Adult Psychiatric Outpatients Research Articles

Prevalence and severity of insomnia in adult outpatients attending Kasralainy Psychiatry and Addiction Treatment Hospital

BackgroundInsomnia is common among patients with psychiatric disorders and affects the clinical presentation and outcomes of the psychiatric disorder. The presentation of insomnia varies according to the type and severity of the psychiatric disorder.ObjectivesThis cross-sectional study aimed to assess the prevalence and severity of insomnia in adult psychiatric outpatients attending Psychiatry and Addiction Medicine Hospital, Faculty of Medicine, Cairo University. The study included 390 patients diagnosed with the following disorders: depressive disorders (n = 126 (32.2%)), anxiety disorders (n = 69 (17.6%)), psychotic spectrum disorders (n = 67 (17.1%)), bipolar and related disorders (n = 50 (12.8%)), trauma and stress-related disorders (n = 46 (11.8%)), obsessive–compulsive disorder (n = 30 (7.7%)), and somatic symptoms disorders (n = 2 (0.5%)). Patients were assessed using the Sleep Disorder Interview, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Global Assessment of Functioning Scale (GAF).ResultsAmong the assessed patients, 314 (80.5%) had insomnia, with a higher prevalence in females (91.5%) compared to males (67.2%). The prevalence of insomnia was 96% in depressive disorders, 97.1% in anxiety disorders, 49.3% in psychotic disorders, and 32% in bipolar and related disorders; while all patients with trauma and stress-related disorders, obsessive–compulsive disorders, and somatic symptoms disorders had insomnia.The severity of insomnia as measured by ISI was positively correlated with the global functioning score (r = 0.341, p = < 0.001) and negatively correlated with the duration of the psychiatric illness (r = − 0.285, p = < 0.001).ConclusionsInsomnia is highly prevalent in outpatients with psychiatric disorders.

Reducing intrusive suicidal mental images in patients with depressive symptoms through a dual-task add-on module: Results of a multicenter randomized clinical trial.

To examine the safety and efficacy of a brief cognitive dual-task (using eye movements) add-on module to treatment as usual (TAU) in reducing the severity and frequency of intrusive suicidal mental images and suicidal ideation. We conducted a single-blind, parallel multicenter randomized trial (No. NTR7563) among adult psychiatric outpatients (N = 91; Mage = 34.4, SD = 13.54; 68% female) with elevated depressive symptoms and experiencing distressing suicidal intrusions in the Netherlands. Primary outcome was the severity (Suicidal Intrusions Attributes Scale) and frequency (Clinical Interview for Suicidal Intrusions) of suicidal mental imagery intrusions at 1-week posttreatment and 3-month follow-up. Primary analysis was intention-to-treat. Between November 27, 2018 and September 13, 2021, 91 patients were included and randomly assigned to intervention group (Cognitive Dual Task Add-on + TAU) (n = 46) or TAU-only (n = 45). Cognitive Dual Task Add-on + TAU had greater reductions in severity (mean difference, -15.50, 95% CI [23.81, -7.19]; p < .001, d = 0.60), and frequency (geometric mean difference, 0.47, 95% CI [0.29, 0.79]; p = .004) of suicidal intrusions over time than TAU-alone. Cognitive Dual Task Add-on + TAU patients also showed lower suicidal ideation over time (p = .008, d = 0.42). There were no significant group differences in reductions in depressive symptoms, rumination, or hopelessness. Four serious adverse events occurred (three Cognitive Dual Task Add-on + TAU; one TAU-only); all unlikely attributable to intervention/trial. Findings provide support for the effectiveness of adding a cognitive dual-task module to the treatment of psychiatric outpatients with elevated depressive symptoms in reducing suicidal intrusions and ideation and can be executed safely. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Association Between Autism and PTSD Among Adult Psychiatric Outpatients.

Autism Spectrum Disorder (ASD) occurs in 1-1.5% of the general population and possibly in up to 20% of psychiatric outpatients. Post Traumatic Stress Disorder (PTSD) occurs at some point in life in 4% of the general population and in 14-20% of psychiatric outpatients. Knowledge about how PTSD manifests in people with ASD is important in order for it to be correctly diagnosed and intervened for. This study investigated the relationship between PTSD and autism among adult psychiatric outpatients (N = 90) of whom 63 had ASD or subthreshold ASD based on DSM-5 criteria. The study group was subjected to in-depth psychiatric assessments using validated instruments. Diagnosis of PTSD was made based on the Mini International Neuropsychiatric Interview (MINI). There was a trend towards PTSD being more common among participants with ASD compared to participants without ASD, although significant differences could not be shown in this small sample. 21% of the ASD group had current PTSD, compared to 4% of the study group without ASD. There were no differences between the groups regarding exposure to trauma. There was a trend towards a relationship between number of autism symptoms and hyperarousal symptoms in PTSD. Conversely, the PTSD symptom of irritability/outbursts of anger, was significantly associated with number of autism symptoms. A subgroup of psychiatric outpatients with ASD also suffer from PTSD. Hyperarousal symptoms are possibly more prevalent in the presentation of PTSD in individuals/patients with ASD compared to those without ASD.

Prevalence and correlates of depression, anxiety and trauma-like symptoms in Chinese psychiatric patients during the fifth wave of COVID-19 pandemic: a cross-sectional study in Hong Kong.

Psychiatric patients are susceptible to adverse mental health outcome during COVID-19 pandemic, but its associated factors are understudied. This observational cross-sectional study aimed to comprehensively examine prevalence and correlates of psychological distress, in terms of depression, anxiety and post-traumatic-stress-disorder (PTSD)-like symptoms, among Chinese adult psychiatric outpatients amidst the peak of fifth COVID-19 wave in Hong-Kong. A total of 415 patients (comprising 246 patients with common-mental-disorders [CMD] and 169 with severe-mental-disorders [SMD]) and 399 demographically-matched controls without mental disorders were assessed with self-rated questionnaires between 28-March and 8-April-2022, encompassing illness profile, mental health symptoms, psychosocial measures (loneliness, resilience, coping styles) and COVID-19 related factors. Univariate and multivariable logistic regression analyses were conducted to determine variables associated with moderate-to-severe depressive, anxiety and PTSD-like symptoms among psychiatric patients. Our results showed that CMD patients had the greatest psychological distress relative to SMD patients and controls. Approximately 40-55% CMD patients and 25% SMD patients exhibited moderate-to-severe depression, anxiety and PTSD-like symptoms. Multivariable regression analyses revealed that female gender, lower educational attainment, single marital status, being housewife, more severe insomnia, psychotic-like symptoms and cognitive complaints, self-harm behavior, lower resilience, avoidance coping, never contracting COVID-19 infection, greater fear of contagion, and longer exposure to pandemic-related information were independently associated with depression, anxiety and/or PTSD-like symptoms in psychiatric patients. Our results affirm increased vulnerability of psychiatric patients toward psychological distress during pandemic. An array of identified correlates facilitates early detection of high-risk psychiatric patients for targeted strategies to minimize pandemic-related negative psychological impact.

Are visual analogue scales valid instruments to measure psychological pain in psychiatric patients?

ObjectiveThe Psychological-Physical-Pain Visual Analogue Scale (PPP-VAS) was thought to probably help in identifying patients at risk of suicide. However, no data on its validity to measure psychological pain was available. Our main aim was to investigate the convergent validity of the PPP-VAS using two well-validated scales of psychological pain, the Orbach and Mikulincer Mental Pain scale (OMMP) and the Holden et al. Psychache Scale. MethodsThis multicentre study recruited a total of 1618 adult psychiatric inpatients and outpatients in Italy. Psychological pain was evaluated using the OMMP, Holden et al., and PPP-VAS scales. Psychiatric status, suicidal status, physical pain, depression, and hopelessness were also assessed. ResultsA structural equation model (SEM) using the items of psychological pain from the PPP-VAS showed that items loaded significantly on the psychological pain factor and showed good fit. Similarly, a second SEM model using the three scales of psychological pain showed acceptable fit and converged into a psychological pain construct. Correlations between the PPP-VAS and depression, hopelessness, and physical pain showed moderate correlations (r = 0.43 to r = 0.67). Finally, psychological pain evaluated with the PPP-VAS was significantly related with recent suicidal ideation in all patients (OR [95 % CI] = 1.07 [1.05, 1.09]) and recent suicide attempts in moderately to severely depressed patients, OR [95 % CI] = 1.01 [1.02, 1.03]. ConclusionThe PPP-VAS showed good psychometric properties in evaluating psychological pain. The characteristics of the PPP-VAS makes this scale a great option for its use in clinical practice to detect patients at risk of suicide.

The prevalence of constipation in adult psychiatric out-patients on clozapine treatment at a regional public hospital in Hong Kong.

To determine the occurrence of constipation in local patients on clozapine treatment, and to compare the demographical and clinical characteristics of patients on clozapine treatment with or without constipation. This is a cross-sectional, observational study. All adult psychiatric out-patients on clozapine treatment attending follow-up at a regional hospital were recruited for clinical interview and medical record review. The Enhanced Asian Rome III Questionnaire (EAR3Q) was used to define patients with constipation. The Bristol Stool Form Scale (BSFS) was used to assess stool form. The Brief Psychiatric Rating Scale-Anchored (BPRS-A) was used to measure psychiatric symptoms. The Brief Medication Adherence Scale (BMAS) was used to assess treatment adherence. Logistic regression was conducted to identify independent associating factors of constipation in patients on clozapine treatment. The prevalence of constipation in patients on clozapine treatment was 26.3%, (95% CI [21.5%, 31.6%]). Independent associating factors included disorder of psychological development (aOR=6.98, 95% CI [1.24, 39.18]), anxiety (very mild: aOR=9.23, 95% CI [2.59, 32.87]; mild: aOR=2.66, 95% CI [1.26, 5.62]), prescription with combination of laxatives (aOR=0.40, 95% CI [0.17, 0.95]), and concomitant use of amisulpride (aOR=2.52, 95% CI [1.09, 5.82]), quetiapine (aOR=5.92, 95% CI [1.11, 31.56]) and metamucil (aOR=9.30, 95% CI [1.53, 56.58]). This study examined the prevalence of clozapine-associated constipation in Hong Kong using a validated questionnaire. The identification of independent factors associated with constipation could facilitate better risk stratification and risk modification in clinical practice.

The temporal association between religious/spiritual struggles and anxiety symptoms: A longitudinal study of psychiatric outpatients

BackgroundAnxiety disorders like Generalized Anxiety Disorder (GAD) often cooccur with religious/spiritual (R/S) struggles, but the temporal association between anxiety symptoms and R/S struggles has not been studied in many clinical samples. The current longitudinal study examines this association in a sample at high risk for elevated anxiety and R/S struggles—adult psychiatric outpatients. MethodsAfter their initial psychiatrist evaluation at a U.S. group practice, 163 outpatients completed measures of R/S struggles, anxiety symptoms, depressive symptoms, and religiousness. The analytic sample (N = 120; 77.9% T1 retention) completed these measures 6-months and 12-months later (T2 and T3). ResultsPatients exhibited high baseline rates of anxiety symptoms (72.5% met likely criteria for GAD) and R/S struggles (59.2% reported high levels of at least one R/S struggle subtype), yet they demonstrated small-to-moderate decreases in anxiety, depression, and R/S struggles over time. Controlling for sociodemographics and baseline struggles, anxiety, and depression, there was a bidirectional association between T2/T3 overall R/S struggles and T3/T2 anxiety symptoms. T2 moral and ultimate-meaning struggles were related to higher T3 anxiety symptoms, and T2 anxiety symptoms were related to higher T3 demonic struggles. LimitationsResults may have been impacted by attrition, selection bias, maturation, and statistical regression. Findings need replication in larger, more diverse samples and in other countries, treatment settings, and clinical populations. ConclusionsAdult psychiatric outpatients are at high risk for R/S struggles, and these struggles are important to assess and address in their mental health treatment. Moral, ultimate-meaning, and demonic struggles may be most anxiety-relevant.

Sleep quality of adult psychiatric outpatients at Chris Hani Baragwanath Academic Hospital.

Sleep disorders are increasingly prevalent among the general population and individuals with mental disorders. However, little research has focused on the sleep quality of psychiatric patients beyond depression, despite its relevance in diagnostic criteria. This study aimed to assess overall sleep quality in psychiatric outpatients and to assess for an association with socio-demographic variables. This study took place at the adult psychiatric outpatient department of Chris Hani Baragwanath Academic Hospital. A cross-sectional study design was employed to evaluate overall sleep quality using the self-administered Pittsburgh Sleep Quality Index (PSQI), a validated tool. The PSQI yields a global score ranging from 0 to 21, with scores of 5 or greater indicating poor sleep quality. Eligibility was determined through structured clinical interviews and data obtained from participant records. Poor sleep quality was found in 50% of participants. Sleep quality did not differ significantly based on sex or age. Subscale analysis revealed reduced sleep duration and efficiency, nocturnal disturbances and daytime dysfunction. Additionally, 38% of participants required pharmacological intervention for sleep issues, despite lacking a diagnosis of primary or comorbid sleep disorders. Half of the psychiatric outpatients experienced poor sleep quality, irrespective of socio-demographic factors, psychiatric diagnosis, symptom remission or medication type. This study highlights the importance of addressing sleep disturbances as comorbid conditions in psychiatric patients. Comprehensive evaluation and management of sleep quality can lead to improved patient outcomes and quality of life.

Factors influencing concentrations of risperidone and 9-hydroxyrisperidone in psychiatric outpatients taking immediate-release formulations of risperidone.

To analyze the factors affecting the concentrations of the active moiety of risperidone (RIS) and its active metabolite 9-hydroxyrisperidone (9-OH-RIS) in psychiatric outpatients taking immediate-release formulations. This is a retrospective study on the therapeutic drug monitoring (TDM) data regarding RIS and 9-OH-RIS in adult psychiatric outpatients. TDM data with simultaneous RIS and 9-OH-RIS monitoring from March 2018 to February 2020 and relevant medical records (including dosage, dosage form, sex, age, diagnosis, combined medication, and comorbid disease) from 399 adult psychiatric outpatients (223 males and 176 females) were included in this study. The daily dose of RIS was 5.56±2.05mg, the concentration of total active moiety was 42.35±25.46ng/mL, and the dose-adjusted plasma concentration (C/D) of active moiety was 7.83±3.87 (ng/ml)/(mg/day). Dose, sex, and age were identified as important factors influencing concentrations of RIS and 9-OH-RIS in adult psychiatric outpatients. Individualized medication adjustments should be made according to the specific conditions of psychiatric outpatients. The findings strongly support the use of TDM to guide dosing decisions in psychiatric outpatients taking RIS.

Autism in adult psychiatric out-patients: self-reported suicidal ideation, suicide attempts and non-suicidal self-injury.

The prevalence of self-reported suicidal ideation, suicide attempts and non-suicidal self-injury (NSSI) remains unclear among adults with autism unrecognised in childhood who attend psychiatric services. We aimed to estimate the prevalence of suicidal ideation, suicide attempts and NSSI; identify factors associated with suicide attempts and NSSI; and describe NSSI in this group. Sixty-three new patients at an adult psychiatric out-patient clinic (57% women, mean age 32 years) who met full (n = 52) or subthreshold (two A criteria and minimum of two B criteria; n = 11) DSM-5 criteria for autism spectrum disorder were included in the study. Clinical assessments included overall diagnostic review, Paykel's questions on passive and active suicidality, evaluation of NSSI with the Functional Assessment of Self-Mutilation, and results of cognitive tests. One follow-up of medical records was made. In this sample of psychiatric out-patients identified as first having autism in adulthood, almost a third (31%) of patients reported suicidal ideation during the past month, 86% had lifetime suicidal ideation and 25% reported at least one suicide attempt. Factors associated with suicide attempts included hazardous or harmful alcohol use and/or drug-related problems, and severity of depression. A total of 44% reported NSSI. Factors associated with NSSI were female sex, history of suicidal plans and antisocial personality disorder. Substance or alcohol use were often overlooked, especially in women. Suicidal ideation, suicide attempts and NSSI were very common in adults with autism who were recently referred to an out-patient psychiatric service. Suicidal ideation and NSSI were more common than suicide attempts. Clinicians should always consider suicidal ideation and NSSI in adult psychiatric patients with autism.

Religious/Spiritual Struggles and Suicide Ideation Among Adult Psychiatric Outpatients: A 12-Month Longitudinal Study

BackgroundInitial empirical evidence links religious/spiritual (R/S) struggles to suicide ideation. However, few longitudinal studies have examined the temporal associations of R/S struggles and suicide ideation, and none have focused on treatment-seeking individuals. This study addresses these gaps. MethodsWe assessed suicide ideation and six subtypes of R/S struggles in a sample of adult psychiatric outpatients (N = 120) at their initial psychiatry appointment (T1), 6-month follow-up (T2), and 12-month follow-up (T3). Following the analytic template for outcome-wide longitudinal designs, separate linear regression models tested the association of (a) T2 R/S struggle subtypes with T3 suicide ideation and (b) T2 suicide ideation with T3 R/S struggle subtypes. All models adjusted for salient demographics, organizational and nonorganizational religiousness, depression symptoms, T1 suicide ideation, and prior values of all six R/S struggle subtypes. ResultsRobust evidence supported a positive bidirectional temporal association between suicide ideation and ultimate-meaning R/S struggles, but not other R/S struggle subtypes. LimitationsWe recruited a relatively small sample that was geographically, racially, and socioeconomically homogenous. We also relied solely on self-report data. ConclusionsFindings highlight the importance both of assessing ultimate-meaning R/S struggles as part of suicide risk assessment and of using clinical interventions that nurture adult psychiatric patients’ sense of ultimate meaning.

Diagnostic Utility of Four Brief Korean Versions of the PTSD Checklist for DSM-5 in Adult Psychiatric Outpatients

Diagnostic Utility of Four Brief Korean Versions of the PTSD Checklist for DSM-5 in Adult Psychiatric Outpatients

Circadian Activity Rhythms and Psychopathology in Major Depressive Episodes

Background: Identifying suicidal risk based on clinical assessment is challenging. Suicidal ideation fluctuates, can be downplayed or denied, and seems stigmatizing if divulged. In contrast, vitality is foundational to subjectivity in being immediately conscious before reflection. Including its assessment may improve detection of suicidal risk compared to relying on suicidal ideation alone. We hypothesized that objective motility measures would be associated with vitality and enhance assessment of suicidal risk. Methods: We evaluated 83 adult-psychiatric outpatients with a DSM-5 bipolar (BD) or major depressive disorder (MDD): BD-I (n = 48), BD-II (20), and MDD (15) during a major depressive episode. They were actigraphically monitored continuously over 3 weekdays and self-rated their subjective states at regular intervals. We applied cosinor analysis to actigraphic data and analyzed associations of subjective psychopathology measures with circadian activity parameters. Results: Actigraphic circadian mesor, amplitude, day- and nighttime activity were lower with BD versus MDD. Self-rated vitality (wish-to-live) was significantly lower, self-rated suicidality (wish-to-die) was higher, and their difference was lower, with BD versus MDD. There were no other significant diagnostic differences in actigraphic sleep parameters or in self-rated depression, dysphoria, or anxiety. By linear regression, the difference between vitality and passive suicidal ideation was strongly positively correlated with mesor (p < 0.0001), daytime activity (p < 0.0001), and amplitude (p = 0.001). Conclusions: Higher circadian activity measures reflected enhanced levels of subjective vitality and were associated with lesser suicidal ideation. Current suicidal-risk assessment might usefully include monitoring of motility and vitality in addition to examining negative affects and suicidal thinking.

Changes in patterns of alcohol consumption in young psychiatric outpatients: two comparable samples assessed with 10 years apart

Aims Over the past 20 years, a trend towards non-drinking and less use of alcohol has been reported among young adults. This study aimed to investigate if a similar trend in alcohol consumption can be seen among young adult psychiatric outpatients. Methods This was a cross-sectional study based on two comparable samples of young adult (18–25 years) psychiatric outpatients recruited approximately 10 years apart in 2002–2003 (N = 197) and 2012–2016 (N = 380). The Swedish version of the Alcohol Use Disorders Identification Test (AUDIT) was used to assess alcohol consumption. Psychiatric diagnoses were based on diagnostic interviews. Differences between the two samples in alcohol consumption and a number of alcohol-use disorder diagnoses were analysed. Cramer’s V was chosen as the effect size measure. Results Mean AUDIT scores and prevalence of diagnosed alcohol-use disorder in the two samples did not differ significantly. The number of non-drinkers was larger among patients in the mid-2010s (15.8% vs. 8.1%; χ2 = 6.76, p < 0.01, Φ = 0.11), but when non-drinkers were excluded, the alcohol consumption was higher among females in the later sample. Conclusion The mean level of alcohol consumption seems not to have changed to the same extent among young psychiatric patients as in the general population. However, some young psychiatric patients have followed the trend of non-drinking, while others consume more alcohol. Further studies on both non-drinking and high alcohol consumption in psychiatric patients are needed to understand their mechanisms.

Botulinum Toxin Therapy for Psychiatric Disorders in Clinical Practice: A Retrospective Case Study.

Inhibiting the facial expression of negative emotions via botulinum toxin A (BTX) has been shown to mitigate symptoms of clinical depression in randomized controlled trials. This retrospective case study sought to reproduce the beneficial effects of BTX in a naturalistic setting for major depressive disorder and collect casuistic data on its effect on other mental disorders. Moreover, we describe symptom development across multiple treatment cycles with BTX, and assess the implementation of additional injection targets in the lower face region. Participants were N = 51 adult psychiatric outpatients mainly seeking treatment for depression. Over 50% suffered from comorbid psychiatric conditions, predominantly generalized anxiety disorder (GAD) or borderline personality disorder (BPD). A pre-post case series design was adapted. All participants received BTX-injections in the glabellar region on at least one occasion. Some received additional injections in the mouth region and over multiple treatment cycles. Treatment response was followed up by self-rated scales at varying time intervals post treatment. The results showed that BTX may yield favorable outcomes across multiple and comorbid mental disorders, especially, however, for patients suffering from depression. It potentially prevents the recurrence of clinical symptoms if applied regularly. Adding additional regions of the face does not seem to be superior over applying it to the glabellar region alone. The results add to the growing evidence that BTX therapy is effective in alleviating symptoms of depression. Positive effects can be sustained and reinstated, when applied over multiple treatment cycles. Observed symptom reduction in other psychiatric disorders was less pronounced. Further research is needed to understand the mechanisms by which BTX therapy reduces psychiatric symptoms.

The 'lost generation' in adult psychiatry: psychiatric, neurodevelopmental and sociodemographic characteristics of psychiatric patients with autism unrecognised in childhood.

Patients with 'underlying' autism spectrum disorder (ASD) constitute a significant minority in adult out-patient psychiatry. Diagnoses of previously unrecognised ASD are increasing in adults. Characteristics of patients with autism within adult out-patient psychiatry have not been sufficiently explored, and there have not been any systematic comparisons of characteristics between patients with and those without autism within adult out-patient psychiatric populations. To examine psychiatrically relevant characteristics in autistic adult psychiatric out-patients, and to compare the characteristics with non-autistic adult psychiatric out-patients. We assessed 90 patients who were referred to a Swedish psychiatric out-patient clinic and screened for ASD during 2019-2020. Sixty-three patients met the DSM-5 criteria for ASD or 'subthreshold' ASD. The 27 who did not meet the criteria for ASD were used as a comparison group. Assessments were made with structured and well-validated instruments, including parent ratings of developmental history. No differences were found between the groups regarding self-reported sociodemographic variables. The ASD group showed a higher number of co-occurring psychiatric disorders than the non-ASD group (t(88) = 5.17, 95% CI 1.29-2.91, d = 1.19). Functional level was lower in the ASD group (t(88) = -2.66, 95% CI -9.46 to -1.27, d = -0.73), and was predicted by the number of co-occurring psychiatric disorders. The results underscore the need for thorough assessment of psychiatric disorders in autistic patients in adult psychiatric services. ASD should be considered as a possible 'underlying' condition in adult psychiatry, and there is no easy way of ruling out ASD in this population.

The effects of walking in nature on negative and positive affect in adult psychiatric outpatients with major depressive disorder: A randomized-controlled study

BackgroundWhile walking in nature has been shown to improve affect in adults from the community to a greater extent than walking in urban settings, it is unknown whether such benefits apply to individuals suffering from depression. Using a parallel group design, this randomized controlled trial examined the effects of a single walk in nature versus urban settings on negative and positive affect in adult psychiatric outpatients diagnosed with major depressive disorder (MDD). MethodParticipants recruited from a psychiatric outpatient clinic for adults with MDD were randomly assigned to a nature or urban walk condition. Thirty-seven adults (mean age = 49 years) completed a single 60-minute walk. Negative and positive affect were assessed using The Positive and Negative Affect Schedule or PANAS at 6 time points: before the walk, halfway during the walk, immediately post-walk, at home before bedtime, 24 h post-walk, and 48 h post-walk. ResultsControlling for baseline levels of affect before the walk, individuals who walked in nature experienced overall lower levels of negative affect, F(1, 35.039) = 4.239, p = .047, compared to those who walked in urban settings. Positive affect did not differ across walk conditions. LimitationsThe generalizability of results are limited by the small sample size and the presence of more female than male participants. ConclusionsWalking in nature might be a useful strategy to improve negative affect in adults with MDD. Future research should investigate different ways to integrate the beneficial effects of nature exposure into existing treatment plans for psychiatric outpatients with MDD.

Evaluation of a standardized posttraumatic stress disorder treatment framework in routine mental health care: Effectiveness and predictors of treatment outcome in a consecutive sample

The primary aim of the present study was to evaluate the effectiveness of standardized care package (CP) treatment for posttraumatic stress disorder (PTSD) in a Danish sample of adult psychiatric outpatients (N=948). Secondary aims were to identify baseline predictors of treatment outcomes and investigate between-group differences in outcomes with regard to sex and treatment modality (i.e., group vs. individual therapy). The naturalistic, nonrandomized study followed a pre-post design. Patient data from five psychiatric outpatient clinics were collected between March 2011 and November 2017. Data were drawn from self-report questionnaires (i.e., SCL-90-R, WHO-5, BHS) and therapist-reported measures (i.e., GAF-S, GAF-F) administered at baseline and posttreatment. Between-group effects for sex and therapy modality (group vs. individual) were analyzed using analyses of variance, and possible predictors of outcomes were selected through LASSO regression and analyzed via hierarchical regression. Pre-post effects were small to moderate, ds=0.39-0.69. No differences emerged regarding treatment modality, but women had significantly better outcomes than men. Aside from sex, only baseline symptom severity predicted outcomes. The effectiveness of the CP treatment was generally limited, indicating the need to implement improved therapeutic practices, such as the use of evidence-based treatments, and to provide better training to mental health clinicians. The findings underscore the need for further comparisons of group and individual treatment modalities using evidence-based therapies as well as the need to investigate factors that may affect treatment outcome.

Abstract- Poster

Aim:The aim of the study was to compare the Neurocognitive impairment in patients with Alcohol Dependence Syndrome patient and Opioid Dependence Syndrome.Objectives:To compare the difference in the domains of neurocognitive assessment in Alcohol Dependence Syndrome with Opioid Dependence Syndrome.METHODS:Fifty patients each diagnosed either as alcohol dependence syndrome or opioid dependence syndrome were evaluated. The baseline demographic of both the groups were quite comparable according to their age, sex, background education, propensity of having an addiction. Clinical Institute withdrawal assessment for alcohol scale (CIWA-Ar) and clinical opiate withdrawal score (COWS), alcohol use disorders identification test, alcohol severity index was the evaluated at baseline in these patients accordingly. These patients were followed up for a period of one month in the outpatient department and re-evaluated on the same scales after the treatment.RESULTS:PGI-Memory Scale was evaluated for the memory components, there was a significant increase in all the domains from baseline to follow up in both the groups except remote memory which although improved a little but was statistically and clinically insignificant in both the groups. The patients had statistically significant and clinically meaningful improvements in the domains of mental balance, improvements in attention and concentration across both the groups. The retention capacity in the patients also improved after one month of treatment. There was not much reduction in remote memory domain at baseline and thus not much improvement in the same at follow-up. This shows that remote memory is not significantly affected in both alcohol and opioid dependencies.Although improvements were seen from baseline to follow-up individually in both the study groups, there was no statistically significant difference in the follow up scores between the groups. At follow up the memory rating improved and none of the patients in either group had a dysfunctional rating score of three.Conclusion:The study has shown that there is an overall neurocognitive impairment associated with both alcohol addiction as well as opioid dependence at baseline when compared to the general population, but the magnitude of neurocognitive improvement is more in opioid dependence syndrome in this current study at follow up when compared to alcohol dependence patients. Thus, the results support our main hypothesis of higher chances of improvement in cognitive performance with therapy in patients of opioids dependency, evident as early as week four or one month of therapy.A cross-sectional survey was conducted among adult psychiatric outpatients with depressive disorders at a teaching hospital in Kuala Lumpur for 10 months. Sociodemographic and illness-related data were gathered. Two questionnaires, Mood Disorder Insight Scale (MDIS) and Internalized Stigma of Mental Illness Scale (ISMI), were administered.

Associations between clinicians' emotion regulation, treatment recommendations, and patient suicidal ideation.

This study examines how clinicians' emotional responses to suicidal patients and their emotion regulation abilities are related to their treatment recommendations for these patients and to patients' concurrent suicidal ideation and at one-month follow-up. Adult psychiatric outpatients (N=361) and the mental health professionals evaluating them for treatment (N=43) completed self-report assessments following their first clinical meeting. Clinician emotion regulation traits, emotional responses to individual patients, and the recommended intensity of treatment were assessed. Patients were assessed for suicidal ideation immediately following the initial meeting and at a one-month follow-up. Moderation and mediation analyses were performed to examine the relationships between study variables. Patient suicidal ideation at the initial clinical encounter was associated with increased negative emotions in clinicians with lower emotion regulation. Further, recommended treatment intensity was associated with clinicians' negative emotional responses but not with patient suicidal ideation among clinicians with lower emotion regulation. Treatment intensification is related to clinicians' emotion regulation abilities. Clinicians' attention to their emotional responses may facilitate improved treatment process and ultimately may improve suicidal outcomes.