Impact Of Psychiatric Diagnosis Research Articles

The art of not being neutral in qualitative research

ABSTRACT This article is a contribution to the ongoing dispute about ethical and methodological standards of neutrality within qualitative research. By invoking the notions of friendship-based research and situated ethics, we discuss important ethical dilemmas that can arise in research processes when informant and researcher develop friendship-like relations. We consider the benefits and drawbacks of such an approach, especially when working within sensitive fields – in this case, the impact of psychiatric diagnoses and gang exit processes on identity formation. We challenge traditional ideals of personal non-involvement in qualitative research, particularly with regard to ethical issues by analyzing and discussing a case of unforeseen events during the establishment of a research group that transformed a formal informant – researcher relationship into friendship-based research.

2022 Canadian Surgery Forum Sept. 15–17, 202201. Operative classification of ventral abdominal hernias: new and practical classification02. Watchful waiting for large primary splenic cysts03. Transversus abdominis plane (TAP) blocks with and without dexamethasone in colorectal surgery04. What factors determine publication of resident research day projects?05. Characterization of near-infrared imaging and indocyanine green use amongst general surgeons06. Variation in opioid prescribing

# 01. Operative classification of ventral abdominal hernias: new and practical classification {#article-title-2} Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system

Evaluation of Psychiatric Diagnoses as a Source of Bias in Prognostication and Decision-Making for Palliative Radiotherapy

<h3>Purpose/Objective(s)</h3> Up to half of patients with advanced cancer may meet diagnostic criteria for a psychiatric disorder. Yet, the impact of psychiatric diagnosis and/or medication prescription (psych Dx/Rx) on decision-making and outcomes for radiotherapy (RT) are not well-characterized. Statistical models and decision tools can be skewed when built from source data that has been influenced by implicit and explicit biases in medical diagnoses and treatment. We investigate the impact of psych Dx/Rx on palliative RT outcomes and decisions to ascertain whether this may serve as a source of bias in prognostication and decision-making in this patient population. <h3>Materials/Methods</h3> Retrospective review identified patients treated with conventional external beam (cEBRT) or stereotactic body RT (SBRT) for bone metastases at 3 radiation oncology facilities from 5/2013-12/2019. Prevalence of psych Dx/Rx was collected, along with 27 other patient, disease, and treatment characteristics that were identified as collectively predictive of survival using the validated Bone Metastases Ensemble Trees for Survival (BMETS) machine-learning model and decision support platform. RT details were documented. Overall survival from consultation to death or last follow up was estimated using the Kaplan-Meier method. Uni- and multivariable regressions evaluated associations between psych Dx/Rx, survival, and RT fractionation and modality. Reported statistics are p<.05. <h3>Results</h3> 346 treated patients were evaluated, including 178 patients with cEBRT and 168 patients with SBRT (median 10 vs. 3 fractions). Psych Dx/Rx was more prevalent among patients treated with cEBRT vs. SBRT (40% vs. 28.6%). On univariate analysis, odds of psych Dx/Rx was significantly higher for patients requiring opiate analgesics, females, white (vs. black) race, and breast (vs. prostate) cancer (OR 2.0, 3.7, 4.3, 5.6). Psych Dx/Rx was associated with use of fewer fractions for cEBRT (β coefficient -1.0) but not SBRT. On multivariable analyses for the cEBRT cohort controlling for other univariable associations, use of fewer fractions remained significantly associated with psych Dx/Rx (β coefficient -1.1). While overall survival was significantly longer for patients treated with SBRT (median 3.3 vs. 0.8 years for cEBRT), psych Dx/Rx was not associated with survival or strongly linked to other predictors of advanced disease for either RT cohort. <h3>Conclusion</h3> Psych Dx/Rx does not appear to impact survival for patients undergoing palliative bone RT, arguing against its direct role as a source of bias in survival models like BMETS. However, given that psych Dx/Rx is associated with lower use of SBRT and foreshortened cEBRT regimens, this variable may serve a source of bias in treatment selection, albeit perhaps concordant with the patient's best interest. This highlights the importance of enhanced shared decision-making in this potentially vulnerable patient population.

The Impact of Psychiatric Diagnoses on Patient-reported Satisfaction and Quality of Life in Postmastectomy Breast Reconstruction.

The purpose of this study was to determine the prevalence of psychiatric diagnoses among a sample of breast reconstruction patients and measure the association between these diagnoses and reconstruction-related, patient-reported outcomes. The impact of psychiatric disorders in conjunction with breast cancer diagnosis, treatment, and reconstruction have the potential to cause significant patient distress but remains not well understood. A retrospective review of postmastectomy breast reconstruction patients from 2007 to 2018 at Memorial Sloan Kettering Cancer Center was conducted. Patient demographics, comorbidities, cancer characteristics, psychiatric diagnoses, and BREAST-Q Reconstruction Module scores (measuring satisfaction with breast, well-being of the chest, psychosocial, and sexual well-being) at postoperative years 1 to 3 were examined. Mixed-effects models and cross-sectional linear regressions were conducted to measure the effect of psychiatric diagnostic class type and number on scores. Of 7414 total patients, 50.1% had at least 1 psychiatric diagnosis. Patients with any psychiatric diagnoses before reconstruction had significantly lower BREAST-Q scores for all domains at all time points. Anxiety (50%) and depression (27.6%) disorders were the most prevalent and had the greatest impact on BREAST-Q scores. Patients with a greater number of psychiatric diagnostic classes had significantly worse patient-reported outcomes compared with patients with no psychiatric diagnosis. Psychosocial (β: -7.29; 95% confidence interval: -8.67, -5.91), and sexual well-being (β: -7.99; 95% confidence interval: -9.57, -6.40) were most sensitive to the impact of psychiatric diagnoses. Mental health status is associated with psychosocial and sexual well-being after breast reconstruction surgery as measured with the BREAST-Q. Future research will need to determine what interventions (eg, screening, early referral) can help improve outcomes for breast cancer patients with psychiatric disorders undergoing breast reconstruction.

The impact of psychiatric diagnoses on two-year outcomes in patients with ventricular assist devices

Abstract Background A multi-specialty approach is required during patient selection for left ventricular assist device (LVAD) implantation. In addition to a comprehensive medical evaluation, patients undergo an extensive psychiatric work up to ensure their candidacy when pursuing durable support devices. We aim to analyze the impact of psychiatric illnesses on 2-year outcomes after VAD implantation. Methods This study was a single center, retrospective analysis of 263 patients who underwent durable LVAD implantation between 2015 and 2017. All patients were evaluated by a single specialist during their work up for LVAD implantation. Patients who had a pre-existing diagnosis defined by criteria outlined in Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were assigned to the History of Psychiatric Diagnosis group. Statistical analysis was performed using Chi-Square and Student's t-tests, wherein p&amp;lt;0.05 was considered statistically significant. Results Of the 263 patients, 68 patients were found to have a history of psychiatric illness compared to 195 who had no previous diagnosis. Of those with a psychiatric history, 30.8% had Depression, 1.5% had Bipolar disorder, 22.1% had Anxiety, 1.5% had PTSD, and 16.2% had more than one diagnosis. 19.5% of patients with no history went on to be transplanted compared to 22.1% of patients with a psychiatric history (p=0.65). No significant difference was found between length of stay, days to readmission, 30-day survival, and 2-year survival. Patients without a psychiatric history were found to have fewer number of readmissions over 2 years (p&amp;lt;0.01) (See Table). No significant difference was seen in complications including driveline infections, bacteremia, cerebrovascular accidents, pump thromboses, pump hemolysis, or major bleeding events (See Table). Conclusion Psychosocial characteristics play a significant role in determining a patient's candidacy for LVAD implantation. Although patients with a history of psychiatric illness were found to have a greater number of readmissions, this did not correlate to poorer outcomes or increased morbidity and mortality over 2 years. This study highlights the importance of taking a multi-faceted approach when determining patient eligibility for mechanical support devices. Future studies with larger population models should be conducted. Funding Acknowledgement Type of funding sources: None.

Impact of Psychiatric Diagnoses and Treatment on Postoperative Outcomes Among Patients Undergoing Surgery for Colorectal Cancer.

Psychiatric diagnoses may be a risk factor for poor colorectal cancer (CRC) surgery outcomes. The authors investigated the risk of psychiatric diagnoses and benefit of mental health treatment for surgery outcomes among CRC patients. This retrospective cohort study of patients undergoing CRC surgery in the 2000-2014 period identified documentation of psychiatric diagnosis and mental health treatment (no treatment, medication only, psychotherapy only, or both medication and psychotherapy) 30 days before surgery. Associations between psychiatric diagnoses, mental health treatment, and postoperative outcomes (postoperative complications, length of stay [LOS], and 90-day readmission rate) were evaluated with multivariable generalized estimating equations. Among 58,961 patients undergoing CRC surgery, 9,029 (15.3%) had psychiatric diagnoses, 4,601 (51.0%) of whom received preoperative mental health treatment (90.0% psychiatric medication, 6.7% psychotherapy, and 3.0% medication and psychotherapy). Patients with psychiatric diagnoses had an increased risk for postoperative complications (odds ratio [OR]=1.09, 95% confidence interval [CI]=1.03-1.15) and 90-day readmission (OR=1.11, 95% CI=1.06-1.17) compared with patients without psychiatric diagnoses. Patients with psychiatric diagnoses who received no mental health treatment or only medication had a 7%-17% increased risk for postoperative complications and 90-day readmission compared with patients without psychiatric diagnoses. Patients who received medication only also had a 4% increase in LOS relative to patients without psychiatric diagnoses. Patients with psychiatric diagnoses receiving only psychotherapy and patients without psychiatric diagnoses had similar postoperative outcomes. Preoperative psychiatric diagnoses were associated with worse postoperative outcomes. Surgical quality-improvement efforts should focus on identifying patients with preoperative psychiatric diagnoses and addressing these conditions presurgery.

Impact of Psychiatric Diagnosis and Treatment on Medication Adherence in Youth With Systemic Lupus Erythematosus.

Youth with systemic lupus erythematosus (SLE) experience high rates of psychiatric comorbidities, which may affect medication adherence. We undertook this study to examine the association between psychiatric disorders and hydroxychloroquine adherence and to determine whether psychiatric treatment modifies this association. We identified incident hydroxychloroquine users among youth with SLE (ages 10-24 years) using de-identified US commercial insurance claims in Optum Clinformatics Data Mart (2000-2016). Adherence was estimated using medication possession ratios (MPRs) over a 365-day time period. Multivariable linear regression models were used to estimate the effect of having any psychiatric disorder on MPRs, as well as the independent effects of depression, anxiety, adjustment, and other psychiatric disorders. We tested for interactions between psychiatric diagnoses and treatment with psychotropic medications or psychotherapy. Among 873 subjects, 20% had a psychiatric diagnosis, most commonly depression. Only adjustment disorders were independently associated with decreased MPRs (β -0.12, P = 0.05). We observed significant crossover interactions, in which psychiatric disorders had opposite effects on adherence depending on the receipt of psychiatric treatment. Among youth with any psychiatric diagnosis, psychotropic medication use was associated with a 0.15 increase in the MPR compared with no psychotropic medication use (P = 0.02 for interaction). Among youth with depression or anxiety, psychotherapy was also associated with a higher MPR compared with no psychotherapy (P = 0.05 and P < 0.01 for interaction, respectively). The impact of psychiatric disorders on medication adherence differed by whether youth had received psychiatric treatment. Improving recognition and treatment of psychiatric conditions may increase medication adherence in youth with SLE.

The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in São Paulo, Brazil

OBJECTIVE:Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special program for victimized children in São Paulo, Brazil.METHODS:A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively.RESULTS:Children with mood disorders alone had the highest rate of adherence (79.5%); those with substance abuse disorders alone had the lowest (40%); and those with both disorders had an intermediate rate of adherence (50%). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence.CONCLUSIONS:Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth.

Impact of psychiatric diagnoses on hospital length of stay in children with sickle cell anemia

Patients with sickle cell anemia (SCA) experience a broad range of psychiatric disorders, placing them at risk for more complicated and longer hospitalizations for vaso-occlusive crises (VOC). The current study examined the frequency of psychiatric disorders in SCA patients (ages birth to 20 years) admitted for VOC in a nationally representative sample and the association between psychiatric disorders and hospital length of stay (LOS). Patients with a primary diagnosis of SCA with crisis identified through the nationally representative Kids' Inpatient Database (KID) 2006 from the Agency of Healthcare Research and Quality were included for analysis. Patients with psychiatric disorders listed as secondary diagnoses were categorized under specific psychiatric disorders (mood disorder, anxiety disorder, disruptive behavior disorder, substance use disorder). Non-parametric and regression analyses were utilized for nationally weighted data, to determine the effect of psychiatric disorders on LOS, while controlling for significant covariates. For 21,255 hospital discharges for children with SCA with crisis in 2006, the mean LOS was 4.51 days. Approximately 6% of the patients discharged had a psychiatric disorder. After adjusting for significant covariates, mood disorders, anxiety disorders, and any psychiatric disorder were each associated with significantly longer LOS (P < 0.01). Substance and disruptive behavior disorders were not associated with LOS. Pediatric patients diagnosed with a psychiatric disorder, specifically mood or anxiety disorders, have longer LOS for VOC. These findings suggest that future interventions aimed at managing VOC may need to consider adjunctive psychiatric assessment and intervention.

W07-02 - Cancer and depression: Integrating scientific evidence with clinical practice

A diagnosis of cancer is one of the most distressing events in life. It changes the course of everyday life and causes an existential crisis. This makes some clinicians think that depression is a normal reaction to a diagnosis of cancer. However, the body of evidence suggests that not all people diagnosed with cancer develop depression, but patients with cancer have an increased rate of depression. This presentation will try to combine the latest data on depression and cancer, including the mechanisms underlying depression in these patients and the impact of psychiatric diagnosis on the outcome of cancer. We will then focus on the implications of these data on the diagnosis and management of depression in the clinical setting.

Longer Hospital Stays Linked To Comorbid Illnesses

Back to table of contents Previous article Next article Health Care EconomicsFull AccessLonger Hospital Stays Linked To Comorbid IllnessesJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:21 Oct 2005https://doi.org/10.1176/pn.40.20.00400015Psychiatric illness prolongs the hospital stay of medical or surgical patients, studies from the 1980s have shown. And this still seems to be the case, even in this era of managed care, in which those companies exert pressure to shorten hospital stays, a new study suggests.The investigation was headed by James Bourgeois, M.D., a professor of psychosomatic medicine at the University of California at Davis, and published in the September-October Psychosomatics.While in this study medical and surgical patients with comorbid psychiatric disorders were found to have stayed in the hospital a markedly shorter time than did such patients in the 1980s, comorbid psychiatric illnesses other than substance-related disorders were still linked with a significantly increased length of stay.Bourgeois and his colleagues based their study on discharge reports for some 49,000 patients cared for at the UC Davis Medical Center between 1999 and 2001. The hospital has 528 beds and no psychiatric inpatient unit.The researchers analyzed the discharge reports to assess patients for a comorbid mental disorder. About one-third of the patients had one. Substance use, mood disorders, and cognitive disorders were the most common. Anxiety disorders, psychotic disorders, and “other psychiatric disorders” followed. Adjustment disorders were last.Then, after taking the complexity of patients' medical and surgical conditions into consideration, the researchers compared patients with and without various comorbid mental disorders on length of hospital stay. They found that patients with no psychiatric disorder and patients with a substance use disorder had the shortest hospital stay— on average 3.29 days—whereas patients with adjustment disorders had the longest hospital stay—on average 5.68 days. Length of stay for patients with coexisting mood disorders, anxiety disorders, psychotic disorders, and cognitive disorders fell between these two extremes, with an average of 4.24 days.In an interview with Psychiatric News, Bourgeois said that he was not surprised by the general thrust of their findings—that even with managed care, patients with comorbid psychiatric illness tend to stay longer in the hospital—since patients with a coexisting psychiatric illness tend to be difficult to treat.However, he said that he did not expect two other results—that patients with a coexisting substance use disorder did not spend extra time in the hospital and that patients with a comorbid adjustment disorder spent the longest time there.Regarding the first finding, he said, “I was initially a bit surprised as one often thinks of substance use disorders being associated with more medical complications, et cetera, which would presumably increase length of stay.... A possible explanation—although our dataset did not address this in detail—may be that some substance-using patients are admitted for brief inpatient detoxification and then promptly discharged, with a short length of stay.”As for the second finding, he said, “This is indeed a curious finding, as adjustment disorder is typically not a very impairing psychiatric illness. There are exceptions, of course—for example, an adjustment disorder patient who makes a medically serious suicide attempt and thus has a long length of stay. Because there were relatively few adjustment-disorder patients versus the large size of the whole dataset, it is difficult to comment further due to the chance that few cases with very long lengths of stay among the adjustment disorder patients may have skewed the length of stay for this small group.”Yet another noteworthy result emerged from the study. Whereas one-third of medical and surgical patients studied had a coexisting mental disorder, Bourgeois and his consultation-liaison staff were asked to formally assess only 4 percent of them. Bourgeois and his team thus hope that this finding might lead to greater involvement of consultation/liaison staffs in such cases and to more funding for consultation/liaison positions in hospitals.The study was funded by the University of California at Davis Psychiatry and Behavioral Sciences Department.An abstract of “The Impact of Psychiatric Diagnosis on Length of Stay in a University Medical Center in the Managed Care Era” is posted at<http://psy.psychiatryonline.org/cgi/content/abstract/46/5/431>.▪ Psychosomatics 2005 46 431 ISSUES NewArchived

The Impact of Psychiatric Diagnosis on Length of Stay in a University Medical Center in the Managed Care Era

Inpatient use data were examined for fiscal years 1999-2001. Patients with and without psychiatric diagnoses were compared for length of hospital stay and complexity of illness. Patients with psychiatric disorders represented 33%-35% of total cases. Substance use (9,824 cases), mood disorders (2,524 cases), and cognitive disorders (2,362 cases) were the most common psychiatric illnesses. Patients with substance use disorders or no psychiatric diagnosis had the shortest adjusted length of stay, whereas the small number with adjustment disorders (N=147) had the longest. Other psychiatric patients had lengths of stay between these extremes. Excepting substance use disorders, increased lengths of stay with psychiatric comorbidity have persisted into the managed care era.

The impact of psychiatric diagnosis and family system relationship on problems identified by families coping with a mentally ill member.

The purpose of this study was to explore how psychiatric diagnosis and family relationships relate to problems identified by participants in three one-day public family psychoeducation workshops for families with a member with a serious mental illness. Workshop participants generated lists of problems they had faced, which were coded into eleven categories. Logistic regression models predicting listing of categories were developed based on ill member (diagnosis, sex, treatment compliance) and family member (sex, age, relationship to the ill member) characteristics. For models predicting content category from ill member characteristics, only denial/noncompliance and interpersonal/social categories were significantly predictive as dependent variables. For models predicting content categories from family member characteristics, only the resources/benefits model was predictive. The significant findings, in conjunction with the important negative results, suggest implications for further development of family intervention models. Building on previous research, groups composed of families coping with more than a single diagnosis and including a variety of family member relationships have the potential to reach consensus on curriculum topics.

Efficacy of Outpatient Intensive Treatment for Drug Abuse

Objective: Outpatient intensive treatment for drug and alcohol abuse has become an alternative approach to management of substance abuse. We evaluated the efficacy of an outpatient intensive treatment program for crack cocaine; and the impact of psychiatric diagnosis on outcome variables. Method: Subjects participating in an outpatient intensive treatment program underwent descriptive testing at entry and at six-month followup. Outcome variables included Addiction Severity Index composite scores and retention in treatment. Results: Subjects demonstrated significant improvement in ASI scales, over time, with an interaction effect of time and scale. Minimal interaction of psychiatric diagnosis and outcome was found. Conclusion: Outpatient intensive treatment demonstrated efficacy in reduction of ASI composite scores. Comparison with standard outpatient treatment and inpatient treatment is needed.

The military psychiatrist as social engineer.

The social roles of the military psychiatrist are examined with special attention to the uses and misuses of power. The ethical dilemma of loyalty divided between the individual patient and the community at large is complicated by the social impact of psychiatric diagnosis. Diagnosis may be considered a seemingly harmless choice of medical language describing social behavior, but the choice of the medical model has profound social consequences.