Formal Psychiatric Evaluation Research Articles

Frequency and Characteristics of Depression and Its Association with Diminished Quality of Life in a Cohort of Individuals with Post-Acute Sequelae of COVID-19.

Approximately one-third of COVID-19 survivors will experience persistent symptoms, which may include neurological and psychiatric disturbances. Previous research has suggested that up to 45% of people develop clinically significant depressive symptoms post-COVID. This study sought to determine frequency, symptom profile, and clinical correlates of depression post-COVID. Seventy-five participants who had recovered from COVID-19 underwent neurocognitive, psychiatric, medical, and cognitive testing/screening. The primary measures of interest in this report included the Patient Health Questionnaire (PHQ-9), a 9-item depression-screening tool, and the Endicott Quality of Life Enjoyment and Satisfaction Questionnaire. One-third of study participants screened as positive on the PHQ-9 for clinically significant depression, with the most commonly reported symptom being fatigue, followed by sleep disturbance and poor concentration. Also reported were decreased satisfaction in employment, sexual life, and mood. Depressed patients described greater illness severity during COVID-19 infection and subjective cognitive impairment, which was not found on neurocognitive testing. The only significant predictor of depression was COVID-19 illness severity. A significant portion of participants was a clinical population with specific post-COVID complaints and was predominately comprised of white females. Formal psychiatric evaluation was not performed. Many individuals may experience depression after COVID-19 infection, with symptoms appearing to be predominately somatic in nature and correspond with COVID-19 illness severity.

Anxiety and depression scores in patients subjected to aortic and iliac aneurysm repair procedures.

This study examines the changes in anxiety and depression scores of 84 patients subjected to aortic or iliac aneurysm correction with no previous psychiatric history. Patients were referred to the evaluation using the Beck Anxiety and Depression Inventories no more than 3 days before surgery (i.e., preoperative [Pre-Op]), 30 days after revascularization (i.e., Early postoperative [PO]), and at least 6 months after revascularization (i.e., Late PO). Mean anxiety scores declined from baseline at both the Early (mean difference: 2.75, p<0.001) and Late PO (mean difference: 2.74, p=0.001). The depression levels showed no significant variation in either evaluation (Early PO; mean difference: -0.84, p>0.05, Late PO: 0.87, p=0.05). A more severe degree of anxiety at baseline was related to better anxiety results both in the Early PO (p=0.041) and Late PO (p=0.008). An endovascular technique was related to the improvement in depression symptoms in the Early PO (p=0.01) but the worsening of the symptoms in the Late PO (p=0.033). Patients subjected to aortoiliac aneurysm corrections have a higher incidence of anxiety and depressive symptoms. Anxiety symptoms, but not the depressive ones, improved considerably following the successful treatment. The formal psychiatric evaluation may be beneficial for patients with less improvement in the symptom.

Anxiety and Depression Scores in Patients Subjected to Arterial Revascularization for Critical Limb Ischemia

This study aims to examine the changes in anxiety and depression scores in 138 patients with critical limb ischemia (rest pain or gangrene) who had no previous psychiatric history, at 30 days and 6 months after surgical revascularization. Patients were submitted to a questionnaire-based evaluation using the Beck Anxiety and Depression Inventories before surgery (no more than three days before surgery) ("Pre-Op"), 30 days after surgical revascularization ("Early PO") and at least 6 months after surgical revascularization ("Late PO"). The cut-off scores for depression were (1) < 10, no depression or minimal depression; (2) 10‒18, mild to moderate depression; (3) 19‒29, moderate to severe depression; and (4) 30‒63, severe depression. The cut-off scores for anxiety were (1) < 8, no anxiety or minimal anxiety; (2) 8‒15, mild anxiety; (3) 16‒25, moderate anxiety; and (4) 26‒63, severe anxiety. No perioperative mortality was observed 30 days after surgical revascularization. Thirty-nine (28.2%) patients underwent major (above-ankle) amputation within 30 days. Mean anxiety and depression scores, respectively, declined from 12.48 ± 9.74 (mean ± SD) and 16.92 ± 12.48 preoperatively to 4.89 ± 7.04 and 6.52 ± 9.36 postoperatively (P<0.001, both). Anxiety and depression scores were not significantly affected by preoperative comorbidities (systemic arterial hypertension, diabetes mellitus, previous stroke, and smoking), affected arterial territory (aortoiliac, femoropopliteal, or infrapopliteal), or surgical technique (open surgery vs endovascular therapy). Only patients undergoing amputation within 30 days showed no improvement in depressive symptoms. Patients with critical limb ischemia have a high incidence of anxiety and depressive symptoms, which improve considerably after successful surgical revascularization. Major amputation was associated with a lack of improvement in depression scores. A formal psychiatric evaluation may be beneficial in patients who show no improvement in depressive symptoms.

Brainstem Pathologies Correlate With Depression and Psychosis in Parkinson's Disease

BackgroundThe pathological hallmarks of Parkinson's disease include intraneuronal Lewy bodies, neuronal loss, and gliosis. We aim to correlate Parkinson's disease neuropsychiatric symptoms, (e.g., depression, psychosis, and anxiety) with the severity of neuropathology in the substantia nigra and locus coeruleus. MethodsThe brains of 175 participants with a primary pathologic diagnosis of Parkinson's disease were analyzed semi-quantitatively to ascertain the burden of neuronal loss and gliosis and Lewy body pathology within the locus coeruleus and substantia nigra. Participants’ history of anxiety, depression, and psychosis were determined using a chart-extracted medical history or record of formal psychiatric evaluation. ResultsOf the sample, 56% (n = 98), 50% (n = 88), and 31.25% (n = 55) of subjects had a diagnosis of psychosis, depression, and anxiety, respectively. Psychosis (χ2 = 7.1, p = 0.008, df = 1) and depression (χ2 = 7.2, p = 0.007, df = 1) were associated with severe neuronal loss and gliosis in the substantia nigra but not in the locus coeruleus. No association was observed between anxiety and neuronal loss and gliosis in either region. No neuropsychiatric symptoms were associated with Lewy body score. After controlling for disease duration and dementia, psychosis (odds ratio [OR]: 3.1, 95% confidence interval [CI]: 1.5–6.4, χ2 = 9.4, p = 0.012, df = 1) and depression (OR: 2.6, 95% CI: 1.3–5.0, χ2 = 7.9, p = 0.005, df = 1) remained associated with severe neuronal loss and gliosis in the substantia nigra. ConclusionThese results suggest that psychosis and depression in Parkinson's disease are associated with the underlying neurodegenerative process and demonstrate that cell loss and gliosis may be a better marker of neuropsychiatric symptoms than Lewy body pathology.

Should Pediatric Behavioral Health Issues be Treated by Primary Care Providers?

Should Pediatric Behavioral Health Issues be Treated by Primary Care Providers?

Does the Psychopathology of the Parents Predict the Developmental-Emotional Problems of the Toddlers?

Parental psychopathology has been defined in respect of psychopathological development in early childhood. This study aimed to investigate the effects of parental psychopathologies on social and emotional problems in the age range of 1-3 years and to determine children at risk. The study data were obtained from the 2009 Early Childhood Mental Health Profile taking population distribution into consideration with the properties representing Turkey. The primary caregiver of the child completed the Psychiatric Evaluation Form for 1-3 years, the Brief Infant-Toddler Social Emotional Assessment (BITSEA), the Ages and Stages Questionnaire (ASQ), and the Brief Symptom Inventory (BSI) for themselves. Machine learning models used for prediction. The performance of prediction models was evaluated with the ten-fold cross-validation method. Area Under Curve (AUC) values were calculated with Receiver Operating Characteristic (ROC) curves to evaluate the performance of each model. The evaluation was made of the data of 2775 children, comprising 1507 (54.3%) males and 1268 (45.7%) females with a mean age of 26.19±9.11 months (range, 10-48 months). A total of 106 children were identified as at risk, as they were above the clinical cut-off point (1.5 standard deviations) of the BITSEA points and below the cut-off points of any one of the developmental areas of the ASQ. Modeling was applied to the data of these 106 children. The Support Vector Machines (SVM) model was selected for prediction with the automatically optimized highest AUC value. Weighting for the SVM algorithm showed mothers' BSI scores, fathers' education and health problems, duration of breastfeeding, unplanned pregnancy are significant for predicting BITSEA-problem scores in the model. To be able to understand the complex relationship with parental psychopathology and behavioral problems, machine learning methods were used successfully in this study. Further studies with more massive data sets, more extended follow-up periods, and stronger algorithms will be able to identify risk groups earlier and allow early interventions to be implemented.

Spinal cord stimulation failure: evaluation of factors underlying hardware explantation.

Spinal cord stimulation has been shown to improve pain relief and reduce narcotic analgesic use in cases of complex refractory pain syndromes. However, a subset of patients ultimately undergoes removal of the spinal cord stimulator (SCS) system, presumably because of surgical complications or poor efficacy. This retrospective study addresses the paucity of evidence regarding risk factors and underlying causes of spinal cord stimulation failures that necessitate this explantation. In this retrospective single-center review, 129 patients underwent explantation of SCS hardware during a 9-year period (2005-2013) following initial placement at the authors' institution or elsewhere. Medical history, including indication of implantation, device characteristics, revision history, and reported reasons for removal of hardware, were reviewed. The 74 (57%) women and 55 (43%) men were a median of 49 years old (IQR 41-61 years) at explantation; the median time to explantation was 20 months (IQR 7.5-45.5 months). Thoracic or upper lumbar leads were placed in 89.9% of patients primarily for the diagnosis of postsurgical failed-back surgery syndrome (70.5%), chronic regional pain syndrome (14.7%), and neuropathic pain (8.5%). More than half of patients were legally disabled. Initial postoperative reduction in pain was reported in 81% of patients, and 37.8% returned to work. Among 15 patients with acute postsurgical complications (12 infections, 2 hemorrhages, 1 immediate paraplegia), the median time to removal was 2 months. Primary reasons for hardware removal were lack of stimulation efficacy (81%), electrode failure due to migration (14%), and allergic reactions to implanted hardware in 2 patients. The 72 patients who underwent formal psychiatric evaluation before implantation were affected by high rates of major depression (64%), anxiety (34%), posttraumatic stress disorder (PTSD) (12%), drug or alcohol abuse (12%), and physical or sexual abuse (22%). The authors' findings provide insight regarding the mechanisms of spinal cord stimulation failure that resulted in total removal of the implanted system. The relationship between spinal cord stimulation failure and certain psychiatric disorders, such as PTSD, depression, and anxiety, is highlighted. Ultimately, this work may shed light on potential avenues to reduce morbidity and improve patient outcomes.

A novel, homozygous mutation in desert hedgehog (DHH) in a 46, XY patient with dysgenetic testes presenting with primary amenorrhoea: a case report

BackgroundDesert hedgehog (DHH) mutations have been described in only a limited number of individuals with 46, XY disorders of sex development (DSD) presenting as either partial or complete gonadal dysgenesis. Gonadal tumours and peripheral neuropathy have been associated with DHH mutations. Herein we report a novel, homozygous mutation of DHH identified through a targeted, massively parallel sequencing (MPS) DSD panel, in a patient presenting with partial gonadal dysgenesis. This novel mutation is two amino acids away from a previously described mutation in a patient who presented with complete gonadal dysgenesis. Adding to the complexity of work-up, our patient also expressed gender identity concern.Case presentationA 14-year-old, phenotypic female presented with primary amenorrhoea and absent secondary sex characteristics. Investigations revealed elevated gonadotrophins with low oestradiol, testosterone of 0.6 nmol/L and a 46, XY karyotype. Müllerian structures were not seen on pelvic ultrasound or laparoscopically and gonadal biopsies demonstrated dysgenetic testes without neoplasia (partial gonadal dysgenesis). The patient expressed gender identity confusion upon initial notification of investigation findings. Formal psychiatric evaluation excluded gender dysphoria. Genetic analysis was performed using a targeted, MPS DSD panel of 64 diagnostic and 927 research candidate genes. This identified a novel, homozygous mutation in exon 2 of DHH (DHH:NM_021044:exon2:c.G491C:p.R164P). With this finding our patient was screened for the possibility of peripheral neuropathy which was not evident clinically nor on investigation. She was commenced on oestrogen for pubertal induction.ConclusionThe evaluation of patients with DSD is associated with considerable psychological distress. Targeted MPS enables an affordable and efficient method for diagnosis of 46, XY DSD cases. Identifying a genetic diagnosis may inform clinical management and in this case directed screening for peripheral neuropathy. In addition to the structural location of the mutation other interacting factors may influence phenotypic expression in homozygous DHH mutations.

Assessment of language disorders in low birth weight children

Abstract The aim of the study was to determine the size and distribution of language disorders among low birth weight (LBW) children to devise a plan for early detection, proper assessment, intervention, and prevention of these problems if possible. Eighty children were included in this study. The study group consisted of 50 children with a history of LBW, 31 boys and 19 girls, with a mean age of 4.3 ± 1.6 years. The control group consisted of 30 children with a history of normal birth weight, 13 boys and 17 girls, with a mean age of 5.1 ± 1.3 years. Children in the two groups were statistically matched in their age and sex distribution. All participant children were subjected to an interview, general examination, vocal tract examination, neurological examination, ENT examination, evaluation of various aptitudes by formal testing, psychiatric evaluation, audiological examination, and language evaluation using the Arabic Preschool Language Scale-4. The results from this study revealed that LBW in addition to poor neonatal outcome and prematurity was an important risk factor for poor language abilities in children. Early consultation is recommended for LBW children with high risk factors in order to facilitate early detection and proper management of language disorders.

Psychiatric symptoms are present in most of the patients with idiopathic normal pressure hydrocephalus.

Normal pressure hydrocephalus (NPH) is characterized by gait disturbance, dementia and/or urinary incontinence associated with dilation of ventricular system with normal opening cerebrospinal fluid pressure. Wide scientifical evidence confirms association between NPH and psychiatric symptoms. We selected 35 patients with idiopathic normal pressure hydrocephalus from January 2010 to January 2012 in a Brazilian tertiary hospital and performed a formal psychiatric evaluation to identify psychiatric disorders. Psychiatric disorders were present in 71% of these patients, especially anxiety, depression and psychotic syndromes. NPH patients may develop symptoms with frontal dominance, such as personality changes, anxiety, depression, psychotic syndromes, obsessive compulsive disorder, Othello syndrome; shoplifting and mania. Unusual appearances of NPH symptoms may hinder early diagnosis and consequently proper treatment.

Nonorganic Visual Loss in Children

NOVL in children is a relatively common problem for the comprehensive ophthalmologist. Although the etiology and pathophysiology of NOVL are variable, rare cases are because of physical or sexual abuse. Clinical tests can make the diagnosis of NOVL, and nonorganic is our preferred terminology for NOVL. Clinicians should be careful to establish a normal eye examination and prove that the vision is better than claimed before labeling a patient with NOVL. Rarely, the clinical examination is insufficient to establish the diagnosis of NOVL and electrophysiology may be helpful. Reassurance is generally all that is necessary for most children with NOVL, but some patients might benefit from formal psychiatric evaluation. The possibility of nonorganic overlay should also be considered in children with NOVL, and the combination of organic and NOVL is relatively common.

Implementation Research: Reducing the Research-to-Practice Gap in Depression Treatment

Implementation Research: Reducing the Research-to-Practice Gap in Depression Treatment

Postpartum Depression: Screening, Diagnosis, and Management Programs 2000 through 2010.

The value and appropriateness of universal postpartum depression (PPD) screening remains controversial in the United States. To date, several PPD screening programs have been introduced and a few have been evaluated. Among those programs that have been evaluated, most report screening rates, diagnosis rates, or treatment initiation rates. Only four studies included patient outcomes such as the level of depressive symptoms at 6 to 12 months postpartum, and only two reported success in improving outcomes. Program characteristics that appear to result in low rates of diagnosis and followup after PPD screening include requirements for a formal psychiatric evaluation, the need to refer women to another site for therapy, and failure to integrate the PPD screening into the care provided at the woman's or her child's medical home. The two programs that reported improved outcomes were both self-contained within primary care and included specific followup, management, and therapy procedures. Both resulted in the need for outside referrals in less than 10% of women diagnosed with postpartum depression. Future studies should be based on the successful programs and their identified facilitators while avoiding identified barriers. To affect policies, the future program must report maternal outcomes going beyond the often reported process outcomes of screening, referral, and therapy initiation rates.

Burnout Among Psychiatrists in Milan: A Multicenter Survey

Burnout Among Psychiatrists in Milan: A Multicenter Survey

Psychiatric Disorders: Are They an Absolute Contraindication to Living Donation?

Little information has been published about the suitability of candidates for living organ donation who have a past or current psychiatric diagnosis. A retrospective review of 445 living donor kidney transplants performed at Barnes-Jewish Hospital's transplant center from 1995 to 2005 disclosed 42 donor candidates with such a history, prompting detailed psychological evaluation. Although 41 candidates (10% of the donor pool) met criteria for 1 or more psychiatric diagnoses, none were considered psychologically unfit for donation. Of these, 22 candidates underwent kidney donation without medical or surgical complications and without development of subsequent active psychological problems. Several donors maintained long-term contact up to 12 years to report good health and a high degree of satisfaction with the decision to donate. This experience suggests that for donor candidates with a psychiatric diagnosis, formal psychiatric evaluation to evaluate current mental health stability is warranted. Stable individuals, on or off therapy, can be considered fit to donate with expected short- and long-term outcome prognoses similar to those for the general population.

The Mental Health Consequences of Terrorism: Implications for Emergency Medicine Practitioners

Emergency physicians are likely to be first-line responders in any local or regional terrorist event. In addition to preparing for the potential physical conditions and injuries that are associated with terrorism, they should be aware of the behavioral and mental health implications as well. It is helpful to be familiar with the characteristics that predict who may be at increased risk for mental illness after such events and how they may be identified in an Emergency Department setting. Although most people in the general population with behavioral conditions stemming from a terrorist event can be expected to recover spontaneously within several months, other individuals are at increased risk of developing more debilitating mental health conditions that have been associated with post-terrorist and disaster environments. Screening tools are available to help emergency practitioners identify them and refer patients for more formal psychiatric evaluation and potential interventions to facilitate and speed the recovery process.

Algorithm for Bedside Diagnosis of Delirium

Bruce Jancin is with the Denver bureau of Elsevier Global Medical News. DALLAS – The Confusion Assessment Method diagnostic algorithm for delirium is a highly useful bedside diagnostic tool when a formal psychiatric evaluation is difficult to come by, Dr. Robert M. Palmer said at the annual meeting of the Society of Hospital Medicine. The Confusion Assessment Method (CAM) is simple and quick, with a sensitivity and specificity in excess of 90%, added Dr. Palmer, head of the section of geriatric medicine at the Cleveland Clinic Foundation. Some in long-term care prefer the Delirium-O-Meter, which is used primarily by nursing staff (see story above). The algorithm, developed by Dr. Sharon K. Inouye of Harvard Medical School, Boston, focuses on several classic features of delirium: acute onset and fluctuating course, inattention, disorganized thinking, and altered consciousness. For a diagnosis of delirium to be made, both features 1 and 2 plus either feature 3 or 4 must be present. Feature 1–acute onset and fluctuating course–involves information readily obtained from a family member or other caregiver. Feature 2–inattention–requires some form of objective documentation. The Mini-Mental State Examination is a good test, but some busy physicians think it takes too long. Dr. Palmer said he prefers the digit span test. Speaking slowly in a mono-tone at 1-second intervals, he asks the patient to repeat numbers after him. A person who can repeat a 5-digit number is very unlikely to have delirium. “Most delirious patients forget what you ask them to do or get distracted by a noise or a passing person in the hallway.” Delirium often overlaps with dementia. After all, Alzheimer's disease, the most common type of dementia, is present in about 20% of 80-year-olds and 30% of 85-year-olds. Factors helpful in making the distinction include onset, which is abrupt in delirium and gradual in dementia, and attention span, which is diminished in delirium but unaffected in dementia. Individuals with delirium are typically hyperactive or hypoactive, while psychomotor changes occur only late in dementia. Consciousness is clouded and fluctuating in delirium but unaffected in dementia.

A Major Event of Self-mutilation in a Patient with Fetal Alcohol Syndrome

We describe a young adult male with fetal alcohol syndrome (FAS) who presented with a non-repetitive, major, genital self-mutilation necessitating urological intervention. On formal psychiatric evaluation, he did not have psychosis or suicidality. Most commonly, self-injury in developmental disability is less severe and more stereotypic; major-class self-mutilation is confined, generally, to psychosis. It is this discrepancy that is the unusual feature of our case.

Patient Health Questionnaire-9 to Screen for Depression in Outpatients With Multiple Sclerosis

Depression is common in multiple sclerosis (MS), with a reported lifetime prevalence of 25–50% and a median point prevalence of 14%. Identification and validation of brief screening tools is essential. The objective of this study was to determine whether the self-administered Patient Health Questionnaire-9 (PHQ-9) is a potentially useful screening tool for depression in an MS clinic population. The PHQ-9 is an increasingly used clinical tool that is brief and specifically queries the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders IV: Text Revision (DSM-IVTR) depression criteria, making it easier for the clinician to diagnose depressive disorders. It has been validated in multiple medical and neurological populations. A total of 248 patients were given the PHQ-9 in the clinic waiting room, and 225 (mean age 43 years, 69% women) provided full responses. Rates of PHQ-9 depression are reported based on two scoring methods. With syndrome-based PHQ-9 scoring, 26 patients (12%) met criteria for either major depression (n = 15, 7%) or subthreshold major depression (n = 11, 5%). With a cut score of ≥10, 19% met criteria for significant depression. Both results are comparable to reported prevalence rates of depression in the MS literature. Twenty patients meeting syndromal depression criteria on the PHQ-9 were available for formal psychiatric evaluation, and all were diagnosed with a depressive disorder. Depressive symptom profiles revealed a low frequency of frank depressed mood and a preponderance of somatic symptoms, particularly fatigue and sleep disturbance. These preliminary results suggest that the PHQ-9 may be a useful tool in screening for depression in outpatients with MS. A formal validation study is indicated.

Utility of a depression score to predict candidacy for hepatitis C virus therapy in veterans: a prospective longitudinal study

The frequency and determinants of receipt of antiviral therapy once a diagnosis of a mood disorder is established in hepatitis C virus (HCV)-infected patients remains unknown. To examine the incidence and determinants of receiving antiviral therapy in HCV-infected veterans with abnormal scores of Zung Self-Rating Depression Scale (SDS). We systematically evaluated the presence of psychiatric disorders among HCV-infected patients with initial referral between September 2000 and May 2002. We reviewed medical records, obtained history, and administered Zung SDS to evaluate for depressive symptoms. Patients with psychiatric disorders were referred for psychiatric evaluation. The primary outcome was the receipt of antiviral therapy during and after the initial evaluation up to December 1, 2003. The association between SDS scores and receipt of antiviral therapy was examined in a multivariate Cox proportional hazards regression. A total of 424 patients completed a Zung SDS. The scores were normal in only 43% of all patients, and were impaired mildly in 25%, moderately in 23%, and severely in 9%. Zung SDS scores were significantly higher in patients who served during the Vietnam War era, participated in combat, or had lower albumin levels. At the end of the first visit, 180 (42%) had psychiatric disorders. An abnormal Zung score (>55) was the only reason for referral to psychiatry in 83 of 180 patients; and in those 78 (94%) a formal psychiatric evaluation confirmed depressive disorder. Psychiatric disorders were the sole contraindication to therapy in 145 (34%) patients in whom eligibility for antiviral therapy was achieved in 42 (29%) during a mean follow-up duration of 27 months. Approximately one-quarter of patients with psychiatric disorders may become eligible for antiviral therapy following subsequent management of these disorders. The Zung self-screening test is an easy, valid method for detecting mood disorders in HCV-infected veterans.