Psychiatric Outpatient Clinic Research Articles

Is age of self-harm onset associated with increased frequency of non-suicidal self-injury and suicide attempts in adolescent outpatients?

BackgroundSelf-harm in adolescents is an increasing public health concern and an important risk factor for suicide. We aimed to examine how age of self-harm onset in adolescents was associated with frequency of subsequent suicidal and non-suicidal self-harm (NSSI) episodes, and how age of onset and duration of self-harm may influence the frequency of self-harm.MethodsData from 103 adolescents with recurrent self-harm recruited from child and adolescent psychiatric outpatient clinics were collected through clinical interviews and self-reports, and analysed with negative binomial and hurdle models.ResultsA lower age of self-harm onset and a longer duration of self-harm were both significantly associated with increased frequency of subsequent episodes of NSSI and risk of a first suicide attempt. There was an increase in repeated suicide attempts when the age of onset of self-harm decreased and the duration increased, and dramatically more for long duration of NSSI before first suicide attempt.ConclusionInitiating self-harm behaviour at the youngest age had the highest risk of increased frequency of NSSI and suicide attempts. Longer duration of self-harm behaviour increased this risk. This underlines the importance of early identification of self-harm behaviour in adolescents, and the use of effective interventions.

Measuring patient satisfaction in an outpatient psychiatric clinic. What factors play a role?

IntroductionPatient satisfaction is defined as the perception that one’s general health care needs are being met. Prior research suggests that positive patient satisfaction with health care facilitates the physician–patient relationship and enhances quality of life.ObjectiveThe primary purpose of this study was to assess patient satisfaction (as measured by the Patient Satisfaction Questionnaire (PSQ-18)) of patients observed by general psychiatry residents and to examine the effects of depression and anxiety on patient satisfaction. A secondary purpose was to explore the effects of three 1-h mentalization-based skills training sessions on the PSQ-18 scores of psychiatric residents. We hypothesized that depressive and anxiety symptoms would negatively impact patient satisfaction. We hypothesized that patients’ satisfaction scores would improve after mentalization training.MethodsThis was a prospective case–controlled study, enrolling adult patients (n = 157) referred for psychiatric assessment in a psychiatric resident outpatient clinic. The primary outcome was patient satisfaction as measured by the PSQ-18. This outcome was compared to anxiety and depression symptoms as measured by the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder 7-Item scale (GAD-7) questionnaires. Outcome data from the PSQ-18 were compared among residents before and after they completed mentalization training. The data were analyzed with univariate analyses and multiple linear regression.ResultsOverall the patients were satisfied with clinician communication and interpersonal manner (4.21 ± 0.66 and 4.15 ± 0.69, respectively). The patients score on PHQ-9 was inversely related to their scores on time spent (TS) (p = 0.01) and accessibility/convenience (AC) (p = 0.0009) subscales of the PSQ-18. GAD-7 score was inversely related to patients scores on AC subscale (p = 0.01). Brief mentalization training for the providers did not impact patient satisfaction scores.ConclusionsOur study reveals that depression and anxiety can negatively impact PSQ-18 patient scoring in psychiatric outpatients observed for the first time in a resident clinic. However, this study failed to show that a brief mentalization-based training could improve patient satisfaction scores that were already quite high at baseline.

Prevalence of Autism Spectrum Disorders in Adult Outpatient Psychiatry.

Relatively little has been published about the prevalence of autism in adults with psychiatric disorders. In this study, all new patients referred to an adult psychiatric outpatient clinic in Sweden between November 2019 and October 2020 (n = 562) were screened for autism spectrum disorders using the Ritvo Autism and Asperger Diagnostic Scale Screen (RAADS-14). Out of the 304 (58%) responders, 197 who scored above the cut off (14) were invited to participate in an in-depth assessment. Twenty-six of the 48 that participated in the assessment met criteria for ASD and an additional eight had subthreshold ASD symptoms. We estimated the prevalence of ASD in this population to at least 18.9%, with another 5-10% having subthreshold symptoms.

Need for improved diabetes support among people with psychiatric disorders and diabetes treated in psychiatric outpatient clinics: results from a Danish cross-sectional study

IntroductionPeople with psychiatric disorders have increased risk of premature death partly due to diabetes. This study aims to explore the quality of diabetes care, diabetes management, diabetes support and well-being...

Rates and correlates of post-traumatic stress disorder and symptoms during the immediate onset of COVID-19 pandemic in a sample of patients from an outpatient psychiatric clinic in Turkiye.

This study was designed to investigate the traumatic stress levels, participants demonstrating higher than post-traumatic stress disorder (PTSD) cutoff, thus PTSD possibility, levels, and related factors of patients who felt the need to apply to the outpatient clinic for the 1st time during the first period of the outbreak of the pandemic as a traumatic event, when many psychiatry outpatient clinics were mostly closed to face-to-face admissions. In our research, we targeted three objectives. First, we evaluated PTSD as indicated with measure cutoff points and post-traumatic stress symptom (PTSS) rates among the individuals who were admitted to an outpatient psychiatric clinic for the 1st time, 3 months after the first COVID-19 case was reported in Turkiye. Second, we investigated the relationship between PTSS and PTSD cutoff with anxiety, stress, depression, hopelessness, fear of COVID-19, and disability levels. Third, we aimed to explore the sociodemographic data and risk factors related to PTSD cutoff and PTSS controlling levels of disability, hopelessness, fear of COVID-19, anxiety, depression, and stress. For our study, a total number of 85 cases were recruited. Post-traumatic Stress Diagnostic Scale (PDS), Beck Hopelessness Scale (BHS), Depression, Anxiety, and Stress Scale (DASS-21), Sheehan Disability Scale (SDS), and Fear of COVID-19 Scale (FCS) were administered to each patient. The rates of possible PTSD and PTSSs were found to be 25.9% and 88.2%. The majority of participants were women (65.9%) who have been presenting complaints with anxiety symptoms (60.1%) and social media users (74.1%). The mean DASS-21 all subscales (anxiety, depression, and stress) (p<0.01), BHS (p<0.01), FCS (p=0.03), and SDS family life/home responsibilities subscale (p<0.01) scores of PTSD cutoff subgroup (n=22) were higher than non-PTSD group (n=63). We observed significant positive correlations between the FCS scores and DASS-21 anxiety subscale (p<0.01), SDS family life/home responsibilities and social life/leisure activities subscales (p<0.05), and PDS symptom severity subscale (p<0.01) scores. These results demonstrate that a COVID-19 pandemic is a traumatic life event that causes high rates of possible PTSD, PTSS, anxiety, depression, hopelessness, and disability and leads to admissions to psychiatric outpatient clinics.

Serum vitamin-D level and major depressive disorder in Upper Egypt

Background There is an increasing evidence of an association between low vitamin-D levels and depression. Consequently, the present study aimed to investigate the serum levels of vitamin D in cases with major depressive disorder in Sohag Governorate in Upper Egypt. Also, we studied the correlation between serum vitamin-D level and different demographic and clinical variables in these patients. This study included 60 patients who attended our outpatient psychiatric clinic at Sohag University Hospital, who were diagnosed as major depressive disorder (group I) and a similar number (60) of age-matched and sex-matched controls (group II). The diagnosis was based on Diagnostic and statistical manual of mental disorders, 5th ed. criteria and verified by application of Quick Inventory of Depressive Symptomatology. A blood sample was taken from all participants for assessment of the levels of serum vitamin D.Results Patients with major depressive disorder have significantly lower serum vitamin-D levels than controls (mean±SD was 17.2±12.3 for patients and 33.4±24.2 for controls, P=0.001). About 58.33% of patients had deficient vitamin D, while 45% of controls had deficient vitamin D (P=0.022). There is a statistically significant negative correlation between the severity of depression and serum vitamin D.Conclusions Serum vitamin D was significantly lower in major depression patients than controls. In addition, it is evident to have a direct correlation with severity of symptom depression.

A longitudinal study of post-traumatic stress, depressive, and anxiety symptoms trajectories in subjects with bipolar disorder during the COVID-19 pandemic.

Bipolar disorder (BD) is recognized to be at high risk for developing negative psychopathological sequelae to potentially traumatic events. Nevertheless, scant data are still available about the effects of the COVID-19 emergency on the clinical course of BD. The present study examined prospectively the development and trajectories of post-traumatic stress, depressive, and anxiety symptoms among subjects with BD that were followed in an outpatient psychiatric clinic at the time of pandemic onset. A cohort of 89 subjects with BD was enrolled during the first wave of the COVID-19 pandemic, and assessed at baseline (T0), 2-months (T1), and 6-months (T2) follow-up. A K-means cluster analysis was used to identify distinct trajectories of depressive, anxiety, and post-traumatic stress symptoms during the three time points. We identified three trajectories: the Acute reaction (13.5%); the Increasing severity (23.6%); and the Low symptoms (62.9%) groups, respectively. In the Acute reaction group a significant prevalence of female gender was reported with respect to the Low symptoms one. Subjects in the Increasing severity group reported significantly lower employment rate, and higher rate of relatives at risk for COVID-19 medical complications. Subjects in the Increasing Severity group reported higher rates of previous hospitalization and manic symptoms at baseline than those included in the Low symptoms one. Our results describe three distinct symptom trajectories during the COVID-19 emergency in a cohort of subjects suffering from BD, suggesting the need of a long-term follow-up for detecting the impact of the COVID-19 pandemic in this vulnerable population.

Psychometric Properties of The Clinician Affective Reactivity Index for Assessment of Irritability in a Clinical Sample of Turkish Children and Adolescents.

BackgroundNo clinician-oriented scale exists to assess irritability in Turkey. This pilot study aimed to evaluate the psychometric properties of the Turkish version of The Clinician Affective Reactivity Index (CL-ARI).MethodA total of 116 children and adolescents aged between 10 to 17 years (14.1 ± 2.1 years) were recruited from the psychiatric outpatient clinics. The participants completed a set of scales (Strengths and Difficulties Questionnaire [SDQ], Affective Reactivity Index [ARI], Revised Child Anxiety and Depression Scale, Swanson, Nolan, and Pelham, Version IV Scale). Diagnostic interviews were administered to confirm psychiatric diagnoses. Cronbach’s alpha was calculated to assess internal consistency. Discriminant validity was further tested using independent sample t-test and Receiver Operating Characteristic curves. Interrater reliability was tested using intraclass correlation coefficients (ICC). Convergent validity was also tested using Pearson’s correlation.ResultsCronbach’s alpha values of CL-ARI were 0.919 total score, 0.842 for the temper outbursts score, 0.861 for the irritable mood score, and 0.840 for the impairment score. ICC values for interrater reliability were high for the temper outbursts (r = 0.993), the irritable mood (r = 0.993), the impairment (r = 0.917), and the total score (r = 0.991). In the sample, there was a high level of correlation between the self-report ARI-child/parent form and the CL-ARI total and subscale scores. Likewise, moderate-high level of correlations were found between the behavioral SDQ child/parent forms and the CL-ARI total and subscale scores.ConclusionsThis is the Turkish validation of the CL-ARI, a dedicated interview and rating scale to assess irritability in the clinical sample. The results of this study suggest that the Turkish version of CL-ARI has adequate internal consistency and interrater reliability, and sufficient convergent and discriminant validity to be used in research settings.

Mother-Adolescent Discrepancies in Reporting Sleep Disturbances: Effects of Diagnosis and Mother's Occupation.

BackgroundSleep disturbances are common in children and adolescents. However, they are rarely diagnosed and treated because parents, who often report the symptoms, may fail to notice the problems. Factors that can affect parent-child discrepancy include child’s diagnosis, parent’s occupation, and child’s sex. The current study retrospectively analyzed the effect of these factors on parent-child discrepancies of sleep disturbance scores.MethodsData for sleep-related items in Youth Self-Report (YSR) and Child Behavior Checklist (CBCL) from 2014 to 2020 August in South Korea were collected from psychiatric outpatient clinics at Konkuk University Medical Center and Soonchunhyang University Hospital.ResultsA three-way analysis of variance revealed main effect of diagnosis type and interaction between diagnosis type and mother’s occupation. Discrepancies were greater for mood and anxiety disorders compared to conduct-related disorder. Interaction effect revealed greater discrepancies in mood disorders for reports completed by working mothers compared to homemaker mothers.ConclusionThe results of this study emphasize the need to explore with caution the self-reported sleep disturbances in adolescents, especially in those with mood disorders. The results also suggest that mother’s occupation should be taken into account when evaluating sleep reports of parents and adolescents.

QRISK*3 Outcome and Its Relationship with Disease Duration and Lipid Parameters in Patients with Obsessive-Compulsive Disorder

Objective: QRISK*3 is an updated web-based calculator that estimates 10-year cardiovascular disease risk based on specific clinical parameters. In this study, individuals with obsessive-compulsive disorder (OCD) who are being monitored in a psychiatric outpatient clinic are analyzed for their ten-year risk of cardiovascular disease. Methods: The study sample consisted of fifty-eight patients diagnosed with OCD. Sociodemographic characteristics and symptom severity of all participants were recorded. The 10-year cardiovascular disease risk of the participants was calculated with the QRISK*3 model. Results: The mean age of the patients was 37.21 (SD=10.48). QRISK*3 score of OCD patients was calculated as 3.59±6.38%. There were positive correlations between duration of illness and QRISK*3 and QAGE scores in patients with OCD (r=.389 and r=.571, respectively). Linear regression analysis showed the predictive effects of duration of illness (t=3.663, p&lt;.001), AIP (t=2.338, p=.023) on QRISK*3 score in patients with OCD. Conclusion: In this study, the risk of cardiovascular illness in OCD patients was independently predicted by the atherogenic index of plasma (AIP) and disease duration. Additionally, the 10-year risk of cardiovascular disease was 3.6% in OCD patients. To explore and comprehend the connection between OCD and cardiovascular illness, more research is required.

A Comparative Assessment of Disability Levels among Nigerian Outpatients with Schizophrenia and Type 2 Diabetes Mellitus

Background: Chronic illnesses are often associated with functional disability, thus compromising the ability to carry out everyday activities of daily living. The degree of disability depends on the severity and the type of illness experienced. Studies that compare the level of disability between people with chronic medical conditions and mental illnesses in North-Central Nigeria are scarce. This study aims to compare the disability levels between people with schizophrenia and Type 2 Diabetes Mellitus (T2DM) attending outpatient clinics at the Jos University Teaching Hospital, north-central Nigeria, and evaluate the factors associated with these conditions. Methods: It was a cross-sectional study with a total of 600 patients who were diagnosed with schizophrenia and T2DM, attending the Psychiatric and medical outpatient clinics of the Jos University Teaching Hospital, north-central Nigeria, between June 2017 and November 2017. The study assessed Psychotic and non-psychotic symptoms by applying the Brief Psychiatric Rating Scale (BPRS) among those with schizophrenia. We evaluated the level of disability by using World Health Organization Disability Assessment Schedule version 2.0 (WHODAS 2.00). Results: Disability was significantly higher among respondents with schizophrenia than those with T2DM. This difference occurred across all the domains except domain 2 (moving around). Marital status, living situation, occupation, and treatment adherence were significant common factors associated with disability in these conditions. In contrast, age, educational status, income level, and duration of illness were significantly associated with disability among respondents with T2DM only. Conclusion: Disability and its associated factors among people with chronic diseases, if identified early and proper interventions instituted, disability can be avoided or minimized among people with chronic illnesses.

Treatment feasibility and preliminary evaluation of group-delivered cognitive behavioral therapy for insomnia adapted for patients with bipolar and related disorders: A pragmatic within-group study

• CBT for insomnia is a feasible treatment in patients with bipolar disorder. • After treatment, insomnia severity is significantly reduced. • Reductions of sleep problem severity are maintained at three-month follow-up. Sleep disturbances, including insomnia, are common in bipolar disorder. Treatment of choice for insomnia is cognitive behavioral therapy (CBT-i), but evidence for CBT-i in patients with bipolar disorder is scarce. We investigated a group delivered treatment based on CBT-I; treatment feasibility in patients with bipolar and related disorders, and improvement in insomnia severity following treatment. This pragmatic within-group evaluation with a pre to post and three-month follow-up design was set at two psychiatric out-patient clinics specialized in bipolar and related disorders. As an adjunct to care-as-usual, the treatment was offered as six two-hour group sessions over eight weeks. Data were analyzed with intent-to-treat using hierarchical linear mixed models. Thirty-four patients (48 [range 19–72] years; 68% female) with bipolar and related disorders and sleep problems provided informed consent. Patients had suffered from sleep problems for 12.7 [range 0.3–65] years, 97% used sleep medications, 91% medicated for their primary disorder. Patient interest, attendance, dropout, satisfaction, credibility, and adverse events met feasibility criteria, and therapists endorsed the manual. Post-treatment, insomnia severity (Insomnia Severity Index; score range 0–28) had improved with 6.1 points (95% CI, 3.27–8.93, g = 1.11, p = 0.0001) and at three months with 7.0 points (95% CI, 4.03–9.97, g = 1.26, p < 0.0001) from pre-treatment. Lack of control group and no control for care-as-usual content. CBT-i adjusted for bipolar disorder delivered as a group treatment is promising for improving insomnia severity in patients with bipolar and related disorders and disturbed sleep.

Prevalence and correlates of negative disposition to marital homogamy among a sample of psychiatric outpatients in Nigeria

Objective: Persons with mental illness (PWMI) have reduced chances of getting married to individuals without mental illness, yet, so much controversy surrounds the propriety or otherwise of a psychiatric patient marrying another psychiatric patient (marital homogamy). The factors that are associated with patients' disposition towards homogamy have received little attention from researchers, creating a gap in literature. In this study, I intended to examine the proportion of psychiatric patients that are negatively disposed towards marrying another psychiatric patient and to find the factors that are associated with their disposition. Methods: A descriptive cross-sectional design was used, and participants included 208 consecutive attendees at the psychiatric outpatient clinic of a tertiary hospital in Benin City, Nigeria. Data were collected from the participants using a sociodemographic data collection sheet and three standard instruments - the Bogardus Social Distance Scale, the World Psychiatric Association Stigma Questionnaire, and the Brief Psychiatric Rating Scale. Results: About two-thirds of the patients (67.3%) were not willing to marry a psychiatric patient, citing concerns about heredity of mental illness; potential financial difficulty and lack of social/spousal support; and perceived dangerousness of psychiatric patients as the reasons. About two-thirds of them desired moderate to high social distance from another psychiatric patient. Three factors - the desire for low social distance (p < 0.001), belief that marriage is a necessity in life (p < 0.001), and belief that people with mental illness who recovered are eligible to marry (p < 0.001) - significantly differentiated between patients who were willing to marry a psychiatric patient and those not willing. Conclusion: Many patients in this study expressed a negative disposition toward marrying a psychiatric patient, yet previous researchers reported that they have reduced chances of marrying persons without mental illness. Appropriate intervention to address the factors that are related to their negative disposition may change their disposition and increase their chances of getting married, either to a nonmentally ill individual or a PWMI if they must not remain single all their life.

Substance use disorders and psychiatric comorbidities and their sex differences in adolescents treated at an addiction psychiatric outpatient clinic

Background Substance use disorders (SUDs) among adolescents are frequently associated with other psychiatric disorders. The diagnostic criteria of the SUDs are problematic for adolescents, who may have a developing problem with substance dependence but not meeting the criteria for either substance abuse or dependence. There is a scarcity of studies about the sex differences and the associations of the SUDs and psychiatric comorbidity in adolescents. Methods Structured background information, clinical data, and EuroADAD assessments were gathered from 359 adolescents (12–19 years) who were treated at a tertiary level outpatient clinic for adolescents with psychiatric and substance abuse problems between 2006 and 2010. Referring conditions were either suspected/probable dual diagnosis or intoxication requiring treatment in an emergency department. The mean age was 15.8 years and 52.6% were girls. The diagnoses were assessed during the treatment period by the treating clinician. Sex differences in psychiatric diagnoses and substance use patterns were examined in bivariate analyses. Results A third of the girls (31.7%) had depression as their primary diagnosis (9.4% of the boys). The most common primary diagnosis for boys (34.1%) was conduct disorder (21.7% of the girls). 53.4% of the girls were diagnosed for both psychiatric and substance use disorders (51.8% of the boys). Alcohol use disorders were the most common SUDs for girls (29.6%) and polysubstance use disorders for boys (23.5%). Conclusions In this clinical and thus selected group of adolescents, the girls had higher rates of depression and alcohol use disorders, and the boys conduct disorder and polysubstance use disorders.

Presentations and Psychiatric Diagnosis in A Psychiatric Out-Patient Clinic of Tertiary Care Hospital in Eastern Nepal

INTRODUCTION This study aimed to see common presenting complaints and psychiatric diagnoses among the patients visiting for the first time to the Psychiatric Out-patient Department (OPD) of a tertiary care hospital in Eastern Nepal. METHODOLOGY A cross-sectional study was conducted in the OPD of B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal during the study period of 3 weeks after the institute ethical approval. Patients were selected via convenience sampling technique. Face to face interview was conducted to collect socio-demographic data and the presenting complains (up to 5) according to the patients and their attendants. Psychiatric diagnoses were recorded as per the clinician. RESULT Among the first contact psychiatry out-patients; various physical/ somatic, anxiety and mood related symptoms were the commonest presenting complaints, as per the patients, attendants and clinicians. Behavioural symptoms were others mostly observed and reported. The commonest diagnoses were: Depression, Recurrent Depressive Disorder, Dysthymia (18.6%); Phobia, Other Anxiety and Obsessive Compulsive Disorder (17.9%); Schizophrenia, schizotypal and delusional disorders (13.8%) and Mental and Behavioural disorders due to Substance use (8.3%). Deliberate self harm and seizures were present in 7% each. CONCLUSION The commonest presenting complaint in psychiatry outpatient clinic was related to physical and somatic symptoms, followed by anxiety and mood related ones. Common diagnoses were Depression, Anxiety, Schizophrenia and Substance use/ related disorders.

Olanzapine Induced Rhabdomyolysis in A Schizophrenic Adult: Case Report

Rhabdomyolysis is a syndrome characterized by acute necrosis of skeletal muscle and subsequent release of its cellular contents into the circulation. It can occur due to trauma, exercise, infections and some metabolic diseases, as well as secondary to the use of various drugs. A 34-year-old male patient with a diagnosis of schizophrenia for 2 months was brought to our emergency department by his relatives because of the intake of 350 mg of olanzapine for suicide. The patient whose extrapyramidal system findings were present and whose creatine kinase (CK) was found to be 42670 U / L in laboratory tests was hospitalized to our service because of the secondary rhabdomyolysis for the use of olanzapine. During the hospitalization period, only the medical treatment returned normalcy to the CK level, and the kidney and liver dysfunction did not develop, and the patient was discharged by psychiatric outpatient clinic control. Rhabdomyolysis is a rare and potentially serious adverse drug reaction to antipsychotic drugs. The patients should be evaluated for side effects and in terms of rhabdomyolysis facilitating factors. Especially in high doses, patients should be monitored for rhabdomyolysis, which is a serious complication, such as acute renal damage.

Efficacy and cost-effectiveness of task-shared care for people with severe mental disorders in Ethiopia (TaSCS): a single-blind, randomised, controlled, phase 3 non-inferiority trial

BackgroundThere have been no trials of task-shared care (TSC) using WHO's mental health Gap Action Programme for people with severe mental disorders (psychosis or affective disorder) in low-income or middle-income countries. We aimed to evaluate the efficacy and cost-effectiveness of TSC compared with enhanced specialist mental health care in rural Ethiopia. MethodsIn this single-blind, phase 3, randomised, controlled, non-inferiority trial, participants had a confirmed diagnosis of a severe mental disorder, recruited from either the community or a local outpatient psychiatric clinic. The intervention was TSC, delivered by supervised, non-physician primary health care workers trained in the mental health Gap Action Programme and working with community health workers. The active comparison group was outpatient psychiatric nurse care augmented with community lay workers (PSY). Our primary endpoint was whether TSC would be non-inferior to PSY at 12 months for the primary outcome of clinical symptom severity using the Brief Psychiatric Rating Scale, Expanded version (BPRS-E; non-inferiority margin of 6 points). Randomisation was stratified by health facility using random permuted blocks. Independent clinicians allocated groups using sealed envelopes with concealment and outcome assessors and investigators were masked. We analysed the primary outcome in the modified intention-to-treat group and safety in the per-protocol group. This trial is registered with ClinicalTrials.gov, number NCT02308956. FindingsWe recruited participants between March 13, 2015 and May 21, 2016. We randomly assigned 329 participants (111 female and 218 male) who were aged 25–72 years and were predominantly of Gurage (198 [60%]), Silte (58 [18%]), and Mareko (53 [16%]) ethnicity. Five participants were found to be ineligible after randomisation, giving a modified intention-to-treat sample of 324. Of these, 12-month assessments were completed in 155 (98%) of 158 in the TSC group and in 158 (95%) of 166 in the PSY group. For the primary outcome, there was no evidence of inferiority of TSC compared with PSY. The mean BPRS-E score was 27·7 (SD 4·7) for TSC and 27·8 (SD 4·6) for PSY, with an adjusted mean difference of 0·06 (90% CI –0·80 to 0·89). Per-protocol analyses (n=291) were similar. There were 47 serious adverse events (18 in the TSC group, 29 in the PSY group), affecting 28 participants. These included 17 episodes of perpetrated violence and seven episodes of violent victimisation leading to injury, ten suicide attempts, six hospital admissions for physical health conditions, four psychiatric admissions, and three deaths (one in the TSC group, two in the PSY group). The incremental cost-effectiveness ratio for TSC indicated lower cost of –US$299·82 (95% CI –454·95 to –144·69) per unit increase in BPRS-E scores from a health care sector perspective at 12 months. InterpretationWHO's mental health Gap Action Programme for people with severe mental disorders is as cost-effective as existing specialist models of care and can be implemented effectively and safely by supervised non-specialists in resource-poor settings. FundingUS National Institute of Mental Health.

Family Experiences and Feedback: An Examination of Attrition in Parent-Child Interaction Therapy

ABSTRACT Attrition is a significant problem in child psychotherapyand has serious implications for overall treatment effectiveness. Predictors of attrition include those at the client, therapist, and treatment levels. The current study investigated factors associated with attrition in Parent-Child Interaction Therapy (PCIT), an evidence-based parent training program for families with young children with disruptive behavior disorders. The sample of 67 caregivers were treated by 25 therapists from 19 different licensed psychiatric outpatient clinics across one state and were part of a larger study (RO1 MH09750; PI: Herschell). The effects of caregivers’ attitudes toward therapy, expectations of therapy, perceived therapist cultural competence, and commitment to treatment were examined using Binomial Logistic Regression. Therapy expectations and commitment to treatment added significantly to the model predicting attrition. Fleiss’ kappa was used to examine caregiver-therapist agreement on completion status, reasons PCIT ended, barriers to treatment experienced by families, and caregiver compliance with post-treatment therapist referrals. Results suggest low agreement across each variable, indicating that therapists may not be aware of caregiver barriers or reasons they leave PCIT prematurely. Limitations, suggestions for future research, and clinical implications are discussed.

Emotional intelligence, alexithymia and suicidal ideation among depressive patients

BackgroundDepression is more than just sentiment sad or passing a rough patch. It is a serious psychological wellbeing disorder that needs curative care and maintenance. Emotional Intelligence (EI) is a comprehensive personality construct denoting the capability to perceive and control affects within the self. Alexithymia is another personality construct that refers to the difficulty of recognizing and expressing feelings, with an outside oriented thinking style. Suicidal ideation is defined as thinking of appealing in conduct intentional to end one’s life. AimThe current study aimed to examine the relationship between emotional intelligence, alexithymia and suicidal ideation among depressive patients. DesignA descriptive correlation design was utilized. SettingThis study was conducted at the Psychiatric Outpatient Clinic in El Ahrar Hospital, Alsharkia Governorate, Egypt. SubjectsA purposeful sample of 65 depressed patients was recruited for this study. ToolsData were collected by using four tools: Socio-demographic Data Sheet, Emotional Intelligence Scales, Toronto Alexithymia Scale (TAS-20) and Suicidal Ideation Scale. ResultsThe majority of depressed patients were having alexithymia and having low emotional intelligence. Emotional intelligence was statistically significantly negatively correlated with alexithymia and suicidal ideation. Nevertheless, alexithymia was statistically significantly positively correlated with suicidal ideation. It was statistically significantly positively predictor of suicidal ideation and alexithymia, while it was statistically significantly negatively predictor of suicidal ideation and emotional intelligence. ConclusionLower emotional intelligence led to higher suicidal ideation in depressive patients. Increasing alexithymia in patients with depressive disorders caused an increase in their suicidal ideation. Therefore, it is recommended implementing a training program such as mindfulness and emotional intelligence skills for patients to enhance their emotional intelligence.

Intimate partner violence among reproductive-age women with chronic mental illness attending a psychiatry outpatient department: cross-sectional facility-based study, Addis Ababa, Ethiopia

ObjectiveTo determine the prevalence of intimate partner violence (IPV), and associated factors, in reproductive-aged women attending psychiatric outpatient departments.DesignCross-sectional facility-based study.SettingOutpatient psychiatric clinics of public hospitals in Addis Ababa.ParticipantsReproductive aged...