Adult Psychiatric Clinic Research Articles

The patient's view of quality in psychiatric outpatient care

The influence of demographic characteristics on patients' ratings of the quality of psychiatric outpatient care has been given little attention in research. The aim of the present study is to elucidate the quality of psychiatric care among outpatients and investigate demographic and clinical factors associated with the way in which this quality is perceived. A sample of 1340 outpatients from 15 general adult psychiatric clinics in Sweden completed the quality in psychiatric care-out-patient (QPC-OP), with a response rate of 71%. The patients' highest ratings were for Encounter; the lowest were for discharge. Most notably, quality of care was rated higher by women, older people, those with a partner, those with a lower educational level and those who were gainfully employed. In regard to visits to the clinic, higher quality of care was associated with shorter waiting time, better information and fewer professions encounters. Older people and those gainfully employed reported better mental health. Thus the QPC-OP was associated with both demographic and clinical factors. In particular, 'wanting to come back to the clinic' was the single strongest predictor of quality.

Psychometric properties of the Quality in Psychiatric Care - Outpatient (QPC-OP) instrument

The purpose of the present study was to test the psychometric properties and dimensionality of the Quality in Psychiatric Care - Outpatient (QPC-OP) instrument, in order to determine whether the model of QPC that is applicable to the inpatient clinic is also applicable to the outpatient clinic, and to briefly describe the patients' perceptions of quality of psychiatric outpatient care. A sample of 1340 outpatients from 15 general adult psychiatric clinics in Sweden participated in the study. A confirmatory factor analysis revealed that the QPC-OP consists of eight dimensions, and has a factor structure largely corresponding to that of the QCP - Inpatient instrument. The internal consistency of the factors was generally acceptable, except in the case of two, where there were not enough items. Thus, the QPC-OP shows adequate psychometric properties. The patients' ratings of quality of care were generally high; the highest rating was for 'encounter' and the lowest for 'discharge'. The quality of discharge was rated as the lowest among the eight dimensions in 14 of the participating outpatient clinics. Thus, this dimension would seem to indicate an important area for improvement. The QPC-OP includes important aspects of patients' assessments of quality of care, and offers a simple and inexpensive way to evaluate psychiatric outpatient care.

Economic Grand Rounds: Predictors of Missed Appointments Over the Course of Child Mental Health Treatment

Although missed appointments in service delivery systems reduce effective case management, clini- cal efficiency, staff morale, and resource utilization, researchers have paid little attention to the impact of missed appointments on patient care. This column presents findings from a study that examined predictors of missed appointments during the course of therapy among 2,903 psychiatric patients between the ages of three and 17. Self-report- ed history of maternal depression proved to be the most powerful predictor. Living more than 30 miles from the clinic and having a parent who was single or never married also predicted missed ap- pointments. (Psychiatric Services 61:657-659, 2010) sufficient notification. Estimates put the missed appointment rate in the range of 30% to 50% for most adult psychiatric clinics (2-5), although lit- tle is known about what factors ac- count for variations in rates across agencies. Given the severe shortage of mental health services nationwide, this substantial loss of clinical capacity has far-reaching implications. Aside from the sheer waste of practitioner and staff time, the failure to adhere to treatment, including appointment nonattendance, can result in a variety of negative patient outcomes. These include higher rates of rehospitaliza- tion and psychiatric deterioration. The few studies on missed appoint- ments in child psychiatric outpatient clinics are limited primarily to initial appointments, rather than to those over the entire course of treatment. These few studies also present highly contradictory findings. For example, although results of some studies sug- gest no age effects, results of others have indicated that older children are more likely to miss initial appoint- ments. Data on sex differences are similarly inconclusive. Some report that females are more likely to miss initial appointments, whereas others dispute that finding. Similar discrep- ancies hold for the factors of race and ethnicity. Missed initial appointments have also been found to be signifi- cantly associated with marital status and with parental opposition to being referred for treatment. Therefore, parent factors likely play an important role in appointment attendance. Because of the somewhat limited body of literature and the inconclu- sive findings regarding a topic as im- portant as missed appointments, we used our computerized clinic man- agement system to analyze a wide va- riety of potential predictors in a large and diverse sample of child patients. For our analysis, we selected factors that have been identified as potential- ly predictive of missed appointments in previous studies. However, we also included variables that have not been considered in prior child psychiatric research, such as the type of treat- ment provided and the distance the family has to travel to the clinic. We sought to add to the previous litera- ture by focusing on missed appoint- ments over the course of treatment. Analysis of missed appointments This column presents data from 2,903

Childhood sexual abuse among outpatients attending adult psychiatric outpatient clinics: a case-control study

Only a few studies have focussed on the importance of routine investigation of childhood sexual abuse in outpatients attending adult psychiatric outpatient clinics. The aim of this study is to explore the association between having a history of childhood sexual abuse (CSA) and attending adult Psychiatric Outpatient Clinics in Trinidad. This was a case-control study conducted in twelve psychiatric outpatient clinics located throughout Trinidad A questionnaire covering demographic, social, and sexual abuse components was administered by semi-structured interview to 566 participants, of whom 242 were cases, 239 were controls and 85 had incomplete questionnaires. The cases were 242 patients attending psychiatric outpatient clinics in Trinidad and the controls were 239 non-physician staffmembers at the clinics. Results were analyzed using the Stastistical Package for the Social Sciences (SPSS) version 10. Chi-square analyses revealed several significant differences between the cases and control group. Sixty-three (26%) cases and 29 (12.1%) controls experienced CSA (p < 0.000). Twenty-five (39.7%) of the CSA cases had their experiences between the ages of 4 to 8 years and 13 (44.8%) of the CSA controls had their experiences between the ages of 9 to 12 (p < 0.01). Twenty-six (41.3%) of the cases and 3 (10.3%) of the controls had been abused at least 5 times (p < 0.000). Seventeen (58.6%) abused CSA controls reported having been sexually abused as a child only once. CSA with both force and manipulation was reported by 30 (47.6%) CSA cases while 6 (20.7%) CSA controls experienced CSA with force and manipulation (p < 0. 025). The abused CSA cases reported having a smaller social network of 2 persons compared to the abused CSA controls who had a social network of more than 4 persons (p < 0. 05). Of the 92 abused participants, 73.9% were women, and only 52.2% had told someone about the CSA. For the majority of CSA cases and CSA controls, the abuse involved one abuser. A positive correlation was established between earlier onset of CSA, repeated abuse (occurring more than 5 times), a limited social network in patients who had CSA and attending adult psychiatric outpatient clinics. Identifying CSA in psychiatric outpatients may lead to early intervention and aid patient management.

Personality factors from the five-factor model of personality that predict dissociative tendencies in a clinical population

This study examined the relation between the five factor model of personality and dissociative tendencies using a heterogeneous clinical population. Thus, 86 psychiatric patients (33 male, 53 female) from a variety of adult psychiatric clinics completed the Dissociative Experiences Scale [Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Diseases, 174, 727–735] and the Revised NEO Personality Inventory [Costa, P. T., & McCrae, R. R. (1992). The revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual. Odessa, FL: Psychological Assessment Resources]. Results indicated that neuroticism, extraversion, and conscientiousness were all significantly correlated with dissociative tendencies. The data provide empirical support for the conceptual relations between dissociative tendencies and personality.

Survey of patient satisfaction in adult psychiatric outpatient clinics

A client satisfaction survey was undertaken in two adult psychiatric outpatient clinics. The anonymous self-report questionnaire covering demographic, setting and satisfaction with service variables was endorsed by 203 participants. The mean age of the subjects was 42.5 ± 19 years, with a small majority (58.6%) of females. Overall satisfaction with psychiatric care was high (79.8%). None of the demographic or setting variables correlated significantly with satisfaction. Psychoeducation was significantly correlated with level of satisfaction with services. These findings further emphasize the importance of psychoeducation by service providers in mental health.

Risperidone-induced ejaculatory dysfunction: a case report

A client satisfaction survey was undertaken in two adult psychiatric outpatient clinics. The anonymous self-report questionnaire covering demographic, setting and satisfaction with service variables was endorsed by 203 participants. The mean age of the subjects was 42.5 ± 19 years, with a small majority (58.6%) of females. Overall satisfaction with psychiatric care was high (79.8%). None of the demographic or setting variables correlated significantly with satisfaction. Psychoeducation was significantly correlated with level of satisfaction with services. These findings further emphasize the importance of psychoeducation by service providers in mental health.

Prospective controlled study of psychiatric out-patient non-attendance. Characteristics and outcome.

Psychiatric clinics have high non-attendance rates and failure to attend may be a sign of deteriorating mental health. To investigate why psychiatric out-patients fail to attend, and the outcome of attenders and non-attenders. Prospective cohort study of randomly selected attenders and non-attenders at general adult psychiatric out-patient clinics. Subjects were interviewed at recruitment and severity of mental disorder and degree of social adjustment were measured. Six and 12 months later their engagement with the clinic and any psychiatric admissions were ascertained. Of the 365 patients included in the study, 30 were untraceable and 224 consented to participate. Follow-up patients were more psychiatrically unwell than new patients. For follow-up patients, non-attenders had lower social functioning and more severe mental disorder than those who attended. At 12-month follow-up patients who missed their appointment were more likely to have been admitted than those who attended. Those who miss psychiatric follow-up out-patient appointments are more unwell and more poorly socially functioning than those who attend. They have a greater chance of drop-out from clinic contact and subsequent admission.

Levels of Dissociation and Histories of Reported Abuse Among Women Outpatients

A total of 99 female patients consecutively admitted to an adult psychiatric outpatient clinic were surveyed about their history of physical and sexual abuse. Sixty-five percent of this sample reported having been physically abused, sexually abused, or both during their lifetimes. Scores on the Dissociative Experiences Scale were significantly higher among those reporting a history of sexual abuse than among those reporting a history of physical abuse or no history of abuse, who did not differ from each other. Dissociative Experiences Scale scores were important predictors of histories of sexual abuse among this sample. The implications of these findings for outpatient evaluation are discussed.

Psychotic disorders diagnosed in adolescence. Outcome at age 30 years.

Fifty-five cases who had been diagnosed in adolescence as suffering from a psychotic condition while attending a child or adult psychiatric clinic were compared with age-, sex- and school-matched cases with respect to various outcome measures at age 30 years. Overall, the outcome for young people who need psychiatric care for psychotic conditions in adolescence appears to be gloomy with respect to psychosocial adjustment. There were clear differences in outcome depending on specific psychosis diagnosis category at the time of original diagnosis. Females tended to have better outcome than males, but differences were small and not conclusive in this respect.

High Rates of Alcohol Use and History of Physical and Sexual Abuse among Women Outpatients

A total of 189 consecutive new women patients were surveyed at an adult psychiatric outpatient clinic which did not have a specific program for the treatment of alcoholics. Twenty-seven patients (14%) reported a history of heavy alcohol consumption measured by scores of 10 or more on the Michigan Alcoholism Screening Test (MAST), but only 16 had a diagnosis of alcohol abuse or alcohol dependence made by a clinician. Those with a self-reported history of physical and/or sexual abuse had significantly higher scores on the MAST than those with no such history. When the first abuse occurred before the age of 18 years and there was no recent reported abuse, the association of abuse and high MAST scores persisted, suggesting that early physical or sexual abuse may be associated with current levels of alcohol use.

Sexual and physical abuse histories and psychiatric symptoms among male psychiatric outpatients

Of 125 consecutive male patients at an adult psychiatric outpatient clinic, 48% reported histories of sexual abuse and/or physical abuse. The mean scores on the global severity index of the SCL-90-R at the first visit were significantly higher for those who reported histories of abuse than for those who had no such history. Childhood abuse also was associated with high levels of psychiatric symptoms in these men.

Factors associated with premature termination from outpatient treatment.

A variety of demographic and clinical data collected on 142 new patients treated in an adult psychiatric outpatient clinic were analyzed to determine factors that discriminated between patients who terminated treatment prematurely during the first eight months of therapy and those who did not. High levels of paranoid ideation, lack of health insurance, and living less than 15 miles from the clinic were significantly associated with premature termination. Those factors were combined with three others--substance abuse, divorced marital status, and absence of fee reduction--in a probit regression model that correctly predicted the incidence of premature termination in 75 percent of the patients. The results suggest that patients who may be at risk for premature termination of outpatient therapy can be identified early in the course of their treatment.

Psychiatric hospital care of children and adolescents in Sweden.

In Sweden in-patient psychiatric care of children and adolescents is in decline. At the same time the out-patient care is increasing. These findings stem from a study of the annual patient statistics provided by the National Board of Health and Welfare. There are considerable differences among the counties in Sweden. In certain counties more than four times as many children and adolescents receive hospital care as in other counties. The distribution between child and adolescent psychiatry and adult psychiatry also varies considerably. However, it is usual that from the age of 18 years care is given in adult psychiatric clinics. Among patients with a diagnosis of psychosis and when compulsory care is necessary, adult psychiatric clinics are also responsible for patients 16 and 17 years old. Care of children at mental hospitals, still common in the 1960's, is nowadays no longer existent. The study is a starting-point for a discussion about how to attain better co-operation between child and adolescent psychiatry and adult psychiatry.

Editor's notes

New Directions for Mental Health ServicesVolume 1979, Issue 3 p. vii-xi Editor's NoteFree Access Editor's notes Alexander S. Rogawski, Alexander S. Rogawski Guest Editor Alexander S. Rogawski is professor, department of psychiatry and the behavioral sciences, University of Southern California School of Medicine and director of the adult psychiatric clinic of the University of Southern California-Los Angeles County Medical Center. For sixteen years he was director of the division of social and community psychiatry at the same department and chief mental health consultant to the department of public social services of the county of Los Angeles.Search for more papers by this author Alexander S. Rogawski, Alexander S. Rogawski Guest Editor Alexander S. Rogawski is professor, department of psychiatry and the behavioral sciences, University of Southern California School of Medicine and director of the adult psychiatric clinic of the University of Southern California-Los Angeles County Medical Center. For sixteen years he was director of the division of social and community psychiatry at the same department and chief mental health consultant to the department of public social services of the county of Los Angeles.Search for more papers by this author First published: 1979 https://doi.org/10.1002/yd.23319790301 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume1979, Issue31979Pages vii-xi ReferencesRelatedInformation

Life stress and psychiatric clinic referral.

A "life stress" scale is applied to the antecedent events motivating 179 patients to seek outpatient psychiatric help. Intake evaluation reports of patients who kept their appointments at the Adult Psychiatric Outpatient Clinic of Vanderbilt University Hospital over a three-month period were reviewed. Almost half of the consecutive new patients indicated that a marriage-related or family-related problem had led them to seek an appointment at the clinic. "Life stress" scales, particularly those developed by Holmes and Rahe and by Paykel, invariably rank undesirable marital and family life events as having high stressful impact. Previous studies have examined life events antecedent to various medical and psychiatric illness, but not the events motivating a patient to seek psychiatric help.

The application of Goldberg's classification rules to parents in a child guidance clinic and in an adult psychiatric clinic

The application of Goldberg's classification rules to parents in a child guidance clinic and in an adult psychiatric clinic

Supervision of the resident's initial interview.

WE wish to report on our experience supervising second-year psychiatric residents who spend six months in adult outpatient work. The setting of our study is the Adult Outpatient Clinic in the Department of Psychiatry, University of Rochester (NY) Medical Center. The Adult Psychiatric Outpatient Clinic was established for those in the community and surrounding counties who cannot afford private care, and affords diagnostic evaluations and therapeutic services of many types. It receives referrals from a variety of sources, and about 25% of the patients are self-referred. A detailed study of our clinic operation has been recently reported.¹ Over the years we have evolved various procedures for evaluating the patients referred to us in an attempt to be more flexible and responsive and offer professional help as quickly as possible. At the present time we employ a triage method of a brief "screening" interview of every new patient by

An Anthropological Study of the Elderly Patient in an Adult Psychiatric Clinic

Back to table of contents Previous article Next article AbstractsNo AccessAn Anthropological Study of the Elderly Patient in an Adult Psychiatric ClinicRalph G. Victor, M.D.Ralph G. VictorSeattle, Wash.Search for more papers by this author, M.D.Published Online:30 Apr 2018https://doi.org/10.1176/appi.psychotherapy.1968.22.2.334AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "An Anthropological Study of the Elderly Patient in an Adult Psychiatric Clinic." American Journal of Psychotherapy, 22(2), pp. 334–335 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - APT - American Journal of Psychotherapy $35.00 Add to cart PPV Articles - APT - American Journal of Psychotherapy Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Volume 22Issue 2 1968, pp. 167–361Pages 334-335 Metrics PDF download History Published online 30 April 2018 Published in print 1 April 1968

A critical look at the community psychiatric clinic.

Adult psychiatric clinics are frequently inefficient in the utilization of personnel. The "team" approach is of little value to the psychiatrist treating a patient; it is rarely used in private practice. Clinic growth spells diminished help to the individual patient. With increased funds available for expansion, it would be cruel to strive to treat the community and fail the individual patient. The patient needs the small clinic and its psychiatrist.