Adult Psychiatric Practice Research Articles

Prescription of psychotropic drugs off label

The review was written based on the analysis of available publications (Pubmed, other Internet resources) on the problem of off-label use of drugs. It reveals the concept of off-label prescribing and discusses modern approaches to the use of off-label drugs in domestic psychiatric and addiction practice. The problems of normative substantiation of prescribing off-label drugs are discussed. It has been established that, despite some progress in this matter, for patients in adult psychiatric practice, the use of off-label therapy is carried out only by decision of the medical commission. The issue of substantiating the prescription of off-label drugs on the basis of scientific and clinical studies and experience in the use of drugs at the legislative level remains relevant.

Measurement-based care training curriculum in psychiatry residency programs: I: Description of the curriculum and demonstration of implementation.

Recent literature shows that most practicing psychiatrists do not receive training in measurement-based care (MBC). Among the primary barriers to MBC implementation are the lack of formal training and curriculums. We present the first comprehensive MBC curriculum for use in adult psychiatric practice, and describe how the curriculum is adapted and implemented in psychiatry residency training programs. The Standard for Clinicians' Interview in Psychiatry (SCIP) was developed as a measurement-based care tool for clinicians' use. The SCIP is the only instrument that includes 18 reliable and validated clinician-rated scales covering most adult psychiatric disorders. The SCIP has simple, unified rules of measurement that apply to the 18 scales. The MBC curriculum includes 2 instruction manuals, 4 didactic lectures, and 12 videotaped interviews. We describe the annual learning and implementation of MBC curriculum in residency programs. The curriculum implementation at West Virginia University and Delaware Psychiatric Center began in 2019 and is ongoing. We present 3 case demonstrations of the implementation of MBC in clinical settings. Comprehensive implementation of MBC curriculum in residency programs has the potential to facilitate research and create a "culture" of MBC in future generations of psychiatrists.

Adult Psychiatric Diagnosis of Niemann-pick Disease Type C (Case Study)

Niemann-Pick disease is a rare, inborn metabolic illness with autosomal recessive inheritance. Its essential characteristic is the disorder of the lysosomal storage of cholesterol, which results in an intracellular accumulation of cholesterol and glycosphingolipoids (the latter are formulated from the former) with consequent cellular lesion. Niemann-Pick disease has three types (A-C), out of which patients suffering from the clinically heterogeneous type C can reach adulthood, and have neuropsychiatric symptoms besides hepatosplenomegaly, so the diagnosis can be identified in the adult psychiatric practice. Among rare diseases, it belongs to those few for which a disease-specific therapy exists. A case with Niemann-Pick disorder Type C identified by us will be referred to. The patient concerned has another rare inborn disease; she has been suffering from Epidermolysis bullosa since infancy. There is no known genetic relationship between the two diseases. In this patient a juvenile form of the NP-C storage disorder has developed, and besides the innate visceral symptoms, neuropsychiatric alterations appeared in the form of learning disabilities. In the beginning, she was treated for attention disorder and specific learning difficulties, then from adolescence for the clinical syndrome of cyclothymia. The first neurological signs also manifested during puberty. The clinical diagnosis of NP-C was made in early adulthood after the recognition of atypical psychotic symptoms and dementia. Besides the symptomatic treatment, we have already been able to start the illness-specific therapy, and now we can show the results of the treatment’s first year.

A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE EFFICACY AND SAFETY OF SODIUM VALPROATE FOR "OFF-LABEL" INDICATIONS IN MENTAL HEALTH

ObjectiveValproate is currently licensed for use in epilepsy and, in mental health practice, for the treatment of acute mania. It is also commonly used for the maintenance treatment of bipolar...

Implementing child‐focused family nursing into routine adult psychiatric practice: hindering factors evaluated by nurses

The aim of this study is to describe nurses' evaluations of factors that are hindering implementation of child-focused family nursing (CF-FN) into adult psychiatric practice. In addition, it explains the nurses' evaluations of the hindering factors related to the hospital organizational structure, the individual nurse, nursing and family. There is an increasing amount of families with dependent children in adult psychiatry. Although these families have long-term benefits from preventive family interventions, implementation of CF-FN is not routine mental health practice. Data were collected via a questionnaire-survey completed by Registered Psychiatric Nurses (n = 223) and practical Mental Health Nurses (n = 88) from 45 adult psychiatric units in five Finnish university hospitals. The response rate was 51%. Family-related factors, such as families' fears and lack of time, were considered as 'most hindering' to CF-FN. Nurses who used a family-centred approach and had further family education considered most of the factors as 'less hindering' in comparison to other nurses. To meet the needs of the families in mental health services, it is essential to develop nursing intervention methods such as CF-FN. There is a need for further education and use of family-centred care to develop this preventive approach. The results of this study could be considered when developing mental health services and family interventions for families with parental mental illness.

Psychotropic Medication: Common Issues From Our Clinical Practice

Since the early 1990s prescriptions of psychotropic medications to the child and adolescent psychiatric population have continued to increase; a substantial majority of youth in psychiatric treatment receive medication. A recent review of changes in the medication prescribing practices of child psychiatrists revealed that, from 1989 to 1994, there was an increase in overall psychotropic medication treatment. Additionally, significant increases in multiple concurrent medication treatments or polypharmacy occurred. The use of antidepressant treatment, particularly the selective serotonin reuptake inhibitors (SSRIs) has seen very rapid increases. This trend has also been observed for stimulants and antipsychotics with similar findings reported in recent studies of primary care practitioners and pediatricians. A recent study evaluated current prescribing patterns of outpatient child and adolescent psychiatrists in 1– to 18–year–olds (n = 1292). In this report, 74% (956 of 1292) of all patients received psychotropic medication, and 50% of these patients (478 of 956) received two or more medications. The most commonly prescribed medications were stimulants, antidepressants, antipsychotics and anticonvulsants. Medications typically used to treat mood disorders became the predominant medication prescribed for both outpatients and inpatients by child psychiatrists in 1994, leading to a proportional decline in prescribed stimulant treatment. This increased prescription of drugs to treat mood disorders and the increased rate of polypharmacy among child psychiatrists mirrors adult psychiatric practice. In our clinical practice, which includes inpatients, outpatients and day treatment at a university hospital, we prescribe medication in the majority of our patients in conjunction with psychoeducation, nutritional counseling, individual and group therapy. We present some of the issues that have arisen with each category of psychotropic medication, as well as our efforts at preventing some and resolving others of these issues. We hope not only to share our approach to using a variety of psychotropic medications, but also to stimulate discussions in similar clinics as to how best to address patient’s needs with rational use of these compounds.

Use of Venlafaxine in Child and Adolescent Psychiatry

Free AccessUse of Venlafaxine in Child and Adolescent PsychiatryE. Jane GarlandE. Jane GarlandSearch for more papers by this authorPublished Online:June 2005https://doi.org/10.1521/capn.8.5.1.22899PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutSuggested ReadingsHornig-Rohan , M., & Amsterdam, J. D. ( 2002). Venlafaxine versus stimulant therapy in patients with dual diagnosis ADD and depression. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 26(3), 585–589. Crossref, Google ScholarKhan , A., Kunz, N. R., Nicolacopoulos, E., Jenkens, L., & Yeung, P. P. ( 2002). Venlafaxine extended release for the treatment of children and adolescents with generalized anxiety disorder (poster) American Psychiatric Association 2002 Annual Meeting, Philadelphia, PA, May 2002 Google ScholarMandoki , M. W., Tapia, M. R., Tapia, M. A., Summer, G. S., & Parker J. L. ( 1997). Venlafaxine in the treatment of children and adolescents with major depression, Psychopharmacol Bulletin, 33, 149–154. Google ScholarOlvera , R. L., Pliszka, S. R., Luh, J., & Tatum, R. (1996). An open trial of venlafaxine in the treatment of attention-deficit/hyperactivity disorder in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 6, 241–250. Crossref, Google ScholarWeller , E. B., Weller, R. A., & Davis, G. P. ( 2000). Use of venlafaxine in children and adolescents: A review of current literature. Depression and Anxiety12(suppl 1), 85–89. (Note: this entire supplement is devoted to excellent research reviews on venlafaxine.) Crossref, Google Scholar Next article FiguresReferencesRelatedDetails Cited byCited by1. Online publication date: Go to citation Crossref Volume 8Issue 5Aug 2003 Information© The Guilford PressPDF download

Use of the Global Assessment of Function scale in learning disability.

The Global Assessment of Function (GAF) scale is widely used in adult psychiatric practice and research but it has not often been used in learning disability, which is inherently more complex. To evaluate the reliability of GAF in the assessment of learning disability. GAF reliability was tested by simultaneous multiple rating of unselected case vignettes (n=19-25) from health professionals of different disciplines, under controlled conditions. Analysis of reliability was made with the intraclass correlation coefficient (R(1)) with separate assessments to determine rater bias and individual performance of raters. The results of three data-sets showed generally poor overall levels of agreement, with R(1) levels of 0.35 and 0.28 and somewhat better levels for current GAF scores (R(1)=0.49). However, a subset of raters was identified that achieved much higher levels (R(1)=0.54 to 0.74). The GAF, in its current format, is not reliable enough to be used in the routine assessment of learning disability. A subgroup of raters, however, have ratings that are, by current biostatistical criteria, sufficiently reliable.

Psychiatric diagnosis in clinical practice: Is comorbidity being missed?

The recognition of comorbidity has important clinical significance. Comorbidity predicts a poorer outcome for patients with depressive and anxiety disorders, and the presence of multiple psychiatric disorders is associated with greater psychosocial impairment. In routine clinical settings, an unstructured interview is typically used to assess patients. However, unstructured interviews may result in missed diagnoses, with potential negative clinical consequences. The goal of the present study was to examine whether diagnostic comorbidity is less frequently identified during a routine clinical evaluation versus a semistructured diagnostic interview. Axis I diagnoses derived from structured and unstructured clinical interviews were compared in two groups of psychiatric outpatients in the same practice setting. Five hundred individuals presenting for an intake appointment to a general adult psychiatric practice underwent a routine unstructured clinical interview. Subsequent to completion of the first study, the method of conducting diagnostic evaluations was changed and 500 individuals were interviewed with the Structural Clinical Interview for DSM-IV Axis I Disorders (SCID). The two groups had similar demographic characteristics and scored similarly on symptom questionnaires. Individuals interviewed with the SCID were assigned significantly more axis I diagnoses than individuals assessed with an unstructured interview. More than one third of the patients interviewed with the SCID were diagnosed with three or more disorders, in contrast to fewer than 10% of the patients assessed with an unstructured interview. Fifteen disorders were more frequently diagnosed in the SCID sample, and these differences occurred across mood, anxiety, eating, somatoform, and impulse-control disorder categories. The results suggest that in routine clinical practice, clinicians underrecognize diagnostic comorbidity. Anxiety, somatoform, and not otherwise specified (NOS) disorders were the most frequently underdetected disorders. The implications of underdiagnosis for the treatment outcome are discussed.

DSM-III-R self-defeating personality disorder criteria evaluated by patients' self-report questionnaire: relationships with other personality disorders and positive predictive powers of the individual criteria.

A self-report questionnaire for DSM-III-R personality disorders (PDs) was completed by 64 patients in adult psychiatric practice and their informants. Various correlations and associations of the number of patients' positive criteria (scores) for the controversial category of self-defeating PD (SDPD) are reported. When evaluated by a patient's self-report, the highest correlations of SDPD scores were with borderline PD in relation to individual PDs, and cluster C in relation to the 3 DSM-III-R PD clusters. Criteria 2 and 7 had positive predictive powers of 0.75 and 0.67 for membership of the subgroup based on scores of 5 or more positive criteria for SDPD. Positive ratings for criterion 5, involving anhedonia, were significantly associated with informants' ratings. SDPD features appear to be present in many psychiatric patients with PD and should be evaluated in PD assessment.

The Minnesota Percepto-Diagnostic Test (MPD) in adult psychiatric practice.

Journal of Clinical PsychologyVolume 29, Issue 2 p. 204-206 Psychodiagnosis: Objective Tests of Ability The Minnesota Percepto-Diagnostic Test (MPD) in adult psychiatric practice T. G. Crookes, T. G. Crookes St. John's Hospital, Aylesbury, EnglandSearch for more papers by this authorJean A. Coleman, Jean A. Coleman St. John's Hospital, Aylesbury, EnglandSearch for more papers by this author T. G. Crookes, T. G. Crookes St. John's Hospital, Aylesbury, EnglandSearch for more papers by this authorJean A. Coleman, Jean A. Coleman St. John's Hospital, Aylesbury, EnglandSearch for more papers by this author First published: April 1973 https://doi.org/10.1002/1097-4679(197304)29:2<204::AID-JCLP2270290214>3.0.CO;2-WCitations: 11AboutPDF 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 No abstract is available for this article.Citing Literature Volume29, Issue2April 1973Pages 204-206 RelatedInformation