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Sample records for psychiatric outpatient department

  1. A Live Threat Violence Simulation Exercise for Psychiatric Outpatient Departments: A Valuable Aid to Training in Violence Prevention.

    Science.gov (United States)

    Feinstein, Robert E; Yager, Joel

    2017-10-30

    approach may be useful for other psychiatric outpatient departments.

  2. Psychosocial profile of male patients presenting with sexual dysfunction in a psychiatric outpatient department in Mumbai, India

    OpenAIRE

    Kalra, Gurvinder; Kamath, Ravindra; Subramanyam, Alka; Shah, Henal

    2015-01-01

    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...

  3. Psychosocial profile of male patients presenting with sexual dysfunction in a psychiatric outpatient department in Mumbai, India.

    Science.gov (United States)

    Kalra, Gurvinder; Kamath, Ravindra; Subramanyam, Alka; Shah, Henal

    2015-01-01

    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.

  4. Tobacco Smoking in Adolescent Psychiatric Outpatients

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    Ditchburn, K. Marie; Sellman, J. Douglas

    2013-01-01

    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…

  5. Suicidal behavior and abuse in psychiatric outpatients.

    Science.gov (United States)

    Kaplan, M L; Asnis, G M; Lipschitz, D S; Chorney, P

    1995-01-01

    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.

  6. Prevalence of dissociative disorders in psychiatric outpatients.

    Science.gov (United States)

    Foote, Brad; Smolin, Yvette; Kaplan, Margaret; Legatt, Michael E; Lipschitz, Deborah

    2006-04-01

    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).

  7. Treatment profiles in a Danish psychiatric university hospital department

    DEFF Research Database (Denmark)

    Okkels, Niels; Mogensen, Rasmus Beyer; Crean, Lea Catherine

    2017-01-01

    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...

  8. Subjective anger and overt aggression in psychiatric outpatients.

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    Genovese, Timothy; Dalrymple, Kristy; Chelminski, Iwona; Zimmerman, Mark

    2017-02-01

    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.

  9. [ADHD in adult psychiatric outpatients: prevalence and comorbidity].

    Science.gov (United States)

    Duran, Şahut; Fıstıkcı, Nurhan; Keyvan, Ali; Bilici, Mustafa; Çalışkan, Mecit

    2014-01-01

    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.

  10. Psychiatric Diagnoses among an HIV-Infected Outpatient Clinic Population.

    Science.gov (United States)

    Shacham, Enbal; Önen, Nur F; Donovan, Michael F; Rosenburg, Neal; Overton, E Turner

    2016-01-01

    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.

  11. Perceived Mental Illness Stigma among Youth in Psychiatric Outpatient Treatment

    Science.gov (United States)

    Elkington, Katherine S.; Hackler, Dusty; McKinnon, Karen; Borges, Cristiane; Wright, Eric R.; Wainberg, Milton L.

    2012-01-01

    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…

  12. FEASIBILITY OF COMPUTERIZED PSYCHOLOGICAL-TESTING WITH PSYCHIATRIC OUTPATIENTS

    NARCIS (Netherlands)

    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

  13. Occurrence of Medical Concerns in Psychiatric Outpatients with Intellectual Disabilities

    Science.gov (United States)

    Azimi, Kousha; Modi, Miti; Hurlbut, Janice; Lunsky, Yona

    2016-01-01

    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…

  14. Self-Esteem and Suicide Ideation in Psychiatric Outpatients

    Science.gov (United States)

    Bhar, Sunil; Ghahramanlou-Holloway, Marjan; Brown, Gregory; Beck, Aaron T.

    2008-01-01

    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…

  15. Testing DEA Models of Efficiency in Norwegian Psychiatric Outpatient Clinics

    OpenAIRE

    Kittelsen, Sverre A.C.; Magnussen, Jon

    2009-01-01

    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...

  16. Migraine predicts physical and pain symptoms among psychiatric outpatients

    Science.gov (United States)

    2013-01-01

    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

  17. Patterns of psychotropic medication use in inpatient and outpatient psychiatric settings in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Alosaimi FD

    2016-04-01

    Full Text Available Fahad D Alosaimi,1 Abdulhadi Alhabbad,2 Mohammed F Abalhassan,3 Ebtihaj O Fallata,4 Nasser M Alzain,5 Mohammad Zayed Alassiry,6 Bander Abdullah Haddad71Department of Psychiatry, King Saud University, Riyadh, 2Department of Psychiatry, Prince Mohammed Medical City, Aljouf, 3Department of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, 4Department of Psychiatry, Mental Health Hospital, Jeddah, 5Department of Psychiatry, Al-Amal Complex for Mental Health, Dammam, 6Medical Services Department, Abha Psychiatric Hospital, Abha, 7Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard, Riyadh, Saudi ArabiaObjective: To study the pattern of psychotropic medication use and compare this pattern between inpatient and outpatient psychiatric settings in Saudi Arabia.Method: This cross-sectional observational study was conducted between July 2012 and June 2014 on patients seeking psychiatric advice at major hospitals in five main regions of Saudi Arabia. Male (n=651 and female (n=594 patients who signed the informed consent form and were currently or had been previously using psychotropic medications, irrespective of the patient’s type of psychiatric diagnosis and duration of the disease, were included. A total of 1,246 patients were found to be suitable in the inclusion criteria of whom 464 were inpatients while 782 were outpatients.Results: Several studied demographic factors have shown that compared with outpatients, inpatients were more likely to be male (P=0.004, unmarried (P<0.001, have less number of children (1–3; P=0.002, unemployed (P=0.001, have a lower family income (<3,000 SR; P<0.001, live in rural communities (P<0.001, have a lower body mass index (P=0.001, and are smokers (P<0.001; however, there were no differences with regard to age or educational levels. The current frequency of use of psychotropic medications in overall patients was antipsychotics (76.6%, antidepressants (41.4%, mood stabilizers

  18. Post-traumatic stress disorder in Australian World War II veterans attending a psychiatric outpatient clinic.

    Science.gov (United States)

    Kidson, M A; Douglas, J C; Holwill, B J

    1993-04-19

    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.

  19. Screening of alcohol use disorders in psychiatric outpatients: influence of gender, age, and psychiatric diagnosis.

    Science.gov (United States)

    Sánchez Autet, Mónica; Garriga, Marina; Zamora, Francisco Javier; González, Idilio; Usall, Judith; Tolosa, Leticia; Benítez, Concepción; Puertas, Raquel; Arranz, Belén

    2017-07-14

    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.

  20. User-driven innovation of an outpatient department

    DEFF Research Database (Denmark)

    Broberg, Ole; Edwards, Kasper

    2012-01-01

    This paper presents experiences from a user-driven innovation process of an outpatient department in a hospital. The mixing of methods from user-driven innovation and participatory design contributed to develop an innovative concept of the spatial and organizational design of an outpatient...

  1. Self-esteem and interpersonal functioning in psychiatric outpatients.

    Science.gov (United States)

    Bjørkvik, Jofrid; Biringer, Eva; Eikeland, Ole-Johan; Nielsen, Geir Høstmark

    2009-06-01

    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.

  2. Depression in young adult psychiatric outpatients: delimiting early onset.

    Science.gov (United States)

    Ramirez, Adriana; Ekselius, Lisa; Ramklint, Mia

    2015-04-01

    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.

  3. Factors associated with problematic drug use among psychiatric outpatients

    Directory of Open Access Journals (Sweden)

    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.

  4. Concurrent Medical and Psychiatric Disorders among Schizophrenic and Neurotic Outpatients.

    Science.gov (United States)

    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…

  5. [Inguinal herniotomy in outpatient clinics and in hospital departments].

    Science.gov (United States)

    Andersen, Finn Heidemann; Bay-Nielsen, Morten; Bak-Christensen, Anders; Nielsen, Kaare; Struckmann, Jan Reinhold; Kehlet, Henrik

    2003-06-02

    The purpose of the investigation was to examine the use of ambulatory surgery, anesthetic technique, reoperation rates, and reembursement fees after inguinal herniotomy in private outpatients clinics compared to herniotomy in hospital departments. Information on number of operations performed, choice of anesthetic and surgical technique in private outpatients clinics and hospital departments was extracted from the Danish Hernia Data Base. Information on reembursement fees was obtained from the relevant health authorities and the Danish Medical Association. 7.4% of the inguinal herniotomies in Denmark were performed in private outpatients clinics. There was an extended use of local infiltration anesthesia (99%) and ambulatory procedures (99%) compared with 12% and 57% in the hospital departments. The reembursement fee for a herniotomy is approximately 3700 DKK in private outpatients clinics vs. 11,000 DKK in hospital departments. The results of the study showed that the quality of inguinal herniotomy in private outpatients clinics is comparable to herniotomy in hospital departments, but the reembursement fees are lower in private outpatients clinics.

  6. Intimate partner violence perpetrators in a forensic psychiatric outpatient setting : Criminal history, psychopathology, and victimization

    NARCIS (Netherlands)

    Henrichs, J.; Bogaerts, S.; Sijtsema, J.J.; Klerx, F.

    2015-01-01

    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

  7. Screening for psychiatric morbidity in an accident and emergency department.

    OpenAIRE

    Bell, G; Hindley, N; Rajiyah, G; Rosser, R

    1990-01-01

    One hundred and twenty A&E Department daytime attenders were screened for psychiatric disorder in a two stage procedure. Thirty-three patients were identified as General Health Questionnaire (GHQ) 'cases' of whom 28 agreed to a psychiatric interview using the Clinical Interview Schedule. Twenty-eight GHQ 'non-cases' were also interviewed. A psychiatric diagnosis was made in 24 patients, 21 of whom were GHQ cases. Patients were more likely to suffer from psychiatric morbidity if the presenting...

  8. The Impact of Psychiatric Patient Boarding in Emergency Departments

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    B. A. Nicks

    2012-01-01

    Full Text Available Objectives. Studies have demonstrated the adverse effects of emergency department (ED boarding. This study examines the impact of resource utilization, throughput, and financial impact for psychiatric patients awaiting inpatient placement. Methods. The authors retrospectively studied all psychiatric and non-psychiatric adult admissions in an Academic Medical Center ED (>68,000 adult visits from January 2007-2008. The main outcomes were ED length of stay (LOS and associated reimbursement. Results. 1,438 patients were consulted to psychiatry with 505 (35.1% requiring inpatient psychiatric care management. The mean psychiatric patient age was 42.5 years (SD 13.1 years, with 2.7 times more women than men. ED LOS was significantly longer for psychiatric admissions (1089 min, CI (1039–1140 versus 340 min, CI (304–375; <0.001 when compared to non-psychiatric admissions. The financial impact of psychiatric boarding accounted for a direct loss of ($1,198 compared to non-psychiatric admissions. Factoring the loss of bed turnover for waiting patients and opportunity cost due to loss of those patients, psychiatric patient boarding cost the department $2,264 per patient. Conclusions. Psychiatric patients awaiting inpatient placement remain in the ED 3.2 times longer than non-psychiatric patients, preventing 2.2 bed turnovers (additional patients per psychiatric patient, and decreasing financial revenue.

  9. Characteristics of psychiatric emergency department use among privately insured adolescents with autism spectrum disorder.

    Science.gov (United States)

    Kalb, Luther G; Stuart, Elizabeth A; Vasa, Roma A

    2018-01-01

    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.

  10. Dropping out of outpatient psychiatric treatment: a preliminary report of a 2-year follow-up of 1500 psychiatric outpatients in Kermanshah, Iran.

    Science.gov (United States)

    Khazaie, Habibolah; Rezaie, Leeba; de Jong, Desiree M

    2013-01-01

    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

  11. Volume, structure and funding of specialized outpatient care at the outpatient Advisory Department of Mariinskaya hospital

    Directory of Open Access Journals (Sweden)

    E. M. Kutyrev

    2015-01-01

    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.

  12. Audit of outpatient department management of patients with ...

    African Journals Online (AJOL)

    Audit of outpatient department management of patients with respiratory symptoms in Lilongwe. Henry Kanyerere ', Thomas E Nyirenda "1, Anthony D Harries', .... ensure quality care along the National Standard Treatment. Guidelines. 5. Lastly, very few patients were referred for care elsewhere or at next level. It is not clear ...

  13. Negative rumor: contagion of a psychiatric department.

    Science.gov (United States)

    Novac, Andrei; McEwan, Stephanie; Bota, Robert G

    2014-01-01

    Over the past few decades, a sizable body of literature on the effects of rumors and gossip has emerged. Addressing rumors in the workplace is an important subject, as rumors have a direct impact on the quality of the work environment and also on the productivity and creativity of the employees. To date, little has been written on the effect of rumors and gossip in psychiatric hospitals. This article presents case vignettes of rumors spread in psychiatric hospitals and the impact on team cohesion and morale among the staff implicated in these, too often, neglected occurrences. Dynamic aspects with particular focus on rumors in psychiatric units and suggestions for remedy and treatment are presented.

  14. Negative Rumor: Contagion of a Psychiatric Department

    OpenAIRE

    Novac, Andrei; McEwan, Stephanie; Bota, Robert G

    2014-01-01

    Over the past few decades, a sizable body of literature on the effects of rumors and gossip has emerged. Addressing rumors in the workplace is an important subject, as rumors have a direct impact on the quality of the work environment and also on the productivity and creativity of the employees. To date, little has been written on the effect of rumors and gossip in psychiatric hospitals. This article presents case vignettes of rumors spread in psychiatric hospitals and the impact on team cohe...

  15. [Statutory duties of German psychiatric outpatient clinics and their real care conditions].

    Science.gov (United States)

    Valdes-Stauber, Juan; Kilian, Reinhold

    2013-04-01

    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.

  16. Service quality of hospital outpatient departments: patients' perspective.

    Science.gov (United States)

    Zarei, Ehsan

    2015-01-01

    Assessment of patient perceptions of health service quality as an important element in quality assessments has attracted much attention in recent years. The purpose of this paper is to assess the service quality of hospital outpatient departments affiliated to Shahid Beheshti University of Medical Sciences from the patients' perspective. This cross-sectional study was conducted in 2014 in Tehran, Iran. The study samples included 500 patients who were selected by multi-stage random sampling from four hospitals. The data collection instrument was a questionnaire consisting of 50 items, and the validity and reliability of the questionnaire were confirmed. For data analysis, exploratory and confirmatory factor analysis, Friedman test, and descriptive statistics were used through LISREL 8.54 and SPSS 18 applications. Eight significant factors were extracted for outpatient service quality, which explained about 67 per cent of the total variance. Physician consultation, information provided to the patient, and the physical environment of the clinic were the three determining factors of the quality of outpatient services. The highest and lowest perceptions were related to physician consultation and perceived waiting time dimension, respectively. The mean score of patients' perception of outpatient service quality was 3.89 (±0.60). About 59.5 per cent of patients assessed the quality of outpatient services as good, 38.2 per cent as moderate, and 2.3 per cent as poor. Practical implications - The instrument developed for this study is valid and reliable, and it can help hospital managers to identify the areas needing improvement and correction. According to the findings of this study, the majority of patients had a positive experience with outpatient departments of teaching hospitals, and the services provided in these centres were of adequate quality, based on patient assessments.

  17. Factors associated with problematic drug use among psychiatric outpatients.

    Science.gov (United States)

    Corradi-Webster, Clarissa Mendonça; Gherardi-Donato, Edilaine Cristina da Silva

    2016-11-28

    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

  18. Sexual Dysfunctions among Psychiatric Outpatients in Calabar. | Oju ...

    African Journals Online (AJOL)

    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 ...

  19. Efficacy of Group Art Therapy on Depressive Symptoms in Adult Heterogeneous Psychiatric Outpatients

    Science.gov (United States)

    Chandraiah, Shambhavi; Ainlay Anand, Susan; Avent, Lindsay Cherryl

    2012-01-01

    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…

  20. The outpatient care of psychiatric patients in a rural area: Mhala ...

    African Journals Online (AJOL)

    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 ...

  1. Traumatization in Deaf and Hard-of-Hearing Adult Psychiatric Outpatients

    Science.gov (United States)

    Øhre, Beate; Uthus, Mette Perly; von Tetzchner, Stephen; Falkum, Erik

    2015-01-01

    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…

  2. Motivation for Psychiatric Treatment in Outpatients with Severe Mental Illness : Different Perspectives

    NARCIS (Netherlands)

    E.C. Jochems (Eline)

    2016-01-01

    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

  3. Screening for psychiatric morbidity in an accident and emergency department.

    Science.gov (United States)

    Bell, G; Hindley, N; Rajiyah, G; Rosser, R

    1990-09-01

    One hundred and twenty A&E Department daytime attenders were screened for psychiatric disorder in a two stage procedure. Thirty-three patients were identified as General Health Questionnaire (GHQ) 'cases' of whom 28 agreed to a psychiatric interview using the Clinical Interview Schedule. Twenty-eight GHQ 'non-cases' were also interviewed. A psychiatric diagnosis was made in 24 patients, 21 of whom were GHQ cases. Patients were more likely to suffer from psychiatric morbidity if the presenting complaint was other than minor trauma. There were trends for psychiatric morbidity to be associated with not being married and living in Bloomsbury Health District (No Fixed Abode or resident) or Northeast London. Sixty-nine percent of cases had a positive past psychiatric history. Ten of 12 cases (83%) requiring primary care intervention were not registered with a GP. It is suggested that appropriate intervention would be for A&E Departments to routinely facilitate such registration. In addition, resources need to be released to make 9am to 5pm walk-in psychiatric services commonplace.

  4. Internalized stigma predicts erosion of morale among psychiatric outpatients.

    Science.gov (United States)

    Ritsher, Jennifer Boyd; Phelan, Jo C

    2004-12-30

    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.

  5. [Decentralized outpatient teams in community-based psychiatric care: comparison of two Bavarian rural catchment areas].

    Science.gov (United States)

    Valdes-Stauber, J; Putzhammer, A; Kilian, R

    2014-05-01

    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

  6. Self-Determination Theory and Outpatient Follow-Up After Psychiatric Hospitalization.

    Science.gov (United States)

    Sripada, Rebecca K; Bowersox, Nicholas W; Ganoczy, Dara; Valenstein, Marcia; Pfeiffer, Paul N

    2016-08-01

    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.

  7. [Psychopharmacotherapy in adolescents with borderline personality disorder in inpatient and outpatient psychiatric treatment].

    Science.gov (United States)

    Wöckel, Lars; Goth, Kirstin; Matic, Nina; Zepf, Florian Daniel; Holtmann, Martin; Poustka, Fritz

    2010-01-01

    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.

  8. Measures of motivation for psychiatric treatment based on self-determination theory: psychometric properties in Dutch psychiatric outpatients.

    Science.gov (United States)

    Jochems, Eline C; Mulder, Cornelis L; Duivenvoorden, Hugo J; van der Feltz-Cornelis, Christina M; van Dam, Arno

    2014-08-01

    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.

  9. Psychiatric and Medical Management of Marijuana Intoxication in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Bui, Quan M.

    2015-05-01

    Full Text Available We use a case report to describe the acute psychiatric and medical management of marijuana intoxication in the emergency setting. A 34-year-old woman presented with erratic, disruptive behavior and psychotic symptoms after recreational ingestion of edible cannabis. She was also found to have mild hypokalemia and QT interval prolongation. Psychiatric management of cannabis psychosis involves symptomatic treatment and maintenance of safety during detoxification. Acute medical complications of marijuana use are primarily cardiovascular and respiratory in nature; electrolyte and electrocardiogram monitoring is indicated. This patient’s psychosis, hypokalemia and prolonged QTc interval resolved over two days with supportive treatment and minimal intervention in the emergency department. Patients with cannabis psychosis are at risk for further psychotic sequelae. Emergency providers may reduce this risk through appropriate diagnosis, acute treatment, and referral for outpatient care. [West J Emerg Med. 2015;16(3:414–417.

  10. Screening for Sexual Orientation in Psychiatric Emergency Departments

    OpenAIRE

    Currier, Glenn W; Brown, Gregory; Walsh, Patrick G.; Jager-Hyman, Shari; Chaudhury, Sadia; Stanley, Barbara

    2015-01-01

    Introduction: Our goal was to explore whether emergency department (ED) patients would disclose their sexual orientation in a research evaluation and to examine demographic and clinical characteristics of patients by self-identified sexual orientation. Methods: Participants (n=177) presented for psychiatric treatment at three urban EDs in New York City, Rochester, NY, and Philadelphia, PA. Participants were interviewed in the context of a larger study of a standardized s...

  11. Effects of Music Therapy on Drug Therapy of Adult Psychiatric Outpatients: A Pilot Randomized Controlled Study

    Science.gov (United States)

    Degli Stefani, Mario; Biasutti, Michele

    2016-01-01

    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

  12. Effects of Music Therapy on Drug Therapy of Adult Psychiatric Outpatients: A Pilot Randomized Controlled Study.

    Science.gov (United States)

    Degli Stefani, Mario; Biasutti, Michele

    2016-01-01

    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.

  13. Effects of music therapy on drug therapy of adult psychiatric outpatients: A pilot randomised controlled study

    Directory of Open Access Journals (Sweden)

    Mario Degli Stefani

    2016-10-01

    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.

  14. Intimate partner violence perpetrators in a forensic psychiatric outpatient setting: criminal history, psychopathology, and victimization.

    Science.gov (United States)

    Henrichs, Jens; Bogaerts, Stefan; Sijtsema, Jelle; Klerx-van Mierlo, Fanny

    2015-07-01

    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.

  15. Evaluation of service quality of hospital outpatient department services.

    Science.gov (United States)

    Chakravarty, Abhijit

    2011-07-01

    It has become essential for hospital managers to understand and measure consumer perspectives and service quality gaps, so that any perceived gap in delivery of service is identified and suitably addressed. A study was conducted at a peripheral service hospital to ascertain any service gap between consumer expectations and perceptions in respect of the hospital outpatient department (OPD) services. A cross-sectional study was conducted using SERVQUAL as the survey instrument, the instrument being validated for use in the hospital environment. Consumer ratings across 22 items of the survey instrument were collected in paired expectation and perception scores and then service quality gaps were identified and statistically analysed. Service quality gaps were identified to exist across all the five dimensions of the survey instrument, with statistically significant gaps across the dimensions of 'tangibles' and 'responsiveness.' The quality gaps were further validated by a total unweighted SERVQUAL score of (-) 1.63. The study concludes that significant service quality gaps existed in the delivery of the hospital OPD services, which need to be addressed by focused improvement efforts by the hospital management.

  16. Monitoring of Metabolic Adverse Effects Associated With Atypical Antipsychotics Use in an Outpatient Psychiatric Clinic.

    Science.gov (United States)

    Pereira, Luis; Budovich, Aliaksandr; Claudio-Saez, Maria

    2018-01-01

    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.

  17. [Feeling of Liberty and Internalized Stigma: Comparison of Inpatient and Outpatient Cases Receiving Psychiatric Treatment].

    Science.gov (United States)

    Kamışlı, Songül; Dil, Satı; Daştan, Leyla; Eni, Nurhayat

    2016-01-01

    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.

  18. [Mental health of college students: experience of the university psychiatric outpatient clinic of Hospital de São João].

    Science.gov (United States)

    Silveira, Celeste; Norton, Andreia; Brandão, Isabel; Roma-Torres, António

    2011-12-01

    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.

  19. [Sociodemographic characteristics and mental disorders in children and adolescents psychiatric outpatient clinic children of Medellin].

    Science.gov (United States)

    Ricardo-Ramírez, Carmenza; Álvarez-Gómez, Matilde; Rodríguez-Gázquez, María de los Ángeles

    2015-01-01

    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.

  20. Validity Evidences for the Dimensional Clinical Personality Inventory in Outpatient Psychiatric Sample

    Directory of Open Access Journals (Sweden)

    Roberta Katz Abela

    2015-08-01

    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.

  1. Dissociative identity disorder among adolescents: prevalence in a university psychiatric outpatient unit.

    Science.gov (United States)

    Sar, Vedat; Onder, Canan; Kilincaslan, Ayse; Zoroglu, Süleyman S; Alyanak, Behiye

    2014-01-01

    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.

  2. Prevalence and associated factors of hypnotics dependence among Japanese outpatients with psychiatric disorders.

    Science.gov (United States)

    Murakoshi, Akiko; Takaesu, Yoshikazu; Komada, Yoko; Ishikawa, Jun; Inoue, Yuichi

    2015-12-30

    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.

  3. Current comorbidity among consecutive adolescent psychiatric outpatients with DSM-IV mood disorders.

    Science.gov (United States)

    Karlsson, Linnea; Pelkonen, Mirjami; Ruuttu, Titta; Kiviruusu, Olli; Heilä, Hannele; Holi, Matti; Kettunen, Kirsi; Tuisku, Virpi; Tuulio-Henriksson, Annamari; Törrönen, Johanna; Marttunen, Mauri

    2006-06-01

    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

  4. Reducing HIV-Risk Behavior Among Adults Receiving Outpatient Psychiatric Treatment: Results From a Randomized Controlled Trial

    Science.gov (United States)

    Carey, Michael P.; Carey, Kate B.; Maisto, Stephen A.; Gordon, Christopher M.; Schroder, Kerstin E. E.; Vanable, Peter A.

    2004-01-01

    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…

  5. Psychometric Properties of the Persian Version of the Short Beck Depression Inventory with Iranian Psychiatric Outpatients

    Directory of Open Access Journals (Sweden)

    Mahboubeh Dadfar

    2016-01-01

    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.

  6. The effect of daily small text message reminders for medicine compliance amongst young people connected with the outpatient department for child and adolescent psychiatry

    DEFF Research Database (Denmark)

    Bjørnholt, Karsten; Christiansen, Erik; Attermann Stokholm, Kristine

    2016-01-01

    Background: Many patients with psychiatric illnesses have difficulty maintaining medication over time. Many take their medicine irregularly and studies show that it is the most vulnerable patients who have the greatest problems adhering to treatment. Often only 50% are still under medical treatment...... after 6 months. Aim: In this study we investigated whether text message reminders could improve medicine compliance amongst vulnerable young people with psychiatric disorders who were being treated in the outpatient department for child and adolescent psychiatry and who either are under or were...... to commence medicinal treatment. Methods: This study was conducted as a randomized controlled trial including all non-acute referrals to an outpatient department for adolescent psychiatry within a group aged 15-20 years starting medical treatment. The patients were followed until the end of their treatment...

  7. Sociodemographic characteristics and frequency of psychiatric disorders in Turkish pilgrims attended to psychiatry outpatient clinics during Hajj

    Directory of Open Access Journals (Sweden)

    Şakir Özen

    2010-03-01

    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.

  8. Psychiatric outpatient consultation for seniors. Perspectives of family physicians, consultants, and patients / family: A descriptive study

    Directory of Open Access Journals (Sweden)

    Dendukuri Nandini

    2005-04-01

    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.

  9. Implementation of a clinical pathway for emergency department out-patient management of deep vein thrombosis.

    LENUS (Irish Health Repository)

    Kidney, R

    2010-09-01

    There is good evidence demonstrating that outpatient management of deep venous thrombosis (DVT) is feasible and safe. However, few emergency departments in Ireland have implemented care pathways for outpatient management of DVT. The aim of this study was to examine the safety and efficacy of implementing an Emergency Department (ED)- care pathway for outpatient management of patients with DVT. A retrospective observational study of this care pathway introduced at our institution was performed. The primary outcome measure was the number of hospital admissions avoided by using the care pathway. Two hundred and eighty-four patients presenting to the ED with suspected lower limb DVT, were managed using the care pathway over a 6 month period. Forty-nine patients (17%) had a DVT diagnosed. Thirty-nine patients (81%) were suitable for outpatient DVT management. Ten patients (19%) were admitted to hospital. At 3 months there were no reported cases of the following complications: missed DVT, pulmonary embolism or death.

  10. Schizophrenic outpatient perceptions of psychiatric treatment and psychotic symptomatology: an investigation using structural equation modeling.

    Science.gov (United States)

    Hayashi, N; Yamashina, M; Taguchi, H; Ishige, N; Igarashi, Y

    2001-12-01

    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.

  11. Enabling healthy living: Experiences of people with severe mental illness in psychiatric outpatient services.

    Science.gov (United States)

    Blomqvist, Marjut; Sandgren, Anna; Carlsson, Ing-Marie; Jormfeldt, Henrika

    2018-02-01

    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.

  12. Internalized stigma among psychiatric outpatients: Associations with quality of life, functioning, hope and self-esteem.

    Science.gov (United States)

    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

    2016-12-30

    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.

  13. A cross-sectional testing of The Iowa Personality Disorder Screen in a psychiatric outpatient setting

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    Sørebø Øystein

    2011-06-01

    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.

  14. Predicting dropout in outpatient dialectical behavior therapy with patients with borderline personality disorder receiving psychiatric disability.

    Science.gov (United States)

    Landes, Sara J; Chalker, Samantha A; Comtois, Katherine Anne

    2016-01-01

    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.

  15. Cannabis and alcohol use, affect and impulsivity in psychiatric out-patients' daily lives.

    Science.gov (United States)

    Trull, Timothy J; Wycoff, Andrea M; Lane, Sean P; Carpenter, Ryan W; Brown, Whitney C

    2016-11-01

    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.

  16. Screening for Sexual Orientation in Psychiatric Emergency Departments

    Directory of Open Access Journals (Sweden)

    Currier, Glenn W.

    2015-01-01

    Full Text Available Introduction: Our goal was to explore whether emergency department (ED patients would disclose their sexual orientation in a research evaluation and to examine demographic and clinical characteristics of patients by self-identified sexual orientation. Methods: Participants (n=177 presented for psychiatric treatment at three urban EDs in New York City, Rochester, NY, and Philadelphia, PA. Participants were interviewed in the context of a larger study of a standardized suicide risk assessment. We assessed participants’ willingness to answer questions regarding sexual orientation along three dimensions: a self-description of sexual orientation, a self-description of sexual attraction, and the gender of any prior sexual partners. Results: No participants (0/177 refused to respond to the categorical question about sexual orientation, 168/177 (94.9% agreed to provide information about prior sexual partners, and 100/109 (91.7% provided information about current sexual attraction toward either gender. Of all 177 participants, 154 (87.0% self-identified as heterosexual, 11 (6.2% as bisexual, 10 (5.6% as gay or lesbian, and 2 (1.1% indicated they were not sure. As compared with heterosexual patients, lesbian, gay and bisexual (LGB patients were significantly younger and more likely to be non-white, but did not differ significantly in terms of education, income, employment, or religious affiliation or participation. Further, LGB participants did not differ from self-identified heterosexual participants for lifetime suicide attempt rate or lifetime history of any mood, substance-related, psychotic spectrum, or other Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV Axis I disorder. Of self-identified heterosexual participants 5.6% (5/89 reported sexual attraction as other than ‘only opposite sex,’ and 10.3% (15/142 of sexually active ‘heterosexual’ participants reported previous same-gender sexual partners. Conclusion

  17. Screening for sexual orientation in psychiatric emergency departments.

    Science.gov (United States)

    Currier, Glenn W; Brown, Gregory; Walsh, Patrick G; Jager-Hyman, Shari; Chaudhury, Sadia; Stanley, Barbara

    2015-01-01

    Our goal was to explore whether emergency department (ED) patients would disclose their sexual orientation in a research evaluation and to examine demographic and clinical characteristics of patients by self-identified sexual orientation. Participants (n=177) presented for psychiatric treatment at three urban EDs in New York City, Rochester, NY, and Philadelphia, PA. Participants were interviewed in the context of a larger study of a standardized suicide risk assessment. We assessed participants' willingness to answer questions regarding sexual orientation along three dimensions: a self-description of sexual orientation, a self-description of sexual attraction, and the gender of any prior sexual partners. No participants (0/177) refused to respond to the categorical question about sexual orientation, 168/177 (94.9%) agreed to provide information about prior sexual partners, and 100/109 (91.7%) provided information about current sexual attraction toward either gender. Of all 177 participants, 154 (87.0%) self-identified as heterosexual, 11 (6.2%) as bisexual, 10 (5.6%) as gay or lesbian, and 2 (1.1%) indicated they were not sure. As compared with heterosexual patients, lesbian, gay and bisexual (LGB) patients were significantly younger and more likely to be non-white, but did not differ significantly in terms of education, income, employment, or religious affiliation or participation. Further, LGB participants did not differ from self-identified heterosexual participants for lifetime suicide attempt rate or lifetime history of any mood, substance-related, psychotic spectrum, or other Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Axis I disorder. Of self-identified heterosexual participants 5.6% (5/89) reported sexual attraction as other than 'only opposite sex,' and 10.3% (15/142) of sexually active 'heterosexual' participants reported previous same-gender sexual partners. Assessing patients' sexual orientation in the ED by a three

  18. [Patient satisfaction in the outpatient department--a pilot study for customer satisfaction in ENT].

    Science.gov (United States)

    Schmidt, K; Meyer, J; Jahnke, I; Wollenberg, B; Schmidt, C

    2009-03-01

    Customer satisfaction in German hospitals is becoming more important because of increasing competition in the healthcare market. Because the majority of patients with ear-nose-throat (ENT) problems are treated in an outpatient setting, this competition is not only taking place among hospitals but also among specialists in private practices. To assess patient preferences, reliable and valid questionnaires are necessary, which so far exist only for inpatients. The aim of the study was to develop an instrument with which to discover areas for potential improvement of the outpatient department. The questionnaire was developed according to the guidelines of the EORTC and tested in a prestudy. During the time of observation, 98 patients were available, of whom 79 could be included in the study. The return rate was 71%. Of these patients, 18 were female and 38 male; the median age was 56 years. There were no differences between the study group and the yearly clinic average in terms of age, gender, or ratio of tumor patients. Patients mainly complained about waiting times in the outpatient department and diagnostic units as well as high patient turnover. Concerning positive aspects, patients mentioned the medical competence of the treating physicians; concerning negative aspects, the building infrastructure was noted. The questionnaire showed sufficient psychometric properties and helped find areas for improvement in the outpatient department. However, a complete picture of the department will be feasible only with repeated measures, especially when taking steps to improve the department's processes.

  19. Factors predicting adherence with psychiatric follow-up appointments for patients assessed by the liaison psychiatric team in the emergency department.

    LENUS (Irish Health Repository)

    Agyapong, Vincent I O

    2010-01-01

    Several factors may predict adherence with psychiatric follow-up appointment for patients seen in the emergency department (ED) by liaison psychiatric teams. Awareness of these factors would allow for interventions targeted at vulnerable groups.

  20. Scale, Efficiency and Organization in Norwegian Psychiatric Outpatient Clinics for Children.

    Science.gov (United States)

    Halsteinli, Vidar; Kittelsen, Sverre A.C.; Magnussen, Jon

    2001-06-01

    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

  1. 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.

    Science.gov (United States)

    Wieland, Jannelien; Van Den Brink, Annemarie; Zitman, Frans G

    2015-01-01

    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.

  2. Inpatient treatment of major depression in Austria between 1989 and 2009: impact of downsizing of psychiatric hospitals on admissions, suicide rates and outpatient psychiatric services.

    Science.gov (United States)

    Vyssoki, B; Willeit, M; Blüml, V; Höfer, P; Erfurth, A; Psota, G; Lesch, O M; Kapusta, N D

    2011-09-01

    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.

  3. Mediating effects of self-stigma on the relationship between perceived stigma and psychosocial outcomes among psychiatric outpatients: findings from a cross-sectional survey in Singapore

    OpenAIRE

    Picco, Louisa; Lau, Ying Wen; Pang, Shirlene; Abdin, Edimansyah; Vaingankar, Janhavi Ajit; Chong, Siow Ann; Subramaniam, Mythily

    2017-01-01

    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...

  4. Skepticism and pharmacophobia toward medication may negatively impact adherence to psychiatric medications: a comparison among outpatient samples recruited in Spain, Argentina, and Venezuela

    Directory of Open Access Journals (Sweden)

    De las Cuevas C

    2018-02-01

    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

  5. Psychiatric comorbidity and plasma levels of 2-acyl-glycerols in outpatient treatment alcohol users. Analysis of gender differences.

    Science.gov (United States)

    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

    2016-09-29

    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.

  6. Attendance at an outpatient follow-up clinic by HIV-positive psychiatric patients initiated on ART as inpatients

    Directory of Open Access Journals (Sweden)

    Yvette M Nel

    2015-08-01

    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.

  7. Measures of motivation for psychiatric treatment based on self-determination theory : Psychometric properties in Dutch psychiatric outpatients

    NARCIS (Netherlands)

    Jochems, Eline C.; Mulder, Cornelis L.; Duivenvoorden, Hugo J.; van der Feltz-Cornelis, Christina M.; van Dam, Arno

    2014-01-01

    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

  8. Sudden Cardiac Death in Young Adults With Previous Hospital-Based Psychiatric Inpatient and Outpatient Treatment

    DEFF Research Database (Denmark)

    Risgaard, Bjarke; Waagstein, Kristine; Winkel, Bo Gregers

    2015-01-01

    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...

  9. Clinical analysis of 48-h emergency department visit post outpatient extracorporeal shock wave lithotripsy for urolithiasis.

    Science.gov (United States)

    Lu, Chin-Heng; Kuo, Junne-Yih; Lin, Tzu-Ping; Huang, Yi-Hsiu; Chung, Hsiao-Jen; Huang, William J S; Wu, Howard H H; Chang, Yen-Hwa; Lin, Alex T L; Chen, Kuang-Kuo

    2017-09-01

    Patients suffering from renal or ureteral stones can undergo significant discomfort, even when timely diagnosed and treated. The aim of this study was to assess the risk factors and safety of outpatient Extracorporeal Shock Wave Lithotripsy (ESWL) in the management of patients with renal or ureteral stones. In this study, our cohort consisted of 844 outpatients who underwent outpatient ESWL treated between February 2012 and November 2014 at Taipei Veterans General Hospital. Patients who visited the emergency room (ER) within 48 h after Outpatient ESWL were included in this article. This article analyzes the stone size, stone shape (long to short axis ratio), stone location, previous medical management, urinalysis data, complications and treatment received in the emergency department. Among the 844 initial consecutive patients who underwent outpatient ESWL a total of 1095 times, there were 22 (2%) patients who sought help at our emergency room within 48 h after the outpatient ESWL. Of those 22 patients, the mean age was 54.3 ± 12.6 years, and the BMI was 25.9 ± 3.2. The most common complication complaint was flank pain (55.2%). Other complications included hematuria (13.8%), fever (17.2%), nausea with vomiting (6.9%), acute urinary retention (3.4%) and chest tightness with cold sweating (3.4%). In 22 patients who went back to the ER, 7 patients were admitted to the ward and 1 patient again returned to the ER. All patients received medical treatment without ESWL or surgical management. The meaningful risk factor of ER-visiting rate following outpatient ESWL within 48 h was stone location, and the renal stones showed statistic significant (p = 0.047) when compared to ureteral stones. Our study indicated that renal stone contributed to a significantly higher risk of ER-visiting rate to patients than did ureteral stone, following outpatient ESWL within 48 h. This study confirmed that Outpatient ESWL is a safe treatment for renal or ureteral stones, while

  10. Do electronic health records affect the patient-psychiatrist relationship? A before & after study of psychiatric outpatients

    Directory of Open Access Journals (Sweden)

    Schuyler Mark

    2010-01-01

    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.

  11. The outpatient care of psychiatric patients in a rural area: Mhala ...

    African Journals Online (AJOL)

    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 ...

  12. Screening Dementia in the Outpatient Department: Patients at Risk for Dementia

    OpenAIRE

    Tai, Shu-Yu; Huang, Shu-Wan; Hsu, Chia-Ling; Yang, Chiu-Hsien; Chou, Mei-Chuan; Yang, Yuan-Han

    2014-01-01

    The targeted screening for individuals at the risks of having dementia would be crucial to the further public health issues for dementia. This study aimed to conduct a screening study in an outpatient department of a regional hospital to screen people who were at risk of developing comorbid dementia. Patients who visited Kaohsiung Municipal Ta-Tung Hospital (KMTTH) clinics during the period from June 1, 2013, to May 31, 2014, were invited to participate in this screening voluntarily. The trai...

  13. Prevalence of unrecognized depression and associated factors among patients attending medical outpatient department in Adare Hospital, Hawassa, Ethiopia

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    Tilahune AB

    2016-10-01

    Full Text Available Asres Bedaso Tilahune,1 Gezahegn Bekele,1 Nibretie Mekonnen,2 Eyerusalem Tamiru2 1School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia; 2Department of Medical Case Team, Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia Abstract: Depression is an illness that involves the body, mood, and thoughts and that affects the way a person eats, sleeps, feels about him or herself and thinks about things. Depression is one of the most common mental disorders affecting 121 million people in the world, and it frequently goes unrecognized among patients. It is estimated that 5%–10% of the population at any given time is suffering from identifiable depression needing psychiatric or psychosocial intervention. An institution-based cross-sectional study design was implemented to determine the magnitude and associated factors of unrecognized depression among patients attending the adult medical outpatient department in Adare Hospital, Hawassa, Southern Nations, Nationalities, and Peoples’ Region, Ethiopia, among 326 patients selected using systematic random sampling technique. Data were collected using the interviewer-administered technique. A structured questionnaire was used to collect data on sociodemographic characteristics and other independent variables. Depression was assessed using the Patient Health Questionnaire 9. Data were entered and analyzed using SPSS 20. The level of significance was determined at P<0.05. About 326 patients were interviewed, of whom 186 (57.1% were males. The mean age of participant was 34 with standard deviation of ±13.1 years. Current substance users accounted for 106 (32.5% of the total participants. Of 326 respondents, 80 (24.5% had significant depressive symptoms, while the detection rate of depression by the clinician was 0%. Depression was associated with female sex (adjusted odds ratio [AOR] =1.63 [1.14–2.34], age >60 years (AOR =4

  14. Cultural differences in symptom representation for depression and somatization measured by the PHQ between Vietnamese and German psychiatric outpatients.

    Science.gov (United States)

    Dreher, Annegret; Hahn, Eric; Diefenbacher, Albert; Nguyen, Main Huong; Böge, Kerem; Burian, Hannah; Dettling, Michael; Burian, Ronald; Ta, Thi Minh Tam

    2017-11-01

    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.

  15. Psychological recovery and its correlates in adults seeking outpatient psychiatric services: An exploratory study from an Indian tertiary care setting.

    Science.gov (United States)

    Gandotra, Aditi; Mehrotra, Seema; Bharath, Srikala

    2017-10-01

    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.

  16. MICROBIAL CONTAMINATION OF PRESERVED OPHTHALMIC DROPS IN OUTPATIENT DEPARTMENTS: POSSIBILITY OF AN EXTENDED PERIOD OF USE

    Directory of Open Access Journals (Sweden)

    MOHAMMAD REZA FAZELI

    2004-09-01

    Full Text Available Ocular infections may arise from topical ophthalmic medications. A standard imposed by the British Pharmaceutical Codex implies that eye drops should be discarded after 1-day use when these remedies are used in outpatient departments. In this study the bioburden rates arising from 2, 4 and 7 days’ use were evaluated and compared with those of 1 day’s use to determine whether it is possible to extend the period of use of preserved eye drops in outpatient departments. A total of 200 eye drops were taken from outpatient departments of Farabi Eye Hospital after 1, 2, 4 and 7 days’ use and the contamination rates of the residual contents, caps and droppers were determined using conventional techniques. High biobudren rates were obtained in all the samples tested. Although the overall recorded incidences of microbial contamination in the 2 and 4-day drops were not considerably different from those of first day (P>0.01 but those of 7 days’ use were significant (P<0.01. However, when contamination rate of drop contents was taken into account there was a significant difference between 4 and 7 days’ use compared to 1-day drops. Most of the isolated organisms were either of human flora types of Gram-positive bacteria or air-borne fungi. It is concluded that the use of eye drops for outpatient practice may be extended up to 2 days; yet, care should be taken to reduce the overall contamination rates of these preparations for prevention of ocular nosocomial infections.

  17. Predicting dropout in outpatient dialectical behavior therapy with patients with borderline personality disorder receiving psychiatric disability

    National Research Council Canada - National Science Library

    Landes, Sara J; Chalker, Samantha A; Comtois, Katherine Anne

    2016-01-01

    .... 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...

  18. Prevalence of the metabolic syndrome in Danish psychiatric outpatients treated with antipsychotics

    DEFF Research Database (Denmark)

    Krane-Gartiser, Karoline; Breum, Leif; Glümrr, Charlotte

    2011-01-01

    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....

  19. Integration of computer and Internet-based programmes into psychiatric out-patient care of adolescents with depression.

    Science.gov (United States)

    Kurki, Marjo; Hätönen, Heli; Koivunen, Marita; Anttila, Minna; Välimäki, Maritta

    2013-03-01

    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.

  20. Reliability and Validity of the Korean Version of the Lifetime Stressor Checklist-Revised in Psychiatric Outpatients with Anxiety or Depressive Disorders.

    Science.gov (United States)

    Choi, Kang Rok; Kim, Daeho; Jang, Eun Young; Bae, Hwallip; Kim, Seok Hyeon

    2017-01-01

    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.

  1. A comprehensive psychiatric service

    DEFF Research Database (Denmark)

    Wang, A G

    1984-01-01

    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...

  2. A comprehensive psychiatric service

    DEFF Research Database (Denmark)

    Wang, A G

    1984-01-01

    , 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...

  3. Medication Non-Adherence among Adult Psychiatric Out-patients in ...

    African Journals Online (AJOL)

    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 ...

  4. The outpatient care of psychiatric patients in a rural area: Mhala ...

    African Journals Online (AJOL)

    '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 ...

  5. Study of adverse drug reactions in out-patient departments of a teaching hospital

    Directory of Open Access Journals (Sweden)

    Zinnat Ara Begum

    2012-06-01

    Full Text Available The study conducted in the Medicine and Skin outpatient departments of Dhaka Medical College, Dhaka revealed 19 cases (7 males, 12 females of adverse drug reactions (ADR out of 160 patients. 31.58% ADRs were of mild type, 42.1% were of moderate and 26.32% were of severe in nature. Gastrointestinal complications were the most frequent adverse effect (56%. Antimicrobial drugs were the most common cause of ADR (42.86% followed by NSAIDs (33.33%. This study is a preliminary study for getting information on the pattern of ADRs in Bangladesh needing further studies.

  6. Socio-Demographic, Clinical and Behavioral Characteristics Associated with a History of Suicide Attempts among Psychiatric Outpatients: A Case Control Study in a Northern Mexican City.

    Science.gov (United States)

    Alvarado-Esquivel, Cosme; Sánchez-Anguiano, Luis Francisco; Arnaud-Gil, Carlos Alberto; Hernández-Tinoco, Jesús; Molina-Espinoza, Luis Fernando; Rábago-Sánchez, Elizabeth

    2014-03-01

    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.

  7. Substance abuse patterns and psychiatric symptomatology among three healthcare provider groups evaluated in an out-patient program for impaired healthcare professionals.

    Science.gov (United States)

    Rojas, Julio I; Jeon-Slaughter, Haekyung; Brand, Michael; Koos, Erin

    2013-01-01

    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.

  8. Antipsychotic Polypharmacy among Children and Young Adults in Office-Based or Hospital Outpatient Department Settings

    Directory of Open Access Journals (Sweden)

    Minji Sohn

    2017-11-01

    Full Text Available The purpose of the study was three-fold: (1 to estimate the national trends in antipsychotic (AP polypharmacy among 6- to 24-year-old patients in the U.S.; (2 to identify frequently used AP agents and mental disorder diagnoses related to AP polypharmacy; and (3 to assess the strength of association between AP polypharmacy and patient/provider characteristics. We used publicly available ambulatory health care datasets to evaluate AP polypharmacy in office-based or hospital outpatient department settings to conduct a cross-sectional study. First, national visit rates between 2007 and 2011 were estimated using sampling weights. Second, common diagnoses and drugs used in AP polypharmacy were identified. Third, a multivariate logistic regression model was developed to assess the strength of association between AP polypharmacy and patient and provider characteristics. Between 2007 and 2011, approximately 2% of office-based or hospital outpatient department visits made by 6- to 24-year-old patients included one or more AP prescriptions. Of these visits, 5% were classified as AP polypharmacy. The most common combination of AP polypharmacy was to use two or more second-generation APs. Also, bipolar disorder and schizophrenia were the two most frequent primary mental disorder diagnoses among AP polypharmacy visits. The factors associated with AP polypharmacy were: older age (young adults, black, having one or more non-AP prescriptions, and having schizophrenia or ADHD.

  9. Potentially inappropriate prescribing in elderly population: A study in medicine out-patient department

    Directory of Open Access Journals (Sweden)

    Ajit Kumar Sah

    2017-03-01

    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.

  10. A dance movement therapy group for depressed adult patients in psychiatric outpatient clinic: Effects of the treatment

    Directory of Open Access Journals (Sweden)

    Päivi Maria Pylvänäinen

    2015-07-01

    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.

  11. A dance movement therapy group for depressed adult patients in a psychiatric outpatient clinic: effects of the treatment.

    Science.gov (United States)

    Pylvänäinen, Päivi M; Muotka, Joona S; Lappalainen, Raimo

    2015-01-01

    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.

  12. Effects of legal and illegal use of benzodiazepines at acute admission to a psychiatric acute department

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    Vaaler Arne E

    2010-10-01

    Full Text Available Abstract Background In the psychiatric acute and emergency services patients present in severe crisis often complicated by behavioral problems, substance use, and multiple axis 1 diagnoses. In these clinical settings both legal and illegal use of benzodiazepines are difficult to evaluate since benzodiazepines could in some patients be regarded as first line treatment and in other patients as the cause of the acute psychiatric condition. The aims of this study were to evaluate the frequency and clinical effects of both legal and illegal use of benzodiazepines at admittance to a psychiatric acute department. Methods All patients acutely admitted to a Norwegian acute psychiatric university department serving a catchment area were asked about use of benzodiazepines, other medications and substances before admission. Patients were asked to give urine samples for analyses of benzodiazepines and substances. Results In 227 consecutive admissions there was legal use of benzodiazepines before admission in 39%, illegal use in 13% and no use in 48%. Patients with legal use of benzodiazepines were older, used more often antidepressants and a higher number of prescribed psychotropic medications. Illegal users of benzodiazepines more often used other illegal substances, were evaluated as clinically affected by a substance at admittance and were diagnosed with a substance use disorder. Patients with psychoses or major affective disorders treated with adequate medication (antidepressants, antipsychotics or mood-stabilizers before admission more often received benzodiazepines than patients without adequate medication. Conclusions The patients using benzodiazepines at admittance to psychiatric acute departments could be divided in illegal and legal users. The illegal users were young, used illegal substances and were more often regarded clinically affected by substances at admittance. The legal users were older, did not use other substances and were not regarded

  13. [Stress and night eating syndrome: a comparison study between a sample of psychiatric outpatients and healthy subjects].

    Science.gov (United States)

    Pacitti, Francesca; Maraone, Annalisa; Zazzara, Francesca; Biondi, Massimo; Caredda, Maria

    2011-01-01

    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.

  14. Prescribing pattern of antipsychotic drugs in the outpatient department of psychiatry in Silchar Medical College and Hospital, Assam

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    Pinaki Chakravarty

    2016-01-01

    Full Text Available Objective: To study the prescribing pattern of antipsychotic drugs in the outpatient department of psychiatry in Silchar Medical College and Hospital (SMCH of Assam. Methods: It is a prospective cross-sectional study which was carried out for three months from August to November 2015 in the outpatient department of psychiatry. All patients irrespective of their ages and sexes were included in this study. Inpatients, referred patients, patients not willing to give consent, patients of epilepsy as well as those cases where diagnoses were not certain were excluded from the study. The prescription patterns of antipsychotic drugs and the occurrences of various psychiatric diseases on both the sexes were studied after taking permission from the Institutional Ethical Committee (SMCH. Results: A total of 112 prescriptions were analysed. The most common disease was found to be schizophrenia. Total drugs prescribed were 265 and average number of drugs per prescription was 2.36. It was seen that out of the 112 prescriptions, monotherapy was practiced in 19.64% (22 compared to polytherapy in 80.35% (90. Out of 265 prescribed drugs atypical antipsychotics were 112 (42.26%, typical antipsychotics 12 (4.52%, antiepileptics 57 (21.50%, antidepressants 29 (10.94%, antiparkinsonian 29 (10.94%, and others 26 (9.81%. Antipsychotics given orally were 122 of which olanzapine was 54 (44.26%, risperidone 40 (32.78%, chlorpromazine ten (8.19%, quetiapine eight (6.55%, aripiprazole five (4.09%, amisulpiride five (4.09% were seen. Injectable antipsychotics were two, of which only haloperidol two (100%. Antipsychotics in combination prescription with same groups were 14 (12.5%, with antidepressants, antipileptics, antiparkinsonian were 88 (78.57% and other agents were ten (8.92%, which included pantoprazole, multivitamins, and benfotiamine. Conclusion: This study shows that atypical antipsychotics are the most common drugs prescribed in patients with psychotic illness and

  15. Psychiatric screening in the emergency department: validation of the General Health Questionnaire.

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    Gold, I; Haughey, L; Baraff, L J

    1985-09-01

    Both a 28-item psychiatric scale, the Goldberg General Health Questionnaire (GHQ), and the National Institute of Mental Health (NIMH) Diagnostic Interview Schedule (DIS) were administered to 25 emergency department patients to determine the validity of the GHQ as a screening instrument for psychopathology in the emergency department setting. There was a significant association (P = 0.0343) between GHQ scores and DIS assessment. The sensitivity of the GHQ in this series was 55.6% and the specificity was 87.5% when compared with the DIS. This suggests that the GHQ may prove to be a valuable screening tool for patients with somatic complaints to detect unsuspected psychiatric illness in the emergency department.

  16. Improving feedback from outpatient medical appointments attended by escorted psychiatric patients in the North London Forensic Service.

    Science.gov (United States)

    McCurdy, Kathleen; Croxford, Anna

    2015-01-01

    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

  17. Gender differences in the use of psychiatric outpatient specialist services in Tromsø, Norway are dependent on age: a population-based cross-sectional survey.

    Science.gov (United States)

    Hansen, Anne Helen; Høye, Anne

    2015-10-22

    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

  18. Psychometric properties of the Overall Anxiety Severity and Impairment Scale (OASIS) among psychiatric outpatients.

    Science.gov (United States)

    Bragdon, Laura B; Diefenbach, Gretchen J; Hannan, Scott; Tolin, David F

    2016-09-01

    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.

  19. Body checking and eating cognitions in Brazilian outpatients with eating disorders and non psychiatric controls.

    Science.gov (United States)

    Kachani, Adriana Trejger; Barroso, Lucia Pereira; Brasiliano, Silvia; Cordás, Táki Athanássios; Hochgraf, Patrícia Brunfentrinker

    2015-12-01

    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.

  20. [Which psychiatric comorbidities in cannabis dependence during adolescence? Comparison of outpatients and controls].

    Science.gov (United States)

    Dorard, G; Bungener, C; Phan, O; Edel, Y; Corcos, M; Berthoz, S

    2018-02-01

    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

  1. Making space work: Staff socio-spatial practices in a paediatric outpatient department.

    Science.gov (United States)

    Water, Tineke; Wrapson, Jill; Reay, Stephen; Ford, Katrina

    2018-02-14

    Studies of the characteristics of therapeutic landscapes have become common in medical geography. However, there is limited analysis of how therapeutic landscapes are produced. Based upon the qualitative theoretical thematic analysis of focus group data, this study examined the spatial work carried out by healthcare practitioners in a paediatric outpatients' department, turning unsatisfactory space into a therapeutic place. The study highlights the spatial strategies employed by staff to mitigate socio-spatial deficiencies in the healthcare environment. Staff perceived the task of making space work as an integral part of their duty of care to patients and an important facet of their professional identity. This study concludes that many of the spatial aspects of health care practice are often taken for granted. However this may hide the crucial role that health professionals have in producing places that heal. Copyright © 2018 Elsevier Ltd. All rights reserved.

  2. Prevalence of attenuated psychotic symptoms and their relationship with DSM-IV diagnoses in a general psychiatric outpatient clinic.

    Science.gov (United States)

    Gaudiano, Brandon A; Zimmerman, Mark

    2013-02-01

    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

  3. Stigma resistance and its association with internalised stigma and psychosocial outcomes among psychiatric outpatients.

    Science.gov (United States)

    Lau, Ying Wen; Picco, Louisa; Pang, Shirlene; Jeyagurunathan, Anitha; Satghare, Pratika; Chong, Siow Ann; Subramaniam, Mythily

    2017-11-01

    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.

  4. Differences in Characteristics and Treatment Received among Depressed Adolescent Psychiatric Outpatients with and without Co-Occuring Alcohol Misuse: A 1-Year Follow-Up Study

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    Tiia Pirkola

    2011-01-01

    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.

  5. Depression and suicide risk of outpatients at specialized hospitals for substance use disorder: comparison with depressive disorder patients at general psychiatric clinics.

    Science.gov (United States)

    Matsumoto, Toshihiko; Matsushita, Sachio; Okudaira, Kenichi; Naruse, Nobuya; Cho, Tetsuji; Muto, Takeo; Ashizawa, Takeshi; Konuma, Kyohei; Morita, Nobuaki; Ino, Aro

    2011-12-01

    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.

  6. Carer involvement in compulsory out-patient psychiatric care in England

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    Jorun Rugkåsa

    2017-11-01

    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

  7. Carer involvement in compulsory out-patient psychiatric care in England.

    Science.gov (United States)

    Rugkåsa, Jorun; Canvin, Krysia

    2017-11-21

    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

  8. Use of Six Sigma Methodology to Reduce Appointment Lead-Time in Obstetrics Outpatient Department.

    Science.gov (United States)

    Ortiz Barrios, Miguel A; Felizzola Jiménez, Heriberto

    2016-10-01

    This paper focuses on the issue of longer appointment lead-time in the obstetrics outpatient department of a maternal-child hospital in Colombia. Because of extended appointment lead-time, women with high-risk pregnancy could develop severe complications in their health status and put their babies at risk. This problem was detected through a project selection process explained in this article and to solve it, Six Sigma methodology has been used. First, the process was defined through a SIPOC diagram to identify its input and output variables. Second, six sigma performance indicators were calculated to establish the process baseline. Then, a fishbone diagram was used to determine the possible causes of the problem. These causes were validated with the aid of correlation analysis and other statistical tools. Later, improvement strategies were designed to reduce appointment lead-time in this department. Project results evidenced that average appointment lead-time reduced from 6,89 days to 4,08 days and the deviation standard dropped from 1,57 days to 1,24 days. In this way, the hospital will serve pregnant women faster, which represents a risk reduction of perinatal and maternal mortality.

  9. Quality management: reduction of waiting time and efficiency enhancement in an ENT-university outpatients' department

    Directory of Open Access Journals (Sweden)

    Helbig Matthias

    2009-01-01

    Full Text Available Abstract Background Public health systems are confronted with constantly rising costs. Furthermore, diagnostic as well as treatment services become more and more specialized. These are the reasons for an interdisciplinary project on the one hand aiming at simplification of planning and scheduling patient appointments, on the other hand at fulfilling all requirements of efficiency and treatment quality. Methods As to understanding procedure and problem solving activities, the responsible project group strictly proceeded with four methodical steps: actual state analysis, analysis of causes, correcting measures, and examination of effectiveness. Various methods of quality management, as for instance opinion polls, data collections, and several procedures of problem identification as well as of solution proposals were applied. All activities were realized according to the requirements of the clinic's ISO 9001:2000 certified quality management system. The development of this project is described step by step from planning phase to inauguration into the daily routine of the clinic and subsequent control of effectiveness. Results Five significant problem fields could be identified. After an analysis of causes the major remedial measures were: installation of a patient telephone hotline, standardization of appointment arrangements for all patients, modification of the appointments book considering the reason for coming in planning defined working periods for certain symptoms and treatments, improvement of telephonic counselling, and transition to flexible time planning by daily updates of the appointments book. After implementation of these changes into the clinic's routine success could be demonstrated by significantly reduced waiting times and resulting increased patient satisfaction. Conclusion Systematic scrutiny of the existing organizational structures of the outpatients' department of our clinic by means of actual state analysis and analysis of

  10. Establishment of a local psychiatric service

    DEFF Research Database (Denmark)

    Wang, A G

    1981-01-01

    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...

  11. [Changes of the psychogeriatric inpatient care at the University Psychiatric Hospitals in Basel following the constitution of an outpatient care service for the elderly].

    Science.gov (United States)

    Eren, Gökhan; Hiss, Barbara; Maeck, Lienhard; Stoppe, Gabriela

    2014-05-01

    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.

  12. Clinical Search for Undiagnosed Mesenteric Phlebosclerosis at Outpatient Departments Specializing in Herbal (Kampo) Medicine.

    Science.gov (United States)

    Nagata, Yutaka; Watanabe, Tetsuo; Nagasaka, Kazuhiko; Yamada, Masaaki; Saito, Minoru; Yazaki, Toshinori; Komatsu, Kenichi; Sano, Mika; Asano, Koji; Ando, Chikao; Taniuchi, Norihide

    2016-01-01

    Mesenteric phlebosclerosis (MP) is a disease characterized by calcification of the mesenteric vein, which causes chronic mesenteric ischemia. Recently, the long-term intake of gardenia fruit ('Sanshishi' in Japanese) has been attracting attention as a possible cause. Usually, only advanced, severe MP cases get reported. However, we suspected that some latent cases of this disease may exist. We performed this study in order to determine the prediagnostic cases at our outpatient departments of herbal (Kampo) medicine, with particular attention paid to the initial changes, such as any slight color change of the colon, as shown in colonoscopy. We recommend colonoscopy and computed tomography (CT) scans for patients with a long-term history of taking herbal medicines containing gardenia fruit. Clinical examinations were performed upon receiving patients' consent from December 2013 to November 2014. Of the 103 patients who took gardenia fruit long-term, 29 agreed to be checked for MP. 14 patients underwent colonoscopy. Four patients were confirmed to have MP due to the presence of fibrotic deposition of the colonic membrane on histological inspection. Twenty-one patients underwent abdominal CT screening. Characteristic calcification of the mesenteric vein was observed on CT scans in 2 patients. All 4 MP patients took Kampo formulas containing gardenia fruit for more than 6.8 years. The other patients did not develop MP, despite long-term gardenia fruit intake. We detected the latent and undiagnosed MP cases. All diagnoses were made while paying careful attention to any slight changes in colonoscopy and CT scans.

  13. Urinary antibiotic activity in paediatric patients attending an outpatient department in north-western Cambodia.

    Science.gov (United States)

    Emary, Katherine R W; Carter, Michael J; Pol, Sreymom; Sona, Soeng; Kumar, Varun; Day, Nicholas P J; Parry, Christopher M; Moore, Catrin E

    2015-01-01

    Antibiotic resistance is a prominent public and global health concern. We investigated antibiotic use in children by determining the proportion of unselected children with antibacterial activity in their urine attending a paediatric outpatient department in Siem Reap, Cambodia. Caregiver reports of medication history and presence of possible infection symptoms were collected in addition to urine samples. Urine antibiotic activity was estimated by exposing bacteria to urine specimens, including assessment against multiresistant bacteria previously isolated from patients in the hospital (a methicillin-resistant Staphylococcus aureus (MRSA), a multiresistant Salmonella typhi and an extended-spectrum β-lactamase (ESBL)-producing Escherichia coli isolate). Medication information and urine were collected from 775 children. Caregivers reported medication use in 69.0% of children in the preceding 48 h. 31.7% samples showed antibacterial activity; 16.3% showed activity against a local multiresistant organism. No specimens demonstrated activity against an ESBL-producing E. coli. Antibiotics are widely used in the community setting in Cambodia. Parents are often ill-informed about drugs given to treat their children. Increasing the regulation and training of private pharmacies in Cambodia may be necessary. Regional surveillance of antibiotic use and resistance is also essential in devising preventive strategies against further development of antibiotic resistance, which would have both local and global consequences. © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  14. Prevalence of sleep disorders and severity of insomnia in psychiatric outpatients attending a tertiary level mental health care facility in Punjab, India.

    Science.gov (United States)

    Mondal, Gargi; Bajaj, Vikrant; Goyal, B L; Mukherjee, Nirmalya

    2018-02-01

    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.

  15. Clinical analysis of 48-h emergency department visit post outpatient extracorporeal shock wave lithotripsy for urolithiasis

    Directory of Open Access Journals (Sweden)

    Chin-Heng Lu

    2017-09-01

    Conclusion: Our study indicated that renal stone contributed to a significantly higher risk of ER-visiting rate to patients than did ureteral stone, following outpatient ESWL within 48 h. This study confirmed that Outpatient ESWL is a safe treatment for renal or ureteral stones, while inpatient ESWL is not absolutely necessary.

  16. Eating Disorder Inventory-3, validation in Swedish patients with eating disorders, psychiatric outpatients and a normal control sample.

    Science.gov (United States)

    Nyman-Carlsson, Erika; Engström, Ingemar; Norring, Claes; Nevonen, Lauri

    2015-02-01

    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.

  17. Psychiatric screening in the emergency department: its effect on physician behavior.

    Science.gov (United States)

    Gold, I; Baraff, L J

    1989-08-01

    The purpose of our prospective, controlled study was to determine whether providing the results of a psychiatric screening instrument, the General Health Questionnaire (GHQ), to emergency physicians would result in a change in the detection and management of patients with psychosocial problems. Five hundred ninety-nine emergency department patients were enrolled, 242 in the control and 357 in the intervention group. Noncritical patients, selected by presenting complaint, were given the GHQ to complete before physician evaluation; those whose GHQ scores were high (10 or higher) were identified as having a greater likelihood of having psychosocial problems. During the intervention phase, physicians were provided the patient's GHQ score before beginning their evaluation, as well as a specific mechanism for psychosocial referral. A significantly greater proportion of patients with high GHQ scores in both study groups were judged by physicians to have a psychiatric problem (P less than .0001). During the intervention phase, patients with high scores more frequently were assigned a psychiatric diagnosis (14.1% vs 7.7%) and received psychosocial referral (36.1% vs 5.7%). However, only the latter difference was statistically significant (P less than .0001). The majority (85.7%) of patients offered psychosocial referral accepted their referral. There was no difference in the number of laboratory tests ordered or medical/surgical referrals requested between patients in the control or intervention groups with high scores. Therefore, providing GHQ results to emergency physicians led to more frequent psychiatric diagnoses and psychosocial referrals of patients with high GHQ scores but did not alter their medical management.

  18. The influence of referral source on characteristics of patients undergoing cardiac stress testing: emergency department versus outpatient office.

    Science.gov (United States)

    Pinkstaff, Sherry; Peberdy, Mary Ann; Kontos, Michael C; Finucane, Sheryl; Lavie, Carl J; Arena, Ross

    2011-03-01

    Chest pain is a common reason for accessing an emergency department (ED) and a frequent cause of outpatient physician visits. Whether patients referred for cardiac stress testing from these referral sources differ in clinically significant ways is unknown, and is thus the purpose of this investigation. This study prospectively assessed 301 patients presenting to Virginia Commonwealth University Medical Center with symptoms suggestive of myocardial ischemia. All subjects underwent nuclear stress testing as a part of their assessment. Patients referred from the ED were more likely to be African American and outpatients were more likely to be Caucasian. Outpatients were older than those referred from the ED. Patients referred from the ED were less likely to have a diagnosis of hypertension, dyslipidemia, or diabetes, but were more likely to smoke. The exercise response was similar, with a few exceptions. There were no differences in the frequency of equivocal or positive nuclear stress test results based on referral source. The results of the present study indicate that several characteristics of patients undergoing outpatient nuclear stress testing differ according to referral source. Future research should be directed toward developing effective strategies to reduce ED utilization and increasing outpatient management.

  19. [Doctor-patient-communication in an oncological outpatient department. A linguistic study of communication problems].

    Science.gov (United States)

    Sator, Marlene; Gstettner, Andreas; Hladschik-Kermer, Birgit

    2008-01-01

    Recognising and attending to patients' most relevant issues and main concerns are the basis for patient-oriented work. This qualitative study investigates the ways in which doctors communicate with their patients. The method of study is conversation and discourse analysis. The source of data are audio recordings of 20 introductory medical consultations in an oncological outpatient department in Austria. In a macro-analytical approach the duration of verbal contribution as well as the topics mentioned are analyzed. Results show that 34% of the consultation time is used for activities other than the actual doctor-patient-communication. Furthermore, the share of patients' verbal contribution was found to be half that of the doctor. Much room is given to information about chemotherapy, less is dedicated to topics like the stages of the illness and the hope for recovery. The micro-analytical approach shows that patients keep trying to allude to topics which are especially relevant to them. This happens very subtly and implicitly by means of interactional markings of relevance. These are communicative and interactive methods such as a change in volume or in speech patterns, the use of strong metaphors or hesitation phenomena. Doctors, however, often give insufficient attention to such initiatives from patients and follow their own, often institutionally-related, pre-requisites. Drawing on two examples, this article shows how insufficient attention to patient-relevant issues results in a lower quality of doctor-patient-communication, and lower satisfaction of patients and doctors. Two positive examples show that adequate attention to patient-relevant issues is possible and increases quality of doctor-patient-communication, as well as participants' satisfaction. It is argued that insufficient attention to patient-relevant issues also reduces time efficiency.

  20. Screening of women for intimate partner violence: a pilot intervention at an outpatient department in Tanzania

    Directory of Open Access Journals (Sweden)

    Rose M. Laisser

    2011-10-01

    Full Text Available Intimate partner violence (IPV is a public health problem in Tanzania with limited health care interventions.To study the feasibility of using an abuse screening tool for women attending an outpatient department, and describe how health care workers perceived its benefits and challenges.Prior to screening, 39 health care workers attended training on gender-based violence and the suggested screening procedures. Seven health care workers were arranged to implement screening in 3 weeks, during March–April 2010. For screening evaluation, health care workers were observed for their interaction with clients. Thereafter, focus group discussions (FGDs were conducted with 21 health care workers among those who had participated in the training and screening. Five health care workers wrote narratives. Women's responses to screening questions were analyzed with descriptive statistics, whereas qualitative content analysis guided analysis of qualitative data.Of the 102 women screened, 78% had experienced emotional, physical, or sexual violence. Among them, 62% had experienced IPV, while 22% were subjected to violence by a relative, and 9.2% by a work mate. Two-thirds (64% had been abused more than once; 14% several times. Almost one-quarter (23% had experienced sexual violence. Six of the health care workers interacted well with clients but three had difficulties to follow counseling guidelines. FGDs and narratives generated three categories Just asking feels good implied a blessing of the tool; what next? indicated ethical dilemmas; and fear of becoming a 'women hospital’ only indicated a concern that abused men would be neglected.Screening for IPV is feasible. Overall, the health care workers perceived the tool to be advantageous. Training on gender-based violence and adjustment of the tool to suit local structures are important. Further studies are needed to explore the implications of including abuse against men and children in future screening.

  1. Awareness of childhood blindness in parents attending Paediatrics Ophthalmology outpatient department

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    Radhika Paranjpe

    2016-01-01

    Full Text Available Background: Blindness is defined by World Health Organisation as having a visual acuity of <3/60 in the better eye. Thirty-seven million people are blind worldwide. One million and four hundred thousand are children. The causes of blindness in children vary according to region and socioeconomic development. The aim of our study is to identify a range of potential issues relating to parental awareness and perceptions of common eye diseases affecting children. Materials and Methods: The type of study was population-based, prospective, cross-sectional study conducted on parents of 200 children ranging from 0 to 16 years of age, attending Paediatric Ophthalmology clinic during the month of August and September 2014. This was an open-ended questionnaire-based study and only the participants who consented were enrolled in the study. Results: The most common eye problem detected among 200 of children was refractive errors. The incidence of refractive errors was found to be 103 out of 200 (51.5%. This is followed by 71 (35.5% cases of squint/strabismus. Of 200 parents, 150 (75% think the present eye condition of their child will reduce the eyesight. However, they did not know about the nature of the eye problem. Forty-four (22% parents did not know anything about the eye condition of their child. Seventy (35% parents were apprehensive about the use of spectacles in the children suffering from refractive errors. One hundred and six (53% parents came to know about the eye problem of their child from the teacher of the child and 63 (31.5% parents got information from their family doctor. Conclusions: As the number of mothers attending the eye department with the child is high, so there is more need of educating the mothers about the eye conditions of the child. Education and socioeconomic conditions affect the knowledge and awareness level of the parents regarding eye problems. Most of the children attending outpatient department were found to be in the

  2. 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.

    Science.gov (United States)

    Teodorescu, Dinu-Stefan; Siqveland, Johan; Heir, Trond; Hauff, Edvard; Wentzel-Larsen, Tore; Lien, Lars

    2012-07-23

    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

  3. 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

    Directory of Open Access Journals (Sweden)

    Teodorescu Dinu-Stefan

    2012-07-01

    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

  4. 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

    Science.gov (United States)

    2012-01-01

    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

  5. Randomized Trial of Interpersonal Psychotherapy and Cognitive Behavioral Therapy for Major Depressive Disorder in a Community-Based Psychiatric Outpatient Clinic.

    Science.gov (United States)

    Ekeblad, Annika; Falkenström, Fredrik; Andersson, Gerhard; Vestberg, Robert; Holmqvist, Rolf

    2016-12-01

    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.

  6. A randomized controlled clinical trial of a nurse-led structured psychosocial intervention program for people with first-onset mental illness in psychiatric outpatient clinics.

    Science.gov (United States)

    Chien, Wai-Tong; Bressington, Daniel

    2015-09-30

    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.

  7. Psychiatric service users' experiences of emergency departments: a CERQual review of qualitative studies.

    Science.gov (United States)

    Carstensen, Kathrine; Lou, Stina; Groth Jensen, Lotte; Konstantin Nissen, Nina; Ortenblad, Lisbeth; Pfau, Margarete; Vedel Ankersen, Pia

    2017-05-01

    There is increased clinical and political attention towards integrating general and psychiatric emergency departments (ED). However, research into psychiatric service users' experiences regarding general EDs is limited. To identify and summarize current, qualitative evidence regarding service users' experiences attending EDs. A secondary aim is to apply and test the newly developed CERQual approach to summarizing qualitative review findings. A systematic literature review of five databases based on PRISMA guidelines yielded 3334 unique entries. Screening by title/abstract identified 57 studies and, after full text assessment, nine studies were included. The included studies were critically appraised using CASP. Thematic synthesis was applied for data extraction and identification of findings. The CERQual approach was utilized to assess the confidence of the findings. The results of the review showed moderate confidence in the findings that service users experience meeting caring and judgmental ED staff, and that waiting times and a stressful environment are integral to their ED experiences. In contrast, low-to-very low confidence was seen in the findings that service users experience having their symptoms ignored and that EDs are used due to a lack of alternatives. A companion may improve service users experience and outcome of ED visits. Service users experience stress and discomfort in the ED. Service users highly appreciate knowing staff who can ease the discomfort. Overall, the results of this review speak in favour of integrated EDs where service users' needs are more likely to be recognized and accommodated.

  8. Coping with suicidal urges among youth seen in a psychiatric emergency department.

    Science.gov (United States)

    Czyz, Ewa K; Horwitz, Adam G; Arango, Alejandra; Cole-Lewis, Yasmin; Berona, Johnny; King, Cheryl A

    2016-07-30

    This study of youth seeking psychiatric emergency department (ED) services examined (1) youth self-efficacy to use suicide-specific coping strategies, (2) whether these self-efficacy beliefs varied by demographic and clinical characteristics, (3) and associations of these beliefs with suicide attempts and ED visits 3-5 months later. Participants were 286 psychiatric ED patients (59% Female), ages 13-25. Ratings of self-efficacy to engage in 10 suicide-specific coping behaviors were assessed at index visit. A total of 226 participants (79%) were assessed 3-5 months later. Youth endorsed low-to-moderate self-efficacy for different suicide-specific coping behaviors, with lowest ratings endorsed for limiting access to lethal means and accessing professional resources. More severe baseline psychopathology was associated with lower self-efficacy. Males endorsed higher self-efficacy for coping behaviors not requiring external support. Lower coping self-efficacy for some of the key strategies, and lower confidence that these strategies will be helpful, differentiated those with and without follow-up suicide attempts and ED visits. The generally low-to-moderate confidence in youths' ability to engage in coping behaviors to manage suicidal crises, and its association with follow-up suicidal crises, is concerning because many of these strategies are commonly included as part of discharge recommendations or safety planning. Implications of findings are discussed. Copyright © 2016. Published by Elsevier Ireland Ltd.

  9. What do you think of us? Evaluating patient knowledge of and satisfaction with a psychiatric outpatient service.

    LENUS (Irish Health Repository)

    Jabbar, F

    2011-03-01

    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.

  10. Risks and clinical relevance of medication discrepancies at outpatient departments for mood and anxiety disorders

    NARCIS (Netherlands)

    Simoons, Mirjam; Mulder, Hans; Risselada, Arne J.; Wilmink, Frederik W.; Schoevers, Robert A.; Ruhé, Henricus G.; Van Roon, Eric N.

    2017-01-01

    OBJECTIVE: To identify discrepancies between actual drug use by outpatients with mood and anxiety disorders and medication overviews from health care providers as well as to investigate the clinical relevance of those discrepancies. DESIGN: Cross-sectional cohort study. METHODS: We included adults

  11. Symptoms of epilepsy and organic brain dysfunctions in patients with acute, brief depression combined with other fluctuating psychiatric symptoms: a controlled study from an acute psychiatric department

    Directory of Open Access Journals (Sweden)

    Linaker Olav M

    2009-09-01

    Full Text Available Abstract Background In psychiatric acute departments some patients present with brief depressive periods accompanied with fluctuating arrays of other psychiatric symptoms like psychosis, panic or mania. For the purpose of the present study we call this condition Acute Unstable Depressive Syndrome (AUDS. The aims of the present study were to compare clinical signs of organic brain dysfunctions and epilepsy in patients with AUDS and Major Depressive Episode (MDE. Methods Out of 1038 consecutive patients admitted to a psychiatric acute ward, 16 patients with AUDS and 16 age- and gender-matched MDE patients were included in the study. Using standardized instruments and methods we recorded clinical data, EEG and MRI. Results A history of epileptic seizures and pathologic EEG activity was more common in the AUDS group than in the MDE group (seizures, n = 6 vs. 0, p = 0.018; pathologic EEG activity, n = 8 vs. 1, p = 0.015. Five patients in the AUDS group were diagnosed as having epilepsy, whereas none of those with MDE had epilepsy (p = 0.043. There were no differences between the groups regarding pathological findings in neurological bedside examination and cerebral MRI investigation. Conclusion Compared to patients admitted with mood symptoms fulfilling DSM 4 criteria of a major depressive disorder, short-lasting atypical depressive symptoms seem to be associated with a high frequency of epileptic and pathologic EEG activity in patients admitted to psychiatric acute departments. Trial registration NCT00201474

  12. Effects of mandatory screening labs in directing the disposition of the apparently healthy psychiatric patient in the emergency department.

    Science.gov (United States)

    Kagel, Karyn E; Smith, Meghan; Latyshenko, Ilya V; Mitchell, Christopher; Kagel, Andrew

    2017-01-01

    To determine whether mandatory psychiatric admission laboratory tests yield results that change the disposition of a patient with primary psychiatric complaint from admission to a psychiatric service to admission to a medical service. This was a single center retrospective cohort chart review study approved by the facility Institutional Review Board in which we used a records database maintained by the emergency department's social workers to access the records of every patient that presented to our emergency department with a psychiatric chief complaint between the dates of December 1, 2011, and December 1, 2013. We focused on those that were admitted to either a psychiatric service or a medical service after a thorough evaluation by the department of social work and an emergency provider. We applied our inclusion and exclusion criteria and reviewed the results of the mandatory psychiatric laboratory tests (complete blood count, comprehensive metabolic panel, thyroid stimulating hormone, acetaminophen, aspirin, blood alcohol level, urinalysis, urine pregnancy test, urine drug screen) required for admission. Our independent variables were the compulsory psychiatric admission laboratory tests and our dependent variable was the admission to a medical service. Of 5,606 laboratory tests that were ordered and produced results for the 682 patients enrolled in our study, 51 results were considered clinically significant abnormal results, or results requiring treatment prior to psychiatric service admission, by the 2 reviewing emergency physicians. Only one of 682 psychiatric patients received a final disposition to a medical service based upon abnormal laboratory studies. That patient presented without any medical complaints but a chief complaint of "suicidal ideation," and was found to have diabetic ketoacidosis. Based on our data, the probability that an abnormal laboratory test will result in a change in disposition is 1/682=0.1% (95% CI: 0.0% to 0.9%). Patients

  13. The Yoruba version of the Beck Hopelessness Scale: psychometric characteristics and correlates of hopelessness in a sample of Nigerian psychiatric outpatients.

    Science.gov (United States)

    Aloba, Olutayo; Akinsulore, Adesanmi; Mapayi, Boladale; Oloniniyi, Ibiduniyi; Mosaku, Kolawole; Alimi, Taiwo; Esan, Olufemi

    2015-01-01

    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

  14. Treating psychiatric emergencies in incarcerated minors in the emergency department: what is the cost and what is their disposition?

    Science.gov (United States)

    Wood, David Brian; Donofrio, Joy Joelle; Santillanes, Genevieve; Lam, Chun Nok; Claudius, Ilene

    2014-06-01

    Although mental health disorders are common among incarcerated minors, psychiatric urgencies and emergencies often cannot be treated in juvenile detention facilities, necessitating emergency department (ED) transfers. The cost of this ED care has not been well studied. This study aimed to provide information on disposition and cost related to ED visits by juvenile hall patients transported for urgent psychiatric evaluation. A retrospective cross-sectional descriptive study of patients presenting to 1 ED from juvenile detention centers for consideration of psychiatric holds was conducted. Eligible patients were identified by a search of the International Classification of Diseases, Ninth Revision, discharge diagnosis codes and chart review. We collected information on patient demographics and disposition and calculated costs of ED visits, screening laboratories performed, inpatient stays on a medical ward, sitter and parole officer salaries, and ambulance transfers. One hundred eight patients accounting for 196 visits were transported from juvenile hall for urgent psychiatric evaluation. Of the 196 visits, 131 (67%) resulted in an involuntary psychiatric hold. More than half of the patients on hold (75 patients) were admitted to a medical ward for boarding because of lack of psychiatric inpatient beds. Included charges for the 196 visits during the 18-month period totaled US $1,357,884, with most of the costs due to boarding on the medical ward. We describe the magnitude and cost associated with addressing psychiatric emergencies in a juvenile correctional system relying on transport of patients to an ED for acute psychiatric evaluation and treatment. Further research is needed to determine if costs could be decreased by increasing psychiatric resources in juvenile detention centers.

  15. [Prevalence and functions of self-injurious thoughts and behaviors in a sample of Spanish adolescents assessed in mental health outpatient departments].

    Science.gov (United States)

    Díaz de Neira, Mónica; García-Nieto, Rebeca; de León-Martinez, Victoria; Pérez Fominaya, Margarita; Baca-García, Enrique; Carballo, Juan J

    2015-01-01

    Suicidal and self-injurious behaviors in adolescents are a major public health concern. However, the prevalence of self-injurious thoughts and behaviors in Spanish outpatient adolescents is unknown. A total of 267 adolescents between 11 and 18 year old were recruited from the Child and Adolescent Outpatient Psychiatric Services, Jiménez Díaz Foundation (Madrid, Spain) from November 1st 2011 to October 31st 2012. All participants were administered the Spanish version of the Self-Injurious Thoughts and Behaviors Inventory, which is a structured interview that assesses the presence, frequency, and characteristics of suicidal ideation, suicide plans, suicide gestures, suicide attempts, and non-suicidal self-injury. One-fifth (20.6%) of adolescents reported having had suicidal ideation at least once during their lifetime. Similarly, 2.2% reported suicide plans, 9.4% reported suicide gesture, 4.5% attempted suicide, and 21.7% reported non-suicidal self-injury, at least once during their lifetime. Of the whole sample, 47.6% of adolescents reported at least one of the studied thoughts or behaviors in their lifetime. Among them, 47.2% reported 2 or more of these thoughts or behaviors. Regarding the reported function of each type of thoughts and behaviors examined, most were performed for emotional regulation purposes, except in the case of suicide gestures (performed for the purposes of social reinforcement). The high prevalence and high comorbidity of self-injurious thoughts and behaviors, together with the known risk of transition among them, underline the need of a systematic and routine assessment of these thoughts and behaviors in adolescents assessed in mental health departments. Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.

  16. Plasma profile of pro-inflammatory cytokines and chemokines in cocaine users under outpatient treatment: influence of cocaine symptom severity and psychiatric co-morbidity.

    Science.gov (United States)

    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

    2015-07-01

    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

  17. [Prevalence of attention deficit/hyperactivity disorder symptoms in outpatient adolescents and young adults with other psychiatric disorders refractory to previous treatments].

    Science.gov (United States)

    Vidal, Raquel; Barrau, Víctor; Casas, Miguel; Caballero-Correa, María; Martínez-Jiménez, Pedro; Ramos-Quiroga, Josep Antoni

    2014-01-01

    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.

  18. Self-assessed and clinically diagnosed periodontal health status among patients visiting the outpatient department of a dental school in Bangalore, India

    OpenAIRE

    Nagarajan Sripriya; Pushpanjali K

    2008-01-01

    Background: The purpose of the present cross-sectional study was to assess the extent of agreement between clinical and self-assessed periodontal health status among patients visiting the outpatient department of M.S. Ramaiah Dental College, Bangalore, India. Materials and Methods: The study population included 216 patients aged between 20 and 44 years who attended the outpatient department of the M.S. Ramaiah Dental College, Bangalore. The study population was subjected to a self-administ...

  19. Factors determining perceptions of fairness in access to hospital outpatient departments in Taiwan.

    Science.gov (United States)

    Lu, Ta-Ping; Rau, Pei-Luen Patrick; Guo, Zhi; Chen, Cui-Ling

    2017-01-01

    Objectives To investigate the effects of four factors on perceptions of fairness in access to outpatient services: proportions of walk-in versus scheduled registration, consultation queues, regulations for late patients and particular categories of patients getting better access. Methods A total of 124 young adults were asked to consider nine different scenarios and report their views of the fairness of each one. Results As regards the balance of types of patients, 60% walk-in registration was seen as fair to both walk-in and scheduled patients. The fairness to both types of patients was higher in the queue with a 1:1 ratio of walk-in to scheduled patients. The policy that a late patient should wait for three on-time patients to be seen was considered to be fair to both on-time and late patients. Immediate consultation for some particular categories of patient (e.g. the elderly) was fair, but for other categories was unfair (e.g. paying an addition amount). Conclusions Fairness in outpatient care is based on equality and need principles. Shorter waiting time does not mean patients view the system as fairer.

  20. Impact of Quality Rights Gujarat program on dropout rate of patients visiting outpatient psychiatry department of tertiary care hospital.

    Science.gov (United States)

    Shah, Sandip; Desai, Nimisha; Shah, Saurabh; Pathare, Soumitra; Chauhan, Ajay; Sharma, Elavatsla

    2017-08-01

    Dropout from an outpatient clinic is the loss of patient to the scheduled follow-up. Noncompliance in the form of treatment dropouts is a major problem across outpatient mental health settings and can range from 15% to 60%. Follow-up studies provide valuable insights into improving the quality of existing mental health facilities. Quality Rights Gujarat (QRG) is a step toward improving mental health facilities across various centers. This retrospective observational study aims to explore follow-up pattern, predictors and any change after QRG implementation. Pre intervention Group (A) attended psychiatry OPD for 6 months before implementation of QRG project and Post intervention Group (B) attended psychiatry OPD for 3 months after implementation of QRG project. Total 1632 Patients consulted in group A and 926 patients consulted Psychiatry OPD in group B. The most common Psychiatric disorder were Depression (A-19.55%, B-28.62%), Schizophrenia and related disorders (A-14.15%, B-15.01%), Neuropsychiatric disorders like headache and epilepsy (A-14.52%, B-18.68%), substance use disorder (A-15.26%, B-13.71%) and Bipolar disorder (A-11.76%, B-13.17%). 59.56% patients dropped out after the first visit in pre intervention group as compared to 51.94% patients in post intervention group. Significant reduction of about 8% in loss to follow up and 16% increase in follow-ups of initial visits after implementation of Quality Rights Gujarat project. Much can be done to improve attendance in most services. The initiative like QRG significantly has positive results on patient's follow-up. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Quality of Publicly-Funded Outpatient Specialty Mental Health Care for Common Childhood Psychiatric Disorders in California.

    Science.gov (United States)

    Zima, Bonnie T.; Hurlburt, Michael S.; Knapp, Penny; Ladd, Heather; Tang, Lingqi; Duan, Naihua; Wallace, Peggy; Rosenblatt, Abram; Landsverk, John; Wells, Kenneth B.

    2005-01-01

    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…

  2. Efficacy of Osteopathic Manipulative Treatment Approach in the Patient with Pulmonary Fibrosis in Critical Care Outpatient Department.

    Science.gov (United States)

    Goyal, Manu; Goyal, Kanu; Narkeesh, Kanimozhi; Samuel, Asir John; Arumugam, Narkeesh; Chatterjee, Subhasish; Sharma, Sorabh

    2017-07-01

    The purpose of the present case study was to explore the efficacy of osteopathic manipulative treatment (OMT) in patient with pulmonary fibrosis (PF) in the critical care outpatient department. Here, we present a 48-year-old male case with breathlessness, increased frequency of defecation, and pain in and around the nape of neck with diagnosed pulmonary fibrosis. He scored 3 on a patient-reported modified Medical Research Council (mMRC) dyspnea scale. Osteopathic examination reveals multiple somatic findings across the chest and abdominal region and treated by OMT. Pre- and post-intervention changes were assessed by the 13-item shortness of breath with daily activities (13iSOBDA). 27.2, 22, 16.4, and 11.8 were noted at the end of 1(st), 2(nd), 3(rd), and 4(th) week of intervention, respectively, on 13iSOBDA while mMRC decreased from 3 to 1. OMT may be a feasible option in decreasing the symptoms of the PPF in the critical care outpatient department.

  3. Psychiatric comorbidity in a sample of cocaine-dependent outpatients seen in the Community of Madrid drug addiction care network.

    Science.gov (United States)

    Martínez-Gras, Isabel; Ferre Navarrete, Francisco; Pascual Arriazu, Jesús; Peñas Pascual, José; de Iceta Ruiz de Gauna, Mariano; Fraguas Herráez, David; Rubio Valladolid, Gabriel

    2016-03-02

    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.

  4. Maltreatment clusters among youth in outpatient substance abuse treatment: co-occurring patterns of psychiatric symptoms and sexual risk behaviors.

    Science.gov (United States)

    Tubman, Jonathan G; Oshri, Assaf; Taylor, Heather L; Morris, Staci L

    2011-04-01

    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.

  5. Prevalence of Attention Deficit Hyperactivity among Children Attending Outpatient Clinic in Psychiatric Teaching Hospital in Erbil City

    Science.gov (United States)

    Shakir, Lana Nabeel; Sulaiman, Karwan Hawez

    2016-01-01

    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…

  6. Accuracy of specific symptoms in the diagnosis of major depressive disorder in psychiatric out-patients: data from the MIDAS project.

    Science.gov (United States)

    Mitchell, A J; McGlinchey, J B; Young, D; Chelminski, I; Zimmerman, M

    2009-07-01

    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.

  7. The relationship of psychological reactance, health locus of control and sense of self-efficacy with adherence to treatment in psychiatric outpatients with depression.

    Science.gov (United States)

    De Las Cuevas, Carlos; Peñate, Wenceslao; Sanz, Emilio J

    2014-11-21

    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.

  8. Avoidable and unavoidable visits to the emergency department among patients with advanced cancer receiving outpatient palliative care.

    Science.gov (United States)

    Delgado-Guay, Marvin Omar; Kim, Yu Jung; Shin, Seong Hoon; Chisholm, Gary; Williams, Janet; Allo, Julio; Bruera, Eduardo

    2015-03-01

    Admissions to the emergency department (ED) can be distressing to patients with advanced cancer receiving palliative care. There is limited research about the clinical characteristics of these patients and whether these ED visits can be categorized as avoidable or unavoidable. To determine the frequency of potentially avoidable ED visits (AvEDs) for patients with advanced cancer receiving outpatient palliative care in a large tertiary cancer center, identify the clinical characteristics of the patients receiving palliative care who visited the ED, and analyze the factors associated with AvEDs and unavoidable ED visits (UnAvEDs). We randomly selected 200 advanced cancer patients receiving treatment in the outpatient palliative care clinic of a tertiary cancer center who visited the ED between January 2010 and December 2011. Visits were classified as AvED (if the problem could have been managed in the outpatient clinic or by telephone) or UnAvED. Forty-six (23%) of 200 ED visits were classified as AvED, and 154 (77%) of 200 ED visits were classified as UnAvED. Pain (71/200, 36%) was the most common chief complaint in both groups. Altered mental status, dyspnea, fever, and bleeding were present in the UnAvED group only. Infection, neurologic events, and cancer-related dyspnea were significantly more frequent in the UnAvED group, whereas constipation and running out of pain medications were significantly more frequent in the AvED group (P palliative care clinic (OR 0.24; 95% CI 0.06, 0.88) and the presence of baseline dyspnea (OR 0.46; 95% CI 0.21, 0.99). Nearly one-fourth of ED visits by patients with advanced cancer receiving palliative care were potentially avoidable. Proactive efforts to improve communication and support between scheduled appointments are needed. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  9. Outpatient Management of Emergency Department Patients With Acute Pulmonary Embolism: Variation, Patient Characteristics, and Outcomes.

    Science.gov (United States)

    Vinson, David R; Ballard, Dustin W; Huang, Jie; Reed, Mary E; Lin, James S; Kene, Mamata V; Sax, Dana R; Rauchwerger, Adina S; Wang, David H; McLachlan, D Ian; Pleshakov, Tamara S; Silver, Matthew A; Clague, Victoria A; Klonecke, Andrew S; Mark, Dustin G

    2017-12-13

    Outpatient management of emergency department (ED) patients with acute pulmonary embolism is uncommon. We seek to evaluate the facility-level variation of outpatient pulmonary embolism management and to describe patient characteristics and outcomes associated with home discharge. The Management of Acute Pulmonary Embolism (MAPLE) study is a retrospective cohort study of patients with acute pulmonary embolism undertaken in 21 community EDs from January 2013 to April 2015. We gathered demographic and clinical variables from comprehensive electronic health records and structured manual chart review. We used multivariable logistic regression to assess the association between patient characteristics and home discharge. We report ED length of stay, consultations, 5-day pulmonary embolism-related return visits and 30-day major hemorrhage, recurrent venous thromboembolism, and all-cause mortality. Of 2,387 patients, 179 were discharged home (7.5%). Home discharge varied significantly between EDs, from 0% to 14.3% (median 7.0%; interquartile range 4.2% to 10.9%). Median length of stay for home discharge patients (excluding those who arrived with a new pulmonary embolism diagnosis) was 6.0 hours (interquartile range 4.6 to 7.2 hours) and 81% received consultations. On adjusted analysis, ambulance arrival, abnormal vital signs, syncope or presyncope, deep venous thrombosis, elevated cardiac biomarker levels, and more proximal emboli were inversely associated with home discharge. Thirteen patients (7.2%) who were discharged home had a 5-day pulmonary embolism-related return visit. Thirty-day major hemorrhage and recurrent venous thromboembolism were uncommon and similar between patients hospitalized and those discharged home. All-cause 30-day mortality was lower in the home discharge group (1.1% versus 4.4%). Home discharge of ED patients with acute pulmonary embolism was uncommon and varied significantly between facilities. Patients selected for outpatient management had a

  10. Lamotrigine in the immediate treatment of outpatients with depersonalization disorder without psychiatric comorbidity: randomized, double-blind, placebo-controlled study.

    Science.gov (United States)

    Aliyev, Nadir A; Aliyev, Zafar N

    2011-02-01

    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.

  11. The impact of exposure to Internet-based information about the Rorschach and the MMPI-2 on psychiatric outpatients' ability to simulate mentally healthy test performance.

    Science.gov (United States)

    Hartmann, Ellen; Hartmann, Terje

    2014-01-01

    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.

  12. Non-suicidal self-injury among psychiatric outpatient adolescent offspring of Croatian posttraumatic stress disorder male war veterans: Prevalence and psychosocial correlates.

    Science.gov (United States)

    Boričević Maršanić, Vlatka; Aukst Margetić, Branka; Ožanić Bulić, Suzana; Đuretić, Irena; Kniewald, Hrvoje; Jukić, Tatjana; Paradžik, Ljubica

    2015-05-01

    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.

  13. Mediating effects of self-stigma on the relationship between perceived stigma and psychosocial outcomes among psychiatric outpatients: findings from a cross-sectional survey in Singapore

    Science.gov (United States)

    Picco, Louisa; Lau, Ying Wen; Pang, Shirlene; Abdin, Edimansyah; Vaingankar, Janhavi Ajit; Chong, Siow Ann; Subramaniam, Mythily

    2017-01-01

    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

  14. Sex Differences in Psychiatric Comorbidity and Plasma Biomarkers for Cocaine Addiction in Abstinent Cocaine-Addicted Subjects in Outpatient Settings

    Science.gov (United States)

    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

    2015-01-01

    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

  15. Using the Integration of Discrete Event and Agent-Based Simulation to Enhance Outpatient Service Quality in an Orthopedic Department

    Directory of Open Access Journals (Sweden)

    Cholada Kittipittayakorn

    2016-01-01

    Full Text Available Many hospitals are currently paying more attention to patient satisfaction since it is an important service quality index. Many Asian countries’ healthcare systems have a mixed-type registration, accepting both walk-in patients and scheduled patients. This complex registration system causes a long patient waiting time in outpatient clinics. Different approaches have been proposed to reduce the waiting time. This study uses the integration of discrete event simulation (DES and agent-based simulation (ABS to improve patient waiting time and is the first attempt to apply this approach to solve this key problem faced by orthopedic departments. From the data collected, patient behaviors are modeled and incorporated into a massive agent-based simulation. The proposed approach is an aid for analyzing and modifying orthopedic department processes, allows us to consider far more details, and provides more reliable results. After applying the proposed approach, the total waiting time of the orthopedic department fell from 1246.39 minutes to 847.21 minutes. Thus, using the correct simulation model significantly reduces patient waiting time in an orthopedic department.

  16. The one-stop clinic as the standard of out-patient care in a hospital urology department

    Directory of Open Access Journals (Sweden)

    Alvaro Páez

    2011-10-01

    Full Text Available PURPOSE: To evaluate the performance of a 'one-stop' clinic in terms of proportion of discharges or inclusion in surgical waiting lists. MATERIALS AND METHODS: All patients were referred from primary care facilities (population 220.646 and from different departments in the hospital. Eight senior urologists, two registered nurses and two nurse attendants participated in the experience. Prior to the start of the project, referral protocols had been agreed with the primary care physicians involved. Compliance with the protocols was periodically tested. Eventually 5537 first visits (January-December 2009 where evaluable. RESULTS: Overall, the 'one-stop' format proved feasible in 74.2% of the patients (4108/5537. Patients, who successfully used the 'one-stop' format, were significantly younger than those who required additional consultations (43 vs 50 years old, respectively, Student's t test < 0.001. For obvious reasons the 'one-stop' format was universally possible in male sterilization and penile phimosis patients. Similarly, the 'one-stop' policy was applied in most consultations due to male sexual dysfunction (75% and urinary tract infection (73%. Other health problems, such as haematuria (62% and renal colic (46%, required more than one visit so that care of the patient reverted to the traditional, outpatient care model. CONCLUSION: A 'one-stop' philosophy is feasible for a number of procedures in a urological outpatient clinic. The costs to implement such an approach would be limited to managerial expenditure.

  17. Relationships between Personal Traits, Emotional Intelligence, Internal Marketing, Service Management, and Customer Orientation in Korean Outpatient Department Nurses.

    Science.gov (United States)

    Kim, Bogyun; Lee, Jia

    2016-03-01

    Current increase and complexity of medical tests and surgical procedures at outpatient department (OPD) require OPD nurses to have customer orientation focusing on various customers' interests and needs. The purpose of this study was to identify the factors associated with customer orientation in nurses working at OPD of hospitals. The study used a descriptive correlational design with cross-sectional survey. The study settings were four general hospitals in Seoul and its metropolitan area. Data were collected from 138 OPD nurses from general hospitals. Study variables were personal traits, emotional intelligence, internal marketing, service management and customer orientation. Factors associated with customer orientation were identified as conscientiousness from personal traits (β = .37, p marketing from environmental characteristics (β = .21, p = .001). Hospital administrators should support OPD nurses to cultivate sincere and sociable personal traits and emotional intelligence, and to consider employees as internal customers to improve patient-oriented services and satisfaction. Copyright © 2015. Published by Elsevier B.V.

  18. Severity of alprazolam dependence and associated features among long-term alprazolam users from psychiatric outpatient clinics in Taiwan.

    Science.gov (United States)

    Chen, Tzu-Ting; Ko, Chih-Hung; Chen, Shao-Tsu; Yen, Chia-Nan; Su, Po-Wen; Hwang, Tzung-Jeng; Lin, Jin-Jia; Yen, Cheng-Fang

    2015-11-01

    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.

  19. Perceived mental illness stigma and HIV risk behaviors among adult psychiatric outpatients in Rio de Janeiro, Brazil.

    Science.gov (United States)

    Elkington, Katherine S; McKinnon, Karen; Mann, Claudio Gruber; Collins, Pamela Y; Leu, Cheng-Shiun; Wainberg, Milton L

    2010-02-01

    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.

  20. Safety and efficiency of outpatient versus emergency department-based coronary CT angiography for evaluation of patients with potential ischemic chest pain.

    Science.gov (United States)

    Scheuermeyer, Frank X; Grunau, Brian; Raju, Rekha; Choy, Stephen; Naoum, Christopher; Blanke, Philipp; Hague, Cameron; Heilbron, Brett; Taylor, Carolyn; Kalla, Daniel; Christenson, Jim; Innes, Grant; Hanakova, Michaela; Leipsic, Jonathon

    2015-01-01

    While coronary CT angiography (coronary CTA) may be comparable to standard care in diagnosing acute coronary syndrome (ACS) in emergency department (ED) chest pain patients, it has traditionally been obtained prior to ED discharge and a strategy of delayed outpatient coronary CTA following an ED visit has not been evaluated. To investigate the safety of discharging stable ED patients and obtaining outpatient CCTA. At two urban Canadian EDs, patients up to 65 years with chest pain but no findings indicating presence of ACS were further evaluated depending upon time of presentation: (1) ED-based coronary CTA during normal working hours, (2) or outpatient coronary CTA within 72 hours at other times. All data were collected prospectively. The primary outcome was the proportion of patients who had an outpatient coronary CTA ordered and had a predefined major adverse cardiac event (MACE) between ED discharge and outpatient CT; secondary outcome was the ED length of stay in both groups. From July 1, 2012 to June 30, 2014, we enrolled 521 consecutive patients: 350 with outpatient CT and 171 with ED-based CT. Demographics and risk factors were similar in both cohorts. No outpatient CT patients had a MACE prior to coronary CTA. (0.0%, 95% CI 0 to 0.9%) The median length of stay for ED-based evaluation was 6.6 hours (interquartile range 5.4 to 8.3 hours) while the outpatient group had a median length of stay of 7.0 hours (IQR 6.0 to 9.8 hours, n.s.). In ED chest pain patients with a low risk of ACS, performing coronary CTA as an outpatient may be a safe strategy. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  1. Prevalence of eye pathology in a group of diabetic patients at National District Hospital Outpatient Department in Bloemfontein, South Africa

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    Joleen P. Cairncross

    2017-01-01

    Full Text Available Background: Diabetic retinopathy is the third most common cause of blindness after cataracts and glaucoma in South Africa. Primary healthcare interventions providing eye care services play an important role in preventing complications.Aim: To determine the prevalence of eye pathology in a group of diabetic patients at National District Hospital by screening for diabetes-associated ocular pathology.Setting: Outpatients Department run by Department of Family Medicine at National District Hospital in Bloemfontein from June to July 2014.Methods: Interviews were used to collect information regarding diabetic patients’ history of diabetes mellitus and if and when previous diabetic retinopathy screening was performed. Visual acuity was assessed, intra-ocular pressure measured and a non-mydriatic digital fundus camera used to screen for retinal pathology.Results: During the last year, only 4.5% of patients had their vision checked with a Snellen chart, and 16.5% were examined with an ophthalmoscope. Since diagnosis of diabetes, only 15.5% of patients were referred to an ophthalmologist. Patient referral was needed for 87 (42.9% cases for refractive disorders, 37 (18.2% for suspected glaucoma, 30 (14.8% for cataracts, and 22 (10.8% for diabetic retinopathy.Conclusion: This study confirms that glaucoma, cataracts and diabetic retinopathy are prevalent eye conditions among diabetic patients. Offering eye screening at primary healthcare level may contribute to early detection of eye pathology and timeous referral for sight-saving treatment.

  2. Health Care Utilization before and after an Outpatient Emergency Department Visit in Older People

    Science.gov (United States)

    Horney, Carolyn; Schmader, Kenneth; Sanders, Linda L.; Heflin, Mitchell; Ragsdale, Luna; McConnell, Eleanor; Hocker, Michael; Hastings, S. Nicole

    2010-01-01

    Background Older adults in the U.S. receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization has not been adequately studied in this population. Objectives The goal of this study were to examine the relationships between health care use before and after an ED visit among older adults. Methods This retrospective cohort study examined health care use among 308 patients ≥ 65 years old discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician (PCP), specialist, ED and hospital) and risk of return ED visits. Results Older ED patients in this study had visited other types of providers frequently in the previous year (median number of primary care physician (PCP) and specialist visits = 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits 7.0 vs 4.0, p<.001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (HR 2.20, 95% CI 1.15–4.21), in models adjusted for demographics and health status. Conclusion Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals. PMID:21216555

  3. Screening for Adult Attention-Deficit/Hyperactivity Disorder in a Psychiatric Outpatient Population with Specific Focus on Sex Differences

    Directory of Open Access Journals (Sweden)

    Salvatore Corbisiero

    2017-06-01

    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.

  4. THE STUDY OF REACTIVE AND PERSONAL ANXIETY, QUALITY OF LIFE IN PATIENTS WITH DYSPEPSIA IN OUTPATIENT DEPARTMENT

    Directory of Open Access Journals (Sweden)

    E. G. Kunakbaeva

    2016-01-01

    Full Text Available Conducted  a comprehensive  examination  of patients  in the  outpatient department, including laboratory  and instrumental methods,  the  test of Spielberg-Hanina to determine  the level of anxiety, the SF 36 test to determine  the level of quality of life. The survey revealed a decline in the quality of life in patients  with dyspepsia, the indicators of psychological health in organic and functional dyspepsia is lower than in healthy people. The intensity of pain was higher in patients  with epigastric pain syndrome. Lower quality of life were in the group with organic lesions of the upper gastrointestinal tract. The results of the test of Spielberg-Hanin demonstrated high personal anxiety in patients with different types of dyspepsia in comparison with healthy group. The obtained results complement the clinical and pathogenetic information regarding the different kinds of dyspepsia. 

  5. A comparative study of quality outcomes in freestanding ambulatory surgery centers and hospital-based outpatient departments: 1997-2004.

    Science.gov (United States)

    Chukmaitov, Askar S; Menachemi, Nir; Brown, L Steven; Saunders, Charles; Brooks, Robert G

    2008-10-01

    To compare quality outcomes from surgical procedures performed at freestanding ambulatory surgery centers (ASCs) and hospital-based outpatient departments (HOPDs). Patient-level ambulatory surgery (1997-2004), hospital discharge (1997-2004), and vital statistics data (1997-2004) for the state of Florida were assembled and analyzed. We used a pooled, cross-sectional design. Logistic regressions with time fixed-effects were estimated separately for the 12 most common ambulatory surgical procedures. Our quality outcomes were risk-adjusted 7-day and 30-day mortality and 7-day and 30-day unexpected hospitalizations. Risk-adjustment for patient demographic characteristics and severity of illness were calculated using the DCG/HCC methodology adjusting for primary diagnosis only and separately for all available diagnoses. Although neither ASCs nor HOPDs performed better overall, we found some difference by procedure that varied based on the risk-adjustment approach used. There appear to be important variations in quality outcomes for certain procedures, which may be related to differences in organizational structure, processes, and strategies between ASCs and HOPDs. The study also confirms the importance of risk-adjustment for comorbidities when using administrative data, particularly for procedures that are sensitive to differences in severity. © Health Research and Educational Trust.

  6. [Smoking habits of employees and patients in the psychiatric department of a general hospital].

    Science.gov (United States)

    Schulz, M; Töpper, M; Behrens, J

    2004-02-01

    Health promotion is becoming an increasingly more meaning in hospitals within their health promotion, primary and secondary prevention programmes. With reference to the preventive measures regarding nicotine dependence, it was first of all the objective of this study to determine the smoking habits of employees and patients in a psychiatric clinic. The question was also which implications for clinical practice could be drawn from this. Apart from the Fagerstroem Test for nicotine dependence, a new questionnaire was developed, supported by the questionnaire "Smoke free in hospital", developed by the Federal Agency for Health Education, and implemented. 382 Patients and 484 employees were questioned. The statistical analysis was done using SPSS, and in addition thereto, the T-Test and the chi (2)-Test were used. Definite gender differences pertaining to smoking habits could be demonstrated. Women smoked less often (p change are still not available. Added to that, it must be tested within the German Health System, whether a clinically supervised smoking cessation programme complementing the treatment of the main diagnosis (a psychiatric disease) is demanded by the affected person, whether the clinic can finance it, and whether it can be successfully implemented.

  7. Diagnostic error in the Emergency Department: follow up of patients with minor trauma in the outpatient clinic.

    Science.gov (United States)

    Moonen, Pieter-Jan; Mercelina, Luc; Boer, Willem; Fret, Tom

    2017-02-14

    The Emergency Department (ED) is prone to diagnostic error. Most frequent diagnostic errors involved "minor" trauma. Our goal was to determine how frequently a missed diagnosis was detected during follow up and to determine the frequency and causes of primary missed diagnosis and diagnostic error. A retrospective single centre study review, during 6 months including all patients presenting to the outpatient clinic after ED admission with a minor trauma. We defined primary missed diagnosis versus diagnostic error. Demographic data were collected in Excel file and analyzed using Χ 2 and unpaired T-test. Inclusion of 56 patients leading to 57 missed diagnoses representing 1.39% of all minor trauma patients presenting to the ED. History and physical examination notes were incomplete or inadequate in respectively 17/56 and 20/56. Most frequently missed diagnoses were ankle (13/57), wrist (8/57) and foot (7/57) fractures. Causes for diagnostic error could be categorized into two main groups: failure to perform adequate history taking and/or physical examination and failure to order or correctly interpret technical investigation. In 6 cases (0.14%) diagnostic error was confirmed. All other cases were defined as primary missed diagnosis. Emergency physicians have to remain vigilant to prevent and avoid primary missed diagnosis (PMD) and diagnostic error (DE), certainly in case of minor trauma patients, representing a large proportion of ED patients. We observed a prevalence of 1.39% of missed diagnoses within a six month study period. This is comparable to previous studies (1% ). However in our study both primary missed diagnoses and DE were included. Using this definition we saw that only one case could be attributed to negligence and DE had a prevalence of 0.14% (6 cases). X-rays remain the mainstay investigation for minor trauma patients, however in certain selected cases (pelvic and spinal trauma) we advise early CT-scan.Follow up in an outpatient clinic or other

  8. A comparison of gains after treatment at a psychiatric outpatient clinic in patients with cluster A + B, or cluster C personality disorders, and non-psychotic axis I disorders.

    Science.gov (United States)

    Narud, Kjersti; Mykletun, Arnstein; Dahl, Alv A

    2005-01-01

    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.

  9. A survey of hand-washing facilities in the outpatient department of a tertiary care teaching hospital in India.

    Science.gov (United States)

    Devnani, Mahesh; Kumar, Rajiv; Sharma, Rakesh Kumar; Gupta, Anil Kumar

    2011-03-02

    Inadequate hand-washing facilities have been reported as a barrier to hand washing. This study aimed to evaluate the availability and accessibility of hand-washing facilities and supplies of hand-washing agents in the outpatient department (OPD) complex of a tertiary care teaching hospital. A checklist containing 13 variables was prepared and all rooms of direct patient care in the OPD were assessed on one occasion.  Out of 211 rooms surveyed, a hand-washing facility was available in 209 (99.05%) rooms. Among these, 206 (98.56%) sinks were easily accessible and were placed close to users. Almost all sinks (99.5%) had hand-operated taps. Thirty-five (16.75%) sinks had no soap stand, and at 21 (10.5%) sinks, soap stands were found to be broken. At 14 (6.70%) sinks, soap bars were not available, while an antiseptic agent was available at 6 (2.87%) sinks. Four (1.91%) sinks had no towel stand, and at 8 (3.83%) sinks the towel stands were broken. At 43 (20.57%) sinks no towel was available, and at 23 (11%) sinks the towels provided were dirty. No sink drain was found to be blocked. No sink had hand-washing instructions displayed demonstrating the correct technique of hand washing. Physical facilities required for hand washing were adequate though not perfect. There is a need to shift from hand-operated taps to non-manual taps and from cloth towels to paper towels. Hospital managers in developing countries should continuously strive to provide the best possible hand-washing facilities within their financial resources.

  10. The effectiveness of holistic diabetic management between Siriraj Continuity of Care clinic and medical out-patient department.

    Science.gov (United States)

    Chalermsri, Chalobol; Paisansudhi, Supalerg; Kantachuvesiri, Pitchaporn; Pramyothin, Pornpoj; Washirasaksiri, Chaiwat; Srivanichakorn, Weerachai; Nopmaneejumruslers, Cherdchai; Chouriyagune, Charoen; Pandejpong, Denla; Phisalprapa, Pochamana

    2014-03-01

    Diabetes mellitus is one of the most common diseases in the Thai population, and it is well known that diabetic complications could be prevented with appropriate management. Despite published guidelines, most Thai patients with diabetes do not achieve treatment goals. Siriraj Continuity of Care clinic (CC clinic) was recently established in order to provide training for medical students and internal medicine residents. It is possible that the training component in the CC clinic may contribute to better overall outcomes in type 2 diabetes mellitus (type 2 DM) patients when compared with usual care at the medical out-patient department (OPD). To compare the effectiveness of diabetic management in type 2 diabetes mellitus patients who attended the CC clinic and the medical OPD. Retrospective chart review was performed in type 2 diabetes mellitus patients who were treated at either clinic at Siriraj Hospital in 2007-2011. Baseline demographics, treatment strategies and outcomes, and participation in an appropriate health maintenance program were assessed in both groups. Seven hundred and fifty seven medical records were reviewed, including 383 patients in the CC clinic group and 374 in the OPD group. Mean HbA1c was significantly lower in the CC clinic group compared with the OPD group (7.3 +/- 0.9% and 7.8 +/- 1.3%, respectively, 3.0% vs. 7.4%, p < 0.001 for colon cancer). Moreover, significantly more patients in the CC clinic group received recommended immunization (influenza, diphtheria tetanus and pneumococcal vaccine) compared with the control group (p < or = 0.001). Diabetic patients treated at the CC clinic had better clinical outcomes and healthcare maintenance compared with those who received usual care at the medical OPD. Continuity of care and integrated training component may have contributed to the improved outcomes.

  11. Clinical experience and institutional in a Department of Mental Health: The multifamily groups for parents and children with psychiatric illness in the time of post-modernity

    Directory of Open Access Journals (Sweden)

    Luisella Ferraris

    2014-09-01

    Full Text Available The following work shows the beginning and development of a multifamily group, involving mental health professionals, parents and psychiatric patients, in a mental health center. The group goals and the main functions of this setting, will be described, observing also the social and community changes, occurring in recent years. Finally, starting from the analysis of the major psychoanalysis research findings, the concepts of inter-subjectivity, therapeutic alliance and institution's role regarding the psychiatric patients’ treatment, will be deepened. Keywords: Department of Mental Health; Multifamily group; Community changes; Therapeutic alliance; Psychiatric patients

  12. Assessment of the Acute Psychiatric Patient in the Emergency Department: Legal Cases and Caveats

    Science.gov (United States)

    2014-05-01

    in his wife’s behavior as she became more lethargic and depressed . He presented to Greenville Memorial Hospital’s emergency department (ED) on a Friday...do this, Dr. Crumpler negligently failed to prescribe appropriate antipsychotic medication.3 In the above case the EP correctly diagnosed a...patient one must always consider medication- related medical issues (neuroleptic malignant syndrome, serotonin syndrome, anticholinergic Good et al

  13. The association of psychiatric comorbidity and use of the emergency department among persons with substance use disorders: an observational cohort study

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    Allee Elise

    2008-12-01

    Full Text Available Abstract Background Psychiatric and substance use problems are commonly found to be contributing factors to frequent Emergency Department (ED use, yet little research has focused on the association between substance use and psychiatric comorbidity. This study assesses the association of a psychiatric comorbidity on (ED use among patients with substance use disorders (SUDs. Methods The study focuses on 6,865 patients who were diagnosed with SUDs in the ED of a large urban hospital in the southern United States from January 1994 – June 1998. Patients were grouped by type of substance use disorder. After examining frequency of visits by diagnosis, the sample was assigned to the following groups–alcohol dependence (ICD9 = 303, alcohol abuse (ICD9 = 305.0, cocaine dependence/abuse (ICD9 = 304.2, 305.6, and polysubstance/mixed use (ICD9 = 305.9. A patient was classified with psychiatric comorbidity if a psychiatric diagnosis appeared during any of the patient's visits. The following psychiatric diagnoses were included–schizophrenia/psychoses, bipolar disorder, depression, anxiety, and dementia (ICD-9 codes available upon request. Results Patients with SUDs and psychiatric comorbidity had significantly higher mean number of ER visits (mean = 5.2 SD = 8.7 than SUD patients without psychiatric comorbidity (mean = 2.5, SD = 3.7. In logistic regressions predicting several categorizations of heavier use of the ED (either 4+, 8+, 12+, 16+, or 20+ visits over the span of the study SUD patients with psychiatric comorbidity had adjusted odds ratios of 3.0 to 5.6 (reference group = patients with SUDs but no psychiatric comorbidity. This association was found across all substance use diagnostic categories studied, with the strongest relationship observed among patients with cocaine disorders or alcohol dependence. Conclusion The results provide further support for the notion that the ED could and should serve as an important identification site for cost

  14. Impact of oral diseases on quality of life in subjects attending out-patient department of a dental hospital, India

    Directory of Open Access Journals (Sweden)

    N Saimadhavi

    2013-01-01

    Full Text Available Context: Currently there is a growing interest in oral health outcomes in how oral health affects quality of life. When oral health related quality of life measures are used alongside traditional clinical methods of measuring oral health status, a more comprehensive assessment of the impact of oral diseases on the several dimensions of subjective wellbeing becomes possible. In this context, we attempted to study the impact of oral diseases on quality of life, so as to address the patient′s needs in an appropriate way and thereby improving one′s quality of life. Aims: To evaluate the impact of different oral diseases on quality of life using a modified OHIP-14 questionnaire, so as to address the patient′s needs in an appropriate way and thereby improving one′s quality of life. Settings and Design: The study was carried out among 302 subjects, attending the outpatient department a dental hospital, India, for check up and treatment of their oral condition. Subjects aged above 20 years, who gave their consent for the study were included. Materials and Methods: The study sample was categorized in to two groups based upon the duration of the affecting disease - group 1 consisted of subjects suffering with chronic diseases and group 2 of subjects suffering with acute diseases. All the subjects were asked to fill up their responses in the given OHIP-14 questionnaires. The completed questionnaires were then collected and statistically analyzed. Statistical Analysis Used: To evaluate the role of age on QOL, age was divided in to 2 groups using median split procedure. For inter and intragroup comparisions, independent sample t test, anova followed by post hoc test and Chi-square tests were employed. Results: Chi square test revealed a moderately impaired quality of life among all the diseases investigated. On comparing the mean domain and total OHIP score between the two groups, the domain of psychological discomfort and disability and the total

  15. Infectious diseases and the use of antibiotics in outpatients at the emergency department of the University Hospital of Leon, Nicaragua

    NARCIS (Netherlands)

    den Engelsen, C.; van der Werf, C.; Matute, A. J.; Delgado, E.; Schurink, C. A. M.; Hoepelman, A. I. M.

    Background: In order to develop guidelines for the use of antimicrobial agents, it is necessary to obtain detailed information on the prevalence of infectious diseases and antibiotic usage. Methods: A retrospective study was conducted among outpatients with acute infections visiting the emergency

  16. Quality of psychiatric referrals to secondary-level care | Struwig ...

    African Journals Online (AJOL)

    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 ...

  17. [Pharmaco- and psychotherapy in psychiatric ambulatory care].

    Science.gov (United States)

    Burner, M

    1983-01-01

    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.

  18. Psychiatric Disorders and Personality Profiles of Middle-Aged Suicide Attempters with no Evidence of Specific Psychopathological Profiles Referring to an Emergency Department

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    Serge Brand

    2017-10-01

    Full Text Available Objective: The aim of the present study was to assess socio-demographic and psychiatric characteristics of 40-65 years old suicide attempters referred to an emergency department within four hours of making their attempt.Method: We assessed a total of 93 suicide attempters (Mage=46.59 years referred to an emergency department. Patients completed questionnaires covering socio-demographic data, personality traits, mood, and impulsivity; experts rated patients’ psychiatric status.Results: Experts rated 85 (92.4% of the suicide attempters as having a psychiatric disorder. Based on self-ratings and compared to normative data, 42 (46.6% were psychopathologically ill. Suicide attempts were not related to impulsive personality traits, mood disorders, socio-demographic patterns or gender (gender-ratio: 1:1.58;f:m.Conclusions: The pattern of results suggests that further unknown factors were involved in pushing people to attempt suicide.

  19. A prospective study on adverse drug reactions in outpatients and inpatients of medicine department in a tertiary care hospital

    OpenAIRE

    Harsha Ramakrishnaiah; Vasundara Krishnaiah; H. P. Pundarikaksha; Vedavathi Ramakrishna

    2015-01-01

    Background: No pharmacotherapeutic agent is completely free from noxious and unintended effects and thus adverse drug reactions (ADRs) are inevitable consequences of drug therapy. Incidence of ADRs in Indian population ranges between 1.8% and 25.1%. However, ADR reporting in India is inadequate. Developing awareness inpatients and healthcare professionals (HCPs) will help in reducing the ADRs, its suffering and socioeconomic impact. Hence, the present study of ADR monitoring in the outpatient...

  20. 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.

    Science.gov (United States)

    van Vreeswijk, M F; Spinhoven, P; Eurelings-Bontekoe, E H M; Broersen, J

    2014-01-01

    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.

  1. Interpersonal Community Psychiatric Treatment for non-psychotic chronic patients and nurses in outpatient mental health care : A controlled pilotstudy on feasibility and effects

    NARCIS (Netherlands)

    A. Schene; A. Smit; A. Kaasenbrood; B. van Meijel; G. Hutschemaekers; Bauke van Koekkoek

    2012-01-01

    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

  2. Interpersonal Community Psychiatric Treatment for non-psychotic chronic patients and nurses in outpatient mental health care: A controlled pilot study on feasibility and effects

    NARCIS (Netherlands)

    A. Smit; A. Schene; A. Kaasenbrood; G. Hutschemaekers; prof Berno van Meijel; B. Koekkoek

    2011-01-01

    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

  3. Interpersonal Community Psychiatric Treatment for non-psychotic chronic patients and nurses in outpatient mental health care: A controlled pilot study on feasibility and effects

    NARCIS (Netherlands)

    Koekkoek, B.W.; Meijel, B.K.G. van; Schene, A.H.; Smit, A.; Kaasenbrood, A.J.A.; Hutschemaekers, G.J.M.

    2012-01-01

    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

  4. Reasons for Referral, Intervention Approaches and Demographic Characteristics of Clients with Intellectual Disability Attending Adult Psychiatric Outpatient Services in the Kingdom of Bahrain

    Science.gov (United States)

    Grey, I.; Al-Saihati, B. A.; Al-Haddad, M.; McClean, B.

    2015-01-01

    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)…

  5. Young People's Risk of Suicide Attempts after Contact with a Psychiatric Department--A Nested Case-Control Design Using Danish Register Data

    Science.gov (United States)

    Christiansen, Erik; Larsen, Kim Juul

    2012-01-01

    Background: There seems to be an increased risk of children and adolescents committing or attempting suicide after contact with a psychiatric department. Children and adolescents living in families with low socio-economic status (SES) might have an especially increased suicide attempt risk. Methods: A complete extraction of Danish register data…

  6. Individuals with Intellectual Disabilities Who Live with Family and Experience Psychiatric Crisis: Who Uses the Emergency Department and Who Stays Home?

    Science.gov (United States)

    Weiss, Jonathan A.; Slusarczyk, Maggie; Lunsky, Yona

    2011-01-01

    Many individuals with intellectual disabilities who live with their families experience mental health problems and ensuing psychiatric emergencies. During periods of crisis, families may require additional services, including going to the emergency department (ED). The goal of this study was to elucidate demographic, clinical, and crisis features…

  7. Young people's risk of suicide attempts after contact with a psychiatric department - a nested case-control design using Danish register data.

    Science.gov (United States)

    Christiansen, Erik; Larsen, Kim Juul

    2012-01-01

    There seems to be an increased risk of children and adolescents committing or attempting suicide after contact with a psychiatric department. Children and adolescents living in families with low socio-economic status (SES) might have an especially increased suicide attempt risk. A complete extraction of Danish register data for every individual born in the period 1983-1989 was made. Of these 403,431 individuals, 3,465 had attempted suicide. In order to control for confounder effects from gender, age and calendar-time, a nested case-control study was designed. A total population of 72,765 individuals was used to analyze the risk of suicide attempts after contact with a psychiatric department. The case-control data were analyzed using conditional logistic regression. This study shows that a child/adolescent's risk of suicide attempt peaks immediately after discharge from last contact with a psychiatric department. The risk of suicide attempt is highest for children and adolescents suffering from personality disorders, depression and substance use disorders. Children and adolescents with previous contact with a psychiatric department and parental income in the lowest third have a significantly higher risk of suicide attempt. Suicide attempters were more likely to have been given several different diagnoses and several different psychopharmacological drugs prior to their attempted suicide. The findings in this study highlight the need for psychopathology assessment in every case of attempted suicide. This study also shows that well-known risk factors such as contact with a psychiatric department do not affect all individuals in the same way. Individuals from families with low SES had the highest risk. This suggests that the presence of factors influencing both vulnerability and resiliency, e.g., family level of SES, needs to be included in the assessment. © 2011 The Authors. Journal of Child Psychology and Psychiatry © 2011 Association for Child and Adolescent Mental

  8. Psychiatric services in Algeria.

    Science.gov (United States)

    Benmebarek, Zoubir

    2017-02-01

    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.

  9. Passing the baton: a grounded practical theory of handoff communication between multidisciplinary providers in two Department of Veterans Affairs outpatient settings.

    Science.gov (United States)

    Koenig, Christopher J; Maguen, Shira; Daley, Aaron; Cohen, Greg; Seal, Karen H

    2013-01-01

    Handoffs are communication processes that enact the transfer of responsibility between providers across clinical settings. Prior research on handoff communication has focused on inpatient settings between provider teams and has emphasized patient safety. This study examines handoff communication within multidisciplinary provider teams in two outpatient settings. To conduct an exploratory study that describes handoff communication among multidisciplinary providers, to develop a theory-driven descriptive framework for outpatient handoffs, and to evaluate the strengths and weaknesses of different handoff types. Qualitative, in-depth, semi-structured interviews with 31 primary care, mental health, and social work providers in two Department of Veterans Affairs (VA) Medical Center outpatient clinics. Audio-recorded interviews were transcribed and analyzed using Grounded Practical Theory to develop a theoretical model of and a descriptive framework for handoff communication among multidisciplinary providers. Multidisciplinary providers reported that handoff decisions across settings were made spontaneously and without clear guidelines. Two situated values, clinic efficiency and patient-centeredness, shaped multidisciplinary providers' handoff decisions. Providers reported three handoff techniques along a continuum: the electronic handoff, which was the most clinically efficient; the provider-to-provider handoff, which balanced clinic efficiency and patient-centeredness; and the collaborative handoff, which was the most patient-centered. Providers described handoff choice as a practical response to manage constituent features of clinic efficiency (time, space, medium of communication) and patient-centeredness (information continuity, management continuity, relational continuity, and social interaction). We present a theoretical and descriptive framework to help providers evaluate differential handoff use, reflect on situated values guiding clinic communication, and guide

  10. [Structures and practice of psychology departments in orthopaedic and cardiac rehabilitation: a comparison of outpatient and inpatient clinics in Germany].

    Science.gov (United States)

    Mittag, O; Reese, C; Gülich, M; Jäckel, W H

    2012-12-01

    We aimed at comparing the present structural quality and practice of psychological services in ambulatory (outpatient) and inpatient rehabilitation in Germany.A nationwide survey of psychological services in orthopaedic and cardiac outpatient rehab centres was carried out. Results were compared to those of an identical study of inpatient services that was conducted simultaneously.Data were obtained from 81 ambulatory centres (return rate: 44%). Structures and practice (e. g., diagnostic procedures, psychological interventions) in ambulatory and inpatient rehabilitation only differed marginally. Differences concern the staff/patient ratio which is slightly better in ambulatory centres and some aspects of working conditions (e. g., less assisting staff or supervision).From its beginning, ambulatory rehabilitation in Germany has followed the standards of the inpatient model as far as structural quality and processes are concerned. Psychological practice in the ambulatory setting reflects that too. It is discussed whether the uniformity of ambulatory and inpatient rehabilitation services really is appropriate, or whether a more flexible model (e. g., regarding treatment duration) is needed in the German rehabilitation system. © Georg Thieme Verlag KG Stuttgart · New York.

  11. Comparison of psychiatric disability on the health of nation outcome scales (HoNOS) in resettled traumatized refugee outpatients and Danish inpatients

    DEFF Research Database (Denmark)

    Palic, Sabina; Kappel, Michelle; Nielsen, Monica

    2014-01-01

    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....

  12. [Outpatient care in emergency departments and primary care services : A descriptive analysis of secondary data in a rural hospital].

    Science.gov (United States)

    Seeger, I; Rupp, P; Naziyok, T; Rölker-Denker, L; Röhrig, R; Hein, A

    2017-09-01

    The use of emergency departments in German hospitals has been increasing in recent years. Emergency care provided by primary care services ("Bereitschaftsdienstpraxis") or a hospital emergency departments (EDs) is the subject of current discussions. The purpose of this study was to determine the reasons that outpatients with lower treatment urgency consult the ED. Further, the effects of the cooperation between primary care services and the ED will be examined. The study was an exploratory secondary data analysis of data from the hospital information system and a quality management survey of a basic and standard care clinic in a rural area. All patients classified as 4 and 5 according to the emergency severity index (ESI), both four weeks before and after the primary care services and ED visit, were included in the study. During the two survey periods, a total of 1565 outpatient cases were treated, of which 962 cases (61%) were triaged ESI 4 or 5. Of these patients, 324 were surveyed (34%). Overall, 276 cases (85%) visited the ED without contacting a physician beforehand, 161 of the cases (50%) reported an emergency as the reason. In 126 cases (39%) the symptoms lasted more than one day. One-third of all outpatient admissions (537 cases, 34%) visited the ED during the opening hours of the general practitioner. More than 80% of the surviving cases visited the ED without physician contact beforehand. The most common reason for attending the ED was, "It is an emergency." The targeted control of the patients by integrating the primary care service into the ED does not lead to an increased number of cases in the primary care service, but to a subjective relief of the ED staff.

  13. [The role of day hospital in optimization of medical care for patients of a therapeutic department of an outpatient clinic].

    Science.gov (United States)

    Guliaev, P V; Stanke, A A; Vikhrova, T V; Ostrovskikh, G Iu

    2012-01-01

    Day hospital (DH) provides consultations and treatment for all referred patients according to standards of medical care quality. DH has facilities for therapeutic and gastroenterological patients. Treatment in DH is performed according to current standards which cover basic treatment of the diseases (documented medicines, duration of treatment). Efficacy of DH's use of the Standards of Diagnosis and Therapy of Acid-Dependent Diseases associated with Helicobacter pylori (standards of Moscow consensus) is used as illustration. As a result of treatment in DH 93% outpatients resumed their jobs, improvement occurred in 96.7% patients, a complete response was seen in 23%, 1.9% cases failed treatment. Most DH patients (83%) were satisfied with treatment given in DH and think it a convenient replacement of hospital stay.

  14. Self-assessed and clinically diagnosed periodontal health status among patients visiting the outpatient department of a dental school in Bangalore, India.

    Science.gov (United States)

    Nagarajan, Sripriya; Pushpanjali, K

    2008-01-01

    The purpose of the present cross-sectional study was to assess the extent of agreement between clinical and self-assessed periodontal health status among patients visiting the outpatient department of M.S. Ramaiah Dental College, Bangalore, India. The study population included 216 patients aged between 20 and 44 years who attended the outpatient department of the M.S. Ramaiah Dental College, Bangalore. The study population was subjected to a self-administered questionnaire (questions regarding bleeding gums, deposits on teeth, receding gums, swelling of gums, loose teeth), which was followed by periodontal examination. The clinical examination included an assessment of the periodontal condition, using the criteria of Loe and Silness Gingival Index, the Community Periodontal Index, and Mobility, respectively. The present study showed that the perceived periodontal health status was low and the discrepancy between the subjectively and objectively assessed needs was very distinct. The awareness of the periodontal problems has been reported to increase with increasing severity of the disease due to the destructive changes that set in.

  15. Self-assessed and clinically diagnosed periodontal health status among patients visiting the outpatient department of a dental school in Bangalore, India

    Directory of Open Access Journals (Sweden)

    Nagarajan Sripriya

    2008-01-01

    Full Text Available Background: The purpose of the present cross-sectional study was to assess the extent of agreement between clinical and self-assessed periodontal health status among patients visiting the outpatient department of M.S. Ramaiah Dental College, Bangalore, India. Materials and Methods: The study population included 216 patients aged between 20 and 44 years who attended the outpatient department of the M.S. Ramaiah Dental College, Bangalore. The study population was subjected to a self-administered questionnaire (questions regarding bleeding gums, deposits on teeth, receding gums, swelling of gums, loose teeth, which was followed by periodontal examination. The clinical examination included an assessment of the periodontal condition, using the criteria of Loe and Silness Gingival Index, the Community Periodontal Index, and Mobility, respectively. Conclusion: The present study showed that the perceived periodontal health status was low and the discrepancy between the subjectively and objectively assessed needs was very distinct. The awareness of the periodontal problems has been reported to increase with increasing severity of the disease due to the destructive changes that set in.

  16. Associations Between Waiting Times, Service Times, and Patient Satisfaction in an Endocrinology Outpatient Department: A Time Study and Questionnaire Survey.

    Science.gov (United States)

    Xie, Zhenzhen; Or, Calvin

    2017-01-01

    The issue of long patient waits has attracted increasing public attention due to the negative effects of waiting on patients' satisfaction with health care. The present study examined the associations between actual waiting time, perceived acceptability of waiting time, actual service time, perceived acceptability of service time, actual visit duration, and the level of patient satisfaction with care. We conducted a cross-sectional time study and questionnaire survey of endocrinology outpatients visiting a major teaching hospital in China. Our results show that actual waiting time was negatively associated with patient satisfaction regarding several aspects of the care they received. Also, patients who were less satisfied with the sociocultural atmosphere and the identity-oriented approach to their care tended to perceive the amounts of time they spent waiting and receiving care as less acceptable. It is not always possible to prevent dissatisfaction with waiting, or to actually reduce waiting times by increasing resources such as increased staffing. However, several improvements in care services can be considered. Our suggestions include providing clearer, more transparent information to keep patients informed about the health care services that they may receive, and the health care professionals who are responsible for those services. We also suggest that care providers are encouraged to continue to show empathy and respect for patients, that patients are provided with private areas where they can talk with health professionals and no one can overhear, and that hospital staff treat the family members or friends who accompany patients in a courteous and friendly way.

  17. Medicare Provider Utilization and Payment Data - Outpatient

    Data.gov (United States)

    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...

  18. Young people's risk of suicide attempts after contact with a psychiatric department - a nested case-control design using Danish register data

    DEFF Research Database (Denmark)

    Christiansen, Erik; Juul Larsen, Kim

    2012-01-01

    Background:  There seems to be an increased risk of children and adolescents committing or attempting suicide after contact with a psychiatric department. Children and adolescents living in families with low socio-economic status (SES) might have an especially increased suicide attempt risk. Meth...... influencing both vulnerability and resiliency, e.g., family level of SES, needs to be included in the assessment....

  19. Lower-Limb Amputation and Effect of Posttraumatic Stress Disorder on Department of Veterans Affairs Outpatient Cost Trends

    Science.gov (United States)

    2015-07-01

    data obtained from other U.S. Department of Defense data- bases [19]. Records from each level of care are reviewed by certified nurse coders at NHRC...M, Quinn K, Galarneau M. Glasgow Coma Scale scores, early opioids , and 4-year psychological outcomes among combat amputees. J Rehabil Res Dev

  20. Screening of the unrecognised bipolar disorders among outpatients with recurrent depressive disorder: a cross-sectional study in psychiatric hospital in Morocco

    Science.gov (United States)

    Bouchra, Oneib; Maria, Sabir; Abderazak, Ouanass

    2017-01-01

    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

  1. Screening of the unrecognised bipolar disorders among outpatients with recurrent depressive disorder: a cross-sectional study in psychiatric hospital in Morocco.

    Science.gov (United States)

    Bouchra, Oneib; Maria, Sabir; Abderazak, Ouanass

    2017-01-01

    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.

  2. The Penicillin for the Emergency Department Outpatient treatment of CELLulitis (PEDOCELL) trial: update to the study protocol and detailed statistical analysis plan (SAP).

    Science.gov (United States)

    Boland, Fiona; Quirke, Michael; Gannon, Brenda; Plunkett, Sinead; Hayden, John; McCourt, John; O'Sullivan, Ronan; Eustace, Joseph; Deasy, Conor; Wakai, Abel

    2017-08-24

    Cellulitis is a painful, potentially serious, infectious process of the dermal and subdermal tissues and represents a significant disease burden. The statistical analysis plan (SAP) for the Penicillin for the Emergency Department Outpatient treatment of CELLulitis (PEDOCELL) trial is described here. The PEDOCELL trial is a multicentre, randomised, parallel-arm, double-blinded, non-inferiority clinical trial comparing the efficacy of flucloxacillin (monotherapy) with combination flucloxacillin/phenoxymethylpenicillin (dual therapy) for the outpatient treatment of cellulitis in the emergency department (ED) setting. To prevent outcome reporting bias, selective reporting and data-driven results, the a priori-defined, detailed SAP is presented here. Patients will be randomised to either orally administered flucloxacillin 500 mg four times daily and placebo or orally administered 500 mg of flucloxacillin four times daily and phenoxymethylpenicillin 500 mg four times daily. The trial consists of a 7-day intervention period and a 2-week follow-up period. Study measurements will be taken at four specific time points: at patient enrolment, day 2-3 after enrolment and commencing treatment (early clinical response (ECR) visit), day 8-10 after enrolment (end-of-treatment (EOT) visit) and day 14-21 after enrolment (test-of-cure (TOC) visit). The primary outcome measure is investigator-determined clinical response measured at the TOC visit. The secondary outcomes are as follows: lesion size at ECR, clinical treatment failure at each follow-up visit, adherence and persistence of trial patients with orally administered antibiotic therapy at EOT, health-related quality of life (HRQoL) and pharmacoeconomic assessments. The plan for the presentation and comparison of baseline characteristics and outcomes is described in this paper. This trial aims to establish the non-inferiority of orally administered flucloxacillin monotherapy with orally administered flucloxacillin

  3. Changing pattern of clinical profile of first-contact patients attending outpatient services at a general hospital psychiatric unit in India over the last 50 years

    Directory of Open Access Journals (Sweden)

    Mamta Sood

    2017-01-01

    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.

  4. Outpatient Imaging Efficiency - National

    Data.gov (United States)

    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...

  5. Outpatient Imaging Efficiency - Hospital

    Data.gov (United States)

    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...

  6. Outpatient Imaging Efficiency - State

    Data.gov (United States)

    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...

  7. Prevalence of hypertension and its risk factors among individuals attending outpatient department of rural health training centre, Haldwani

    Directory of Open Access Journals (Sweden)

    Janki Bartwal

    2014-03-01

    Full Text Available Introduction: Hypertension is one of the major health and development challenges of the 21st century, which, for most countries, has developed together with rapid cultural and social changes, ageing populations, increasing urbanization, dietary changes, reduced physical activity, and other unhealthy behaviours. Objectives: 1 To find out the prevalence of Hypertension in study subjects 2 To identify the risk factors associated with Hypertension. Materials and Methods: A Cross-sectional study was carried out among 369 individuals of 30 years and above attending Out Patient Department (OPD in Rural Health Training Centre (RHTC under the Department of Community Medicine, Government Medical College, Haldwani during June 2013-August 2013. A pretested predesigned questionnaire was used to collect demographic data by interview technique .The blood pressure was recorded and classified using JNC VII criteria to grade hypertension. Data was compiled, entered & analyzed using SPSS version 20. Results: Among 369 patients, the prevalence of hypertension was 41.7%; out of this, 28.7% were aware of their hypertensive status while 13% were newly diagnosed cases. The association between hypertension with increase in age, family history of hypertension, increase salt intake, consuming mixed diet, increase waist circumference, waist hip ratio and body mass index was found significant. Physical inactivity, gender, tobacco and alcohol consumption were not significantly associated with hypertension. Conclusions: The prevalence of hypertension in rural area is relatively high. Extensive efforts are required for raising the awareness level & regular screening of high-risk population is recommended for preventing the complications & disability.

  8. 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.

    Science.gov (United States)

    Sawaya, Helen; Atoui, Mia; Hamadeh, Aya; Zeinoun, Pia; Nahas, Ziad

    2016-05-30

    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.

  9. 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

    Directory of Open Access Journals (Sweden)

    Cristina Lunardi Munaretti

    2007-01-01

    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

  10. Health-hazard-evaluation determination report No. HHE-78-6-503, Cumberland Outpatient Department of Beth Israel Hospital, Brooklyn, New York

    Energy Technology Data Exchange (ETDEWEB)

    Messite, J.; Fannick, N.L.

    1978-07-01

    In response to a request from a representative of the nursing staff, an investigation was made of possible methadone exposures at the Cumberland Outpatient Department of Beth Israel Hospital, Brooklyn, New York, a methadone-dispensing clinic. The distribution room measured 12 feet in all dimensions and was enclosed on three sides. Methadone had previously been received in prepackaged doses, but more recently the nurses had to count the contents of each 100-count bottle of methadone hydrochloride and separate tablets or diskets into individual doses. Nurses involved in dispensing the medication reported intermittent sleepiness, itching of the face, nose, and eyes, and dryness of skin on the hands and face. Urine studies indicated no detectable methadone or methadone metabolites at a limit of 1 microgram per milliliter. There is no evidence of methadone absorption; however, they recommend that skin contact with the tablets and diskets be kept to a minimum by use of instruments for moving the pills on the counting tray, frequent clean up of dust, and periodic hand washing.

  11. The history of Radiumhemmet in Stockholm in the period 1895-1950. The transformation of an outpatient clinic to an academic department,.

    Science.gov (United States)

    Kardamakis, Dimitrios; Gustavson-Kadaka, Evi; Spiliopoulou, Ekaterini; Nilsson, Sten

    2010-12-01

    Radiation therapy has been in use as a cancer treatment for more than 100 years, with its earliest roots traced from the discovery of X rays in 1895 by Wilhelm Rontgen. The field of radiation therapy began to grow in the early 1900s, largely due to the groundbreaking work of Nobel Prize-winning scientist Marie Curie, who discovered the radioactive elements polonium and radium.This began a new era in medical treatment and research. Radium was used in various forms until the mid-1900s, when cobalt and caesium units came into use. Medical cobalt units and linear accelerators have been used to as sources of radiation since the late 1940s. Swedish doctors showed a great interest in this medical specialty from the beginning, making major contributions in the fields of radiobiology, radiophysics and radiotherapy are contributed to doctors of Swedish origin, working mainly those early days in Stockholm. Immediately after the discovery of X rays, the first treatment of patients with these'mysterious rays' took place, with two patients with skin carcinomas being treated by Stenbeck and Sjogren in Stockholm. This article makes a detailed reference to historical data regarding the gradual transformation of a small private outpatient clinic into an academic department with a world-wide recognition.

  12. Impact of pre-packaging antimalarial drugs and counselling on compliance with malaria treatment at Port Moresby General Hospital Adult Outpatient Department.

    Science.gov (United States)

    Lauwo, J A K; Hombhanje, F W; Tulo, S P; Maibani, G; Bjorge, S

    2006-01-01

    We investigated the impact of pre-packaging antimalarial drugs and counselling on compliance with treatment of malaria at the Adult Outpatient Department of Port Moresby General Hospital. Adult patients who were prescribed standard antimalarial drugs following clinical and microscopic diagnosis of malaria were randomly assigned to one of three groups: an intervention group, where pre-packaging and counselling instructions were applied; control group A, with counselling but no pre-packaging; and control group B, with neither counselling nor pre-packaging. Patients were interviewed on two occasions, day 1 of treatment and day 4 post treatment. Of a total of 436 patients, 322 patients (179 males and 143 females) completed the study. Our data indicate an increase of 18% in compliance with treatment in the intervention group and 16% in control group A, when compared with control group B. While compliance with treatment was gender independent, the language spoken and used for giving instructions and counselling may have influenced patients' behaviour on prescribed medication. The results of our study indicate that a simple pre-packaging system and proper counselling could improve compliance with antimalarial drug treatment. As an additional beneficial observation, pre-packaging is likely to eliminate errors and possible contamination of the products during dispensing.

  13. Fever phobia: a comparison survey between caregivers in the inpatient ward and caregivers at the outpatient department in a children's hospital in China.

    Science.gov (United States)

    Dong, Lili; Jin, Jiahui; Lu, Yili; Jiang, Lili; Shan, Xiaoou

    2015-10-19

    Fever in children is one of the most common clinical symptoms and a chief complaint and a main reason that caregivers took the children to the outpatient service or admitted to hospital. Studies have found that the majority of parents surveyed at a hospital pediatric clinic held unrealistic and unwarranted concerns about fevers, first termed as 'fever phobia' by Schmitt in 1980. In the present study, we explore whether 'fever phobia' exists in Chinese caregivers and investigate whether such phobia is alleviated when admitted to hospital after propaganda of fever related knowledge by doctors and nurses. A questionnaire was distributed to caregivers of children who visited the pediatric outpatient department and those with caregivers in the wards between June 2012 and Feb 2013 in Wenzhou, China. Data were obtained from 621 caregivers, 305(49%) from the OPD and 316(51%) from the ward. Most caregivers of the two groups (OPD vs. ward group, 75.1 vs. 74.4%) believed fever could cause brain damage. 77.7% (76.0 vs. 81.3%) caregivers were very worried when their children had fever and 12.8% (14.1 vs. 11.4%) caregivers would check the temperature within 30 min. Moreover, 68.0% (63.0 vs. 72.8%, P sleep and 39.9% (40.3 vs. 39.6%) would administrate antipyretics when temperature was above 38 °C. After admitted to hospital, 83.9% caregivers stated to have received education about fever and 96.5% felt relieved. Less caregivers (ward group vs. OPD, 42.4 vs. 46.9%, P cold sponging as physical cooling method compared to the OPD caregivers. Alarmingly, more caregivers (42.7 vs. 34.3%, P < 0.05) in the ward group believed fever could lead to death or/and deafness (17.4 vs. 10.5%, P < 0.05) and even 0.6% caregivers in the ward group chose aspirin when the children had fever. 'Fever phobia' also exists in Chinese caregivers. Fever related knowledge propaganda after admitted to hospital did not work effectively to improve the caregivers' understanding and management of fever and an

  14. Perinatal psychiatric episodes

    DEFF Research Database (Denmark)

    Munk-Olsen, Trine; Maegbaek, M L; Johannsen, B M

    2016-01-01

    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...

  15. A 64-week, multicenter, open-label study of aripiprazole effectiveness in the management of patients with schizophrenia or schizoaffective disorder in a general psychiatric outpatient setting

    Directory of Open Access Journals (Sweden)

    Chiu Nan-Ying

    2010-09-01

    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

  16. ASSESSMENT OF KNOWLEDGE ABOUT IMMUNIZATION OF UNDER FIVE CHILDREN AMONG MOTHERS ATTENDING OUTPATIENT DEPARTMENT OF PEDIATRICS IN A TERTIARY CARE HOSPITAL IN KOLLAM, KERALA

    Directory of Open Access Journals (Sweden)

    Ahmad Nadeem

    2015-07-01

    Full Text Available BACKGROUND : Immunization is the most cost effective public health intervention to reduce childhood morbidity and mortality. Thousands of children can be saved from vaccine preventable diseases each year by immunization. The knowledge of mothers’ is an important factor for better immunization coverage. Less knowledge affects decision making regarding immunization. OBJECTIVES: To assess the knowledge about immunization of under five children among mothers a ttending outpatient department of paediatrics in a tertiary care hospital in Kollam, Kerala and to find out the association of the knowledge level of mothers with some selected variables. MATERIAL AND METHODS : A Cross sectional study was done among mothers of under five children attending the OPD of pediatrics in a tertiary care hospital in Kollam, Kerala from 1 st to 30 th May, 2014. The sample size was 210 and simple random sampling was used. Statistical analysis was done and chi - square test & percentages w ere calculated. RESULT: 93.8% of mothers knew that vaccines are beneficial for their child. 58% were aware about the side effects of few vaccines. 50% of mothers believed that as polio is eradicated from India, there is no need to give polio vaccine. 35% o f mothers acquired knowledge regarding immunization through health workers. All of them had knowledge about polio vaccine but only half of them knew about rotavirus vaccine. 60% mothers believed that multiple vaccines are beneficial although 26% hold their view that it has no benefit at all. 39.5% of mothers’ had adequate knowledge about immunization. It was positively associated with education, working class and high socio - economic status of mothers. CONCLUSION: There are several loopholes in the mother’s knowledge regarding immunization. Many of them had no knowledge about optional vaccines. There is a need to improve knowledge regarding immunization among general population. Adequate information about completin g the

  17. Awareness of diabetic foot disease amongst patients with type 2 diabetes mellitus attending the chronic outpatients department at a regional hospital in Durban, South Africa.

    Science.gov (United States)

    Goie, Thea T; Naidoo, Mergan

    2016-11-17

    Diabetic foot disease (DFD) is a major challenge for the healthcare system, with enormous economic consequences for people living with diabetes, their families, and society, affecting both quality of life and quality of care. The study aim was to assess the level of awareness of DFD amongst patients with type 2 diabetes mellitus (T2DM). An observational descriptive cross-sectional study was conducted at the chronic outpatients department of a regional hospital in Durban, South Africa. Two hundred participants with T2DM participated in the study. Ninety-one per cent of participants were either overweight or obese. Ninety-two per cent of participants had concomitant hypertension (57.5%), dyslipidaemia (26.7%) and eye disease (7.2%). Seventy-six per cent reported altered sensation in their lower limbs, and 90% reported having no previous DFD education. Only 22.2% of participants reported having examined their feet, but only when they experienced a problem. Participants achieved mediocre scores for knowledge (mean 4.45, standard deviation (s.d.) 2.201, confidence interval (CI) 4.2-4.7) and practice (mean 11.09, s.d. 2.233, CI 10.8-11.5) on diabetic foot care (DFC). Those who had a higher level of education and who were less than 65 years old had a significantly better score for previous foot care education (p < 0.05). The study demonstrated that awareness of DFD was suboptimal, based on current DFC guidelines. To minimise the burden of DFD, improved screening and prevention programmes as well as patient education should be provided to T2DM patients, whilst maintaining an aggressive approach to risk factor modifications, footwear and identifying the at-risk foot.

  18. Awareness of diabetic foot disease amongst patients with type 2 diabetes mellitus attending the chronic outpatients department at a regional hospital in Durban, South Africa

    Directory of Open Access Journals (Sweden)

    Thea T. Goie

    2016-03-01

    Full Text Available Background: Diabetic foot disease (DFD is a major challenge for the healthcare system, with enormous economic consequences for people living with diabetes, their families, and society, affecting both quality of life and quality of care. The study aim was to assess the level of awareness of DFD amongst patients with type 2 diabetes mellitus (T2DM.Methods: An observational descriptive cross-sectional study was conducted at the chronic outpatients department of a regional hospital in Durban, South Africa.Results: Two hundred participants with T2DM participated in the study. Ninety-one per cent of participants were either overweight or obese. Ninety-two per cent of participants had concomitant hypertension (57.5%, dyslipidaemia (26.7% and eye disease (7.2%. Seventy-six per cent reported altered sensation in their lower limbs, and 90% reported having no previous DFD education. Only 22.2% of participants reported having examined their feet, but only when they experienced a problem. Participants achieved mediocre scores for knowledge (mean 4.45, standard deviation (s.d. 2.201, confidence interval (CI 4.2–4.7 and practice (mean 11.09, s.d. 2.233, CI 10.8–11.5 on diabetic foot care (DFC. Those who had a higher level of education and who were less than 65 years old had a significantly better score for previous foot care education (p < 0.05.Conclusion: The study demonstrated that awareness of DFD was suboptimal, based on current DFC guidelines. To minimise the burden of DFD, improved screening and prevention programmes as well as patient education should be provided to T2DM patients, whilst maintaining an aggressive approach to risk factor modifications, footwear and identifying the at-risk foot.

  19. Awareness and Practices of Oral Hygiene and its Relation to Sociodemographic Factors among Patients attending the General Outpatient Department in a Tertiary Care Hospital of Kolkata, India.

    Science.gov (United States)

    Paul, Bobby; Basu, Mausumi; Dutta, Sinjita; Chattopadhyay, Sita; Sinha, Debasis; Misra, Raghunath

    2014-04-01

    Periodontal diseases, dental caries, malocclusion, and oral cancer are the most prevalent dental diseases affecting people in the Indian community. The study was conducted to assess the awareness and practices on oral hygiene and its association with the sociodemographic factors among patients attending the general Outpatient Department (OPD). A cross-sectional study was conducted among 224 patients attending the general OPD of the SSKM Hospital, Kolkata, India, from 1 April to 30 April, 2013. The study tool was a pre-designed and pre-tested semi-structured schedule. About 69.20% of the participants used a toothbrush with toothpaste as a method of cleaning their teeth; 35.71% brushed twice in a day; 33.03% brushed both in the morning and at bedtime; and 8.93% used mouthwash. About 40.62% visited the dentist during the last six months; among them 61.18% attended because of pain. Almost three-fourth of the participants knew that tooth decay and bad breath were the effects of not cleaning the teeth. It was known to 71.42, 63.39, 70.53, and 73.21% of the respondents, respectively, that excess sweet, cold drink, alcohol, and smoking/pan chewing were bad for dental health. Television was the source of knowledge to 57.14% of the participants and 35.71% acquired their knowledge from a dentist. Females, literates, urban residents, users of mouthwash, and regular visitors to the dentist had good oral hygiene practices. Oral health awareness and practices among the study population are poor and need to improve.

  20. Awareness and practices of oral hygiene and its relation to sociodemographic factors among patients attending the general outpatient department in a tertiary care hospital of Kolkata, India

    Directory of Open Access Journals (Sweden)

    Bobby Paul

    2014-01-01

    Full Text Available Background: Periodontal diseases, dental caries, malocclusion, and oral cancer are the most prevalent dental diseases affecting people in the Indian community. Objective: The study was conducted to assess the awareness and practices on oral hygiene and its association with the sociodemographic factors among patients attending the general Outpatient Department (OPD. Materials and Methods: A cross-sectional study was conducted among 224 patients attending the general OPD of the SSKM Hospital, Kolkata, India, from 1 April to 30 April, 2013. The study tool was a pre-designed and pre-tested semi-structured schedule. Results: About 69.20% of the participants used a toothbrush with toothpaste as a method of cleaning their teeth; 35.71% brushed twice in a day; 33.03% brushed both in the morning and at bedtime; and 8.93% used mouthwash. About 40.62% visited the dentist during the last six months; among them 61.18% attended because of pain. Almost three-fourth of the participants knew that tooth decay and bad breath were the effects of not cleaning the teeth. It was known to 71.42, 63.39, 70.53, and 73.21% of the respondents, respectively, that excess sweet, cold drink, alcohol, and smoking/pan chewing were bad for dental health. Television was the source of knowledge to 57.14% of the participants and 35.71% acquired their knowledge from a dentist. Females, literates, urban residents, users of mouthwash, and regular visitors to the dentist had good oral hygiene practices. Conclusion: Oral health awareness and practices among the study population are poor and need to improve.

  1. Elderly alcoholics in outpatient treatment

    DEFF Research Database (Denmark)

    Nielsen, Bent; Nielsen, Anette Søgaard; Lolk, Anette

    2010-01-01

    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...

  2. Screening for Suicidal Ideation and Attempts among Emergency Department Medical Patients: Instrument and Results from the Psychiatric Emergency Research Collaboration

    Science.gov (United States)

    Allen, Michael H.; Abar, Beau W.; McCormick, Mark; Barnes, Donna H.; Haukoos, Jason; Garmel, Gus M.; Boudreaux, Edwin D.

    2013-01-01

    Joint Commission National Patient Safety Goal 15 calls for organizations "to identify patients at risk for suicide." Overt suicidal behavior accounts for 0.6% of emergency department (ED) visits, but incidental suicidal ideation is found in 3%-11.6%. This is the first multicenter study of suicide screening in EDs. Of 2,243 patients in…

  3. Prevalence of psychiatric comorbidities in chronic obstructive pulmonary disease patients.

    Science.gov (United States)

    Chaudhary, Shyam Chand; Nanda, Satyan; Tripathi, Adarsh; Sawlani, Kamal Kumar; Gupta, Kamlesh Kumar; Himanshu, D; Verma, Ajay Kumar

    2016-01-01

    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.

  4. Differences in aerobic fitness between inpatients and outpatients with severe mental disorders

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    Helene Daae-Qvale Holmemo

    2014-08-01

    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.

  5. Basic Stand Alone Medicare Outpatient Procedures PUF

    Data.gov (United States)

    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...

  6. Hospital Outpatient Prospective Payment System (OPPS) Lim...

    Data.gov (United States)

    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...

  7. INFANCY AND EARLY CHILDHOOD PSYCHIATRY – CHARACTERIZATION OF THE OUTPATIENT CLINIC IN A CENTRAL HOSPITAL

    OpenAIRE

    Aguiar, Inês Guerra; Barroso, Cláudia; Moreira, Filipa; Fonseca, Maria da Luz; Mendes, Patrícia; Pangaio, Nuno; Miranda, Vânia; Fernandes, Graça

    2017-01-01

    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...

  8. Evaluation of trends of drug-prescribing patterns based on WHO prescribing indicators at outpatient departments of four hospitals in southern Ethiopia

    Directory of Open Access Journals (Sweden)

    Summoro TS

    2015-08-01

    Full Text Available Temesgen Sidamo Summoro,1 Kassa Daka Gidebo,2 Zewde Zemma Kanche,1 Eskinder Wolka Woticha2 1School of Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 2School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia Background: Rational prescribing is a primary step to ensure rational drug use. Often, half of the medicines are prescribed irrationally and half of these are even used incorrectly as the patients fail to take their medicines appropriately. The aim of this research was to evaluate drug-prescribing patterns of four hospitals in southern Ethiopia.Methods: A retrospective cross-sectional study was conducted between May 15 and June 25, 2014, to evaluate the drug-prescribing patterns based on the World health Organization (WHO prescribing indicators. The prescription papers, kept for the last 1 year in the outpatient departments of the four hospitals, were analyzed according to WHO guidelines. Also, prescriptions in the hospitals were analyzed to determine the most frequently prescribed drugs. All the statistical calculations were performed using SPSS® version 20.0 software.Results and discussion: The average number of drugs per prescription ranges from 1.82±0.90 to 2.28±0.90, whereas the percentage of use of antibiotics and injections ranged from 46.7 to 85 and 15 to 61.7, respectively. The average percentages of drugs prescribed by generic name and from the essential drugs list were 95.8 and 94.1, respectively. Anti-infective and analgesic drugs are found to be the most frequently prescribed medicines. In terms of polypharmacy, there was a slight deviation in prescribing patterns from what is acceptable according to the WHO criteria. Prescribing by generic name and from essential drug list was almost optimal. There was a significant deviation in the use of injectables in two of the four hospitals (50%, whereas their use in the other

  9. Survey on Awareness and Knowledge about the Effect of Diabetes Mellitus on Systemic and Oral Health in Patients Visiting General Medicine Outpatient Department in Dental Hospital

    Directory of Open Access Journals (Sweden)

    Shantala Arunkumar

    2015-04-01

    Full Text Available Objective: This survey was conducted on known diabetic patients to appraise the awareness and knowledge about the effect of diabetes mellitus (DM on systemic and oral health and to evaluate the source of the information. Aim: The aim of this study was to gather baseline information on awareness and knowledge of diabetic patients regarding their systemic and oral health with the view of enhancing their oral health education. Which will help in updating their knowledge regarding strong association of DM on oral diseases, also about importance of maintaining glycemic levels and good oral health. Methodology: This experimental study was conducted on known diabetic patients visiting general medicine outpatient department for fitness to undergo dental treatments. Patients were evaluated by using a self developed questionnaire by interview method. The questions were about awareness regarding effect of DM on systemic and oral health, sources of information patients have received and elicit the symptoms of DM in those diabetics and educate them regarding importance of glycemic control and maintenance of oral health. Results: All the participants had Type 2 DM. The knowledge about DM disease was poor and most of them attended camps related to DM and their systemic consequences, but none of them attended DM associated oral health camps. Many patients(47.5% were educated about the effect of DM on systemic organs and their prevention, by their treating physician, but none of the physicians informed about effect of DM on oral tissues (0%. Surprisingly, only some dentists (24% told regarding oral complications of DM, large number of patients gathered information by other sources mainly from relatives and friends, who are diabetics (61.9%. So awareness of diabetic patients of their increased risk for oral diseases is low compared to their awareness of systemic diseases. Conclusion: It is of paramount importance for dental specialist to raise the attentiveness

  10. Viral Respiratory Tract Infections in Adult Patients Attending Outpatient and Emergency Departments, Taiwan, 2012-2013: A PCR/Electrospray Ionization Mass Spectrometry Study.

    Science.gov (United States)

    Shih, Hsin-I; Wang, Hsuan-Chen; Su, Ih-Jen; Hsu, Hsiang-Chin; Wang, Jen-Ren; Sun, Hsiao Fang Sunny; Chou, Chien-Hsuan; Ko, Wen-Chien; Hsieh, Ming-I; Wu, Chi-Jung

    2015-09-01

    Viral etiologies of respiratory tract infections (RTIs) have been less studied in adult than in pediatric populations. Furthermore, the ability of PCR/electrospray ionization mass spectrometry (PCR/ESI-MS) to detect enteroviruses and rhinoviruses in respiratory samples has not been well evaluated. We sought to use PCR/ESI-MS to comprehensively investigate the viral epidemiology of adult RTIs, including testing for rhinoviruses and enteroviruses. Nasopharyngeal or throat swabs from 267 adults with acute RTIs (212 upper RTIs and 55 lower RTIs) who visited a local clinic or the outpatient or emergency departments of a medical center in Taiwan between October 2012 and June 2013 were tested for respiratory viruses by both virus isolation and PCR/ESI-MS. Throat swabs from 15 patients with bacterial infections and 27 individuals without active infections were included as control samples. Respiratory viruses were found in 23.6%, 47.2%, and 47.9% of the 267 cases by virus isolation, PCR/ESI-MS, and both methods, respectively. When both methods were used, the influenza A virus (24.3%) and rhinoviruses (9.4%) were the most frequently identified viruses, whereas human coronaviruses, human metapneumovirus (hMPV), enteroviruses, adenoviruses, respiratory syncytial virus, and parainfluenza viruses were identified in small proportions of cases (respiratory virus by PCR/ESI-MS. Patients who were undergoing steroid treatment, had an active malignancy, or suffered from chronic obstructive pulmonary disease (COPD) were at risk for rhinovirus, hMPV, or parainfluenza infections, respectively. Overall, immunocompromised patients, patients with COPD, and patients receiving dialysis were at risk for noninfluenza respiratory virus infection. Rhinoviruses (12.7%), influenza A virus (10.9%), and parainfluenza viruses (7.3%) were the most common viruses involved in the 55 cases of lower RTIs. The factors of parainfluenza infection, old age, and immunosuppression were independently associated

  11. Student-selected component in the medical curriculum: investigations and psychiatric referral for paracetamol overdose in an accident and emergency department

    Directory of Open Access Journals (Sweden)

    Cowman JG

    2017-08-01

    Full Text Available James G Cowman, Manuel Bakheet Royal College of Surgeons in Ireland – Medical University of Bahrain, Manama, Bahrain Background: A student-selected component (SSC of the medical curriculum requires the student to be self-directed in locating and undertaking a placement in a clinical specialty of their choosing and completing a project. The clinical area for experience was an accident and emergency department, and our topic was a focused audit on the investigations and referral for paracetamol overdose. The purpose of this paper is twofold: to reflect on the education value to medical students of an SSC in a medical curriculum, and to highlight learning and understanding through completion of an audit.Materials and methods: An audit approach was applied. The aim of the project study was to investigate the level of compliance with best-practice guidelines for investigations and psychiatric referral in paracetamol overdose.Results: A total of 40 cases meeting the inclusion criteria were randomly selected. The sample had a mean age of 27 years, of whom 70.5% were female, and the ingested dose of paracetamol ranged from 0.864 to 80 g. Paracetamol abuse may present as intentional and unintentional overdose. In our study, 85% of cases were identified as intentional overdose and 76% had a history of psychiatric illness. Generally, medical management was compliant with guidelines, with some minor irregularities. The international normalized ratio was the most underperformed test.Conclusion: Our choice of topic, paracetamol overdose, contributed to our understanding of the breadth of factors to be considered in the emergency medical management of a patient. In this regard, we had the benefit of understanding how the diagnostic and therapeutic factors, when applied in accordance with best-practice guidelines, work very effectively. The SSC impacted positively on our cognitive, personal, and professional development. In facilitating the student with

  12. Knowledge, Self-Confidence and Attitudes towards Suicidal Patients at Emergency and Psychiatric Departments: A Randomised Controlled Trial of the Effects of an Educational Poster Campaign.

    Science.gov (United States)

    van Landschoot, Renate; Portzky, Gwendolyn; van Heeringen, Kees

    2017-03-14

    Educational posters are used to enhance knowledge, attitudes and self-confidence of patients. Little is known on their effectiveness for educating health care professionals. As these professionals may play an important role in suicide prevention, the effects of a poster and accompanying evaluation and triage guide on knowledge, self-confidence and attitudes regarding suicidal thoughts and behaviours, were studied in a multicentre cluster randomised controlled trial, involving staff from 39 emergency and 38 psychiatric departments throughout Flanders ( n = 1171). Structured self-report questionnaires assessed the knowledge, confidence and beliefs regarding suicidal behaviour management, and attitudes. Data were analysed through a Solomon four-group design, with random assignment to the different conditions. Baseline scores for knowledge and provider confidence were high. The poster and accompanying evaluation and triage guide did not have an effect on knowledge about suicide and self-confidence in suicidal behaviour management. However, the poster campaign appeared to be beneficial for attitudes towards suicidal patients, but only among staff from mental health departments that were assigned to the un-pretested condition. Given the limited effects of the poster campaign in the studied population with a relatively high baseline knowledge, the evaluation of this poster as part of a multimodal educational programme in a more heterogeneous sample of health care professionals is recommended.

  13. Differential diagnosis between dementia and psychiatric disorders: Diagnostic criteria and supplementary exams. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology.

    Science.gov (United States)

    Bottino, Cássio M C; de Pádua, Analuiza Camozzato; Smid, Jerusa; Areza-Fegyveres, Renata; Novaretti, Tânia; Bahia, Valeria S

    2011-01-01

    In 2005, the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology published recommendations for the diagnosis of Alzheimer's disease These recommendations were updated following a review of evidence retrieved from national and international studies held on PUBMED, SCIELO and LILACS medical databases. The main aims of this review article are as follows: 1) to present the evidence found on Brazilian (LILACS, SCIELO) and International (MEDLINE) databases from articles published up to May 2011, on the differential diagnosis of these psychiatric disorders and dementia, with special focus on Dementia due to Alzheimer's and vascular dementia, including a review of supplementary exams which may facilitate the diagnostic process; and2) to propose recommendations for use by clinicians and researchers involved in diagnosing patients with dementia. Differential diagnosis between dementia and other neuropsychiatric disorders should always include assessments for depression, delirium, and use of psychoactive substances, as well as investigate the use of benzodiazepines, anti-epileptics and pattern of alcohol consumption.

  14. Differential diagnosis between dementia and psychiatric disorders: Diagnostic criteria and supplementary exams Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

    Directory of Open Access Journals (Sweden)

    Cássio M.C. Bottino

    Full Text Available Abstract In 2005, the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology published recommendations for the diagnosis of Alzheimer's disease These recommendations were updated following a review of evidence retrieved from national and international studies held on PUBMED, SCIELO and LILACS medical databases. The main aims of this review article are as follows: 1 to present the evidence found on Brazilian (LILACS, SCIELO and International (MEDLINE databases from articles published up to May 2011, on the differential diagnosis of these psychiatric disorders and dementia, with special focus on Dementia due to Alzheimer's and vascular dementia, including a review of supplementary exams which may facilitate the diagnostic process; and 2 to propose recommendations for use by clinicians and researchers involved in diagnosing patients with dementia. Differential diagnosis between dementia and other neuropsychiatric disorders should always include assessments for depression, delirium, and use of psychoactive substances, as well as investigate the use of benzodiazepines, anti-epileptics and pattern of alcohol consumption.

  15. Patterns of care in patients with cervical cancer 2012. Results of a survey among German radiotherapy departments and out-patient health care centers

    Energy Technology Data Exchange (ETDEWEB)

    Marnitz, S.; Rauer, A.; Budach, V. [Charite Universitaetsmedizin, Department of Radiooncology, Berlin (Germany); Koehler, C.; Schneider, A.; Mangler, M. [Charite Universitaetsmedizin, Department of Gynecology, Berlin (Germany); Tsunoda, A. [Barretos Cancer Centre, Department of Gynecologic Oncology, Barretos (Brazil)

    2014-01-15

    Platinum-based primary or adjuvant chemoradiation is the treatment of choice for patients with cervical cancer. However, despite national guidelines and international recommendations, many aspects in diagnosis, therapy, and follow-up of patients with cervical cancer are not based on valid data. To evaluate the current patterns of care for patients with cervical cancer in Germany, a questionnaire with 25 items was sent to 281 radiooncologic departments and out-patient health care centers. The response rate was 51 %. While 87 % of institutions treat 0-25 patients/year, 12 % treat between 26 and 50 and only 1 % treat more than 50 patients/year. In 2011, the stage distribution of 1,706 treated cervical cancers were IB1, IB2, IIA, IIB, IIIA/IIIB, and IV in 11, 12, 11, 22, 28, and 16 %, respectively. CT (90 %) and MRI (86 %) are mainly used as staging procedures in contrast to PET-CT with 14 %. Interestingly, 27 % of institutions advocate surgical staging prior to chemoradiation. In the majority of departments 3D-based (70 %) and intensity-modulated radiotherapy (76 %) are used for percutaneous radiation, less frequently volumetric arc techniques (26 %). Nearly all colleagues (99.3 %) apply conventional fractioning of 1.8-2 Gy for external-beam radiotherapy, in 19 % combined with a simultaneous integrated boost. Cisplatinum mono is used as a radiosensitizer with 40 mg/m{sup 2} weekly by 90 % of radiooncologists. For boost application in the primary treatment, HDR (high-dose rate) brachytherapy is the dominant technique (84 %). In patients after radical hysterectomy pT1B1/1B2, node negative and resection in sound margins adjuvant chemoradiation is applied due to the occurrence of 1-4 other risk factors in 16-97 %. There is a broad spectrum of recommended primary treatment strategies in stages IIB and IVA. Results of the survey underline the leading role but also differences in the use of chemoradiation in the treatment of cervical cancer patients in Germany. (orig

  16. [Forensic psychiatric patients in Denmark].

    Science.gov (United States)

    Larsen, Tina Gram; Valbak, Lone; Perto, Gurli; Reinert, Kjeld

    2006-06-05

    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.

  17. Perceived sleep quality of psychiatric patients

    NARCIS (Netherlands)

    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

  18. The functioning and behaviour of biological parents of children diagnosed with attention-deficit/hyperactivity disorder, attending the outpatient department at Weskoppies Hospital, Pretoria

    Directory of Open Access Journals (Sweden)

    Ravindra Sundarlall

    2016-05-01

    Full Text Available Background: ADHD (attention-deficit/hyperactivity disorder is gradually being acknowledged as a functionally impairing disorder across the lifespan, underscored by heritability. Nonetheless, lack of ADHD (adult attention-deficit/hyperactivity disorder data from South Africa is alarming which could be due to either the unawareness of ADHD symptoms or underutilization of available screening measures. Undiagnosed ADHD may influence family- and working lives unpleasantly. Parenting a child with ADHD may intensify parental stress through functional impairment notwithstanding the diagnosis of ADHD. Methods: Eighty-one biological parents of children diagnosed with attention-deficit/ hyperactivity disorder were screened using self-reporting measurements. ADHD self-report scale (ASRS-V 1.1 identified either positive or negative subgroups; the Weiss functional impairment rating scale (WFIR-S for functional impairment and the Jerome driving questionnaire (JDQ for risk-taking behaviour specifically driving. Results: Of the 39 (48% parents who experienced impairment in all seven areas of functioning, 23 (59% screened negative for ADHD, while 16 (41% screened positive. A significant association was found between parents who screened either positive or negative for ADHD and functional impairment across five of the seven individual categories namely family, work, self-concept, life-skills and social functioning. Conclusion: This study emphasized the high incidence of functional impairment in parents of ADHD children. Although a substantial number of parents screened negative for ADHD, they still reported impairment in functioning; probably due to undiagnosed ADHD with comorbid psychiatric disorders, and/or parental stress due to the complex behaviour of the child. Parents of children diagnosed with ADHD should be screened for functional impairment followed by referral for psychiatric assessment and parent management training to achieve better clinical outcomes.

  19. Psychiatric emergencies of minors with and without migration background.

    Science.gov (United States)

    Akkaya-Kalayci, Türkan; Popow, Christian; Waldhör, Thomas; Winkler, Dietmar; Özlü-Erkilic, Zeliha

    2017-03-01

    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.

  20. Language, subjectivity and participation in psychiatric institutions in Denmark

    DEFF Research Database (Denmark)

    Ringer, Agnes

    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...

  1. Psychiatric morbidity in elderly patients attending OPD of tertiary care centre in western region of Nepal

    Directory of Open Access Journals (Sweden)

    Prakash Thapa

    2014-01-01

    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.

  2. EMTALA and patients with psychiatric emergencies: a review of relevant case law.

    Science.gov (United States)

    Lindor, Rachel A; Campbell, Ronna L; Pines, Jesse M; Melin, Gabrielle J; Schipper, Agnes M; Goyal, Deepi G; Sadosty, Annie T

    2014-11-01

    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.

  3. Failure of a patient-centered intervention to substantially increase the identification and referral for-treatment of ambulatory emergency department patients with occult psychiatric conditions: a randomized trial [ISRCTN61514736

    Directory of Open Access Journals (Sweden)

    Nezami Wais A

    2005-05-01

    Full Text Available Abstract Background We previously demonstrated that a computerized psychiatric screening interview (the PRIME-MD can be used in the Emergency Department (ED waiting room to identify patients with mental illness. In that trial, however, informing the ED physician of the PRIME-MD results did not increase the frequency of psychiatric diagnosis, consultation or referral. We conducted this study to determine whether telling the patient and physician the PRIME-MD result would result in the majority of PRIME-MD-diagnosed patients being directed toward treatment for their mental illness. Methods In this single-site RCT, consenting patients with non-specific somatic chief complaints (e.g., fatigue, back pain, etc. completed the computerized PRIME-MD in the waiting room and were randomly assigned to one of three groups: patient and physician told PRIME-MD results, patient told PRIME-MD results, and neither told PRIME-MD results. The main outcome measure was the percentage of patients with a PRIME-MD diagnosis who received a psychiatric consultation or referral from the ED. Results 183 (5% of all ED patients were approached. 123 eligible patients consented to participate, completed the PRIME-MD and were randomized. 95 patients had outcomes recorded. 51 (54% had a PRIME-MD diagnosis and 8 (16% of them were given a psychiatric consultation or referral in the ED. While the frequency of consultation or referral increased as the intervention's intensity increased (tell neither = 11% (1/9, tell patient 15% (3/20, tell patient and physician 18% (4/22, no group came close to the 50% threshold we sought. For this reason, we stopped the trial after an interim analysis. Conclusion Patients willingly completed the PRIME-MD and 54% had a PRIME-MD diagnosis. Unfortunately, at our institution, informing the patient (and physician of the PRIME-MD results infrequently led to the patient being directed toward care for their psychiatric condition.

  4. Arrival time pattern and waiting time distribution of patients in the emergency outpatient department of a tertiary level health care institution of North India

    Directory of Open Access Journals (Sweden)

    Yogesh Tiwari

    2014-01-01

    Full Text Available Background: Emergency Department (ED of tertiary health care institute in India is mostly overcrowded, over utilized and inappropriately staffed. The challenges of overcrowded EDs and ill-managed patient flow and admission processes result in excessively long waits for patients. Aim: The objective of the present study was to analyze the patient flow system by assessing the arrival and waiting time distribution of patients in an Emergency out Patient Department (EOPD. Materials and Methods: This short cross-sectional descriptive study was conducted in the EOPD of a Tertiary level health care Institution in North India in the month of May, 2011. The data was obtained from 591 patients, who were present in the EOPD during the month of May, 2011. The waiting time, inter arrival time between two consecutive patients were calculated in addition to the daily census data (discharge rate, admission rate and transfer out rates etc. of the emergency. Results: Arrival time pattern of patients in the EOPD was highly stochastic with the peak arrival hours to be "9.00-12.00 h" in which around 26.3% patients arrived in the EOPD. The primary waiting areas of patients included patients "under observation" (29.6%; "waiting for routine diagnostic tests" (16.4% and "waiting for discharge" (14.6%. Around 71% patients were waiting due to reasons within emergency complex. Conclusion: The patient flow of the ED could only be addressed by multifaceted, multidisciplinary and hospital wide approach.

  5. [Psychiatric and Psychotherapeutic Care of Refugees by Reference of a Large Psychiatric Care Hospital in Western Germany].

    Science.gov (United States)

    Schaffrath, Jonas; Schmitz-Buhl, Mario; Gün, Ali Kemal; Gouzoulis-Mayfrank, Euphrosyne

    2017-04-01

    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.

  6. [Headache and immigration. A study in the outpatient department of the Hospital de la Santa Creu i Sant Pau in Barcelona].

    Science.gov (United States)

    Vidal-Jordana, A; Barroeta-Espar, I; Sainz-Pelayo, M P; Sala, I; Roig, C

    2011-09-01

    The immigrant population (IP) is visiting neurology departments on an increasingly more frequent basis. Research has still not made it clear whether there are geographical differences in the prevalence of primary headaches and the possible influence of emigration. We conducted a retrospective (12 months) and prospective study (18 months) of the first visits to the Headache Unit at the Hospital de la Santa Creu i Sant Pau. Data collected included the country of birth, time parameters of the headache and of the immigration, diagnoses according to the criteria of the IHS and treatments that had been used. Related headaches were considered to be those that began within one year of having immigrated. The IP represents 13.6% (n = 142) of the total number of first visits because of headaches (n = 1044). Immigrants came mostly from Latin America (83.9%). Headaches began after immigration in 40.1% of cases without the existence of any temporal relation with immigration. The distribution of the diagnoses of headache is similar to those of the local population, the most frequent being migraine (57.7%) and tension-type headache (15.5%). On comparing treatments prior to and following immigration, we find differences in the use of triptans (2.1% versus 46.2%), ergotamine (9.8% versus 2.1%) and in the use of preventive treatments (2% versus 45%). The IP accounts for 13% of all first visits due to headaches and their diagnoses are similar to those of the local population. Emigration is neither a precipitating nor an aggravating factor for headaches in our series. There is a significant difference in symptomatic and preventive treatment between the period prior to immigration and afterwards.

  7. [Perception of the Emergency Department for Outpatient Care in a Rural Region in Saxony-Anhalt: A Qualitative Survey of Patients and General Practitioners].

    Science.gov (United States)

    Schmiedhofer, Martina; Searle, Julia; Slagman, Anna; Frick, Johann; Ruhla, Stephan; Möckel, Martin

    2017-05-01

    Background  The increasing number of low-acuity visits to Emergency Departments (ED) is an important issue in Germany and contributes to ED crowding. A sustainable solution needs deeper knowledge of patients' underlying rationales. Methods  To explore patients' motives we conducted 31 semi-structured face-to-face interviews with low-acuity ED patients in a rural region in Saxony-Anhalt. Subsequently we interviewed 12 General Practitioners (GP)s about their perspectives on patients visiting ED with low-acuity conditions and referring patients to ED. A qualitative content analysis approach was used for data analysis. Results  All patients were connected to a GP. One third had visited ED because of 24/7 availability when consultation hours and working times overlapped. Another third had addressed EDs full range of laboratory and imaging technology with a subjective need for fast diagnosis. One group reported that they had been referred to the ED by their GP. The interviewed GPs classified patients' ED usage for time-constraints as impatience and growing demand, while they expressed greater understanding for patients striving to ED for anxiety reasons. Most GPs sometimes referred patients to ED for diagnostic reasons. Conclusion  The findings demonstrate that ED usage with non-urgent conditions takes place for different reasons. Therefore, ED plays a pivotal role not only in emergency care, but also in ambulant care. The growing demand for ambulant care indicates a need for changed health care structures. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Psychiatric emergency services in Copenhagen 2012

    DEFF Research Database (Denmark)

    Moltke, Katinka; Høegh, Erica B; Sæbye, Ditte

    2015-01-01

    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...

  9. Predictors of premature discontinuation of outpatient treatment after discharge of patients with posttraumatic stress disorder

    Directory of Open Access Journals (Sweden)

    Wang HR

    2015-03-01

    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

  10. Hospital Outpatient PPS Partial Hospitalization Program LDS

    Data.gov (United States)

    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...

  11. Psychiatric characteristics of homicide defendants.

    Science.gov (United States)

    Martone, Christine A; Mulvey, Edward P; Yang, Suzanne; Nemoianu, Andrei; Shugarman, Ryan; Soliman, Layla

    2013-09-01

    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.

  12. 38 CFR 17.165 - Emergency outpatient dental treatment.

    Science.gov (United States)

    2010-07-01

    ... for outpatient dental care, the treatment will be restricted to the alleviation of pain or extreme... dental treatment. 17.165 Section 17.165 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Dental Services § 17.165 Emergency outpatient dental treatment. When outpatient emergency...

  13. Medical education in the outpatient department.

    Science.gov (United States)

    Griffiths, D A

    1982-01-01

    Many disease processes are described by doctors in terms which make no sense to the layman. Here, I describe the methods I use to educate patients about the nature, management, treatment and outcome of their disease processes using teaching methods that were first applied in the undergraduate medical school. In my approach I have been influenced by the old Chinese proverb "the palest ink is stronger than the most powerful memory".

  14. Gender and Psychiatric Morbidity at First Contact in General Practice ...

    African Journals Online (AJOL)

    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 ...

  15. Sintomas psiquiátricos entre pacientes com demência atendidos em um serviço ambulatorial Psychiatric symptoms amongst outpatients with dementia in São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    OSVALDO P. ALMEIDA

    1999-12-01

    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

  16. Prostitution use has non sexual functions - case report of a depressed psychiatric out-patient [v2; ref status: indexed, http://f1000r.es/16c

    Directory of Open Access Journals (Sweden)

    Fátima Gysin

    2013-05-01

    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.

  17. Psychiatric Genomics

    DEFF Research Database (Denmark)

    Sullivan, Patrick F; Agrawal, Arpana; Bulik, Cynthia M

    2018-01-01

    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...

  18. Community emergency psychiatric service in Israel: a one-year experience.

    Science.gov (United States)

    Khawaled, Razek; Bauer, Arie; Rosca, Paola; Helman, Dafna; Shai, Uzi; Grinshpoon, Alexander; Ponizovsky, Alexander M

    2009-01-01

    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

  19. [Association between ambient PM(l0)/PM(2.5) concentration and outpatient department visits due to respiratory disease in a hospital in Jinan, 2013-2015: a time series analysis].

    Science.gov (United States)

    Zhao, M J; Geng, X Y; Cui, L L; Zhou, J W; Zhang, J

    2017-03-10

    Objective: To estimate the influence of the ambient PM(l0) and PM(2.5) pollution on the hospital outpatient department visit due to respiratory diseases in local residents in Jinan quantitatively. Methods: Time serial analysis using generalized addictive model (GAM) was conducted. After controlling the confounding factors, such as long term trend, weekly pattern and meteorological factors, considering lag effect and the influence of other air pollutants, the excess relative risks of daily hospital visits associated with increased ambient PM(10) and PM(2.5) levels were estimated by fitting a Poisson regression model. Results: A 10 μg/m(3) increase of PM(10) and PM(2.5) levels was associated with an increase of 0.36%(95%CI: 0.30%-0.43%) and 0.50%(95%CI: 0.30%-0.70%) respectively for hospital visits due to respiratory diseases. Lag effect of 6 days was strongest, the excess relative risks were 0.65% (95% CI: 0.58% -0.71% ) and 0.54% (95% CI: 0.42%-0.67%) respectively. When NO(2) concentration was introduced, the daily hospital visits due to respiratory disease increased by 0.83% as a 10 μg/m(3) increase of PM(10) concentration (95% CI: 0.76%-0.91%). Conclusion: The ambient PM(l0) and PM(2.5) pollution was positively associated with daily hospital visits due to respiratory disease in Jinan, and ambient NO(2) concentration would have the synergistic effect.

  20. Recent life events and subjective well-being of personality disordered forensic outpatients

    NARCIS (Netherlands)

    Bouman, Yvonne H. A.; de Ruiter, Corine; Schene, Aart H.

    2009-01-01

    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

  1. Outpatient pulmonary rehabilitation - rehabilitation models and shortcomings in outpatient aftercare.

    Science.gov (United States)

    Korczak, Dieter; Huber, Beate; Steinhauser, Gerlinde; Dietl, Markus

    2010-07-29

    -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.

  2. CLINICAL STATISTICAL STUDIES ON HEMATURIA IN OUTPATIENTS

    OpenAIRE

    青木, 正治; 熊本, 悦明

    1982-01-01

    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...

  3. Manejo do paciente com transtornos relacionados ao uso de substância psicoativa na emergência psiquiátrica Management of patients with substance use illnesses in psychiatric emergency department

    Directory of Open Access Journals (Sweden)

    Ricardo Abrantes do Amaral

    2010-10-01

    Full Text Available OBJETIVO: Transtornos por uso de substâncias são prevalentes em setores de emergência gerais e psiquiátricos, atingindo taxas de 28% das ocorrências em prontos-socorros gerais. Todavia, profissionais dos setores de emergência identificam menos que 50% dos casos de problemas relacionados ao álcool. Este artigo visa fornecer base fundamentada em evidências para o tratamento específico a pacientes que preencham os critérios diagnósticos de transtornos por uso de substâncias e que se apresentam ao pronto-socorro em quadros de intoxicação ou abstinência. MÉTODO: Uma revisão sobre o tema foi realizada na base de dados Medline, usando-se os descritores "intoxicação aguda", "abstinência", "álcool", "cocaína", "cannabis", "opioides", "inalantes" e "manejo", tendo o inglês como idioma. RESULTADOS E CONCLUSÃO: O cuidado de pessoas com transtornos por uso de substâncias deve conter: avaliação completa (médica geral e psiquiátrica, tratamento dos quadros diagnosticados (abstinência, intoxicação e quadros clínicos que caracterizem uma emergência, sensibilização do paciente para realizar tratamento, se for necessário, e elaboração de encaminhamento.OBJECTIVE: Substance use disorders are prevalent in emergency departments in medical and psychiatric services, reaching rates of 28% of cases in medical emergency departments. However, professionals in the emergency department identify less than 50% of cases of alcohol-related problems. This article aims to provide evidence-based interventions for the specific treatment to patients who meet diagnostic criteria for substance use disorders and who present to emergency rooms during intoxication or abstinence. METHOD: A literature review was performed on Medline database, using the descriptors "acute intoxication", "withdrawal", "alcohol", "cocaine", "cannabis", "opioid", "inhalant", "management", using English as the language. RESULTS: AND CONCLUSION: The care of persons with

  4. The application of the interpersonal-psychological theory of suicide to a sample of Swiss patients attending a psychiatric emergency department for a non-lethal suicidal event.

    Science.gov (United States)

    Baertschi, Marc; Costanza, Alessandra; Richard-Lepouriel, Hélène; Pompili, Maurizio; Sarasin, François; Weber, Kerstin; Canuto, Alessandra

    2017-03-01

    Visits to emergency departments (EDs) for suicidal ideation or a suicide attempt have increased in the past decades. Yet comprehensive models of suicide are scarce, potentially enhancing misunderstandings from health professionals. This study aimed to investigate the applicability of the interpersonal-psychological theory of suicide (IPTS) in a population visiting EDs for suicide-related issues. Three major hypotheses formulated by the IPTS were tested in a sample of 167 individuals visiting EDs for suicidal ideation or a suicide attempt. As predicted by the IPTS, greater levels of perceived burdensomeness (PB) were associated with presence of current suicidal ideation. However, contrary to the theory assumptions, thwarted belongingness (TB) was not predictive of current suicidal ideation (Hypothesis 1). Similarly, the interaction between PB, TB and hopelessness did not account for the transition from passive to active suicidal ideation (Hypothesis 2). The interaction between active suicidal ideation and fearlessness of death did not either predict the transition from active suicidal ideation to suicidal intent (Hypothesis 3). The cross-sectional design limited the interpretation of causal hypotheses. Patients visiting EDs during nights and weekends were underrepresented. A general measure of hopelessness was considered, not a measure of hopelessness specifically related to PB and TB. Although the three hypotheses were only partially verified, health professionals might consider the IPTS as useful for the management of patient with suicide-related issues. Clinical intervention based on perceived burdensomeness could notably be proposed shortly after ED admission. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. [Social psychiatric service as a cornerstone of psychiatric community care].

    Science.gov (United States)

    Hoffmann, P; Tiggemann, H G

    1991-12-01

    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.

  6. Risk of suicide according to level of psychiatric treatment

    DEFF Research Database (Denmark)

    Hjorthøj, Carsten Rygaard; Madsen, Trine; Agerbo, Esben

    2014-01-01

    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...

  7. Interventions for alcohol and drug problems in outpatient settings: a systematic review.

    Science.gov (United States)

    Watson, Judith M; Fayter, Debra; Mdege, Noreen; Stirk, Lisa; Sowden, Amanda J; Godfrey, Christine

    2013-07-01

    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.

  8. Morbilidad en la consulta de endocrinología del Centro de Investigaciones Medicoquirúrgicas de Angola Morbidity at the Endocrinology outpatient department of the Center for Medicosurgical Research in Angola

    Directory of Open Access Journals (Sweden)

    Rubén S. Padrón Durán

    2006-04-01

    trastornos endocrinometabólicos comunes en otras poblaciones fueron motivo de consulta poco frecuentes o inexistentes, e los resultados indican que en este medio no se conoce bien todo el perfil de atención de la endocrinología.The data on morbidity at the outpatient department may be useful to know the causes for which the patients visit the health center, as well as to plan and provide special consultations and complementary tests. The objective of this study is to present and analyze morbidity at the Endocrinology outpatient department of the Center for Medicosurgical Research in Angola. All the diagnoses of every case were collected for 28 months in a row. The specific diagnoses were classified into 7 big groups. 1 glycemia alterations, 2 obesity and other metabolic disorders, 3 reproductive medicine, 4 thryoid disorders, 5 pediatric endocrinology, 6 other endocrinopathies and 7 no endocrinopathies. 2 294 patients received medical attention. The most frequent diagnostic groups were type 2 diabetes mellitus (DM2 and exogenous obesity (53.01 and 24.72, respectively, followed by hyperlipoproteinemias (11.73. In a range between 4.5 and 10 %, we observed euthyroid diffuse goiter, altered fasting glycemia, female infertility and hyperuricemia. The rest was found in less than 3 % of the total of cases. The most important results and conclusions were the following: a the most common diagnostic groups were glycemia alterations, obesity and other metabolic disorders, among them DM2 and exogenous obesity, b the diagnoses of reproductive medicine and thyroid disorders were relatively frequent, c the endocrine disorders at pediatric ages and other endocrinopathies were rare, d the common endocrinometabolic disorders in other populations were unfrequent or non-existent reasons to seek medical attention, e the results showed that the whole endocrinology care profile is not well known in this setting.

  9. [Involuntary outpatient treatment].

    Science.gov (United States)

    Oyffe, Igor; Melamed, Yuval

    2012-03-01

    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

  10. Identifying Outpatients with Entrenched Suicidal Ideation Following Hospitalization

    Science.gov (United States)

    O'Connor, Stephen S.; Jobes, David A.; Comtois, Katherine Anne; Atkins, David C.; Janis, Karin; Chessen, Chloe E.; Landes, Sara J.

    2012-01-01

    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…

  11. Assessing Old Order Amish outpatients with the MCMI-III.

    Science.gov (United States)

    Knabb, Joshua J; Vogt, Ronald G

    2011-05-01

    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.

  12. Shared decision making in psychiatric practice and the primary care setting is unique, as measured using a 9-item Shared Decision Making Questionnaire (SDM-Q-9

    Directory of Open Access Journals (Sweden)

    De las Cuevas C

    2013-07-01

    Full Text Available Carlos De las Cuevas,1,2 Wenceslao Peñate,3 Lilisbeth Perestelo-Pérez,2,4 Pedro Serrano-Aguilar2,41Department of Psychiatry, University of La Laguna, Tenerife, Spain; 2Health Services Research Network for Chronic Diseases (REDISSEC, Tenerife, Spain; 3Department of Personality, Assessment and Psychological Treatments, University of La Laguna, Tenerife, Spain; 4Evaluation Unit, Canary Island Health Service, Santa Cruz de Tenerife, SpainBackground: To measure and compare the extent to which shared a decision making (SDM process is implemented both in psychiatric outpatient clinical encounters and in the primary care setting from the patient’s perspective.Methods: A total of 1,477 patients recruited from the Canary Islands Health Service mental health and primary care departments were invited to complete the nine-item Shared Decision Making Questionnaire (SDM-Q-9 immediately after their consultation. MANCOVA, Student’s t-test, and Pearson correlations were used to assess the relationship and differences between SDM-Q-9 scores in patient samples.Results: No differences were found in SDM-Q-9 total scores between the two patient samples, but there were relevant differences when item by item analysis was applied; differences were observed according to the different steps of the SDM process. SDM is present to a very limited extent in the routine psychiatric setting compared to primary care. Patients’ age, education, type of appointment, and treatment decision all play a specific role in predicting SDM.Conclusion: The study provides evidence that SDM is a complex process that needs to be analyzed according to its different steps. SDM patterns were different in the primary care and psychiatric outpatient care settings and reflect quite a different perspective of the decision making process.Keywords: primary care patients, psychiatric outpatients, SDM-Q-9, shared decision making

  13. Estimating the costs of psychiatric hospital services at a public health facility in Nigeria.

    Science.gov (United States)

    Ezenduka, Charles; Ichoku, Hyacinth; Ochonma, Ogbonnia

    2012-09-01

    Information on the cost of mental health services in Africa is very limited even though mental health disorders represent a significant public health concern, in terms of health and economic impact. Cost analysis is important for planning and for efficiency in the provision of hospital services. The study estimated the total and unit costs of psychiatric hospital services to guide policy and psychiatric hospital management efficiency in Nigeria. The study was exploratory and analytical, examining 2008 data. A standard costing methodology based on ingredient approach was adopted combining top-down method with step-down approach to allocate resources (overhead and indirect costs) to the final cost centers. Total and unit cost items related to the treatment of psychiatric patients (including the costs of personnel, overhead and annualised costs of capital items) were identified and measured on the basis of outpatients' visits, inpatients' days and inpatients' admissions. The exercise reflected the input-output process of hospital services where inputs were measured in terms of resource utilisation and output measured by activities carried out at both the outpatient and inpatient departments. In the estimation process total costs were calculated at every cost center/department and divided by a measure of corresponding patient output to produce the average cost per output. This followed a stepwise process of first allocating the direct costs of overhead to the intermediate and final cost centers and from intermediate cost centers to final cost centers for the calculation of total and unit costs. Costs were calculated from the perspective of the healthcare facility, and converted to the US Dollars at the 2008 exchange rate. Personnel constituted the greatest resource input in all departments, averaging 80% of total hospital cost, reflecting the mix of capital and recurrent inputs. Cost per inpatient day, at $56 was equivalent to 1.4 times the cost per outpatient visit at

  14. Psychiatric service users' experiences of emergency departments

    DEFF Research Database (Denmark)

    Carstensen, Kathrine; Lou, Stina; Jensen, Lotte Groth

    2017-01-01

    regarding service users’ experiences attending EDs. A secondary aim is to apply and test the newly developed CERQual approach to summarizing qualitative review findings. Methods: A systematic literature review of five databases based on PRISMA guidelines yielded 3334 unique entries. Screening by title...

  15. SOCIODEMOGRAPHIC FEATURES OF CHILD AND ADOLESCENTS ADMITTED TO KARADENIZ TECHNICAL UNIVERSITY MEDICAL FACULTY CHILD OUTPATIENT CLINIC WITH SUICIDE ATTEMPT

    Directory of Open Access Journals (Sweden)

    Evrim AKTEPE

    2006-12-01

    Full Text Available Assesment of sociodemographic and psychiatric characteristics of attempted suicide in children and adolescents. The aim of this study is to identify risk factors and sociodemographic, psychiatric characteristics of adolescents and children who attempted suicide. Suicide attempters (range 7-15 years, fifty-eight cases who referred to Karadeniz Technical University, School of Medicine, Department of Child and Adolescent Psychiatry outpatient clinic between January 2003 and January 2005 were analyzed retrospectively, in terms of sex, age, living residence, number of suicide attempts, educational achievement and level, psychiatric examinations, method of suicide, precipitating events, psychiatric evaluations of parents, socioeconomic status in our study. The majority of subjects were girls (89.7%. The commonest age group involved was 15-16 years (46.6%. Girls, aged 15-16 years, from middle-low socioeconomic status with low achievement at school, living in urban area were found to be risky group for suicide attempt. From the view of low tolerance to problems, insufficient coping abilites in youth; acquirement of problem solving capacity and aiding in familiar problems solutions may be efficient in prevention and treatment of suicide. [TAF Prev Med Bull 2006; 5(6.000: 444-454

  16. [Psychopathology in families: an integral approach via the family outpatient clinic].

    Science.gov (United States)

    van Veen, S C; Batelaan, N M; Wesseldijk, L W; Rozeboom, J; Middeldorp, C M

    2016-01-01

    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

  17. Outpatient Total Joint Arthroplasty.

    Science.gov (United States)

    Bert, Jack M; Hooper, Jessica; Moen, Sam

    2017-12-01

    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.

  18. 42 CFR 410.60 - Outpatient physical therapy services: Conditions.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Outpatient physical therapy services: Conditions. 410.60 Section 410.60 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services § 410.60 Outpatient physical...

  19. Utilisation of outpatient services at Red Cross War Memorial ...

    African Journals Online (AJOL)

    1990-10-06

    Oct 6, 1990 ... P. M. STREBEL, P. I. LACHMAN, M. L. PAINTER, I. A. STANDER, J. IRELAND. Summary. The demand for outpatient services continues to grow at Red. Cross War Memorial Children's Hospital (RCCH). To determine current utilisation patterns, we conducted a 2-week survey in the outpatient department ...

  20. Outpatient waiting time in Jos University Teaching Hospital ...

    African Journals Online (AJOL)

    Problem Long waiting time for services has been identified as a reason people avoid presenting to for care in African countries. Design Examination of causes for long outpatient waiting time and the effect of measures to reduce waiting time. Setting Outpatient department of the Jos University Teaching Hospital.

  1. Prevalence and determinants for malnutrition in geriatric outpatients

    NARCIS (Netherlands)

    van Bokhorst-de van der Schueren, M.A.E.; Lonterman-Monasch, S.; de Vries, O.J.; Danner, S.A.; Kramer, M.H.H.; Muller, M.

    2013-01-01

    Background & aims: Few data is available on the nutritional status of geriatric outpatients. The aim of this study is to describe the nutritional status and its clinical correlates of independently living geriatric older individuals visiting a geriatric outpatient department. Methods: From 2005 to

  2. Dream Recall Frequency Among Patients in a Psychiatric Outpatient ...

    African Journals Online (AJOL)

    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 ...

  3. Clinical features and psychiatric comorbidity of epicrania fugax

    Directory of Open Access Journals (Sweden)

    K Rammohan

    2018-01-01

    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

  4. Price elasticity of demand for psychiatric consultation in a Nigerian psychiatric service.

    Science.gov (United States)

    Esan, Oluyomi

    2016-12-01

    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.

  5. VA Outpatient Visits by Administrative Parent, FY2010-2014

    Data.gov (United States)

    Department of Veterans Affairs — Outpatient visits by Administrative Parent. A visit is counted as a visit to one or more clinics or units within 1 calendar day at the site of care level. A patient...

  6. Outpatient diagnostic of bladder tumours in flexible cystoscopes

    DEFF Research Database (Denmark)

    Hermann, Gregers G; Mogensen, Karin; Toft, Birgitte Grønkær

    2012-01-01

    The aim of this study was to evaluate photodynamic diagnosis (PDD) in flexible cystoscopes and the diagnostic quality of biopsies for diagnosis of non-muscle-invasive bladder cancer in the outpatients department (OPD).......The aim of this study was to evaluate photodynamic diagnosis (PDD) in flexible cystoscopes and the diagnostic quality of biopsies for diagnosis of non-muscle-invasive bladder cancer in the outpatients department (OPD)....

  7. Price elasticity of demand for psychiatric consultation in a Nigerian ...

    African Journals Online (AJOL)

    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 ...

  8. Burden and Stress among Psychiatry Residents and Psychiatric Healthcare Providers

    Science.gov (United States)

    Zuardi, Antonio Waldo; Ishara, Sergio; Bandeira, Marina

    2011-01-01

    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…

  9. [The proportion of unaccompanied refugee minors suffering from psychiatric disorders in Germany].

    Science.gov (United States)

    Walg, Marco; Fink, Ewgeni; Großmeier, Mark; Temprano, Miguel; Hapfelmeier, Gerhard

    2017-01-01

    This article is the first investigation into the proportion of unaccompanied refugee minors suffering from psychiatric disorders in Germany. Method: In a retrospective study done between 2013 and 2015, any refugees showing symptoms of a psychiatric disorder during their stay in a residential refugee center were referred to an Outpatient Department of Child and Adolescent Psychiatry for diagnostic assessment. To this end, special consultation hours were arranged. Besides the diagnoses, the number of emergency consultations occurring before and after the implementation of the special consultation hours was recorded. Of the 75 refugee minors (75 %) referred, 56 were suffering from a psychiatric disorder, with posttraumatic stress disorder and depression being the most common diagnoses. Following implementation of the consultation hours, the number of refugee patients initially admitted in the Child and Adolescent Psychiatry on an emergency basis fell. Unaccompanied refugee minors are a highly vulnerable group that poses great challenges to clinical care. The implementation of special consultation hours is a constructive option for meeting these challenges. In particular, this special offer enables improvement of crisis management in the case of emergency consultations.

  10. Quality of life of patients with schizophrenia treated in foster home care and in outpatient treatment

    Directory of Open Access Journals (Sweden)

    Mihanović M

    2015-03-01

    Full Text Available Mate Mihanović,1,2 Branka Restek-Petrović,1,2 Anamarija Bogović,1 Ena Ivezić,1 Davor Bodor,1 Ivan Požgain3 1Psychiatric Hospital “Sveti Ivan”, Zagreb, 2Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 3Department of Psychiatry, University Hospital Center Osijek, Osijek, Croatia Background: The Sveti Ivan Psychiatric Hospital in Zagreb, Croatia, offers foster home care treatment that includes pharmacotherapy, group psychodynamic psychotherapy, family therapy, and work and occupational therapy. The aim of this study is to compare the health-related quality of life of patients with schizophrenia treated in foster home care with that of patients in standard outpatient treatment. Methods: The sample consisted of 44 patients with schizophrenia who, upon discharge from the hospital, were included in foster home care treatment and a comparative group of 50 patients who returned to their families and continued receiving outpatient treatment. All patients completed the Short Form 36 Health Survey Questionnaire on the day they completed hospital treatment, 6 months later, and 1 year after they participated in the study. The research also included data on the number of hospitalizations for both groups of patients. Results: Though directly upon discharge from the hospital, patients who entered foster home care treatment assessed their health-related quality of life as poorer than patients who returned to their families, their assessments significantly improved over time. After 6 months of treatment, these patients even achieved better results in several dimensions than did patients in the outpatient program, and they also had fewer hospitalizations. These effects remained the same at the follow-up 1 year after the inclusion in the study. Conclusion: Notwithstanding the limitations of this study, it can be concluded that treatment in foster home care is associated with an improvement in the quality of life of patients

  11. Outcome of Pediatric Gastroenterology Outpatients With Fever and Central Line.

    Science.gov (United States)

    Alexander, Thomas; Blatt, Julie; Skinner, Asheley Cockrell; Jhaveri, Ravi; Jobson, Meghan; Freeman, Katherine

    2016-11-01

    Although management algorithms for fever and central venous catheters (CVCs) have been implemented for pediatric oncology (PO) patients, management of pediatric outpatients with noncancer diagnoses and CVCs lacks clear protocols. The aim of the study was to assess outcomes for pediatric outpatients with gastrointestinal disorders presenting with fever and CVC. Using a microbiology database and emergency department records, we created a database of pediatric gastroenterology (PGI) and PO outpatients with fever and a CVC who presented to our emergency department or clinics from January 2010 through December 2012. We excluded patients who had severe neutropenia (absolute neutrophil count, gastroenterology outpatients with fever and a CVC have a high prevalence of bloodstream infection. Algorithms for management need to be subspecialty specific. Pediatric gastroenterology patients presenting to emergency departments or clinics with fever and CVC require admission for monitoring and management.

  12. Risk of Criminal Victimisation in Outpatients with Common Mental Health Disorders.

    Directory of Open Access Journals (Sweden)

    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.

  13. [Psychiatric comorbidities and quality of life in adult individuals with high potential: Relationships with self-esteem].

    Science.gov (United States)

    Lancon, Christophe; Martinelli, Marion; Michel, Pierre; Debals, Matthias; Auquier, Pascal; Guedj, Eric; Boyer, Laurent

    2015-05-01

    The objectives of this study were: 1) to describe the psychiatric comorbidities in adult individuals with high potential; 2) to assess self-esteem and quality of life in comparison with general population; 3) to study the relationships between intelligent quotient (IQ), self-esteem, psychiatric comorbidities and quality of life. This cross-sectional study was conducted in the psychiatric department of a public university hospital (Marseille, France). An outpatient hospital service has been specifically opened to test intelligence since 2012. During a period of six months, it was proposed to all the major individuals with high intellectual potential to receive a psychiatric evaluation using the Mini International Neuropsychiatric Interview (MINI) and to complete self-report questionnaires assessing depression (Beck scale), anxiety (STAI), self-esteem (Rosenberg scale) and quality of life (SF-36). Relationships between IQ, self-esteem, psychiatric comorbidities and quality of life were analyzed using a Bayesian path analysis. Twenty-eight subjects were included, 8 had an IQ between 115 and 130, and 20 had an IQ>130. Fifty-seven percent of individuals had generalized anxiety, 21.4% a current major depressive episode, and 75% a past major depressive episode. Subjects had a low self-esteem and quality of life levels significantly lower than those in the French general population. Subjects with higher self-esteem levels had more depressive (β=0.726, Pself-esteem was defensive and inadequate. Our study found a high frequency of psychiatric disorders associated with low levels of self-esteem and quality of life. A psychological treatment focusing on self-esteem may have a beneficial effect on anxiety, depression and quality of life. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. [Kinshicho Model for Community Care by Multifunctional Vertical Integration of Psychiatric Care].

    Science.gov (United States)

    Kubota, Akira

    2015-01-01

    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.

  15. PSYCHIATRIC DISORDERS AND SLEEP

    Science.gov (United States)

    Krystal, Andrew D.

    2012-01-01

    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

  16. Smoking and psychiatric disorders: a comorbidity survey

    Directory of Open Access Journals (Sweden)

    Lopes F.L.

    2002-01-01

    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.

  17. Order of onset of substance abuse and depression in a sample of depressed outpatients.

    Science.gov (United States)

    Abraham, H D; Fava, M

    1999-01-01

    Drug abuse has been thought to cause depression, or to serve as a form of self-medication for depression. Our objective was to examine whether specific types of drug abuse preceded or followed the onset of depression. A retrospective, blinded case-controlled assessment of the drug and depressive history of depressed outpatients was conducted. Three hundred seventy-five patients with major depressive disorder were evaluated for comorbid drug dependence using the Structured Clinical Interview for DSM-III-R (SCID). They were selected from the psychiatric outpatient department of a metropolitan teaching hospital and grouped into homogeneous classes of drug dependence including alcohol, cannabis, cocaine, amphetamine, LSD, hypnosedative, opiate, and polysubstance use. We determined the percent of depressed patients with each specific type of drug abuse, their age of onset of depression and onset of specific drug abuse, and the mean number of lifetime depressive episodes for each patient. We found that alcohol dependence followed the onset of first life depression by 4.7 years (P = .02, two-tailed). Among polydrug-dependent patients, each drug abused followed the onset of depression, except for LSD, which coincided with the onset of depression. Among polydrug users, cocaine dependence occurred 6.8 years after the first major depressive episode (P = .007) and alcohol dependence 4.5 years after the onset of depression (P = .007). Opiate and sedative users had the least number of lifetime depressive episodes (3.7), and LSD and cocaine users had the greatest number (12.2). We conclude that alcohol and cocaine use in this sample of depressed outpatients conformed to a pattern of self-medication.

  18. Inpatient Psychiatric Facility Quality Measure Data – National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Psychiatric facilities that are eligible for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program are required to meet all program requirements,...

  19. Inpatient Psychiatric Facility Quality Measure Data – by Facility

    Data.gov (United States)

    U.S. Department of Health & Human Services — Psychiatric facilities that are eligible for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program are required to meet all program requirements,...

  20. Inpatient Psychiatric Facility Quality Measure Data – by State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Psychiatric facilities that are eligible for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program are required to meet all program requirements,...

  1. [Psychiatric emergencies in drug addiction].

    Science.gov (United States)

    Benyamina, Amine; Bouchez, Jacques; Rahioui, Hassan; Reynaud, Michel

    2003-06-01

    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.

  2. Psychiatric emergency services in Copenhagen 2012: A 27-year psychiatric and demographic follow-up study.

    Science.gov (United States)

    Moltke, Katinka; Høegh, Erica B; Sæbye, Ditte; Larsen, Peter Lindorff; Reff, Kasper Thybo; Knop, Joachim

    2015-08-01

    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.

  3. Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Hansen, Hanne Vibe; Hvenegaard, Anne

    2013-01-01

    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...

  4. Refugee children have fewer contacts to psychiatric healthcare services

    DEFF Research Database (Denmark)

    Barghadouch, Amina; Kristiansen, Maria; Jervelund, Signe Smith

    2016-01-01

    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...

  5. Psychiatric and psychosocial correlates of sexual risk behavior among adults with severe mental illness.

    Science.gov (United States)

    Meade, Christina S; Sikkema, Kathleen J

    2007-04-01

    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.

  6. Pediatric outpatient anesthesia.

    Science.gov (United States)

    Hannallah, R S

    1987-02-01

    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.

  7. Genetic Counselling for Psychiatric Disorders: Accounts of Psychiatric Health Professionals in the United Kingdom.

    Science.gov (United States)

    Jenkins, Sian; Arribas-Ayllon, Michael

    2016-12-01

    Genetic counselling is not routinely offered for psychiatric disorders in the United Kingdom through NHS regional clinical genetics departments. However, recent genomic advances, confirming a genetic contribution to mental illness, are anticipated to increase demand for psychiatric genetic counselling. This is the first study of its kind to employ qualitative methods of research to explore accounts of psychiatric health professionals regarding the prospects for genetic counselling services within clinical psychiatry in the UK. Data were collected from 32 questionnaire participants, and 9 subsequent interviewees. Data analysis revealed that although participants had not encountered patients explicitly demanding psychiatric genetic counselling, psychiatric health professionals believe that such a service would be useful and desirable. Genomic advances may have significant implications for genetic counselling in clinical psychiatry even if these discoveries do not lead to genetic testing. Psychiatric health professionals describe clinical genetics as a skilled profession capable of combining complex risk communication with much needed psychosocial support. However, participants noted barriers to the implementation of psychiatric genetic counselling services including, but not limited to, the complexities of uncertainty in psychiatric diagnoses, patient engagement and ethical concerns regarding limited capacity.

  8. Perceptions Among Psychiatric Staff of Creating a Therapeutic Alliance With Patients on Community Treatment Orders.

    Science.gov (United States)

    Jansson, Susanne; Fridlund, Bengt

    2016-10-01

    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.

  9. Psychiatric disorders and pregnancy

    Directory of Open Access Journals (Sweden)

    "SH. Akhondzadeh

    2006-07-01

    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.

  10. Primary Psychiatric Diseases

    Directory of Open Access Journals (Sweden)

    Sibel Mercan

    2010-07-01

    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.

  11. Assessment of quality of life with the WHOQOL-BREF in a group of Turkish psychiatric patients compared with diabetic and healthy subjects.

    Science.gov (United States)

    Akvardar, Yildiz; Akdede, Berna Binnur; Ozerdem, Ayşegül; Eser, Erhan; Topkaya, Sule; Alptekin, Köksal

    2006-12-01

    Decreased quality of life is often an important cause or consequence of psychiatric illness, and needs to be included in a comprehensive treatment plan. The authors aimed to identify how psychiatric patients characterize the quality of their lives compared to others who are suffering from a chronic physical illness (diabetes) and healthy individuals. A total of 100 psychiatric patients were recruited from Dokuz Eylül University Psychiatry Department outpatient clinic. Of these, 34 had 4(th) edition Diagnostic and Statistical Manual diagnosis of alcohol dependence, 38 had schizophrenia, and 28 had bipolar disorder. A total of 35 patients with diabetes and 49 healthy individuals were also included in the study. The World Health Organization's Quality of Life Questionnaire was used to measure the quality of life. Patients with alcohol dependence, bipolar disorder, and schizophrenia scored lower than healthy subjects on the physical aspects of quality of life. Patients with schizophrenia had lower scores in the psychological domain compared to patients with bipolar disorder, patients with diabetes, and healthy subjects. In the social relationship domain, patients with schizophrenia and alcohol dependence scored lower compared to healthy subjects. Patients with schizophrenia were worse with respect to social relationships than bipolar patients and diabetics. World Health Organization's Quality of Life Questionnaire is useful for evaluating the needs and targets for interventions in psychiatric patients.

  12. Word use of outpatients with a personality disorder and concurrent or previous major depressive disorder

    NARCIS (Netherlands)

    Molendijk, M.L.; Bamelis, L.; van Emmerik, A.A.P.; Arntz, A.; Haringsma, R.; Spinhoven, P.

    2010-01-01

    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

  13. Body dysmorphic disorder screening in maxillofacial outpatients presenting for orthognathic surgery

    NARCIS (Netherlands)

    Vulink, N. C. C.; Rosenberg, A.; Plooij, J. M.; Koole, R.; Bergé, S. J.; Denys, D.

    2008-01-01

    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

  14. Body dysmorphic disorder screening in maxillofacial outpatients presenting for orthognathic surgery.

    NARCIS (Netherlands)

    Vulink, N.C.; Rosenberg, A.; Plooij, J.M.; Koole, R.A.; Berge, S.J.; Denys, D.

    2008-01-01

    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

  15. The impact of self-reported depressive symptoms on memory function in neurological outpatients.

    NARCIS (Netherlands)

    Kessels, R.P.C.; Ruis, C.; Kappelle, L.J.

    2007-01-01

    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

  16. PSYCHIATRIC MORBIDITY IN A NIGERIAN NEUROLOGY CLINIC

    African Journals Online (AJOL)

    2013-05-28

    May 28, 2013 ... East African Medical Journal Vol. 89 No. 2 February 2012. PSYCHIATRIC MORBIDITY IN A NIGERIAN NEUROLOGY CLINIC. P. O. Ajiboye, FWACP, Senior Lecturer/ Consultant Psychiatrist, Department of Behavioural Sciences, University of Ilorin/. University of Ilorin Teaching Hospital, Ilorin, Kwara State, ...

  17. 42 CFR 415.184 - Psychiatric services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Psychiatric services. 415.184 Section 415.184 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.184...

  18. Prevalence of smoking in psychiatric patients.

    Science.gov (United States)

    Poirier, Marie-France; Canceil, Olivier; Baylé, Franck; Millet, Bruno; Bourdel, Marie-Chantal; Moatti, Cécile; Olié, Jean-Pierre; Attar-Lévy, Dominique

    2002-04-01

    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.

  19. Medical Mishap and Negligence: It happens in the Outpatients too

    LENUS (Irish Health Repository)

    Murphy, JFA

    2011-06-01

    When we consider medical negligence and clinical error we think of busy hospitals late at night and at week-ends. We think of crowded emergency medicine departments, complex surgery and the critically ill ICU patient. We think of prescribing errors in the administration of potent intravenous therapy. We think of high risk specialties such as obstetrics, anaesthesia and surgery. We are less likely to think of outpatients\\/ ambulatory care or a non-interventionist specialty as an important source of litigation. This is remiss on our part. Risks in this setting have gone relatively unnoticed. There 30 times more outpatients than inpatients annually. In the US there are 900 million outpatient visits compared with 30 million inpatients. It is not surprising that this quantum of patient-doctor interaction should also be a source of litigation claims. Furthermore it is likely to continue rising with the increased numbers of procedures now being undertaken at outpatients.

  20. Barometric pressure, emergency psychiatric visits, and violent acts.

    Science.gov (United States)

    Schory, Thomas J; Piecznski, Natasha; Nair, Sunil; el-Mallakh, Rif S

    2003-10-01

    Associations between human behaviour and psychiatric decompensation and weather variables have been inconsistent. We studied the association of certain weather variables (specifically, humidity, wind speed, and barometric pressure) with emergent psychiatric presentations, psychiatric admissions, incidence of violent crimes, and suicides in a metropolitan area. We performed a retrospective study for the year 1999 in a mid-sized city. We included all documented emergent psychiatric visits to the city's psychiatric emergency room. We obtained violence data from the city police department and suicide data from the country medical examiner. The data suggest that total numbers of acts of violence and emergency psychiatry visits are significantly associated with low barometric pressure. Psychiatric inpatient admissions and suicides are not associated with any of the weather variables investigated. While alternate conclusions can be drawn, we propose that the data support the interpretation that low barometric pressure is associated with an increase in impulsive behaviours. Additional investigation is warranted.

  1. Oxytocin and Psychiatric Disorders

    Directory of Open Access Journals (Sweden)

    Gokce Nur Say

    2016-06-01

    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

  2. Outpatient healthcare settings and transmission of Clostridium difficile.

    Directory of Open Access Journals (Sweden)

    Lucy A Jury

    Full Text Available BACKGROUND: Recent reports suggest that community-associated Clostridium difficile infection (CDI (i.e., no healthcare facility admission within 90 days may be increasing in frequency. We hypothesized that outpatient clinics could be an important source for acquisition of community-associated CDI. METHODS: We performed a 6-month prospective study of CDI patients to determine frequency of and risk factors for skin and environmental shedding during outpatient visits and to derive a prediction rule for positive cultures. We performed a point-prevalence culture survey to assess the frequency of C. difficile contamination in outpatient settings and evaluated the frequency of prior outpatient visits in patients with community-associated CDI. RESULTS: Of 67 CDI patients studied, 54 (81% had 1 or more outpatient visits within 12 weeks after diagnosis. Of 44 patients cultured during outpatient visits, 14 (32% had skin contamination and 12 (27% contaminated environmental surfaces. Decreased mobility, fecal incontinence, and treatment with non-CDI antibiotics were associated with positive cultures, whereas vancomycin taper therapy was protective. In patients not on CDI therapy, a prediction rule including incontinence or decreased mobility was 90% sensitive and 79% specific for detection of spore shedding. Of 84 clinic and emergency department rooms cultured, 12 (14% had 1 or more contaminated environmental sites. For 33 community-associated CDI cases, 31 (94% had an outpatient visit during the 12 weeks prior to onset of diarrhea. CONCLUSIONS: Patients with recent CDI present a significant risk for transmission of spores during outpatient visits. The outpatient setting may be an underappreciated source of community-associated CDI cases.

  3. Stability and Change in Personality Disorder Symptoms in 1-Year Follow-up of Depressed Adolescent Outpatients.

    Science.gov (United States)

    Strandholm, Thea; Kiviruusu, Olli; Karlsson, Linnea; Pankakoski, Maiju; Pelkonen, Mirjami; Marttunen, Mauri

    2017-01-01

    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.

  4. Hospital Outpatient PPS

    Data.gov (United States)

    U.S. Department of Health & Human Services — Section 4523 of the Balanced Budget Act of 1997 (BBA) provides authority for CMS to implement a prospective payment system (PPS) under Medicare for hospital...

  5. Monitoring Outpatient Care

    Science.gov (United States)

    2003-01-01

    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.

  6. Comprehensive Psychiatric Evaluation

    Science.gov (United States)

    ... 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 ...

  7. Culture and Psychiatric Diagnosis

    OpenAIRE

    Lewis-Fernández, Roberto; Aggarwal, Neil Krishan

    2013-01-01

    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...

  8. Hyperthyroidism and psychiatric morbidity

    DEFF Research Database (Denmark)

    Brandt, Frans; Thvilum, Marianne; Pedersen, Dorthe Almind

    2014-01-01

    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....

  9. Felt stigma and self-esteem among psychiatric hospital outdoor and community camp attending patients

    OpenAIRE

    Shantna Kumari; Inderjeet Banerjee; G Majhi; Suprakash Chaudhury; Amool R Singh; A N Verma

    2014-01-01

    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...

  10. Psychiatric disorders and sleep issues.

    Science.gov (United States)

    Sutton, Eliza L

    2014-09-01

    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.

  11. Lesotho - Renovation of Health Centers and Out-Patient Departments

    Data.gov (United States)

    Millennium Challenge Corporation — The randomized rollout design that was developed for the Lesotho Health Centers was rendered infeasible due to infrastructure delays. Before pursuing an alternative...

  12. Low self-esteem and psychiatric patients: Part I – The relationship between low self-esteem and psychiatric diagnosis

    Science.gov (United States)

    Silverstone, Peter H; Salsali, Mahnaz

    2003-01-01

    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

  13. Low self-esteem and psychiatric patients: Part I - The relationship between low self-esteem and psychiatric diagnosis.

    Science.gov (United States)

    Silverstone, Peter H; Salsali, Mahnaz

    2003-02-11

    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.

  14. Outpatient pulmonary rehabilitation – rehabilitation models and shortcomings in outpatient aftercare

    Directory of Open Access Journals (Sweden)

    Dietl, Markus

    2010-01-01

    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.

  15. Assessment of child neurology outpatients with headache, dizziness, and fainting.

    Science.gov (United States)

    Emiroğlu, Fatma Neslihan Inal; Kurul, Semra; Akay, Aynur; Miral, Süha; Dirik, Eray

    2004-05-01

    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.

  16. [State of suicide and effective efforts in suicide prevention in psychiatric hospitals and clinics].

    Science.gov (United States)

    Orui, Masatsugu; Hirokawa, Seiko; Akazawa, Masato; Tachimori, Hisateru; Kawano, Kenji; Mori, Takao; Akita, Hiroya; Takeshima, Tadashi

    2012-01-01

    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.

  17. Out-patient gastroscopy risks

    DEFF Research Database (Denmark)

    Andersen, Klaus Ejner; Clausen, N

    1978-01-01

    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...

  18. The impact of comorbid psychiatric disorders on methadone maintenance treatment in opioid use disorder: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Rosic T

    2017-05-01

    Full Text Available Tea Rosic,1 Leen Naji,2 Monica Bawor,3 Brittany B Dennis,3 Carolyn Plater,4 David C Marsh,5 Lehana Thabane,6–8 Zainab Samaan6–11 1St Joseph’s Healthcare, 2Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; 3St George’s University of London, London, UK; 4Canadian Addiction Treatment Centre, Richmond Hill, 5Northern Ontario School of Medicine, Sudbury, 6Biostatistics Unit, Research Institute, St Joseph’s Healthcare, 7Department of Clinical Epidemiology and Biostatistics, McMaster University, 8Peter Boris Centre for Addictions Research, 9Mood Disorders Research Unit, St Joseph’s Healthcare, 10Population Genomics Program, Chanchlani Research Centre, 11Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada Objective: There is a significant interindividual variability in treatment outcomes in methadone maintenance treatment (MMT for opioid use disorder (OUD. This prospective cohort study examines the impact of comorbid psychiatric disorders on continued illicit opioid use in patients receiving MMT for OUD. Methods: Data were collected from 935 patients receiving MMT in outpatient clinics between June 2011 and June 2015. Using linear regression analysis, we evaluated the impact of having a comorbid psychiatric disorder on continued illicit opioid use during MMT, adjusting for important confounders. The main outcome measure was percentage of opioid-positive urine screens for 6 months. We conducted a subgroup analysis to determine the influence of specific comorbid psychiatric disorders, including substance use disorders, on continued illicit opioid use. Results: Approximately 80% of participants had at least one comorbid psychiatric disorder in addition to OUD, and 42% of participants had a comorbid substance use disorder. There was no significant association between having a psychiatric comorbidity and continuing opioid use (P=0.248. Results from subgroup analysis

  19. Outpatient management of pulmonary embolism.

    Science.gov (United States)

    Roy, P-M; Moumneh, T; Penaloza, A; Sanchez, O

    2017-07-01

    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.

  20. Treatment to targets in type 2 diabetics: analysis of out-patients ...

    African Journals Online (AJOL)

    Tight control of diabetes in the outpatients will reduce complications and hospitalizations. This study of Nigerian patients with diabetes examined the adequacy of glycemic and BP control in line with current guidelines. A 4 month retrospective analysis of type 2 diabetics attending Medical Outpatients Department (MOPD) of ...

  1. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Science.gov (United States)

    2010-07-01

    ... medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities for outpatient medical services and inpatient hospital care. In scheduling appointments for outpatient medical...

  2. Economic impact of prescreening on gastroenterology outpatient clinic practice.

    Science.gov (United States)

    Donnellan, Fergal; Harewood, Gavin C; Cagney, Daniel; Basri, Fadzwani; Patchett, Stephen E; Murray, Frank E

    2010-04-01

    Outpatient clinic activity represents a major workload for clinicians. Unnecessary outpatient visits place a strain on service provision, resulting in unnecessary delays for more urgent cases. We sought to determine both the impact and economic benefit of employing phone follow-up and physician assistant (PA) triage systems on attendances at a gastroenterology outpatient department. We performed a retrospective chart review of all patients attending a gastroenterology outpatient clinic over a 2-week period. Patients were categorized into new or follow-up attendees and the follow-up patients were further subcategorized into 1 of 4 groups: (1) those attending to receive results of investigations requiring no further treatment (group A); (2) those attending to receive results of investigations requiring further treatment (group B); (3) those attending with a chronic gastrointestinal disease requiring no active change in management (group C); (4) those attending with a chronic gastrointestinal disease requiring active change in management (group D). It was assumed that patients in group A could be managed by phone follow-up in place of clinic attendance and patients in group C could be triaged to see a PA. Out of a total of 329 outpatient attendees, 40 (12%) required no active intervention (group A) and would have been suitable for phone follow-up. A further 58 (18%) had stable disease, requiring no change in management and hence, could have been triaged to see a PA. Implementation of phone follow-up and patient review by PA could reduce salary expenses of outpatient practice by 17%. Our findings support routine prescreening of outpatient attendees to enhance the efficiency of gastroenterology outpatient practice.

  3. Psychiatric Disability in Law Enforcement Officers.

    Science.gov (United States)

    Price, Marilyn

    2017-03-01

    Law enforcement officers all across the world are exposed to violence, confrontation, and traumatic incidents. They regularly witness death and suffering and are at risk of personal injury. Psychiatric sequelae include an increased risk for trauma-related symptoms, depression, alcohol-use disorders, and stress-related medical conditions. Law enforcement officers have been applying for early disability retirement pensions at an increased rate for stress-related psychiatric and medical conditions. As a result, law enforcement agencies are prematurely losing valuable resources, officers with training and experience. Departments have become proactive in trying to address mental health issues to prevent psychiatric disability by implementing employee wellness plans and stress reduction interventions. Programs have been developed to mitigate the effects of stress on law enforcement personnel. Many law enforcement agencies have developed strategies to encourage early confidential referral for psychiatric treatment. They utilize peer support groups and employee assistance programs and develop alliances with mental health professionals. When these approaches fail, a fitness for duty process can be used to identify impairment in work functioning due to psychiatric factors with the prospect of later returning the officer to full duty. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  4. Assessment of History Taking Skills of Doctors in an Outpatient ...

    African Journals Online (AJOL)

    A study of medical history–taking skills of doctors at the adult outpatient department of the Ikeja General Hospital was conducted. Patient records were selected through a systematic random sampling method. Three hundred and ninety–one records were studied. The most frequently obtained component of the patient history ...

  5. Can audio recording of outpatient consultations improve patient outcome?

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette

    different departments: Orthopedics, Urology, Internal Medicine and Pediatrics. A total of 5,460 patients will be included from the outpatient clinics. All patients randomized to an intervention group are offered audio recording of their consultation. An Interactive Voice Response platform enables an audio...

  6. Users' perceptions of outpatient quality of care in Kilosa District ...

    African Journals Online (AJOL)

    and imposes a heavy financial burden on poor ... was to assess users' perceptions of quality of care given at outpatient department (OPD) at Kilosa ... Information on perceptions on care provider-patient interaction, cost of service, availability of medicines, equipment and health personnel was sought from the participants.

  7. Trends in outpatient malaria cases, following Mass Long Lasting ...

    African Journals Online (AJOL)

    Background: There were over 6 million case of malaria reported in Kenya in 2015 and it remains a major public health priority despite significant investments in interventions to control and prevent infections in high risk areas. Objectives: To analyse trends from 2011-2015, and report i) outpatient department (OPD) malaria ...

  8. Psychiatric Aspects of Infertility

    Directory of Open Access Journals (Sweden)

    Hacer Sezgin

    2014-06-01

    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

  9. Psychiatric patient and anaesthesia

    Directory of Open Access Journals (Sweden)

    Joginder Pal Attri

    2012-01-01

    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.

  10. Recidivism after treatment in a forensic youth-psychiatric setting: the effect of treatment characteristics

    NARCIS (Netherlands)

    van der Put, C.E.; Asscher, J.J.; Stams, G.J.J.M.; van der Laan, P.H.; Breuk, R.; Jongman, E.; Doreleijers, T.

    2013-01-01

    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.

  11. Psychometric properties of the aggression questionnaire in Dutch violent forensic psychiatric patients and secondary vocational students.

    NARCIS (Netherlands)

    Hornsveld, R.H.J.; Muris, P.; Kraaimaat, F.W.; Meesters, C.

    2009-01-01

    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

  12. Presentation and prognosis of female acute urinary retention: Analysis of an unusual clinical condition in outpatients

    Directory of Open Access Journals (Sweden)

    Bora Özveren

    2016-01-01

    Conclusions: The proportion of true, complete AUR among female outpatients presenting to the emergency department was 23% following urological evaluation. Acute condition was resolved by urgent catheterization in all, and the majority of women had eventually resumed spontaneous voiding.

  13. Psychiatric impairment and

    African Journals Online (AJOL)

    2002-12-03

    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 ...

  14. Aggression in Psychiatric Wards

    DEFF Research Database (Denmark)

    Hvidhjelm, Jacob; Sestoft, Dorte; Skovgaard, Lene Theil

    2016-01-01

    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...

  15. Psychiatric genetics:AJP

    African Journals Online (AJOL)

    Pippa

    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.

  16. Cerebellum and psychiatric disorders

    OpenAIRE

    Baldaçara,Leonardo; Borgio,João Guilherme Fiorani; Lacerda,Acioly Luiz Tavares de; Jackowski,Andrea Parolin

    2008-01-01

    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...

  17. Antidepressant use during pregnancy and psychiatric disorders in offspring

    DEFF Research Database (Denmark)

    Liu, Xiaoqin; Agerbo, Esben; Ingstrup, Katja G

    2017-01-01

    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...

  18. Psychiatric disorders and menopause symptoms in Brazilian women.

    Science.gov (United States)

    Barazzetti, Lidiane; Pattussi, Marcos Pascoal; Garcez, Anderson da Silva; Mendes, Karina Giane; Theodoro, Heloísa; Paniz, Vera Maria Vieira; Olinto, Maria Teresa Anselmo

    2016-04-01

    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.

  19. Sleep complaints among adolescent outpatients with major depressive disorder.

    Science.gov (United States)

    Urrila, Anna S; Karlsson, Linnea; Kiviruusu, Olli; Pelkonen, Mirjami; Strandholm, Thea; Marttunen, Mauri

    2012-08-01

    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.

  20. Understanding the management of people seeking voluntary psychiatric hospitalization who do not meet the criteria for inpatient admission: a qualitative study of mental health liaison nurses working in accident and emergency departments in the north of England.

    Science.gov (United States)

    Hepworth, Iain; McGowan, Linda

    2015-02-01

    Mental health liaison nurses assess people who self-present at accident and emergency departments seeking inpatient admission, however not all presentations meet the criteria for admission. Little is known about how liaison nurses manage this client group. This qualitative study explored how liaison nurses manage this client group. This study used the think aloud technique to recreate clinical scenarios of clients requesting admission who do not meet the criteria for such admission. Participants were then subsequently interviewed. Eighteen liaison nurses working in hospitals across the North of England participated. Data were analysed using framework analysis methods. Findings indicate that the liaison nurses use a variety of therapeutic skills and methods in managing this client group. Liaison nurses were found to 'sell' crisis and home-based treatment as an equivalent, or superior in quality, to hospital care. However, the existing evidence base does not fully support this assertion. Liaison nurses face numerous difficulties in this role. In the absence of any formalized training, liaison nurses rely on their own clinical knowledge and expertise. Implications for future service provision and further research are discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Predictors of non-drug psychiatric/psychotherapeutic treatment in children and adolescents with mental or behavioural disorders.

    Science.gov (United States)

    Abbas, Sascha; Ihle, Peter; Adler, Jürgen-Bernhard; Engel, Susanne; Günster, Christian; Holtmann, Martin; Kortevoss, Axel; Linder, Roland; Maier, Werner; Lehmkuhl, Gerd; Schubert, Ingrid

    2017-04-01

    Children and adolescents with mental health problems need effective and safe therapies to support their emotional and social development and to avoid functional impairment and progress of social deficits. Though psychotropic drugs seem to be the preferential treatment, psychotherapy and psychosocial interventions are essential in mental health care. For Germany, current data on the utilization of psychotherapy and psychosocial interventions in children with mental health problems is lacking. To analyse why certain children and adolescents with mental or behavioural disorders do and others do not receive non-drug treatment, we assessed predictors associated with specific non-drug psychiatric/psychotherapeutic treatment including psychosocial interventions, psychotherapy and other non-drug treatments. The study is based on data of two large German health insurance funds, AOK and TK, comprising 30 % of the German child and adolescent population. Predictors of non-drug psychiatric/psychotherapeutic treatment were analysed for 23,795 cases and two controls for every case of the same age and sex in children aged 0-17 years following a new diagnosis of mental or behavioural disorder in 2010. Predictors were divided according to Andersen's behavioural model into predisposing, need and enabling factors. The most prominent and significant predictors positively associated with non-drug psychiatric/psychotherapeutic treatment were the residential region as predisposing factor; specific, both ex- and internalizing, mental and behavioural disorders, psychiatric co-morbidity and psychotropic drug use as need factors; and low area deprivation and high accessibility to outpatient physicians and inpatient institutions with non-drug psychiatric/psychotherapeutic department as enabling factors. In conclusion, the present study suggests that the residential region as proxy for supply of therapist and socioeconomic situation is an influencing factor for the use of psychotherapy. The

  2. Usefulness of internet in adolescent mental health outpatient care.

    Science.gov (United States)

    Kurki, M; Koivunen, M; Anttila, M; Hätönen, H; Välimäki, M

    2011-04-01

    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.

  3. Obstructive sleep apnea: management considerations in psychiatric patients

    Directory of Open Access Journals (Sweden)

    Heck T

    2015-10-01

    Full Text Available Taryn Heck,1 Monica Zolezzi21Pharmacy Department, University of Alberta Hospital, Alberta Health Services, Edmonton, AB, Canada; 2Clinical Pharmacy and Practice, College of Pharmacy, Qatar University, Doha, QatarAbstract: Psychiatric disorders and obstructive sleep apnea (OSA are often comorbid. However, there is limited information on the impact of psychotropic medications on OSA symptoms, on how to manage psychiatric pharmacotherapy in patients presenting with OSA, or on the effectiveness and challenges of OSA treatments in patients with comorbid mental illness. As such, the objective of this article is to provide an overview of some epidemiological aspects of OSA and treatment considerations in the management of OSA in individuals with comorbid psychiatric disorders. Predefined keywords were used to search for relevant literature in electronic databases. Data show that OSA is particularly prevalent in patients with psychiatric disorders. The medical care that patients with these comorbidities require can be challenging, as some of the psychiatric medications used by these patients may exacerbate OSA symptoms. As such, continuous positive airway pressure continues to be the first-line treatment, even in patients with psychiatric comorbidity. However, more controlled studies are required, particularly to determine continuous positive airway pressure compliance in patients with mental illness, the impact of treating OSA on psychiatric symptoms, and the impact of the use of psychotropic medications on OSA symptoms.Keywords: obstructive sleep apnea, psychiatric disorders, comorbidity, psychotropic medications

  4. The Psychiatric Case Register Middle Netherlands

    Directory of Open Access Journals (Sweden)

    Boks Marco PM

    2011-06-01

    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.

  5. Outpatient Provider Concentration and Commercial Colonoscopy Prices

    Directory of Open Access Journals (Sweden)

    Alexis Pozen PhD

    2015-04-01

    Full Text Available The objective was to evaluate the magnitude of various contributors to outpatient commercial colonoscopy prices, including market- and provider-level factors, especially market share. We used adjudicated fee-for-service facility claims from a large commercial insurer for colonoscopies occurring in hospital outpatient department or ambulatory surgery center from October 2005 to December 2012. Claims were matched to provider- and market-level data. Linear fixed effects regressions of negotiated colonoscopy price were run on provider, system, and market characteristics. Markets were defined as counties. There were 178 433 claims from 169 providers (104 systems. The mean system market share was 76% (SD = 0.34 and the mean real (deflated price was US$1363 (SD = 374, ranging from US$169 to US$2748. For every percentage point increase in a system or individual facility’s bed share, relative price increased by 2 to 4 percentage points; this result was stable across a number of specifications. Market population and price were also consistently positively related, though this relation was small in magnitude. No other factor explained price as strongly as market share. Price variation for colonoscopy was driven primarily by market share, of particular concern as the number of mergers increases in wake of the recession and the Affordable Care Act. Whether variation is justified by better quality care requires further research to determine whether quality is subsumed in prices.

  6. Dissociative disorders in the psychiatric emergency ward.

    Science.gov (United States)

    Sar, Vedat; Koyuncu, Ahmet; Ozturk, Erdinc; Yargic, L Ilhan; Kundakci, Turgut; Yazici, Ahmet; Kuskonmaz, Ekrem; Aksüt, Didem

    2007-01-01

    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.

  7. Preliminary Outcomes from an Integrated Pediatric Mental Health Outpatient Clinic.

    Science.gov (United States)

    Maslow, Gary R; Banny, Adrienne; Pollock, McLean; Stefureac, Kristen; Rosa, Kendra; Walter, Barbara Keith; Hobbs Knutson, Katherine; Lucas, Joseph; Heilbron, Nicole

    2017-10-01

    An estimated 1 in 5 children in the United States meet criteria for a diagnosable mental disorder, yet fewer than 20% receive mental health services. Unmet need for psychiatric treatment may contribute to patterns of increasing use of the emergency department. This article describes an integrated pediatric evaluation center designed to prevent the need for treatment in emergency settings by increasing access to timely and appropriate care for emergent and critical mental health needs. Preliminary results showed that the center provided rapid access to assessment and treatment services for children and adolescents presenting with a wide range of psychiatric concerns. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Delusional infestation is typically comorbid with other psychiatric diagnoses: review of 54 patients receiving psychiatric evaluation at Mayo Clinic.

    Science.gov (United States)

    Hylwa, Sara A; Foster, Ashley A; Bury, Jessica E; Davis, Mark D P; Pittelkow, Mark R; Bostwick, J Michael

    2012-01-01

    Delusional infestation, which encompasses both delusions of parasitosis and delusions of infestation with inanimate objects (sometimes called Morgellons disease), has been said to represent a distinct and encapsulated delusion, that is, a stand-alone diagnosis. Anecdotally, we have observed that patients with delusional infestation often have one or more psychiatric comorbid conditions and that delusional infestation should not be regarded as a stand-alone diagnosis. The purpose of this study was to identify whether patients with delusional infestation have psychiatric comorbid conditions. We therefore identified patients who had been formally evaluated in the Department of Psychiatry during their visit to Mayo Clinic. We retrospectively searched for and reviewed the cases of all patients with delusional infestation seen from 2001 through 2007 at Mayo Clinic, Rochester, Minnesota, and who underwent psychiatric evaluation. The diagnoses resulting from psychiatric evaluation were analyzed. During the 7-year study period, 109 patients seen for delusional infestation at Mayo Clinic were referred to the Department of Psychiatry, 54 (50%) of whom actually followed through with psychiatric consultation. Of these 54 patients, 40 (74%) received additional active psychiatric diagnoses; 14 patients (26%) had delusional infestation alone. Abnormal personality traits were rarely documented. Most patients with delusional infestation have multiple coexisting or underlying psychiatric disorders. Therefore, evaluation by a psychiatrist, when possible, is advised for all patients with delusional infestation. Copyright © 2012 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  9. Outpatient Surgery In Day Clinics*

    African Journals Online (AJOL)

    1971-12-18

    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 ...

  10. Clostridium difficile Infection in Outpatients

    Centers for Disease Control (CDC) Podcasts

    2011-11-07

    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.

  11. Progress monitoring and feedback in psychiatric care reduces depressive symptoms.

    Science.gov (United States)

    Newnham, Elizabeth A; Hooke, Geoff R; Page, Andrew C

    2010-12-01

    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.

  12. [Rheumatic fibromyalgia: psychiatric features].

    Science.gov (United States)

    Sarró Alvarez, S

    2002-01-01

    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.

  13. Use of yoga in outpatient eating disorder treatment: a pilot study

    OpenAIRE

    Hall, Allison; Ofei-Tenkorang, Nana Ama; Machan, Jason T.; Gordon, Catherine M

    2016-01-01

    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...

  14. [The relation of selected psychiatric disorders to occurrence of suicide attempts among teenage psychiatrically hospitalized patients].

    Science.gov (United States)

    Krajewska, Katarzyna; Gawlik-Kotelnicka, Oliwia; Gmitrowicz, Agnieszka

    2015-06-01

    Suicide is the third cause of death globally in the age group 10-19. Multiple risk factors (genetic, psychiatric, psychological, familial, social) increased number of suicide attempts. The aim of this study was to explore whether mental disorders are associated with the number of suicide attempts among psychiatric hospitalized adolescents. Retrospective, chart-based analysis of 119 patients, aged 13-18, treated in 2013-2014 in the Department of Adolescent Psychiatry in Łódź. Inclusion criteria was diagnosis of schizophrenia, schizotypal and delusional disorders, mood disorders, neurotic, stress-related and somatoform disorders, behavioral and emotional disorders according to ICD 10. Exclusion criteria were other psychiatric diagnosis, incomplete information about intention of self-harm behaviors. For statistical analysis used Statistica 9.1. Among psychiatricaly hospitalized patients, 51.2% of people attempted suicide. No relationship was found (p > 0.05) between psychiatric diagnosis and frequency of suicide attempts in adolescents, but the most common suicide attempts related to people with a diagnosis of mood disorders (59.3%) and neurotic disorders (54.6%), and least frequently in patients with a diagnosis of schizophrenia , schizotypal and delusional disorders (40%) and behavioral and emotional disorders (44.4%). There is no relation between the occurrence of suicide attempts and the type of mental disorders among psychiatrically hospitalized adolescents. © 2015 MEDPRESS.

  15. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; Electronic Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off-Campus Provider-Based Department of a Hospital; Hospital Value-Based Purchasing (VBP) Program; Establishment of Payment Rates Under the Medicare Physician Fee Schedule for Nonexcepted Items and Services Furnished by an Off-Campus Provider-Based Department of a Hospital. Final rule with comment period and interim final rule with comment period.

    Science.gov (United States)

    2016-11-14

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, in this final rule with comment period, we are making changes to tolerance thresholds for clinical outcomes for solid organ transplant programs; to Organ Procurement Organizations (OPOs) definitions, outcome measures, and organ transport documentation; and to the Medicare and Medicaid Electronic Health Record Incentive Programs. We also are removing the HCAHPS Pain Management dimension from the Hospital Value-Based Purchasing (VBP) Program. In addition, we are implementing section 603 of the Bipartisan Budget Act of 2015 relating to payment for certain items and services furnished by certain off-campus provider-based departments of a provider. In this document, we also are issuing an interim final rule with comment period to establish the Medicare Physician Fee Schedule payment rates for the nonexcepted items and services billed by a nonexcepted off-campus provider-based department of a hospital in accordance with the provisions of section 603.

  16. Culture and psychiatric diagnosis.

    Science.gov (United States)

    Lewis-Fernández, Roberto; Aggarwal, Neil Krishan

    2013-01-01

    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*

  17. Unnatural causes of death and suicide among former adolescent psychiatric patients.

    Science.gov (United States)

    Park, Subin; Kim, Chang Yoon; Hong, Jin Pyo

    2013-02-01

    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.

  18. Comprehensive Outpatient Rehabilitation Program: Hospital-Based Stroke Outpatient Rehabilitation.

    Science.gov (United States)

    Rice, Danielle; Janzen, Shannon; McIntyre, Amanda; Vermeer, Julianne; Britt, Eileen; Teasell, Robert

    2016-05-01

    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.

  19. Felt stigma and self-esteem among psychiatric hospital outdoor and community camp attending patients

    Directory of Open Access Journals (Sweden)

    Shantna Kumari

    2014-01-01

    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.

  20. Phenomenology and predisposing factors of morbid jealousy in a psychiatric outdoor: a cross-sectional, descriptive study

    Directory of Open Access Journals (Sweden)

    Satyajeet Kumar Singh

    2017-06-01

    Full Text Available Background: Jealousy in a sexual relation has some advantage that it ensures propagation of one’s own gene as put by evolutionary psychologists. However, if this belief is based on unfounded evidence it may impair the relationship between partners and may be extremely distressful. Morbid jealousy may present as obsession, overvalued idea, or delusion as one of the symptoms in different psychiatric disorders. Aim: The aim of the study was to find the frequency of patients with morbid jealousy presenting in the Department of Psychiatry of Patna Medical College and Hospital (PMCH, the psychiatric diagnoses of such patients, frequency of different forms of morbid jealousy (obsession, overvalued idea, and delusion. Also, to assess predisposing or triggering factors for jealousy and to assess for suicidality in such patients and their partners. Materials and methods: All patients attending the Department of Psychiatry, PMCH were administered a screening questionnaire and if they qualified they were further administered the operational criteria for morbid jealousy. The psychiatric diagnosis was confirmed with the tenth revision of the International Statistical Classification of Diseases and Related Health Problems: Diagnostic Criteria for Research (ICD-10: DCR. Each patient was then administered a rating scale to quantify the psychopathology. Results: Out of 970 patients who attended outpatient department, 658 patients were administered the screening questionnaire, 174 qualified who were later assessed with the operational criteria for morbid jealousy. Fifty patients who fulfilled the criteria were assessed. The mean age of presentation for both sexes were 36.44 year (SD=13.12 years. Morbid jealousy was found to be twice as common in males as compared in females. Highest prevalence was found among participants who had higher secondary education, belonged to middle socioeconomic status, and having psychiatric diagnosis of schizophrenia followed by

  1. Psychiatric symptoms, quality of life, and HIV status among people using opioids in Saint Petersburg, Russia.

    Science.gov (United States)

    Desrosiers, Alethea; Blokhina, Elena; Krupitsky, Evgeny; Zvartau, Edwin; Schottenfeld, Richard; Chawarski, Marek

    2017-03-01

    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.

  2. [Effectiveness of aftercare treatment after release from prison: A first evaluation of the forensic therapeutic outpatient clinic for serious violent and sexual offenders in Berlin].

    Science.gov (United States)

    Sauter, J; Voss, T; Dahle, K-P

    2015-05-01

    The Forensic Therapeutic Outpatient Clinic (FTA) in Berlin targets the professional aftercare treatment of classified high-risk violent and sexual offenders released from prison or forensic psychiatric hospitals. A comparison sample (n = 32) matched to the patients of the FTA (complete survey n = 32) according to similar criminal histories and diagnoses (ICD-10) was collected from offenders released from prison and forensic psychiatry at a time before the FTA was established. The focus of the study was on recidivism measured by complaints received by police departments during the follow-up period. Sexual recidivism occurred significantly later in the case of released offenders with aftercare treatment compared to those without. Moreover, for the duration of aftercare treatment the general risk of recidivism was approximately 85 % lower; however, after termination of treatment the recidivism rates of both samples converged to almost the same level. Individually adapted measures should be maintained after finishing aftercare treatment; however, because prisoners released from prison are frequently less prepared than patients from forensic psychiatric hospitals, the therapeutic work often reaches its limits in these cases. Therefore, social work should be taken into account right from the start.

  3. Prevalence of Vitamin D Deficiency in Adult Outpatients With Bipolar Disorder or Schizophrenia.

    Science.gov (United States)

    Boerman, Remco; Cohen, Dan; Schulte, Peter F J; Nugter, Annet

    2016-12-01

    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.

  4. Intensive outpatient treatment of elephantiasis.

    Science.gov (United States)

    Pereira De Godoy, J M; Amador Franco Brigidio, P; Buzato, E; Fátima Guerreiro De Godoy, M

    2012-10-01

    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.

  5. Blood cultures in ambulatory outpatients

    Directory of Open Access Journals (Sweden)

    Laupland Kevin B

    2005-05-01

    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.

  6. Adolescents and Dual Diagnosis in a Psychiatric Emergency Service.

    Science.gov (United States)

    Matali, José Luis; Andión, Oscar; Pardo, Marta; Iniesta, Raquel; Serrano, Eduard; San, Luis

    2016-03-02

    In recent years, both the prevalence of drug use and related child and adolescent psychiatric emergencies have risen sharply. There are few studies about the impact on child and adolescent emergency services. This study has a twofold aim. The first is to describe the prevalence of substance use disorders, mental disorders and dual diagnosis (substance use problems plus mental disorder) in adolescents in psychiatric emergency service. The second is to analyze clinical and healthcare differences between patients with dual diagnosis and patients with a mental disorder without substance use disorder.We retrospectively reviewed 4012 discharge forms for emergencies treated at the psychiatric emergency department during the period 2007-2009. We obtained a sample of 1795 visits. This sample was divided into two groups: the dual diagnosis group (n = 477) and the psychiatric disorder group (n = 1318).The dual diagnosis group accounted for 26.5% of psychiatric emergencies analyzed. Compared to the psychiatric disorder group,the dual diagnosis group had significantly more conduct disorders, social problems, involuntariness in the visit, less hospital admissions and less connection with the healthcare network.Adolescents with a dual diagnosis account for a high percentage of visits at child and adolescent psychiatric emergency services. This patient group requires specialized care both at emergency services and in specific units. Accordingly, these units should play a triple role when handling dual diagnosis: detection, brief treatment and referral to a specialised unit.

  7. Case-based reimbursement for psychiatric hospital care.

    Science.gov (United States)

    Sederer, L I; Eisen, S V; Dill, D; Grob, M C; Gougeon, M L; Mirin, S M

    1992-11-01

    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.

  8. Defense styles explain psychiatric symptoms: an empirical study.

    Science.gov (United States)

    Holi, M M; Sammallahti, P R; Aalberg, V A

    1999-11-01

    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.

  9. [Psychiatric complications of abortion].

    Science.gov (United States)

    Gurpegui, Manuel; Jurado, Dolores

    2009-01-01

    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.

  10. Lamotrigine in psychiatric disorders.

    Science.gov (United States)

    Reid, Jennifer G; Gitlin, Michael J; Altshuler, Lori L

    2013-07-01

    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.

  11. Parricide: Psychiatric morbidity

    Directory of Open Access Journals (Sweden)

    Dunjić Bojana

    2008-01-01

    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.

  12. The characteristics, management, and aftercare of patients with suicide attempts who attended the emergency department of a general hospital in northern Taiwan

    Directory of Open Access Journals (Sweden)

    Chen-Ju Lin

    2014-06-01

    Conclusion: Individuals who harmed themselves had a high rate of psychiatric morbidity and interpersonal problems. However, their adherence to psychiatric outpatient aftercare was low. Improved identification of the needs of patients with suicidal tendencies who did not attend outpatient services will have implications for future services provided to this patient population, and will better enable medical personnel to most effectively assist in suicide attempt interventions.

  13. Psychiatric aspects of dwarfism.

    Science.gov (United States)

    Brust, J S; Ford, C V; Rimoin, D L

    1976-02-01

    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.

  14. Caring conversations - psychiatric patients' narratives about suffering.

    Science.gov (United States)

    Fredriksson, Lennart; Lindström, Unni A

    2002-11-01

    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.

  15. Psychiatric impairment and childhood victimization experiences in female child molesters.

    Science.gov (United States)

    Green, A H; Kaplan, M S

    1994-09-01

    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.

  16. Burden of psychiatric morbidity among attendees of a secondary level hospital in Northern India: Implications for integration of mental health care at subdistrict level.

    Science.gov (United States)

    Haldar, Partha; Sagar, Rajesh; Malhotra, Sumit; Kant, Shashi

    2017-01-01

    There is little information available on the type, pattern, trend, and demographic differentials of psychiatric cases attending a subdistrict level facility in India. Our objectives were to describe the sociodemographic profile of the patients availing the psychiatric outpatient department services and document the diagnosis. This study is based on a retrospective analysis of routinely recorded administrative data collected during psychiatry consultations that took place between January 2010 and June 2014, at the subdistrict level hospital, Ballabgarh, Faridabad district, Haryana, Northern India. The data were abstracted in Microsoft Excel, scrutinized for duplicates, and cleaned in terms of the International Classification of Diseases 10th Revision coding. Descriptive analysis was done for dependent variables and continuous variables were compared using independent t-test. A total of 2806 people (new registrations) were provided psychiatric consultations between January 2010 and June 2014. The mean age of males was 33.7 years (95% confidence interval [CI], 32.9, 34.5) and of females was 35.6 years (95% CI, 34.9, 36.3). Neurotic, stress-related, and somatoform disorders (F40-F48) comprised the major category of diagnoses with 661 cases (24%), followed by unspecified mental disorders (F99) with 528 cases (19%), mood (affective) disorders (F30-F39) with 448 cases (16%), and episodic and paroxysmal disorders (G40-G47) with 334 cases (12%). We reported an increase in level and trend in the monthly attendance of patients who required psychiatric at a secondary care hospital in Northern India. We suggest that setting up of mental health units only at district hospital might not be a sufficient health system's approach as has been envisaged under the District Mental Health Program.

  17. Increasing risk of psychiatric morbidity after childhood onset type 1 diabetes

    DEFF Research Database (Denmark)

    Dybdal, Daniel; Tolstrup, Janne S; Sildorf, Stine M

    2017-01-01

    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...

  18. Quality standards for rheumatology outpatient clinic. The EXTRELLA project.

    Science.gov (United States)

    Nolla, Joan M; Martínez, Carmen; García-Vicuña, Rosario; Seoane-Mato, Daniel; Rosario Lozano, M Piedad; Alonso, Alberto; Alperi, Mercedes; Barbazán, Ceferino; Calvo, Jaime; Delgado, Concepción; Fernández-Nebro, Antonio; Mateo, Lourdes; Pérez Sandoval, Trinidad; Pérez Venegas, José; Rodríguez Lozano, Carlos; Rosas, José

    2016-01-01

    In recent years, outpatient clinics have undergone extensive development. At present, patients with rheumatic diseases are mainly assisted in this area. However, the quality standards of care are poorly documented. To develop specific quality criteria and standards for an outpatient rheumatology clinic. The project was based on the two-round Delphi method. The following groups of participants took part: scientific committee (13 rheumatologists), five nominal groups (45 rheumatologists and 12 nurses) and a group of discussion formed by 9 patients. Different drafts were consecutively generated until a final document was obtained that included the standards that received a punctuation equal or over 7 in at least 70% of the participants. 148 standards were developed, grouped into the following 9 dimensions: a) structure (22), b) clinical activity and relationship with the patients (34), c) planning (7), d) levels of priority (5), e) relations with primary care physicians, with Emergency Department and with other clinical departments, f) process (26), g) nursing (13), h) teaching and research (13) and i) activity measures (8). This study established specific quality standards for rheumatology outpatient clinic. It can be a useful tool for organising this area in the Rheumatology Department and as a reference when proposing improvement measures to health administrators. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  19. Identification of patients with low-risk pulmonary embolism suitable for outpatient treatment using the pulmonary embolism severity index (PESI).

    LENUS (Irish Health Repository)

    McCabe, A

    2013-06-01

    There is increasing evidence that outpatient treatment of patients with low-risk stable pulmonary embolism (PE) is safe, effective and potentially reduces costs. It is not clear how many patients presenting to an Irish Emergency Department (ED) are potentially suitable for outpatient management.

  20. Cerebellum and psychiatric disorders.

    Science.gov (United States)

    Baldaçara, Leonardo; Borgio, João Guilherme Fiorani; Lacerda, Acioly Luiz Tavares de; Jackowski, Andrea Parolin

    2008-09-01

    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.

  1. Patient mix in outpatient surgery settings and implications for Medicare payment policy.

    Science.gov (United States)

    Meyerhoefer, Chad D; Colby, Margaret S; McFetridge, Jeffrey T

    2012-02-01

    In 2008, Medicare implemented a new payment policy for ambulatory surgical centers (ASCs), which aligns the ASC payment system with that used for hospital outpatient departments and reimburses ASCs approximately 65% of what hospitals receive for the same outpatient surgery. The authors assess patient selection across ASCs and hospital outpatient departments for four common surgeries (colonoscopy, hernia repair, knee arthroscopy, cataract repair), using data on procedures performed in Florida from 2004 to 2008. The authors construct measures of patient illness severity and cost risk and find that ASCs benefit from positive selection. Nonetheless, the degree of selection varies by surgery type and patient population. While similar studies in other states are needed, the findings suggest that modifications to the Medicare outpatient payment system may be appropriate to account for the different populations that each setting attracts.

  2. Maternal Smoking During Pregnancy and the Risk of Psychiatric Morbidity in Singleton Sibling Pairs.

    Science.gov (United States)

    Ekblad, Mikael; Lehtonen, Liisa; Korkeila, Jyrki; Gissler, Mika

    2017-05-01

    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

  3. Screening and correlates of neurotic disorders among general medical outpatients in Xi'an China.

    Science.gov (United States)

    Ni, Chunping; Ma, Lihua; Wang, Bo; Hua, Yan; Hua, Qianzhen; Wallen, Gwenyth R; Gao, Bo; Yan, Yongping; Huang, Yueqin

    2015-04-01

    Little is known about the distribution and correlates of neurotic disorders among general medical outpatients. The aim was to identify the population distribution and associated factors of neurotic disorders among general medical outpatients. A cross-sectional design was used. Computer-assisted interviews of 372 general outpatients aged 16 years or older in Xi'an China were conducted using a Chinese version of the World Health Organization Composite International Diagnostic Interview version 3.0 (CIDI-3.0). The estimated lifetime prevalence of any ICD-10 neurotic disorder among general medical outpatients was 10.8%. The most prevalent subtype of neurotic disorders was specific phobias (5.7%) followed by obsessive-compulsive disorders (3.8%) and social phobias (1.3%). General outpatients who visited the department of internal medicine (OR = 6.55, 95% CI 1.51-28.38), who were under 40 years old (OR = 4.44, 95% CI 2.05-9.62), had less than high school education (OR = 4.19, 95% CI 1.79-9.79), and were female (OR = 2.25, 95% CI 1.14-4.47) were most likely to report neurotic disorders. Effective identification of neurotic disorders is crucial for its early detection and targeted intervention among general medical outpatients. Those outpatients who had younger age and lower education level, and were female and had visited internal medicine departments require additional attention. © 2014 Wiley Periodicals, Inc.

  4. Outpatient treatment of uncomplicated diverticulitis: a systematic review.

    Science.gov (United States)

    Sánchez-Velázquez, Patricia; Grande, Luis; Pera, Miguel

    2016-06-01

    Acute diverticulitis occurs in up to 25% of patients with diverticulosis. The majority of cases are mild or uncomplicated and it has become a frequent reason for consultation in the emergency department. On the basis of the National Inpatient Sample database from the USA, 86% of patients admitted with diverticulitis were treated with medical therapy. However, several recent studies have shown that outpatient treatment with antibiotics is safe and effective. The aim of this systematic review is to update the evidence published in the outpatient treatment of uncomplicated acute diverticulitis. We performed a systematic review according to the PRISMA guidelines and searched in MEDLINE and Cochrane databases all English-language articles on the management of acute diverticulitis using the following search terms: 'diverticulitis', 'outpatient', and 'uncomplicated'. Data were extracted independently by two investigators. A total of 11 articles for full review were yielded: one randomized controlled trial, eight prospective cohort studies, and two retrospective cohort studies. Treatment successful rate on an outpatient basis, which means that no further complications were reported, ranged from 91.5 to 100%. Fewer than 8% of patients were readmitted in the hospital. Intolerance to oral intake and lack of family or social support are common exclusion criteria used for this approach, whereas severe comorbidities are not definitive exclusion criteria in all the studies. Ambulatory treatment of uncomplicated acute diverticulitis is safe, effective, and economically efficient when applying an appropriate selection in most reviewed studies.

  5. Factors Related to Stress in Outpatients with Permanent Colostomies

    Directory of Open Access Journals (Sweden)

    Hui-Chen Tseng

    2004-02-01

    Full Text Available The main purpose of this study was to explore factors related to stress in outpatients with permanent colostomies, using a convenience sample. Subjects were selected from one medical center in southern Taiwan. The Stress of Colostomy Patients Scale and demographic data were collected using questionnaires either at the colorectal outpatient department or in the home of colostomy patients. Seventy-three subjects with colostomies participated in the study. Other diseases and caregivers of colostomy patients influenced overall stress in outpatients with permanent colostomies. The five major stressors were: “I have urination problems”; “I feel tired easily owing to physical decline”; “I can't travel freely because of my colostomy”; “I worry about recurrence of the disease”; and, “I suffer from insomnia”. This study provides important information for assessing the stress level of outpatients with permanent colostomies and for developing nursing assessment tools for colostomy patients. To alleviate the overall stress of colostomy patients and to help them return to the activities of daily living before the operation, health care professionals could design individual nursing care plans based on data from assessment tools.

  6. Differences in Hypnotic Capacity: Patients Referred to a Psychiatric Consultation Liaison Clinic vs. Patients Referred to a Psychiatric Outpatient Clinic

    Science.gov (United States)

    1994-01-04

    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

  7. Trends of indigenous healing among people with psychiatric disorders: comparative study of Arabic and Kurdish ethnicities in Iraq.

    Science.gov (United States)

    Rahim, Twana Abdulrahman; Saeed, Banaz Adnan; Farhan, Hafidh Muhammed; Aziz, Rosh Rauf

    2015-02-01

    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.

  8. Treating the disconfirmed psychiatric client.

    Science.gov (United States)

    Heineken, J

    1983-01-01

    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.

  9. Psychiatric comorbidity : fact or artifact?

    NARCIS (Netherlands)

    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

  10. College Students with Psychiatric Disabilities

    Science.gov (United States)

    Singh, Delar K.

    2011-01-01

    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…

  11. Religiosity and mental health of pre-adolescents with psychiatric problems and their parents: the TRAILS study

    NARCIS (Netherlands)

    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.

    2015-01-01

    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

  12. Religiosity and mental health of pre-adolescents with psychiatric problems and their parents : The TRAILS study

    NARCIS (Netherlands)

    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.

    2015-01-01

    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

  13. Expanding the Scope of Mindfulness-Based Cognitive Therapy: Evidence for Effectiveness in a Heterogeneous Psychiatric Sample

    Science.gov (United States)

    Green, Sheryl M.; Bieling, Peter J.

    2012-01-01

    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…

  14. Wechsler Adult Intelligence Scale-Third Edition Short Form for Index and IQ Scores in a Psychiatric Population

    Science.gov (United States)

    Christensen, Bruce K.; Girard, Todd A.; Bagby, R. Michael

    2007-01-01

    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…

  15. Gene therapy for psychiatric disorders.

    Science.gov (United States)

    Gelfand, Yaroslav; Kaplitt, Michael G

    2013-01-01

    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.

  16. Effectiveness of outpatient, day hospital, and inpatient psychotherapeutic treatment for patients with cluster B personality disorders.

    Science.gov (United States)

    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

    2011-01-01

    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.

  17. The psychiatric interview

    DEFF Research Database (Denmark)

    Frederiksen, Julie Elisabeth Nordgaard; Sass, Louis A; Parnas, Josef

    2012-01-01

    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...

  18. Psychiatric approach to the living kidney donor

    Directory of Open Access Journals (Sweden)

    Raquel Correia

    2013-12-01

    Full Text Available Kidney transplantation is considered the treatment of choice for patients with end-stage renal disease. Living donor transplantation has increased because of the shortage, the needs of cadaver donors.Based on existing literature the authors address ethical issues and major psychiatric aspects involved in the evaluation of living donor kidney transplant, and the interference of this procedure on quality of life for donors, and their contraindications. The authors further describe the evaluation procedures used in the Hospital S. João, as well as data related to the 32 patients evaluated in the Department of Psychiatry since 2004.

  19. God's eyes and the schizophrenic hands: listening to a psychiatric patient

    Directory of Open Access Journals (Sweden)

    Luciane Loss Jardim

    2010-12-01

    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.

  20. Behavioural and psychiatric symptoms in cognitive neurology.

    Science.gov (United States)

    Robles Bayón, A; Gude Sampedro, F

    2017-03-01

    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.

  1. [Recommendations for psychotherapy in psychiatric inpatient treatment : Results of the PAKT Study Part I].

    Science.gov (United States)

    Uhlmann, C; Flammer, E; Pfiffner, C; Grempler, J; Längle, G; Eschweiler, G-W; Spießl, H; Steinert, T

    2017-03-01

    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.

  2. Outpatient management of pediatric burns.

    Science.gov (United States)

    Kassira, Wrood; Namias, Nicholas

    2008-07-01

    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.

  3. Association between bullying and pediatric psychiatric hospitalizations

    Science.gov (United States)

    Leader, Hadassa; Singh, Jasmine; Ghaffar, Ayesha; de Silva, Cheryl

    2018-01-01

    Objectives: Bullying is a serious public health issue. We sought to demonstrate an association between bullying victimization and hospital admissions for acute psychiatric problems. We described the demographics and types of bullying in a sample of hospitalized patients in Staten Island, NY, and compared bullying victimization scores with psychiatric versus medical admissions. Methods: Patients in grades 3–12 were recruited from the Staten Island University Hospital Inpatient Pediatrics unit and emergency department. Patients completed the validated Olweus Bully/Victim Questionnaire (OBQ) was analyzed to formulate a report of bullying in our sample as well as a sub-score measurement of bullying victimization. Pediatric residents simultaneously documented whether the subject was a medical versus an in-patient psychiatry admission. Statistical analysis was performed to look for an association between the victimization sub-score and a psychiatric indication for admission. Results: A total of 185 surveys were analyzed. Peak bullying occurred in 7th and 8th grades. Demographics and types of bullying in our sample were described. A strong association between bullying victimization and hospitalization for in-patient psychiatry was demonstrated. Association between bullying victimization and suicidal ideation, psychiatry, and social work consults was also shown. Concern for an association between hospitalization for psychogenic illness and bullying victimization was also raised. Conclusions: There is a significant association between bullying victimization and psychiatric hospital admissions. This raises the specter of the serious consequences of bullying as it is the first study to prospectively link hospital admissions to bullying. Studies using a valid measure of psychogenic illness to look for an association with bullying victimization are needed. PMID:29326819

  4. Long-waiting outpatients: target audience for health education.

    Science.gov (United States)

    Bamgboye, E A; Jarallah, J S

    1994-04-01

    The study examines the meaning of waiting time in an outpatient department. Attention is payed to the activities of the patients and companions during the waiting time, the potential for health education programmes during the waiting time and the form such a health education programme should take. The setting was the King Khalid University Hospital Outpatient Department, Riyadh, Saudi Arabia. The study sample was selected by a systematic random sample approach of one in every 10 patients or companions visiting the clinic in a period of 2 weeks. The results showed an average waiting time of 148 min with a standard deviation of 11 min. Patients currently engage in reading, sleeping or talking during long waiting time. However, they showed a preference for health education programmes for specific diseases such as heart disease, diabetes mellitus and bowel diseases during the waiting time. Leaflets were favoured to be the most preferred mode for disseminating such information. A sizeable proportion of patients also wanted religious programmes included. We conclude that education programmes for preferred specific health topics at outpatient clinic services would be of potential benefit to patients' overall health.

  5. Temporal trends in outpatient management of incident pulmonary embolism and associated mortality.

    Science.gov (United States)

    Klil-Drori, Adi J; Coulombe, Janie; Suissa, Samy; Hirsch, Andrew; Tagalakis, Vicky

    2018-01-01

    In clinical trial settings, outpatient management of pulmonary embolism (PE) is feasible and safe, but less is known on its use in routine care. We determined trends in outpatient management of PE and associated mortality in a large non-select patient population. All residents of Quebec, Canada with a first-ever work-up for suspected PE in the emergency department (ED) over 10years were included. Patients could transition to outpatient management and from unconfirmed to confirmed PE in a time-varying fashion. Comparing the years 2005-9 with 2000-4, we assessed the odds ratio (OR) for outpatient management, and relative risk (RR) for all-cause mortality, readmissions for PE, and major bleeding in 30days. We adjusted the RR for a mortality risk score. Of 15,217 patients included, 7583 were outpatients (7.5% confirmed PE) and 7634 were inpatients (60.6% confirmed PE). In all, 10.9% of patients with confirmed PE were outpatients, but outpatient management of confirmed PE was more likely in the latter study period (OR 1.73, 95%CI 1.44-2.09). Among outpatients with confirmed PE, mortality (RR 0.84, 95%CI 0.15-4.61) and readmission (RR 1.25, 95%CI 0.45-3.48) rates were stable, and only 3 major bleeding events were noted. Inpatients with confirmed PE had stable mortality rates (RR 0.95, 95%CI 0.72-1.24). Outpatient PE management increased over 10years while remaining fairly uncommon. Nevertheless, stable mortality and readmission rates indicate this practice is safe in routine care, and add to the growing evidence in support of outpatient PE management. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Metallurgy Department

    DEFF Research Database (Denmark)

    Risø National Laboratory, Roskilde

    The activities of the Metallurgy Department at Risø during 1981 are described. The work is presented in three chapters: General Materials Research, Technology and Materials Development, Fuel Elements. Furthermore, a survey is given of the department's participation in international collaboration...

  7. Pathological gamblers: inpatients' versus outpatients' characteristics.

    Science.gov (United States)

    Ladouceur, Robert; Sylvain, Caroline; Sévigny, Serge; Poirier, Lynda; Brisson, Laurent; Dias, Carlos; Dufour, Claudie; Pilote, Pierrette

    2006-12-01

    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.

  8. Occupational disability on psychiatric grounds in South African ...

    African Journals Online (AJOL)

    extra-ordinary levels of stress on people in many occupational sectors, including the teaching ... R Emsley, L Emsley, S Seedat. Department of Psychiatry, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa ... Almost half had a family history of psychiatric disorder, and the majority (N = 66.

  9. Pre-trial psychiatric evaluations and ethnicity in the Netherlands.

    Science.gov (United States)

    Vinkers, David J; de Beurs, Edwin; Barendregt, Marko; Rinne, Thomas; Hoek, H Wijbrand

    2010-01-01

    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.

  10. Inpatient Psychiatric Facility PPS

    Data.gov (United States)

    U.S. Department of Health & Human Services — Since October 1, 1983, most hospitals have been paid under the hospital inpatient prospective payment system (PPS). However, certain types of specialty hospitals and...

  11. Gender, status, and psychiatric labels.

    Science.gov (United States)

    Kroska, Amy; Harkness, Sarah K; Brown, Ryan P; Thomas, Lauren S

    2015-11-01

    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.

  12. Prevalence and determinants for malnutrition in geriatric outpatients.

    Science.gov (United States)

    van Bokhorst-de van der Schueren, Marian A E; Lonterman-Monasch, Sabine; de Vries, Oscar J; Danner, Sven A; Kramer, Mark H H; Muller, Majon

    2013-12-01

    Few data is available on the nutritional status of geriatric outpatients. The aim of this study is to describe the nutritional status and its clinical correlates of independently living geriatric older individuals visiting a geriatric outpatient department. From 2005 to 2010, all consecutive patients visiting a geriatric outpatient department in the Netherlands were screened for malnutrition. Nutritional status was assessed by the Mini Nutritional Assessment (MNA). Determinants of malnutrition were categorized into somatic factors (medicine use, comorbidity, walking aid, falls, urinary incontinence), psychological factors (GDS-15 depression scale, MMSE cognition scale), functional status (Activities of Daily Life (ADL), Instrumental ADL (IADL)), social factors (children, marital status), and life style factors (smoking, alcohol use). Univariate and multivariate logistic regression analyses, adjusted for age and sex and all other risk factors were performed to identify correlates of malnutrition (MNA Prevalence of malnutrition and risk for malnutrition were 17% and 58%. Depression, being IADL dependent, and smoking were independently associated with an increased risk of malnutrition with OR's (95%CI) of 2.6 (1.3-5.3), 2.8 (1.3-6.4), 5.5 (1.9-16.4) respectively. Alcohol use was associated with a decreased risk (OR 0.4 (0.2-0.9)). Malnutrition is highly prevalent among geriatric outpatients and is independently associated with depressive symptoms, poor functional status, and life style factors. Our results emphasize the importance of integrating nutritional assessment within a comprehensive geriatric assessment. Future longitudinal studies should be performed to examine the effects of causal relationships and multifactorial interventions. Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  13. Dissociative disorders in a psychiatric institute in India--a selected review and patterns over a decade.

    Science.gov (United States)

    Chaturvedi, Santosh K; Desai, Geetha; Shaligram, Deepika

    2010-09-01

    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.

  14. Psychiatric disorders in myasthenia gravis

    Directory of Open Access Journals (Sweden)

    Mariana Inés Ybarra

    2011-04-01

    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.

  15. The cerebellum and psychiatric disorders

    Directory of Open Access Journals (Sweden)

    Joseph ePhillips

    2015-05-01

    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.

  16. [Qualitative methods in psychiatric research].

    Science.gov (United States)

    Sikorski, Claudia; Glaesmer, Heide

    2011-01-01

    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.

  17. [THE CLINICAL ORGANIZATIONAL SUBSTANTIATION OF NEW TECHNOLOGY OF HOSPITAL PSYCHIATRIC CARE].

    Science.gov (United States)

    Podsevatkin, V G; Blinov, D S; Podsevatkin, D V; Podsevatkina, S V; Smirnova, O A

    2015-01-01

    The new technology of hospital psychiatric care, developed and implemented in the Mordovia republican clinical hospital, permits resolving problems of hospitalism, lethality, pharmaceutical resistance and others. The essence of this technology is in staging of hospital care under condition of intensification and standardization of curative diagnostic process, implementation of complex approach to treatment of psychiatric disorders. The patient sequentially passes through three stages: intensive diagnostics and intensive treatment (intensive care department, intensive therapy department), supportive therapy (general psychiatric department); rehabilitation measures (curative rehabilitative department). The concentration of resources at the first stage, application of intensive therapy techniques permit in the shortest period to arrest acute psychotic symptomatic. The described new technology of hospital psychiatric care permits enhancing effectiveness of treatment, significantly shorten period of hospitalization (37.5 days), to obtain lasting and qualitative remission, to rehabilitate most fully social working status of patient and to significantly decrease lethality.

  18. A template for reducing ophthalmology outpatient waiting times: community ophthalmic care.

    Science.gov (United States)

    Goetz, R K; Hughes, F E; Duignan, E S; O'Neill, E C; Connell, P P; Fulcher, T P; Treacy, M P

    2018-02-01

    Through an Irish Health Service Executive (HSE) initiative to tackle excessive hospital outpatient waiting times, 996 patients referred to the Ophthalmology Outpatient Department (OPD) of the Mater Misericordiae University Hospital (MMUH), Eccles Street, Dublin 7, Ireland, were outsourced to a community medical eye clinic (CMEC) for consultation with specialist-registered ophthalmologists. The study aims to determine if patients referred as routine to the OPD department could be managed in a community setting. 996 patients were reviewed in the CMEC, and their data was collected and placed into a spreadsheet for analysis. 61.2% of patients referred to the OPD were fully managed in the community clinic, and 34.9% required ophthalmic surgery in hospital. By facilitating direct listing of some of the surgical patients to the hospital theatre list, 89.8% of the 996 referrals received treatment without needing to attend the hospital outpatients department.

  19. Prevalence, comorbidities and outpatient treatment of anorexia and bulimia nervosa in German children and adolescents.

    Science.gov (United States)

    Jaite, Charlotte; Hoffmann, Falk; Glaeske, Gerd; Bachmann, Christian J

    2013-06-01

    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.

  20. Stigma experienced by persons under psychiatric care.

    Science.gov (United States)

    Struch, Naomi; Levav, Itzhak; Shereshevsky, Yechiel; Baidani-Auerbach, Alona; Lachman, Max; Daniel, Noga; Zehavi, Tali

    2008-01-01

    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.

  1. EARLY INTERVENTION PROGRAM FOR PSYCHOTIC DISORDERS AT THE PSYCHIATRIC HOSPITAL ''SVETI IVAN

    OpenAIRE

    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

    2012-01-01

    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...

  2. [Counselling versus a self-help manual for tinnitus outpatients: a comparison of effectiveness].

    Science.gov (United States)

    Konzag, T A; Rübler, D; Bloching, M; Bandemer-Greulich, U; Fikentscher, E; Frommer, J

    2006-08-01

    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.

  3. [Women in outpatient treatment for alcohol abuse: sociodemographic and clinical characteristics].

    Science.gov (United States)

    Esper, Larissa Horta; Corradi-Webster, Clarissa Mendonça; Carvalho, Ana Maria Pimenta; Furtado, Erikson Felipe

    2013-06-01

    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.

  4. Use of VA and Medicare services by dually eligible veterans with psychiatric problems.

    Science.gov (United States)

    Carey, Kathleen; Montez-Rath, Maria E; Rosen, Amy K; Christiansen, Cindy L; Loveland, Susan; Ettner, Susan L

    2008-08-01

    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.

  5. Rabeprazole and psychiatric symptoms.

    Science.gov (United States)

    Polimeni, Giovanni; Cutroneo, Paola; Gallo, Adele; Gallo, Salvatore; Spina, Edoardo; Caputi, Achille P

    2007-07-01

    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.

  6. Outpatient treatment for acute uncomplicated diverticulitis

    NARCIS (Netherlands)

    Ünlü, Çagdas; Gunadi, Patrick M.; Gerhards, Michael F.; Boermeester, Marja A.; Vrouenraets, Bart C.

    2013-01-01

    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

  7. Predictors of readmission after outpatient plastic surgery.

    Science.gov (United States)

    Mioton, Lauren M; Buck, Donald W; Rambachan, Aksharananda; Ver Halen, Jon; Dumanian, Gregory A; Kim, John Y S

    2014-01-01

    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.

  8. Lesion procedures in psychiatric neurosurgery.

    Science.gov (United States)

    Patel, Shaun R; Aronson, Joshua P; Sheth, Sameer A; Eskandar, Emad N

    2013-01-01

    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.

  9. Tics, ADHD and Psychiatric Comorbidity

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2002-06-01

    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.

  10. Tics, ADHD and Psychiatric Comorbidity

    OpenAIRE

    J Gordon Millichap

    2002-01-01

    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.

  11. Psychiatric disorders in the elderly.

    Science.gov (United States)

    Skoog, Ingmar

    2011-07-01

    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.

  12. Psychiatric patients' perspectives of student involvement in their care.

    Science.gov (United States)

    Öster, Caisa; Bäckström, Susan; Lantz, Ingrid; Ramklint, Mia

    2015-04-03

    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.

  13. [Compulsory referral to institutionalised psychiatric care and its organizational structure].

    Science.gov (United States)

    Gollmer, E

    1998-11-01

    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.

  14. Psychiatric emergencies (part II): psychiatric disorders coexisting with organic diseases.

    Science.gov (United States)

    Testa, A; Giannuzzi, R; Sollazzo, F; Petrongolo, L; Bernardini, L; Dain, S

    2013-02-01

    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

  15. The Association between Psychiatric Disorders and Quality of Life of Patient with Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    Olusegun Baiyewu

    2007-05-01

    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.

  16. Psychiatric disorders after epilepsy diagnosis: a population-based retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Hsiu-Ju Chang

    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.

  17. Psychiatric aspects of induced abortion.

    Science.gov (United States)

    Stotland, Nada L

    2011-08-01

    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.

  18. Ethnic diversity outpatient clinic in paediatrics

    Directory of Open Access Journals (Sweden)

    Dahhan Nordin

    2012-01-01

    Full Text Available Abstract 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 was integrated in the general Paediatric Outpatient Departments (POPD of three hospitals in Amsterdam. Methods Feasibility of the MOC, factors influencing the health care process and encountered bottlenecks in health care were studied in ethnic minority children with asthma, diabetes type 1 or metabolic disease originating from Morocco, Turkey and Surinam. Feasibility was determined by the number of patients attended, support from the paediatric medical staff and willingness of the patients to participate. Influences on the health care process comprised parents' level of knowledge of disease, sense of disease severity, level of effort, linguistic skills, health literacy, adherence to treatment and encountered bottlenecks in the health care process. Moreover, the number of admissions and visits to the POPD in the years before, during and after the MOC were analysed. Results In 2006 a total of 189 ethnic minority children were seen. Integration of the MOC within the general POPD of the hospital is feasible. The ability of the parents to speak and understand Dutch was found to be 58%, functional health literacy was 88%; sufficient knowledge of disease and sense of disease severity were 59% and 67%, respectively. The main bottlenecks in the healthcare process: poor knowledge of disease, limited sense of disease severity and low health literacy in the parents proved to be the best predictors for decreased adherence. After attending the MOC there was a decrease in the number of admissions and visits to the POPD for asthma while the number of visits increased in patients with diabetes and the amount of no-shows decreased in patients with a metabolic

  19. acute psychiatric readmissions

    African Journals Online (AJOL)

    Department of Psychiatry, Maudsley Hospital, London). Centre for Health Policy, University of the Witwaters- rand, Johannesburg. International trends have seen a policy shift from chronic psychi- atric institutions and long hospital admissions towards acute, short hospital stays and community-based care. Following this ...

  20. Does Primary Care Mental Health Resourcing Affect the Use and Costs of Secondary Psychiatric Services?

    Directory of Open Access Journals (Sweden)

    Minna Sadeniemi

    2014-08-01

    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.

  1. Associations between problematic gaming and psychiatric symptoms among adolescents in two samples.

    Science.gov (United States)

    Vadlin, Sofia; Åslund, Cecilia; Hellström, Charlotta; Nilsson, Kent W

    2016-10-01

    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.

  2. Childhood physical abuse in outpatients with psychosomatic symptoms

    Directory of Open Access Journals (Sweden)

    Kubo Chiharu

    2008-03-01

    Full Text Available Abstract Background In Japan and Asia, few studies have been done of physical and sexual abuse. This study was aimed to determine whether a history of childhood physical abuse is associated with anxiety, depression and self-injurious behavior in outpatients with psychosomatic symptoms. Methods We divided 564 consecutive new outpatients at the Department of Psychosomatic Medicine of Kyushu University Hospital into two groups: a physically abused group and a non-abused group. Psychological test scores and the prevalence of self-injurious behavior were compared between the two groups. Results A history of childhood physical abuse was reported by patients with depressive disorders(12.7%, anxiety disorders(16.7%, eating disorders (16.3%, pain disorders (10.8%, irritable bowel syndrome (12.5%, and functional dyspepsia(7.5%. In both the patients with depressive disorders and those with anxiety disorders, STAI-I (state anxiety and STAI-II (trait anxiety were higher in the abused group than in the non-abused group (p In the patients with depressive disorders, the abused group was younger than the non-abused group (p Conclusion A history of childhood physical abuse is associated with psychological distress such as anxiety, depression and self-injurious behavior in outpatients with psychosomatic symptoms. It is important for physicians to consider the history of abuse in the primary care of these patients.

  3. Incidence of eating disorders in Danish psychiatric secondary healthcare 1970-2008

    DEFF Research Database (Denmark)

    Gammelmark, Carina; Jensen, Signe Ow; Plessen, Kerstin J

    2015-01-01

    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...

  4. Outcomes of outpatient management of pediatric burns.

    Science.gov (United States)

    Brown, Matthew; Coffee, Tammy; Adenuga, Paul; Yowler, Charles J

    2014-01-01

    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.

  5. Association Between Bipolar Spectrum Features and Treatment Outcomes in Outpatients With Major Depressive Disorder

    Science.gov (United States)

    Perlis, Roy H.; Uher, Rudolf; Ostacher, Michael; Goldberg, Joseph F.; Trivedi, Madhukar H.; Rush, A. John; Fava, Maurizio

    2013-01-01

    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

  6. Association between bipolar spectrum features and treatment outcomes in outpatients with major depressive disorder.

    Science.gov (United States)

    Perlis, Roy H; Uher, Rudolf; Ostacher, Michael; Goldberg, Joseph F; Trivedi, Madhukar H; Rush, A John; Fava, Maurizio

    2011-04-01

    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

  7. Preliminary Evaluation of Treatment Outcomes at a Military Intensive Outpatient Program.

    Science.gov (United States)

    Hoyt, Tim; Barry, David; Kwon, So Heui; Capron, Claire; De Guzman, Noriko; Gilligan, James; Edwards-Stewart, Amanda

    2017-10-12

    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).

  8. Observational study of outpatients with schizophrenia in the Middle ...

    African Journals Online (AJOL)

    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.

  9. A study of tobacco and substance abuse among mentally ill outpatients in a tertiary care general hospital

    Directory of Open Access Journals (Sweden)

    Anju Gupta

    2016-01-01

    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.

  10. Correlation between Anger and Job Motivation among Psychiatric Nurses in Kashan Psychiatric Hospital

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    Kouchaki E.

    2016-12-01

    Full Text Available Abstract Aims: In general, nurses who work in department of psychiatric are in fact interacting with emotional disorders of patients once providing their care services. higher levels of job motivation and satisfaction can markedly foster service improvement. The aim of this study was to evaluate the correlation between anger and job motivation in nurses of a psychiatric hospital. Instrument & Methods: In this cross-sectional descriptive research in 2014, all 50 psychiatry nurses working at Kargarnejad Hospital of Kashan City, Iran, were entirely studied. A demographical questionnaire, the Anger Multiple Scale and the Job Motivation Scale were used for data gathering. Data were analyzed by SPSS 19 software using Pearson correlation coefficient. Findings: The mean score of anger was 3.01±0.36 and of job motivation was 1.70±0.86. There was a significant relationship between job motivation and the number of family members and conditions of employment of nurses (p=0.001. There was a significant inverse relationship between scores of anger and job motivation of psychiatry nurses of the hospital (r=-0.712; p=0.001. Conclusion: There is a relationship between anger and job motivation in nurses of Kashan Psychiatric hospital.

  11. Who’s Boarding in the Psychiatric Emergency Service?

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    Scott A. Simpson

    2014-09-01

    Full Text Available Introduction: When a psychiatric patient in the emergency department requires inpatient admission, but no bed is available, they may become a “boarder.” The psychiatric emergency service (PES has been suggested as one means to reduce psychiatric boarding, but the frequency and characteristics of adult PES boarders have not been described. Methods: We electronically extracted electronic medical records for adult patients presenting to the PES in an urban county safety-net hospital over 12 months. Correlative analyses included Student’s t-tests and multivariate regression. Results: 521 of 5363 patient encounters (9.7% resulted in boarding. Compared to non-boarding encounters, boarding patient encounters were associated with diagnoses of a primary psychotic, anxiety, or personality disorder, or a bipolar manic/mixed episode. Boarders were also more likely to be referred by family, friends or providers than self-referred; arrive in restraints; experience restraint/ seclusion in the PES; or be referred for involuntary hospitalization. Boarders were more likely to present to the PES on the weekend. Substance use was common, but only tobacco use was more likely associated with boarding status in multivariate analysis. Conclusion: Boarding is common in the PES, and boarders have substantial psychiatric morbidity requiring treatment during extended PES stays. We question the appropriateness of PES boarding for seriously ill psychiatric patients. [West J Emerg Med. 2014;15(6:669-674

  12. PSYCHIATRIC ASPECTS OF HUNTINGTON DISEASE – CASE REPORTS

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    Mirela Batta

    2004-04-01

    Full Text Available Background. Huntington disease occurrs rarely, it can be encountered not only by neurologists and psychiatrists but also by other medical practitioners. Its characteristic features are involuntary movements, cognitive disorders and gradual development of dementia. Diagnosis is given on the basis of these clinical features, positive familial anamnesis, with the laboratory exclusion of other neuropsychiatric diseases and with the help of neuroimaging methods (in particular NMR. The disease can be only confirmed by means of genetic analysis.Patients and methods. In this article, four cases of patients with Huntington disease and diverse psychiatric disorders that were hospitalised at the psychiatric department of the Maribor General Hospital between October 2002 and March 2003 are described. All the patients fulfilled the valid criteria for the diagnosis of Huntington disease. However, they differed according to their accompanying psychiatric psychopathology, age and social problems.Conclusions. The purpose of this article is to draw attention to different psychiatric symptoms and clinical manifestations of Huntington disease that are often misleading in the diagnostic process. In addition, exigency of early diagnostics, guidelines for referrals to genetic testing and psychiatric monitoring of these patients are emphasised.

  13. Stress and satisfaction of family members and independent living skills of psychiatric outpatients

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    Marcos Hirata Soares

    2014-01-01

    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.

  14. Mindfulness-Based Stress Reduction for the Treatment of Adolescent Psychiatric Outpatients: A Randomized Clinical Trial

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    Biegel, Gina M.; Brown, Kirk Warren; Shapiro, Shauna L.; Schubert, Christine M.

    2009-01-01

    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…

  15. Caffeine Use: Association with Nicotine Use, Aggression, and Other Psychopathology in Psychiatric and Pediatric Outpatient Adolescents

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    Catherine A. Martin

    2008-01-01

    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.

  16. A study of psychiatric morbidity in patients of peptic ulcer diseases

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    Jagpal Singh Klair

    2012-01-01

    Full Text Available Aims and Objectives: To study the prevalence of psychiatric morbidity among patients of peptic ulcer disease and to study the patients of peptic ulcer disease with psychiatric morbidity in comparison to patients of peptic ulcer disease without psychiatric morbidity on following variables: sociodemographic variables and attributes/risk factors of peptic ulcer disease. Materials and Methods: Fifty cases of clinically proven acid peptic diseases and 30 cases of the control group were screened in department of General Medicine, outdoor as well as indoor patients. Instruments applied for the purpose of the study were Personal Bio-data Performa (Appendix-I, (SCL- 80 (Appendix-II, Hamilton rating scale for anxiety and depression, (P.S.L.E.; clinical diagnosis of psychiatric disorders was made as per ICD- 10 criteria. Data collected shall be subjected to statistical analysis. Results and Findings: The psychiatric morbidity was significantly (P10 years, compared to 23.80% in patients without psychiatric morbidity. Lastly, 48.27% of patients with psychiatric morbidity had significantly (P<0.01 stronger family history of acid peptic disease compared to 9.52% in patients without psychiatric morbidity. Conclusions: There is a significant relationship between the peptic ulcer disease and the various psychiatric morbidity factors as illustrated from the findings of this study.

  17. Psychiatric conditions associated with bullying.

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    Kumpulainen, Kirsti

    2008-01-01

    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.

  18. OCCUPATIONAL ROLE AFTER PSYCHIATRIC HOSPITALIZATION

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    GH.R GHASSEMI

    2003-03-01

    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.

  19. Cutaneous factitia in elderly patients: alarm signal for psychiatric disorders

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    Chiriac A

    2014-03-01

    Full Text Available Anca Chiriac,1 Liliana Foia,2 Cristina Birsan,1 Ancuta Goriuc,2 Caius Solovan3 1Department of Dermatology, Nicolina Medical Center, Iaşi, Romania; 2Surgical Department, Grigore T Popa University of Medicine and Pharmacy, Iaşi, Romania; 3Department of Dermatology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania Background: The factitious disorders, more commonly known in daily practice as pathomimia, are expressed in dermatology units by skin lesions induced voluntarily by the patient, in order to draw attention of the medical staff and/or the family members. The disorder is often challenging to diagnose and even more difficult to document in front of the patient or relatives. It represents a challenge for the physician, and any attempt at treatment may be followed by recurrence of the self-mutilation. This paper describes two cases of pathomimia diagnosed by dermatologists and treated in a psychiatry unit, highlighting the importance of collaboration in these situations. Patients and methods: Two case reports, describing old female patients with pathomimia, hospitalized in a department of dermatology for bizarre skin lesions. Results: The first case was a 77-year-old female with unknown psychiatric problems and atrophic skin lesions on the face, self-induced for many months, with multiple hospitalizations in dermatology units, with no response to different therapeutic patterns, and full recovery after psychiatric treatment for a major depressive syndrome. The second case was a 61-year-old female patient with disseminated atrophic scars on the face, trunk, and limbs. She raised our interest because of possible psychiatric issues, as she had attempted to commit suicide. The prescription of antidepressants led to a significant clinical improvement. Conclusion: These cases indicate that a real psychiatric disease may be recorded in patients suffering from pathomimia. Therefore, complete psychiatric evaluation in order to

  20. Borderline personality symptomatology and employment disability: a survey among outpatients in an internal medicine clinic.

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    Sansone, Randy A; Butler, Melissa; Dakroub, Hassan; Pole, Michele

    2006-01-01

    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.