Outpatient Psychiatric Care Research Articles

Factors Associated With Receiving Early Post-Discharge Follow-up Care in Patients With Schizophrenia.

Identifying factors associated with early post-discharge outpatient care is crucial to prevent relapse and suicide in patients with schizophrenia. This study aimed to investigate factors associated with receiving follow-up care within seven days after hospital discharge among patients with schizophrenia. This nationwide population-based study was conducted using data from the National Health Insurance Claim Database of South Korea. All patients aged ≥ 18 years, newly admitted to the hospital with schizophrenia between January 1, 2017, and December 31, 2018, were included. The outcome of interest was the receipt of outpatient follow-up care within seven days of hospital discharge. Patients' general characteristics and healthcare services were included as independent variables. A generalized estimating equation model was used to examine factors associated with the outcome. Of 17,565 patients with schizophrenia, 37.6% received outpatient follow-up care within seven days after hospital discharge. Patients who were older and male were less likely to receive follow-up care seven days after discharge. Patients with prior psychiatric outpatient care to their index admission were more likely to receive follow-up care than those without prior outpatient care. A longer hospital stay significantly decreased the likelihood of receiving outpatient follow-up. However, comorbid alcohol use disorder was not associated with receiving follow-up care within seven days of discharge. This study highlights the need to ensure continuity of care for patients with schizophrenia during discharge planning, with particular attention to vulnerable patients.

Treatment Adherence, Internalised Stigma and Recovery Among Individuals Diagnosed With Schizophrenia in Eastern Turkey.

This study aimed to assess the relationship between treatment adherence, internalised stigma, recovery and the mediating effect of internalised stigma on these relations in individuals diagnosed with schizophrenia. This study was conducted using a cross-sectional design. A purposive sample of 107 individuals diagnosed with schizophrenia receiving psychiatric outpatient care at outpatient clinics and community mental health services (CMHC) affiliated with SBU Van research and education hospital was recruited for this study. The data were collected by the following tools: sociodemographic data questionnaire, the internalised stigma in mental illnesses scale, the medication adherence rating scale and recovery assessment scale. The study participants reported low levels of treatment adherence, high levels of internalised stigma and moderate levels of recovery. Furthermore, we found a weak negative correlation between internalised stigma and treatment adherence. There was a moderate negative correlation between internalised stigma and recovery. Additionally, it was found that internalised stigma has fully mediating effect on the relation between treatment adherence and recovery. The results of this study can guide mental health nurses in developing tailored interventions and support programmes to improve this population's treatment adherence, recovery and overall mental health outcomes.

A descriptive study of first time outpatient public psychiatric care after 65 years

BackgroundMental health in the older adults represents a public health issue, especially depression and suicide, and even more in the Brittany French region. Community Mental Health Centers (CMHC) are the front-line French psychiatric healthcare organizations, but the number, characteristics and trajectories of the older adults consulting there for the first time are unknown.MethodAn exhaustive cross-sectional study from medical records about first-time consultants in any CMHC of the Guillaume Régnier Hospital Center in 2019, and quantifying and describing the 65 and over ones according to socio-demographic, clinical, geographic and trajectory criteria.ResultsThis population represents 9.7% of all first consulting in CMHCs. We can note that 70.5% are female, 46.8% are living alone and 31.2% are widowed. These 3 rates are higher than in the general population. The main diagnosis we found is mood disorder (35.1%). Organic mental disorders are scarce (8.2%). Most people are referred by a general practitioner (53.4%) or a specialist/hospital center (23.7%). The main referral at the end is to CMHC care (73.6%). Only 20.0% had a referral to non-psychiatric health professionals (GP, coordination support teams, geriatrics, other professionals). Significant differences in the referral at the end exist between 65 and 74, who are more referred to CMHC professionals, and 75 and over, who are more frequently referred to non-psychiatric health professionals. Significant discrepancies about who referred are found according to community area-type.ConclusionThese results align with the literature about known health-related characteristics and the importance of depression in the older people. They question the link with non-psychiatric professionals, and the need to structure a homogeneous care organization in psychiatric care for the older adults with trained professionals, especially for the 75 and over.

Learning to be mindful ─ experiences of mindfulness-based stress reduction for young adults with moderate to severe mental disorders

IntroductionMental disorders among young adults are a major health challenge. Mindfulness-based stress reduction (MBSR) has in previous research shown positive effects on mental health. However, research evaluating MBSR for young adults with mental disorders is insufficient and qualitative research exploring experiences of the programme is scarce. The aim of this study was to explore experiences of MBSR as a supplementary treatment in psychiatric outpatient care among young adults with moderate to severe mental disorders, from a short- and long-term perspective. MethodEleven young adults (aged 18–27 years) who had participated in an MBSR programme were interviewed approximately three months or two years later. The analytic method was Grounded Theory. ResultsThe analysis resulted in a theoretical model including one core category and five categories. The model illustrated a learning process, explaining the participants’ short- and long-term experiences of learning to pay attention to the body, regulate emotions, a change of attitude towards oneself, and still using skills two years after the programme. DiscussionThe MBSR programme was experienced as a learning process which improved the longstanding ability to cope with emotional stress in daily life. Tailoring MBSR to individual needs may further enhance its effectiveness. ConclusionThe experienced short- and long-term health-promotion benefits of an MBSR programme among young adults with mental disorders support its implementation in psychiatric and primary health care. Future research should investigate how to optimise implementation and tailor to individual needs.

Examining The Care Pathways Patients Experience When Accessing Outpatient Psychiatric Care in British Columbia

The British Columbia (BC) mental health roadmap prioritizes equitable access to care. This study investigates the equity of care pathways experienced by BC residents accessing outpatient psychiatric care for the first time. Community-based care pathways are paramount as they indicate timely access to care and are less expensive for the health system. We analyzed linked administrative BC health data spanning April 1st 2013, to March 31st 2022, to study how sociodemographic factors relate to accessing psychiatric care pathways. Pathways to outpatient psychiatric care include a community-based pathway, hospitalization to primary care to outpatient psychiatry, and hospitalization directly to outpatient psychiatry. Sociodemographic factors considered were administrative sex, immigration recency and status, neighbourhood income quintile and being a recipient of a low-income drug plan. These relationships were analyzed using multinomial logistic regression, adjusting for age, location, fiscal year, and stratifying by mental disorder diagnoses. Being male, a low-income drug plan recipient, living in a lower income neighbourhood, or being a recent economic immigrant or permit holder was associated with increased odds of accessing outpatient psychiatric care via either hospitalization pathway. Having a diagnosis of schizophrenia/bipolar disorder was independently associated with both hospitalization pathways, and this diagnosis exacerbated the magnitude of the estimates for the sociodemographic characteristics. We find clear disparities in pathways to accessing outpatient psychiatric care. These disparities indicate health system failures in addressing specific population needs, highlighting the importance of targeted interventions, such as increasing the number of community health workers, to achieve equitable mental health care in BC.

Evaluating an Autistic Burnout Measurement in Women.

This study evaluated the suitability of an unpublished autistic burnout assessment tool, focusing on autistic women. Distinguishing autistic burnout from conditions like depression or anxiety is crucial for effective interventions, emphasizing the need for nuanced research and refined measures in understanding and addressing autistic burnout. The Dutch version of the AASPIRE Autistic Burnout Measure (AABM-NL) was evaluated within a sample of 45 autistic women from the Autism Expertise Center. Preliminary findings of the AABM-NL scores demonstrated promising evidence of good internal consistency and convergent validity. Positive associations were observed between AABM-NL scores and a Likert scale assessing identification with autistic burnout, as well as with an instrument measuring physical and psychological complaints (SCL-90-R; Symptom Checklist-90-Revised). Specifically, anxiety, somatization, cognitive-performance deficits, and depression were correlated with the severity of autistic burnout. There was no significant difference between work status and the severity of autistic burnout, implying no employment-related connection. The AABM-NL effectively differentiated between women with and without autistic burnout, with 62 points as a suitable cut-off point. However, these results may not be generalized to women requiring daily living support, individuals beyond outpatient psychiatric settings, or those in institutionalized populations. The preliminary findings provide empirical evidence supporting the use of the AABM-NL as a potential tool for assessing autistic burnout in women receiving outpatient psychiatric care. Its implementation may contribute to programs aimed at recognizing and preventing autistic burnout in women. Further research is needed to enhance intervention strategies for mitigating the risk of autistic burnout.

Acceptance by and evaluation of unidirectional hearing systems by patients in outpatient and (partial) inpatient geriatric psychiatric care

The aim of the present study was to investigate the use and subjective benefit of specific temporary hearing-improvement measures (unidirectional hearing aids) in hearing-impaired, geriatric psychiatric patients. Simultaneously, employees evaluated the handling and acceptance of the hearing-improving measures. Between October 2022 and July 2023, subjective hearing ability and use of conventional hearing aids were recorded in outpatients and in those in partial inpatient care (n=151) based on a self-assessment questionnaire. After using unidirectional hearing aids in diagnostics and treatment for four to six weeks, the hearing ability of 21 patients who had not used the hearing-improving measures was surveyed again and the experiences of active users (n=34) and employees (n=24) with the hearing-improving measures were analyzed via questionnaires. Of the 151 included patients (79.2 years, 62.1% female), 147 patients and 24 employees (79.2% female) took part in the study. Subjective hearing impairments were reported by 50 patients (34.0%). The hearing of 93 patients (63.2%) had already been assessed once. Treatment with conventional hearing aids was recommended for 34 of those surveyed (23.1%). Likewise, 34 patients (23.1%) took advantage of the offer of hearing-improving measures. All 34 users and all participating employees rated the hearing-improving measures used as mostly positive. Hearing impairment in geriatric psychiatric patients is common and often not adequately treated with conventional hearing aids, yet hearing-improving measures are only used to a limited extent. Mostly positive results among the users of hearing-improving measures favor their implementation in patients in routine outpatient and (partial) inpatient geriatric psychiatric care.

Attention deficit hyperactivity disorder in adults : prevalence and association with addictive disorders

Introduction Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder witch assumed to be a disorder of childhoood but recently has been shown to persist into adulthood. As in children, core features of adult ADHD include inattention, impulsivity, and/or hyperactivity.Despite growing interest in adult ADHD, little is known about its prevalence or correlates.ObjectivesWe aimed to estimate the prevalence of ADHD in adult outpatient psychiatric care at the university hospital of Gabes (southern Tunisia) and to explore its association with addictive disorders.MethodsWe conducted a cross-sectional, descriptive, and analytical observation study,in the outpatient psychiatry department of the Gabes university hospital, during the period ranging from 1/1/2023 to 30/06/2023. We used an anonymous pre-established information sheet exploring the socio-demographic, clinical, therapeutic data of the patients, lifestyle habits and substance use, the DSM-5 to classify diagnoses, CGI-S to rate the severity of overall mental illness, Fagerström test to assess the nicotine dependence, Adult ADHD Self-Report Scale (ASRS) in its validated Arabic version to screen ADHD and the Diagnostic Interview for ADHD in Adults (DIVA) to confirm the ADHD diagnosis. Data entry and analysis were performed using Statistical Package for Social Sciences (SPSS) version 21.0.Results The response rate in our study was around 64.5%, 205 patients were included.The mean age of the patients was 48years ±14.9, the male/female ratio was 1.The estimated prevalence of adult ADHD according to the DIVA was 5.9% (male/female ratio=1/2). At the uni-variate study, significant associations were found between ADHD and the age category (p=0), the marital status (OR=0.14; CI [0.03- 0.55], p=0.003), theFagestrom score (p=0.01), cannabis consumption (OR=19; CI [1.8-201], p=0.018), psychotropic drugs consumption (OR=39; CI[3-196], p=0.02), self-harm behavior (OR=6.9, CI[1.9-26], p=0.01), excessive use of internet and screens (OR=38, CI[7-179],p=0). At the multivariate study, two determining factors were found: cannabis consumption(OR=8 [1- 58]; p=0.031), and the excessive use of internet and screens (OR=25 [4-144]; p=0).Conclusions Regarding our findings and the important prevalence of the adult ADHD,more efforts are needed to increase the detection and treatment of this disorder, in order to set up an early intervention before major impairments and complications become irreversible.Disclosure of InterestNone Declared

Monitoring Persons’ Rights to Equal Care: Registered Nurses’ Experiences of Caring for People with Mental Ill-Health and Somatic Comorbidity in Psychiatric Outpatient Care

Persons with severe mental ill-health die early from preventable physical ill-health. Registered nurses in psychiatric outpatient care play a key role in improving persons’ physical health, and it is important to examine how they view their responsibility, their experiences of care, and the obstacles they meet in providing person-centred care. The purpose of this study was to explore registered nurses’ experiences of caring for persons with mental ill-health and somatic comorbidity in psychiatric outpatient care, using qualitative content analysis to analyze data from semi-structured interviews. The results show that these nurses monitored the person’s right to equal care, embraced the whole of the persons suffering, and dealt with unclear boundaries in care. This highlights the unique role that registered nurses play in psychiatric outpatient care via their ability to interpret symptoms and find ways to adapt care based on persons’ needs. Registered nurses consider physical health in all care and provide a link between psychiatric and somatic care. Together with mental health nurses at primary health care centers, they are key in reducing persons’ suffering. There is a need for structural and functional changes in line with person-centred care including collaboration both within and outside healthcare organizations.

Impact of the National Suicide Hotline Number on Care of Outpatient Psychiatric Patients

Background: The Federal Communications Commission (FCC) has selected 988 as the number for mental health crisis and this came into effect in July 2022. It is not clear how aware psychiatric patients are of this event, and how much impact this will have on outpatient psychiatric care. Methods: Prior to the introduction of 988, the authors performed a study of patients attending the outpatient psychiatric clinic at the department of psychiatry’s outpatient services. The study comprised of a one-page questionnaire to acquire qualitative and quantitative data on patients’ knowledge and acceptance of the change in the access of the suicide prevention number. Results: A total of 74 outpatient psychiatric patients were surveyed during the course of the study. Most (87.8%) of surveyed individuals denied memorisation of their local mental health crisis or suicide prevention hotline number. Of the 24 individuals who reported previously having called a crisis hotline, over one-third (37.5%) reported difficulty remembering or finding the number. In response to the introduction of a three-digit crisis hotline number, 63.5% (47) of surveyed individuals reported both increased confidence in receiving prompt, effective psychiatric care, and greater likelihood of seeking help with the three-digit number. Finally, 77.0% (57) stated that a three-digit number would be more easily remembered than current options. The majority (89%) of responders were not aware of the 988 hotline number. Conclusion: Patients believe the 988 number will be a helpful tool in their care. One year after its introduction, awareness of 988 has barely changed.

Adolescent utilization of eating disorder higher level of care: roles of family-based treatment adherence and demographic factors

BackgroundOutpatient family-based treatment (FBT) is effective in treating restrictive eating disorders among adolescents. However, little is known about whether FBT reduces higher level of care (HLOC) utilization or if utilization of HLOC is associated with patient characteristics. This study examined associations between utilization of eating disorder related care (HLOC and outpatient treatment) and reported adherence to FBT and patient characteristics in a large integrated health system.MethodsThis retrospective cohort study examined 4101 adolescents who received care for restrictive eating disorders at Kaiser Permanente Northern California. A survey was sent to each medical center to identify treatment teams as high FBT adherence (hFBT) and low FBT adherence (lFBT). Outpatient medical and psychiatry encounters and HLOC, including medical hospitalizations and higher-level psychiatric care as well as patient characteristics were extracted from the EHR and examined over 12 months post-index.Results2111 and 1990 adolescents were treated in the hFBT and lFBT, respectively. After adjusting for age, sex, race/ethnicity, initial percent median BMI, and comorbid mental health diagnoses, there were no differences in HLOC or outpatient utilization between hFBT and lFBT. Females had higher odds of any utilization compared with males. Compared to White adolescents, Latinos/Hispanics had lower odds of HLOC utilization. Asian, Black, and Latino/Hispanic adolescents had lower odds of psychiatric outpatient care than Whites.ConclusionsReported FBT adherence was not associated with HLOC utilization in this sample. However, significant disparities across patient characteristics were found in the utilization of psychiatric care for eating disorders. More efforts are needed to understand treatment pathways that are accessible and effective for all populations with eating disorders.

Transfer to community and prison mental health care from Ireland's main remand prison over three years: 2015-2017.

The post-release period is associated with an increased risk of morbidity and mortality. Previous studies have identified deficits in pre-release planning for mentally ill people in prison, particularly in remand settings. We aimed to determine the proportion of mentally ill people in Ireland's main remand prison who were referred for mental health follow up in community and prison settings, who achieved face to face contact with the receiving service. This retrospective observational cohort study was based in Ireland's main male remand prison, Cloverhill. Participants included all those individuals on the caseload of the prison inreach mental health team who were referred for mental health follow up in community and prison settings at the time of discharge, prison transfer or release from custody over a three-year period, 2015 - 2017. Successful transfer of care (TOC) was defined as face-to-face contact with the receiving service, confirmed by written correspondence or by follow up telephone call. Clinical, demographic and offence related variables were recorded for all participants. There were 911 discharges from the prison inreach mental health team within the three-year study period. Of these, 121 were admitted to hospital, 166 were transferred to other prison inreach mental health services and 237 were discharged to community based mental health follow up in psychiatric outpatient or primary care settings. One third (304/911) had an ICD-10 diagnosis of schizophreniform or bipolar disorder (F20-31) and 37.5% (161/911) were homeless. Over 90% (152/166) of those referred to mental health teams in other prisons achieved successful TOC, with a median of six days to first face-to face assessment. Overall, 59% (140/237) of those referred to community psychiatric outpatient or primary care services achieved TOC following referral on release from custody, with a median of nine days from release to assessment. Clinical and demographic variables did not differ between those achieving and not achieving successful TOC, other than having had input from the PICLS Housing Support Service. Successful transfer of care can be achieved in remand settings using a systematic approach with an emphasis on early and sustained interagency liaison and clear mapping of patient pathways. For incarcerated individuals experiencing homelessness and mental health disorders, provision of a housing support service was associated with increased likelihood of successful transfer of care to community mental health supports.

Psychiatric Goals of Care at the End of Life: A Qualitative Analysis of Medical Records at a Geriatric Psychiatric Outpatient Clinic.

Objectives: Person-centered care emphasizes patient choice and autonomy and is considered an important means for improving the quality of care and quality of life for older adults with multiple chronic conditions and functional limitations. In implementing person-centered care, goals of care based on the patient's preferences are considered fundamental. Psychiatry is generally practiced in a curative paradigm, and little is known about the goals of care in geriatric psychiatric settings. In this study, goals of care as documented in care plans and medical records in geriatric psychiatric outpatient care have been explored, with a special focus on the end of life. Methods: This study was based on a descriptive qualitative content analysis of medical records of patients enrolled at an outpatient clinic for geriatric psychiatry at the time of death. It was complemented by a basic quantitative analysis of patient characteristics. Results: A total of 66 medical records were included, with a male/female ratio of 41/59% and a mean age of 83 years (66-104 years). Among psychiatric diagnoses, depression predominated. The dataset was generally limited, and clearly defined goals of care were sparsely presented. Therefore, the included medical records were analyzed twice: first regarding goals of care and second regarding patient wishes and requests. In both cases, the highest level of abstraction in terms of themes was achieved. Analysis of goals of care resulted in the themes patient well-being and care arrangements. Analysis of patient wishes resulted in the themes active patienthood and living and being. Conclusion: Goals of care were often disease-oriented, focusing on recovery or symptom management, whereas analysis of patients' wishes revealed personal goals other than remission, including outspoken existential needs. The results call for further research on the interplay between person-centered care and the goal-planning process and point to the potential of a palliative approach in geriatric psychiatric care involving patients with complex comorbidities and multilevel needs.

Predictors of relapse and engagement in care one year after ending services in an urban safety net coordinated specialty care program for first episode psychosis

ObjectiveThis study aimed to identify risk factors for relapse (psychiatric emergency department visits or hospitalization) and lack of follow-up with outpatient psychiatric care in the 12 months after ending services in an urban safety net coordinated specialty care (CSC) program for first episode psychosis (FEP). MethodsThe study population (n = 143) were individuals with FEP who had any CSC care between 2014 and 2021. To identify risk factors for relapse and follow up after exit, multivariable logistic regression was performed using data from electronic health records and linked insurance claims data. ResultsIndividuals with any emergency department visit or hospitalization 12 months prior to ending CSC (aOR = 4.69, 95 % CI 1.78–12.34) and those who were using cannabis at last CSC contact (aOR = 4.06, 95 % CI 1.56–10.56) had a higher risk of relapse after ending CSC services. Cannabis use at last contact was also associated with lower rates of outpatient psychiatric follow-up (aOR = 0.32, 95 % CI 0.12–0.94), while CSC duration in months had a small positive association with post-CSC psychiatric follow-up. There were no differences in relapse or follow-up by race or ethnicity, primary diagnosis, or medication usage. ConclusionsPrior relapse during CSC predicted relapse in the 12 months after ending CSC services, but not outpatient follow up. Cannabis use predicted both a higher rate of relapse and a lower rate of follow up after ending services. There were no differences by race or ethnicity in our sample, suggesting that once individuals engaged in FEP care there were no evident disparities in the observed outcomes.

What happens after forensic psychiatric care? A latent class analysis of dimensions of welfare for former forensic psychiatric patients

BackgroundMentally disordered offenders are a heterogenous group regarding psychopathology as well as background factors, which makes it likely that more than one stereotypical life situation will apply to all forensic psychiatric patients following discharge. Knowledge about typical life situations would be valuable for optimising support for improving the overall life situation of these individuals. This paper investigates life situations from the perspective of level of living research and resources in terms of different welfare dimensions.MethodsIncluded were all all individuals (n = 1146) who had been discharged from forensic psychiatric care in Sweden during 2009–2018 and were included in the Swedish National Forensic Psychiatric Register. Follow-up time varied from 4 to 3644 days, (m = 1697, Md = 1685). Register data from several different registers was combined. Data was analysed using latent class analysis, and multinominal logistic regression analysis investigated what background factors were associated with class membership.ResultsThe results show that there are four subgroups of post-discharge life situations: the high support group, the general psychiatric needs group, the working group, and the family group. The high support group was the largest, representing 54% of the entire sample. There are background factors associated with group membership, including both age at discharge, length of stay in forensic psychiatric care and pre-index crime historical factors.ConclusionsThis study contributes to the understanding of the post-discharge lives of former forensic psychiatric patients and shows that for several subgroups, negative outcomes are rare. Knowledge about these subgroups could be drawn upon to make informed decisions about in- and outpatient forensic psychiatric care, discharge from forensic psychiatric services, and what support is offered to former forensic psychiatric patients.

Health locus of control, resilience and self-efficacy among elderly patients with psychiatric disorders.

This study aimed to assess the relationship between health locus control, resilience and self-efficacy in older adults with psychiatric disorders. This study was conducted using a cross-sectional design. Sample: A purposive sample of 291 older adults receiving psychiatric outpatient care at Alabbasya Hospital for Mental Health in Cairo was recruited for this study. The data were collected by the following tools: sociodemographic data sheet, the multidimensional health locus of control scale, the general self-efficacy scale, the brief resilience scale and the general health questionnaire. The study participants reported low levels of health locus of control, low levels of self-efficacy and normal levels of resilience. Furthermore, we found a strong positive correlation between resilience and general self-efficacy. The study concluded that older people with psychiatric disorders reported low levels of health locus of control and self-efficacy, while they experienced normal resilience levels. There was a strong positive correlation between resilience and general self-efficacy among the study participants. The results of this study can guide healthcare professionals in developing tailored interventions and support programs to improve this population's quality of life and overall mental health outcomes.

Improvement of anxiety in ADHD following goal-focused cognitive remediation: a randomized controlled trial.

Despite the high prevalence and detrimental consequences of cognitive and executive dysfunction in ADHD, the evidence base of cognitive remediation in the adult ADHD population is sparse. Executive problems can increase both anxiety and depression in ADHD. Thcus, it is important to develop treatment options for adults with ADHD, aiming to improve goal-directed behavior and mood. Goal Management Training (GMT) is an intervention that has received empirical support in improving executive functions and mood in normal aging and for various neurological and psychiatric conditions. The present randomized controlled trial investigated the effects of a goal-focused intervention combining 1) group-based GMT incorporating psychoeducation about ADHD and 2) guidance in implementing individual goals for coping with executive problems in everyday life, compared to treatment as usual (TAU). The primary outcome was perceived executive functioning in everyday life. Secondary outcomes included psychological well-being (anxiety, depression, and coping with ADHD symptoms). We recruited 81 adult participants with a verified ADHD diagnosis (Mage = 31 years). Inclusion was based upon the presence of executive functioning complaints. The participants were randomly assigned to either the intervention or TAU. The intervention group (n = 41) received 16 hours of GMT and psychoeducation, in addition to 4 individual sessions focusing on formulating goals. The goals were assessed in 6 bi-weekly phone calls in the first three months following the group sessions. Participants in the TAU group (n = 40) received standard, individually-adapted follow-up in an outpatient psychiatric health care setting. All participants were assessed at baseline, post-intervention, and at 8-month follow-up (main measurement time point). Significant improvements in everyday executive functioning, psychological wellbeing, and symptoms of ADHD from baseline to 8-month follow-up were reported in both groups. The intervention group reported a significantly higher reduction in symptoms of anxiety compared to TAU. Conclusions. Our findings provide support for considering cognitive remediation as a treatment option for patients with ADHD.Clinical Trial Registration: https://clinicaltrials.gov/study/NCT04638283?term=NCT04638283&rank=1, identifier: NCT04638283.

Measuring patient satisfaction with four items: validity of the client satisfaction questionnaire 4 in an outpatient population

IntroductionPatient satisfaction with mental health services has for several decades been considered an important component when evaluating service quality. It is often assessed in the context of monitoring quality of care, developing or evaluating newly implemented interventions or changes in practice. Because of this, patient satisfaction questionnaires are often added to longer questionnaire batteries, and shorter questionnaires are preferred to prevent respondent fatigue and non-compliance and to secure easy implementation. However, most studies use unvalidated patient satisfaction measures, making comparisons between studies difficult. Validation studies of short patient satisfaction measures are therefore warranted.MethodsThe primary aim was to examine the construct validity and internal reliability of the Client Satisfaction Questionnaire-4 (CSQ-4) in a Norwegian outpatient mental health setting. A total of 467 patients were recruited from an outpatient psychiatric care clinic in Central Norway. The secondary aim was to examine an earlier proposed cutoff for classifying dissatisfied patients in this new population. A principal component analysis was conducted to evaluate factor structure, correlation analyses were conducted to test for predicted relationships, and Cronbach’s alpha was calculated to examine internal reliability.ResultsThe CSQ-4 showed a clear unidimensional structure with one factor explaining 80% of its variance. Its internal reliability was very high, with a Cronbach’s alpha of 0.92. As hypothesised this study found no statistically significant sex differences in satisfaction and no statistically significant association between age and satisfaction. Positive changes in symptoms during treatment and higher post-treatment functional impairment were associated with higher patient-reported treatment satisfaction scores, which indicates good construct validity.ConclusionThis is the first study to evaluate the CSQ-4 in a psychiatric population. The CSQ-4 demonstrated good structural validity and internal reliability and was correlated with outcome variables in terms of symptom change and post-treatment functioning. In sum, this indicates that the CSQ-4 is a good short alternative for evaluating patient satisfaction in routine outpatient mental health care.

L’entourage et la prise en charge psychiatrique ambulatoire en milieu pénitentiaire : enquête menée auprès des structures d’accompagnement vers la sortie implantées en France

ObjectivesA specific population category, that of prisoners, is particularly affected by mental health problems, as demonstrated by the main epidemiological studies on the subject. This finding has prompted the French prison administration to consider factors likely to improve the mental state of prisoners and reduce the chances of recidivism in the future. Among these factors, maintaining ties with family and friends is at the top of the list and is currently a priority for the prison administration. We wanted to understand how well professionals working in outpatient psychiatry in prisons were aware of this issue, particularly those who prepare patients for their release from prison. The principle aim of this study is to examine the current role of family and friends in the patient's care and within the systems that support patients on their release from prison. MethodsThis study is a prospective, multi-center qualitative study of medical staff working in discharge support structures, known as “SAS” in France, using semi-structured interviews. The SAS facilities included were those that existed and had been operating for at least one year at the time of the interviews. The interviews were conducted until all the data were compiled. ResultsSixteen interviews were carried out. The results show that in the majority of cases there was no contact with the patient's family and friends during the outpatient psychiatric care in prisons. This contrasts with the repeated reference to family and friends in the comments made by caregivers during the interviews. For the vast majority, the people close to the patient are considered to be the pillars of the patient's reintegration into society, and caregivers would like to integrate the patients’ entourages more significantly into their practices. According to several of the people interviewed, those close to the patient have an influence on the development and recurrence of mental disorders, on the experience of imprisonment and on acting out. Caregivers perceive many benefits from the inclusion of family and friends, both for the patient and his or her loved ones. On the other hand, the study showed that there are limits to this integration in treatment, specifically those concerning the prison institution, the caregivers and the patients themselves. This study provides several elements confirming the idea that the SAS is a structure conducive to the inclusion of family and friends in psychiatric practices. Finally, the results highlight some innovative ideas for integrating family and friends into this pre-release care. ConclusionsCurrently, there is little integration of family and friends in the outpatient psychiatric care of patients in French prisons, particularly within the SAS. This study proposes future developments in these practices and suggests some very interesting perspectives on the subject. Integrating family and friends into care can be achieved by taking the concrete steps set out in this study, in order to provide optimum care and overall patient management.

Patient Experience of Digitalized Follow-up of Antidepressant Treatment in Psychiatric Outpatient Care: Qualitative Analysis.

Nonadherence to pharmaceutical antidepressant treatment is common among patients with depression. Digitalized follow-up (ie, self-monitoring systems through mobile apps) has been suggested as an effective adjunct to conventional antidepressant treatment to increase medical adherence, improve symptoms of depression, and reduce health care resource use. The aim of this study was to determine patients' experience of digitalized follow-up using a mobile app as an adjunct to treatment concurrent with a new prescription, a change of antidepressant, or a dose increase. This was a qualitative, descriptive study. Patients at 2 psychiatric outpatient clinics were recruited at the time of changing antidepressant medication. After using a mobile app (either a commercial app or a public app) for 4-6 weeks with daily registrations of active data, such as medical intake and questions concerning general mental health status, individual semistructured interviews were conducted. Recorded data were transcribed and then analyzed using content analysis. In total, 13 patients completed the study. The mean age was 35 (range 20-67) years, 8 (61.5%) were female, and all reported high digital literacy. Overall, the emerging themes indicated that the patients found the digital app to be a valuable adjunct to antidepressant treatment but with potential for improvement. Both user adherence and medical adherence were positively affected by a daily reminder and the app's ease of use. User adherence was negatively affected by the severity of depression. The positive experience of visually presented data as graphs was a key finding, which was beneficial for self-awareness, the patient-physician relationship, and user adherence. Finally, the patients had mixed reactions to the app's content and requested tailored content. The patients identified several factors addressing both medical adherence and user adherence to a digital app when using it for digitalized follow-up concurrent with the critical time related to changes in antidepressant medication. The findings highlight the need for rigorous evidence-based empirical studies to generate sustainable research results.