereas effectiveness is the ... Method: The IC-SOHO study is an ongoing prospective, three-year, ... two North African and two Middle Eastern countries. ... and either overweight (46%) or obese (8%) when they entered the study.
There is paucity of data on the prevalence of pulmonary tuberculosis (PTB) among out-patient attendees from individual Institutions and Health Care Facilities performing sputum smear microscopy in Ghana. This retrospective study analyzed sputum smear microscopy results among pulmonary TB suspected patients ...
South African Medical Journal. Journal Home · ABOUT · Advanced Search · Current Issue · Archives · Journal Home > Vol 104, No 1 (2014) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Outpatient management of adult alcoholism. MF Williams. Abstract.
Bauer, Arie; Rosca, Paola; Shai, Ozi; Charnas, Jacob; Lehman, Dina; Mester, Roberto; Khawaled, Razek
Outpatient commitment under court order is a controversial issue among mental health professionals in different countries. This kind of outpatient involuntary treatment is provided for mental patients suspected to have committed a crime endangering society while in a severe psychotic state. Despite their dangerousness, the Israeli Mental Health Law of 1991 provides outpatient commitment under court order as an alternative to inpatient commitment. This legal provision raises several concerns and important ethical questions. A major dilemma is the question of whether this legal tool is efficacious in stabilizing the mental condition of criminal mental patients in order to prevent the perpetuation of violent crimes in an open setting such as outpatient clinics. Other major concerns are: (a) who bears the responsibility for the implementation of the enforcement? (b) how the enforcement might be implemented? This paper discusses this complex issue and presents some possible solutions aimed at improving the practical use of this important component of the comprehensive modern system of care for mental patients.
Dahhan, Nordin; Meijssen, Dominique; Chegary, Malika; Bosman, Diederik; Wolf, Bart
Background: The health status of chronic sick ethnic minority children in the Netherlands is unequal compared with indigenous Dutch children. In order to optimize the health care for these children a specific patient-oriented clinic in ethnic-cultural diversity: the Mosaic Outpatient Clinic (MOC)