General Psychiatric Outpatients Research Articles

Mental health concerns in outpatients during COVID-19 pandemic: Comparison between psychiatric and general hospital clinics in an Indian population

We intended to compare mental health concerns in patients attending a general hospital clinic with that of patients attending a psychiatric clinic during the coronavirus disease 2019 (COVID-19) pandemic. We specially wished to know about the perceived stress, worries, possibility of anxiety and depression, and the quality of life (QOL) of the patients. In a cross-sectional study, we used two screening questions for depression, Generalised Anxiety Disorder-2 (GAD-2) scale for anxiety, Perceived Stress Scale (PSS) for stress, nature and degree of worries in a 0–10 scale, and QOL in a 1–10 scale. Majority (75.5 percent) of outpatients had moderate to high level of stress, 76.5 percent were screen positive for depression, and 42 percent for anxiety. Psychiatric patients had significantly higher perceived stress, level of worry, and lower QOL to those with physical illness and were screen positive for depression (99 percent v 54 percent) and anxiety (68 percent v 16 percent), respectively. Patients with major physical illnesses had significantly higher stress levels and anxiety compared with those without. Fear of getting the infection, loss of job, and financial issues were the major worries along with social stigma. The results highlighted the need for screening mental health concerns in general hospital and psychiatric outpatients during the COVID-19 pandemic and facilitate appropriate interventions.

Prevalence, Clinical Features and Comorbidities of Alcohol and Substance Use Disorders Among Patients Admitted to Psychiatry Outpatient Clinic

Objective: Comorbidity of substance use disorders and other psychiatric disorders is common. However, data on the prevalence of substance use disorders in general psychiatric outpatient population is rather scarce. Method: In order to investigate the prevalence of substance use disorders among the patients who admitted to the general psychiatric outpatient unit and followed with any psychiatric diagnosis, 734 consecutive adult patients were included in this study. Michigan Alcoholism Screening Test–AD was administered to these patients. Substance screening form and SCID-I dependence module were administered to 47 patients (6.4%) who had a MAST-AD score above 4. Later, SCID-II and the rest of SCID-I were administered to 33 patients (4.5%) who met any diagnostic criteria on this module. Results: From these 734 patients, 33 (4.5%) had alcohol or substance use disorder: Five patients (0.7%) had alcohol dependence, 26 patients (3.5%) had alcohol abuse and 3 patients (0.4%) had multiple substance dependence. There were 9 patients (1.2%) with cannabis abuse, 4 patients (0.5%) with ecstasy abuse, 1 patient (0.1%) with heroin abuse, 1 patient with (0.1%) biperiden abuse and 9 patients (1.2%) with benzodiazepin abuse. From this 33 patients, 7 (1.0%) patients were diagnosed with borderline personality disorder, 2 (0.3%) with antisocial personality disorder, 1 patient (0.1%) with paranoid personality disorder, 1 patient (0.1%) with narcissistic personality disorder, 2 patients (0.3%) with avoidant personality disorder, 1 patient (0.1%) with schizoid personality disorder and 1 patient (0.1%) with dependent personality disorder. With SCID-I, we found 5 (0.7%) major depressive disorder, 3 (0.4%) bipolar I, 1 (0.1%) distimic disorder, 2 (0.3%) paranoid schizophrenia, 1 (0.1%) delusional disorder, 3 (0.4%) generalized anxiety disorder, 3 (0.4%) panic disorder, 1 (0.1%) panic disorder with agoraphobia, 1 (0.1%) anxiety disorder not otherwise specified, 1 (0.1%) social phobia and 1 (0.1%) post traumatic stress disorder. Conclusion: These results suggest that substance use disorders are prevalent among general psychiatric outpatients. Substance use disorders should be carefully assessed in the patients with diagnoses of mood disorders, anxiety disorders or personality disorders.

Predictive factors for suicidal attempts: A case-control study.

To identify predictors for 12-month suicide attempt from general psychiatric outpatients. A case-control study compared 55 cases of suicide attempt within the previous 12 months matched for age and sex with 55 nonsuicidal cases. All were interviewed for psychiatric and personality disorder (PD) diagnoses using a DSM-IV-TR diagnostic interview. Factors associated with suicide attempt included depressive disorders (odds ratio [OR] = 4.62) and borderline PD (OR = 8.99). More attention should be paid to identifying PD especially borderline PD in suicidal attempters, and further study of modifiable factors associated with depression and borderline PD is encouraged.

Attention-deficit/hyperactivity disorder symptoms and suicidal behavior in adult psychiatric outpatients.

We aimed to examine the association between attention-deficit/hyperactivity disorder (ADHD) symptoms and suicidal behavior in psychiatric outpatients and whether this association differs among patients with different psychiatric disorders. Cross-sectional data came from the Japan Prevalence Study of Adult ADHD at Psychiatric Outpatient Care, which included psychiatric outpatients aged 18-65 years recruited from one university hospital and three general psychiatric outpatient clinics in Kitakyushu City, Fukuoka, Japan from April 2014 to January 2015 (N = 864). The Adult ADHD Self-Report Scale (ASRS) Screener was used to collect information on ADHD symptoms. Reports of current and lifetime suicidal behavior were also obtained. A multivariable Poisson regression analysis was used to examine the association between ADHD symptoms and suicidal behavior. After adjusting for covariates there was a strong association between possible ADHD (ASRS ≥14) and suicidal behavior with prevalence ratios ranging from 1.17 (lifetime suicidal ideation) to 1.59 (lifetime suicide attempt) and 2.36 (current suicidal ideation). When ASRS strata were used, there was a dose-response association between increasing ADHD symptoms and suicidal ideation and suicide attempts. Analyses of individual ICD-10 psychiatric disorders showed that associations varied across disorders and that for anxiety disorder, ADHD symptoms were significantly linked to all forms of suicidal behavior. ADHD symptom severity is associated with an increased risk for suicidal behavior in general psychiatric outpatients. As ADHD symptoms are common among adult psychiatric outpatients, detecting and treating ADHD in this population may be important for preventing suicidal behavior.

A Validation Study of the Web Screening Questionnaire (WSQ) Compared With the Mini-International Neuropsychiatric Interview-Plus (MINI-Plus).

BackgroundThere is a need for brief screening methods for psychiatric disorders in clinical practice. This study assesses the validity and accuracy of a brief self-report screening questionnaire, the Web Screening Questionnaire (WSQ), in detecting psychiatric disorders in a study group comprising the general population and psychiatric outpatients aged 18 years and older.ObjectiveThe aim of this study was to investigate whether the WSQ is an adequate test to screen for the presence of depressive and anxiety disorders in clinical practice.MethodsParticipants were 1292 adults (1117 subjects from the general population and 175 psychiatric outpatients), aged 18 to 65 years. The discriminant characteristics of the WSQ were examined in relation to the (“gold standard”) Mini-International Neuropsychiatric Interview-Plus (MINI-Plus) disorders, by means of sensitivity, specificity, area under the curve (AUC), and positive and negative predictive values (PPVs, NPVs).ResultsThe specificity of the WSQ to individually detect depressive disorders, anxiety disorders, and alcohol abuse or dependence ranged from 0.89 to 0.97 for most disorders, with the exception of post-traumatic stress disorder (0.52) and specific phobia (0.73). The sensitivity values ranged from 0.67 to 1.00, with the exception of depressive disorder (0.56) and alcohol abuse or dependence (0.56). Given the low prevalence of separate disorders in the general population sample, NPVs were extremely high across disorders (≥0.97), whereas PPVs were of poor strength (range 0.02-0.33).ConclusionsIn this study group, the WSQ was a relatively good screening tool to identify individuals without a depressive or anxiety disorder, as it accurately identified those unlikely to suffer from these disorders (except for post-traumatic stress disorders and specific phobias). However, in case of a positive WSQ screening result, further diagnostic procedures are required.

Anger Assessment in Clinical and Nonclinical Populations: Further Validation of the State-Trait Anger Expression Inventory-2.

The most commonly used instrument for measuring anger is the State-Trait Anger Expression Inventory-2 (STAXI-2; Spielberger, 1999). This study further examines the validity of the STAXI-2 and compares anger scores between several clinical and nonclinical samples. Reliability, concurrent, and construct validity were investigated in Dutch undergraduate students (N = 764), a general population sample (N = 1211), and psychiatric outpatients (N = 226). The results support the reliability and validity of the STAXI-2. Concurrent validity was strong, with meaningful correlations between the STAXI-2 scales and anger-related constructs in both clinical and nonclinical samples. Importantly, patients showed higher experience and expression of anger than the general population sample. Additionally, forensic outpatients with addiction problems reported higher Anger Expression-Out than general psychiatric outpatients. Our conclusion is that the STAXI-2 is a suitable instrument to measure both the experience and the expression of anger in both general and clinical populations.

Hazardous alcohol use in general psychiatric outpatients

Background: Hazardous alcohol use in psychiatric patients may increase the risk of the development of a substance use disorder and negatively affect the course of the psychiatric disorder.Aims: To investigate the prevalence of hazardous alcohol and drug use in a Swedish psychiatric outpatient population with particular focus on hazardous alcohol consumption and assess relationships of hazardous alcohol use to sex, age and psychiatric diagnosis.Methods: General psychiatric outpatients, n = 1,679, completed a self-rating Alcohol Use Disorders Identification Test (AUDIT).Results: Hazardous or harmful alcohol habits occurred among 22% of all women and 30% of all men with higher prevalence among younger patients. Nine percent of all women and 22 % of all men reported binge drinking. Binge drinking was more frequent in younger subjects. Women with a personality disorder diagnosis had a higher frequency of at risk drinking. Apart from that, psychiatric diagnosis was unrelated to rate of hazardous drinking.Conclusions: Hazardous alcohol use was common in this psychiatric outpatient population. With regard to possible risks related to drinking in psychiatric patients, alcohol habits should be assessed as a part of good clinical practice.

Evaluation of the Psychometric Properties of the Icelandic Version of the Clinical Outcomes in Routine Evaluation–Outcome Measure, its Transdiagnostic Utility and Cross‐Cultural Validation

The development of transdiagnostic standardized measures of psychological distress have contributed to the development of practice-based evidence networks. The translation and validation of such measures cross culturally is important if such research is to be generalized across health care systems in different countries. Translation of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) from English into Icelandic was undertaken according to recommended protocols. The resulting instrument was evaluated for reliability and validity in three groups: patients undergoing psychological treatment in general practice (n = 289), psychiatric outpatients (n = 98) and student controls (n = 207). The Mini-International Neuropsychiatric Interview was administered to the clinical participants. They also completed the CORE-OM and the Beck depression and anxiety inventories before and after treatment. The transdiagnostic relationship between CORE-OM scores and scores on those diagnostic measures was assessed. Good levels of validity, reliability and internal consistency were found for the CORE-OM and its domains and sensitivity to change over treatment shown. As anticipated, the risk domain had different characteristics than other domains. CORE-OM scores correlated strongly with both Beck Depression Inventory-Second edition and Beck Anxiety Inventory, particularly the problem domain. The Icelandic translation of the CORE-OM is psychometrically sound and can be applied in Icelandic mental health studies as it has been in English speaking settings. Nevertheless, the validity of the Icelandic version of the CORE-OM needs to be further investigated in larger and more diverse samples. The psychometric properties of the Icelandic version of the CORE-OM are comparable with the original English version. The results indicate transdiagnostic utility of the CORE-OM. The CORE-OM is a valuable instrument in outcome research on psychological treatment, specifically transdiagnostic treatment.

The Korean Version of the Connor–Davidson Resilience Scale: An Extended Validation

The Connor-Davidson Resilience Scale (CD-RISC) is a brief self-rating questionnaire for measuring resilience. The aims of the present study were to describe the development of a Korean version of the CD-RISC (K-CD-RISC) and to more firmly establish its psychometric properties in terms of reliability and validity. The participants consisted of a general population sample (n=194) and psychiatric outpatients (n=127) with non-psychotic mood or anxiety disorders. The K-CD-RISC score means (standard deviation) were 65.9 (13.6) in the general population and 50.4 (20.5) in the psychiatric outpatients. The mean score of the general population was significantly higher than that of the psychiatric outpatients. Exploratory factor analysis revealed five factors, and the obtained factor structure was verified through confirmatory factor analysis. In the general population, the Cronbach's α coefficient of the K-CD-RISC was found to be 0.92. Greater resilience was found to be associated with less perceived stress, anxiety and depression and with higher levels of positive affect and purpose in life. Taken together, our findings suggest that the K-CD-RISC has good psychometric properties and is a valid and reliable tool for assessing resilience.

Quality of Life in a Population of Dutch Prisoners with Mental Disorders: Relations with Psychopathological, Social, Demographical, Judicial and Penitentiary Factors

Little research is done on the impact of psychopathology in prison settings as expressed in outcome measures such as Quality of Life (QOL). The aim of the present study was to examine the QOL of Dutch male prisoners with mental disorders and to compare their QOL with the QOL of three reference groups: the general Dutch population (GDP), psychiatric outpatients, and prisoners without mental disorders. Also, the QOL of the reference group of prisoners without mental disorders was compared with the QOL of the other reference groups. An additional aim was to investigate possible relationships between the QOL of the study population and psychopathological, social, demographic, judicial and penitentiary factors. The QOL of the study population (N = 71) was measured with the WHOQOL-Bref. In addition, psychopathological, social, demographic, judicial and penitentiary data were collected. The QOL of the study population was worse compared with the QOL of the GDP and prisoners without psychopathology but better than the QOL of the psychiatric outpatients. Within the study population, the impact of DSM-IV-TR Axis I and II disorders on experienced QOL was of a similar negative magnitude. Correlations between substance dependence or abuse, social and demographic variables, judicial/penitentiary variables and QOL were small or absent. Psychopathological factors explained the major part of the known QOL variance of the study population. The relatively good QOL of the imprisoned patient group, in comparison to the QOL of the outpatient group, leads to the recommendation to implement elements of the detention regime in regular psychiatric care.

An abbreviated version of the Connor-Davidson Resilience Scale (CD-RISC), the CD-RISC2: Psychometric properties and applications in psychopharmacological trials

Resilience may be an important component of the prevention of neuropsychiatric disease. Resilience has proved to be quantifiable by scales such as the Connor-Davidson Resilience Scale (CD-RISC). Here, we introduce a two-item version of this scale, the CD-RISC2. We hypothesize that this shortened version of the scale has internal consistency, test-retest reliability, convergent validity, and divergent validity as well as significant correlation with the full scale. Additionally, we hypothesize that the CD-RISC2 can be used to assess pharmacological modification of resilience. We test these hypotheses by utilizing data from treatment trials of post-traumatic stress disorder, major depression, and generalized anxiety disorder with setraline, mirtazapine, fluoxetine, paroxetine, venlafaxine XR, and kava as well as data from the general population, psychiatric outpatients, and family medicine clinic patients.

Are patients with COPD psychologically distressed?

This study was designed to assess the level of psychological distress in a heterogeneous group of patients with chronic obstructive pulmonary disease (COPD), and compare them with the general population and psychiatric outpatients. A total of 118 patients with COPD, a random sample of 500 subjects from the general population and 500 psychiatric outpatients participated in this study. The Dutch version of the Symptom Checklist-90-Revised was used to assess general psychological distress. The sample of patients with COPD experienced significantly more psychological distress than the general population and significantly less than psychiatric outpatients. Furthermore, no significant association was found between the severity of the pulmonary disease and the level of psychological distress, although patients with severe or very severe COPD appeared to be at increased risk of depression. Lastly, the pattern of psychological complaints seems comparable in depressed patients with COPD and psychiatric outpatients. Once patients with COPD report suffering from depressive symptoms, the level of distress seems to increase to that found in psychiatric outpatients. In conclusion, in clinical settings in which psychological complaints are not routinely assessed, the Beck Depression Inventory and Symptom Checklist-90-Revised are very useful for drawing attention to depression and psychological distress.

Somatoform dissociation, reported abuse and animal defence-like reactions.

To test the hypotheses that among general psychiatric outpatients, somatoform dissociation is associated with posttraumatic stress symptoms and with reported potentially traumatizing events, especially with events that involve bodily threat from a person, also when reported age at onset, duration and subjectively rated impact of potentially traumatizing events are considered. Administration of self-report questionnaires evaluating the severity of somatoform and psychoform dissociation, posttraumatic stress-symptoms, and reported traumatizing events, using samples of consecutive and unselected psychiatric outpatients (n = 153). Somatoform dissociation was strongly correlated with posttraumatic stress symptoms and with reported cumulative traumatization as assessed with two different self-report trauma questionnaires. Among a wide range of trauma types, bodily threat from a person best predicted somatoform dissociation. Emotional neglect and age further improved the prediction, but emotional neglect and abuse did not predict somatoform dissociation when interpersonal threat to the body was not reported. Somatoform dissociation was also best predicted by bodily threat when reported age at onset, duration and subjective impact of reported traumatization were included in the analyses. This retrospective study suggests that recurrent interpersonal bodily threat may evoke animal defence-like psychobiological systems manifesting as somatoform dissociation and that this type of threat is often accompanied by emotional neglect. These hypotheses should now be tested in prospective studies.

Habitual self-mutilation in Japan.

The purpose of the present study was to clarify the relationship between bulimic behavior, dissociative phenomenon and sexual/physical abuse histories in Japanese subjects with habitual self-mutilation. Subjects consisted of 34 female outpatients who had cut their wrists or arms on more than 10 occasions. Two age-matched groups, which consisted of 31 general psychiatric outpatients and 26 non-clinical volunteers, served as controls. They were assessed with the Beck Depression Inventory-II, Bulimia Investigatory Test of Edinburgh, Adolescent Dissociative Experience Scale, and an original self-reporting questionnaire concerning various problematic behaviors and sexual/physical abuse histories. The habitual self-mutilation and the two control groups were compared. The habitual self-mutilation group had significantly higher scores on the Beck Depression Inventory-II, Bulimia Investigatory Test of Edinburgh, and Adolescent Dissociative Experience Scale than either of the two control groups (P < 0.001). Furthermore, the habitual self-mutilation group more frequently had a history of illicit psychoactive drug use (P = 0.001), shoplifting (P < 0.001), suicide attempts (P < 0.001), overdosing with medicine (P < 0.001), sexual abuse (P = 0.011), and childhood physical abuse (P = 0.001) than the general psychiatric controls. These results are consistent with those in Western studies. Habitual self-mutilation is likely to coexist with depression, bulimia, and dissociation. Such patients frequently have clinical features similar to those of 'multi-impulsive bulimia'. Evidence supports the association between habitual self-mutilation and sexual/childhood physical abuse in Japan.

Patient experiences of basic body awareness therapy and the relationship with the physiotherapist

Background and Purpose: To explore the experiences of patients undergoing basic body awareness therapy in psychiatric physiotherapy. In addition, the therapeutic relationship and the concept of the working alliance were examined. Subjects: Two groups of patients participated: patients with schizophrenia (n=6) and general psychiatric outpatients (n=5). Method: A qualitative technique, video taping and interviewing the patients during treatment was used. Results: The most common experience from the treatment was ‘balance and posture’. Other experiences were ‘body movement control’ and ‘awareness and handling of body signals’. Themes central to establishing a good working alliance were identified. Discussion and Conclusions: The impact of balance and posture was discussed and some new hypotheses were generated.

A review of suicide within the State Hospital, Carstairs 1972-1996.

This retrospective case note review describes the demographic, forensic and psychiatric backgrounds of 14 in-patient suicides in a maximum secure hospital. The majority were schizophrenic with chronic treatment-resistant illnesses, who had committed proportionally more violent offences, had a history of serious self-injury but no recognized clear depressive episodes. This profile is markedly different from that reported in general psychiatric in-patients, out-patients and suicides in prison, but is similar to that described in a maximum secure hospital in the United States and in long-stay patients in Canada. Many of the patients had continued to experience significantly subjective distress over many years. The clinical relevance of this series is discussed in the context of the assessment of suicidal intent in psychotic patients. We speculate that the decrease in in-patient suicides in the State Hospital may be due to a less restrictive ward milieu, increased staff/patient ratios, or the introduction of Clozapine.

Clinical correlates of self-mutilation in a sample of general psychiatric patients.

The aims of this study were to examine whether certain axis I disorders characterized by impulsive aggression were associated with self-mutilative behavior and to evaluate the clinical correlates of self-mutilation in a sample of general psychiatric outpatients. Two hundred fifty-six outpatients were administered diagnostic interviews for axis I and axis II disorders. In addition, questionnaires that measured self-mutilative acts within the last 3 months, dissociation, and childhood abuse were completed. This study found that axis I disorders of substance abuse, posttraumatic stress disorder, and intermittent explosive disorder were significantly related to self-mutilative behavior, independent of borderline personality disorder and antisocial personality disorder. Also, a higher level of dissociation was related to self-mutilation, controlling for borderline personality disorder and childhood abuse. Outpatients with certain axis I disorders and those who dissociate may represent a sizable group of patients who are at risk for self-mutilative behavior.

The discriminant validity of the Eating Disorder Inventory--2.

The scores of 78 bulimia nervosa (BN) patients and 67 general psychiatric outpatients on the Revised Eating Disorder Inventory (EDI-2) were compared in a multivariate discriminant analysis. The bulimia scale was found to correctly classify 97 per cent of all cases. Of the EDI-2 scales thought to be not directly related to food and weight, only interoceptive awareness (IA) and asceticism (AS) showed discriminative validity. Three eating-related items were found to account for the discriminative value of the IA scale, and the new AS scale was found to be a discriminative extension of the EDI.

A Naturalistic Prospective Study of the Use of Fluoxetine in General Psychiatric Outpatients

A Naturalistic Prospective Study of the Use of Fluoxetine in General Psychiatric Outpatients

Self-reported levels of psychopathology of drug abusers not currently in treatment

This study assessed levels of psychopathology, as measured by the Symptom Checklist-90-Revised, of drug users not in treatment. These levels were then compared with levels of psychopathology reported previously in the literature of drug users in treatment, the general population, psychiatric inpatients, and psychiatric outpatients. Results suggest that drug users not in treatment endorse significantly lower levels of psychopathology than drug users in treatment, psychiatric inpatients, and psychiatric outpatients. However, they endorse significantly higher levels of pathology than adult nonpatients and they appear most similar to adolescent nonpatients. Implications for clinical work (prevention and intervention) as well as for future research are discussed. The study also established preliminary cultural validity of SCL-90-R with Alaska Natives.