Psychiatric Outpatient Setting Research Articles

Peer learning in clinical placements in psychiatry for undergraduate nursing students: preceptors and students' perspective.

AimTo describe the experiences of peer learning in psychiatric inpatient settings during clinical placement of undergraduate nursing students and to highlight the possibility for peer learning in psychiatric outpatient settings.DesignA qualitative inductive design.MethodQuestionnaires with 14 students and 12 preceptors in inpatient and outpatient care and interviews with one student and one preceptor in outpatient care were analysed with content analysis.ResultsStudents and preceptors perceived learning benefits with peer learning. They described how learning increased through exchange of knowledge and how collaboration created security and independence, structured learning activities were appreciated as a learning tool. Incompatibility of students was an issue that could be overcome. Peer learning was perceived to contribute to a secure learning atmosphere, increased self‐confidence and to provide a deeper understanding of psychiatric nursing. Peer learning was described as promoting discussion and reflection on practice and preparing nursing students for their future profession.

A preliminary review of the Beck Depression Inventory-II (BDI-II) in veterans: Are new norms and cut scores needed?

The Beck Depression Inventory-II (BDI-II) is used within the Veterans Health Administration (VHA) to measure depression symptom severity. This naturalistic study aimed to examine VHA-specific BDI-II use and establish normative data and psychometric properties. Initial BDI-II data for 152,260 individual veterans were extracted from preexisting medical records using the VA Informatics and Computing Infrastructure. BDI-II scores were compared against Beck, Steer, and Brown (1996)'s original sample, as well as across veteran subgroups. Exploratory and confirmatory factor analyses were also conducted. Similar to Beck et al.'s (1996) sample, the BDI-II was most frequently administered in outpatient psychiatric VHA settings, although it was also used in inpatient and medical settings. Veterans scored significantly higher on the BDI-II than the original comparison groups. This was true across diagnostic categories. The largest discrepancy was seen between nondepressed veterans and corresponding patients from the original sample (Cohen's d = 1.34). Older veterans endorsed less severe levels of depression symptomatology. Additionally, a 2-factor model similar to Beck et al.'s (1996) original solution provided the best fit to the data. Veterans reported higher levels of somatic-affective symptoms than cognitive symptoms. Although potentially useful, the BDI-II requires further investigation in veterans. Standard cut scores are not recommended for use in this population when evaluating severity of depression. A cut score of 27 or higher best differentiated between veterans with and without mood disorders in the current sample. Treatment providers should also consider using BDI-II factor scores, rather than the total score, to measure depressive symptom change. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Challenges and opportunities in the science of research to practice: lessons learned from a randomized controlled trial of a sexual risk-reduction intervention for psychiatric patients in a public mental health system

Objective:Human immunodeficiency virus (HIV) prevention efficacy trials with psychiatric patients have been conducted in research settings in high-resourced countries, establishing short-term efficacy for reducing sexual risk behavior. None has been implemented within systems of care. In the last decade, overcoming this research-to-practice gap has become a focus of implementation science. This paper describes the first and only HIV Prevention intervention trial for psychiatric patients conducted in real-world outpatient psychiatric settings facilitated by trained clinic-based providers.Methods:The HIV Prevention intervention, which uses the Information-Motivation-Behavioral Skills model to achieve sexual risk-reduction, was rigorously adapted to the local context and clinic services’ needs. Participants from eight clinics were randomized to HIV Prevention or Health Promotion conditions.Results:HIV Prevention participants showed significant improvement in Information-Motivation-Behavioral domains; in this group, behavioral intentions were associated with significantly fewer unprotected sex occasions, but reduction of unprotected sex occasions was similar in both conditions.Conclusion:Our trial was conducted before implementation studies became widely funded. Transporting an intervention to a new culture or into real-world practice settings may require adaptations. Our results demonstrate that clear guidelines are needed regarding whether to conduct efficacy, effectiveness, and/or implementation research as the most appropriate next step.Clinical trial registration:NCT00881699

Using the Nursing Interventions Classification to identify nursing interventions in free-text nursing documentation in adult psychiatric outpatient care setting.

To identify and describe nursing interventions in patient documentation in adult psychiatric outpatient setting and to explore the potential for using the Nursing Interventions Classification in documentation in this setting. Documentation is an important part of nurses' work, and in the psychiatric outpatient care setting, it can be time-consuming. Only very few research reports are available on nursing documentation in this care setting. A qualitative analysis of secondary data consisting of nursing documentation for 79 patients in four outpatient units (years 2016-2017). The data consisted of 1,150 free-text entries describing a contact or an attempted contact with 79 patients, their family members or supporting networks and 17 nursing care summaries. Deductive and inductive content analysis was used. SRQR guideline was used for reporting. We identified 71 different nursing interventions, 64 of which are described in the Nursing Interventions Classification. Surveillance and Care Coordination were the most common interventions. The analysis revealed two perspectives which challenge the use of the classification: the problem of overlapping interventions and the difficulty of naming group-based interventions. There is an urgent need to improve patient documentation in the adult psychiatric outpatient care setting, and standardised nursing terminologies such as the Nursing Interventions Classification could be a solution to this. However, the problems of overlapping interventions and naming group-based interventions suggest that the classification needs to be further developed before it can fully support the systematic documentation of nursing interventions in the psychiatric outpatient care setting. This study describes possibilities of using a systematic nursing language to describe the interventions nurses use in the adult psychiatric outpatient setting. It also describes problems in the current free text-based documentation.

Background characteristics and exposure to violence predict well-being at work among psychiatric outpatient nurses

AimsTo investigate the well-being at work and analyze relevant predictors of it among nurses working in psychiatric outpatient settings including following specific objectives 1) describe the current state of well-being at work among psychiatric nurses; and 2) examine how background characteristics and exposure to violence predict well-being at work. DesignA cross-sectional survey design. MethodsTwo-staged sampling was used to select participants from psychiatric outpatient units. Data were collected with printed Nordic Questionnaire for Monitoring the Age Diverse Workforce (QPSNordic-ADW) and Violence Incidence Assessment (VIA-Q) questionnaire from January 2019 to June 2019. Descriptive statistics were performed to summarize the collected data and binary logistic regression was used to identify predictors related to the well-being at work. ResultsThe respondents (n = 181) generally evaluated well-being at work quite positively but were more critical towards interaction with their immediate superior, organizational culture, interaction between work and private life, and organizational commitment. Working experience in psychiatric nursing and experiences of harassment were identified as strong predictors of well-being at work. ConclusionThe management of healthcare organizations should discuss nursing ethics and morale more, as well as pay attention to the ethical environment to prevent moral distress among nurses. Several weaknesses seem to exist especially in the management of psychiatric outpatient units which influence nurses' well-being at work. Identification of these can help organizations to develop management and implement interventions to increase nurses' well-being at work. Conversations about the managerial culture and collegial climate should also arise at the organizational and unit levels.

Comparison of Different Adherence Measures in Adolescent Outpatients with Depressive Disorder.

PurposeAdolescent depression can have a chronic course; hence, the importance of adherence to antidepressant medication for successful treatment outcomes is emphasized. This study aimed to examine different adherence measures and identify clinical factors that influence adherence in adolescent depression.Patients and MethodsA prospective study was conducted for patients diagnosed with depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition from outpatient psychiatric settings at Korea University Medical Center, Guro Hospital. Patient demographics were obtained from a questionnaire, interview, and review of chart records. Adherence was assessed by four methods (Medication Event Monitoring System [MEMS], pill count, clinical rating scale, and patient’s self-report). The Toronto Side Effect Scale was used to evaluate side effects, and specific depressive symptoms were assessed using the Hamilton Rating Scale for Depression and Childhood Depression Inventory–Korean version. The Multidimensional Scale of Perceived Social Support was administered to analyze social support, and the Parenting Stress Index-Short Form was used to evaluate parental stress levels. We used concordance correlation analysis to evaluate the relationship among the four adherence measures and the relationship between adherence level and clinical factors.ResultsOverall, the study enrolled 48 outpatients (mean age 16.33±1.93 years). The mean duration of illness was 1.27±2.17 years. Adherence rates for MEMS, clinician rating scale, pill count, and self-report after conversion to dichotomous measures were 67.5%, 48.9%, 60.0%, and 56.3%, respectively. Only the duration of illness remained significantly correlated with MEMS (r = 0.510, p =0.001).ConclusionPill count exhibited a higher degree of agreement with MEMS adherence than the other two adherence measures, possibly indicating that pill count may be a considerably reliable measure of adherence. Furthermore, MEMS adherence was positively correlated with disease duration, suggesting that the longer the duration of illness, the higher the adherence.

Bupropion for the Treatment of Apathy in Alzheimer Disease

Apathy is a frequent neuropsychiatric symptom in dementia of Alzheimer type and negatively affects the disease course and patients' and caregivers' quality of life. Effective treatment options are needed. To examine the efficacy and safety of the dopamine and noradrenaline reuptake inhibitor bupropion in the treatment of apathy in patients with dementia of Alzheimer type. This 12-week, multicenter, double-blind, placebo-controlled, randomized clinical trial was conducted in a psychiatric and neurological outpatient setting between July 2010 and July 2014 in Germany. Patients with mild-to-moderate dementia of Alzheimer type and clinically relevant apathy were included. Patients with additional clinically relevant depressed mood were excluded. Data analyses were performed between August 2018 and August 2019. Patients received either bupropion or placebo (150 mg for 4 weeks plus 300 mg for 8 weeks). In case of intolerability of 300 mg, patients continued to receive 150 mg throughout the study. Change on the Apathy Evaluation Scale-Clinician Version (AES-C) (score range, 18-72 points) between baseline and week 12 was the primary outcome parameter. Secondary outcome parameters included measures of neuropsychiatric symptoms, cognition, activities of daily living, and quality of life. Outcome measures were assessed at baseline and at 4, 8, and 12 weeks. A total of 108 patients (mean [SD] age, 74.8 [5.9] years; 67 men [62%]) were included in the intention-to-treat analysis, with 54 randomized to receive bupropion and 54 randomized to receive placebo. The baseline AES-C score was comparable between the bupropion group and the placebo group (mean [SD], 52.2 [8.7] vs 50.4 [8.2]). After controlling for the baseline AES-C score, site, and comedication with donepezil or galantamine, the mean change in the AES-C score between the bupropion and placebo groups was not statistically significant (mean change, 2.22; 95% CI, -0.47 to 4.91; P = .11). Results on secondary outcomes showed statistically significant differences between bupropion and placebo in terms of total neuropsychiatric symptoms (mean change, 5.52; 95% CI, 2.00 to 9.04; P = .003) and health-related quality of life (uncorrected for multiple comparisons; mean change, -1.66; 95% CI, -3.01 to -0.31; P = .02) with greater improvement in the placebo group. No statistically significant changes between groups were found for activities of daily living (mean change, -2.92; 95% CI, -5.89 to 0.06; P = .05) and cognition (mean change, -0.27; 95% CI, -3.26 to 2.73; P = .86). The numbers of adverse events (bupropion group, 39 patients [72.2%]; placebo group, 33 patients [61.1%]) and serious adverse events (bupropion group, 5 patients [9.3%]; placebo group, 2 patients [3.7%]) were comparable between groups. Although it is safe, bupropion was not superior to placebo for the treatment of apathy in patients with dementia of Alzheimer type in the absence of clinically relevant depressed mood. EU Clinical Trials Register Identifier: 2007-005352-17.

An Automated Mobile Mood Tracking Technology (Mood 24/7): Validation Study.

BackgroundElectronic tracking has been utilized for a variety of health conditions. Previous studies have shown that there is higher adherence to electronic methods vs paper-and-pencil tracking modalities. Electronic tracking also ensures that there are no back-filled entries, where patients have—to appear compliant—entered their responses retrospectively just before their visits with their health care provider. On the basis of the recognition of an unmet need for a Web-based automated platform to track psychiatric outcomes, Johns Hopkins University partnered with Health Central (a subsidiary of Remedy Health Media LLC) to develop Mood 24/7, an electronic, mobile, automated, SMS-based mood tracker. This is a pilot study to validate the use of Mood 24/7 in anticipation of clinical trials to demonstrate the therapeutic benefit on patients’ health outcomes of utilizing digital mood-tracking technology.ObjectiveMood 24/7 is an electronic mood-monitoring platform developed to accurately and efficiently track mood over time through automated daily SMS texts or emails. This study was designed to assess the accuracy and validity of Mood 24/7 in an outpatient psychiatric setting.MethodsThis pilot study involved a retrospective chart review for depressed outpatients (N=9) to compare their self-reported Mood 24/7 daily mood ratings with their psychiatrist’s independent clinical mood assessment at the time of the patient’s visit. Their mood ratings via Mood 24/7 were collected over 36 weeks. In addition, a mixed model analysis was applied to compare the weekly Montgomery-Åsberg Depression Rating Scale (MADRS) scores with Mood 24/7 scores over an average of 3 months.ResultsA 97.2% (315/324) digital mood reporting adherence was found over 36 weeks, and a significant correlation (r=0.86, P<.001) was observed between patients’ Mood 24/7 scores and their psychiatrist’s blinded clinical assessment of the patient’s mood when seen in the clinic. In addition, a significant concordance (intraclass correlation of 0.69, 95% CI 0.33-0.91, P<.001) was observed in the mixed model analysis of the clinician-administered MADRS vs Mood 24/7 scores over time.ConclusionsOur chart review and mixed model analyses demonstrate that Mood 24/7 is a valid instrument for convenient, simple, noninvasive, and accurate longitudinal mood assessment in the outpatient clinical setting.

M219. OVERESTIMATING FUNCTION – A RISK FACTOR FOR SUBOPTIMAL COMMUNITY AID IN SCHIZOPHRENIA

BackgroundPatients with schizophrenia have difficulties in judging their own performance. Patients with no or little practical experience of demands from active performance in society tends to overestimate their ability. Research has also found that patients who overestimate their function also runs a risk to be perceived as better functioning than what they actually are when judged by caregivers. The aim with this study is to examine if patients who overestimate their ability will receive less community support compared to patients who have an accurate perception of their ability?MethodsThe study population was 184 patients with schizophrenia spectrum disorder. They were tested with the Swedish version of the UCSD Performance-based Skills Assessment–Brief Version (UPSA-B). Before the test they were asked how they thought their functioning were in four different domains covered in the UPSA-B. After the test they were divided into four groups: “Good functioning with realistic perception”, “Good functioning but underestimating their function”, “Impaired function with realistic perception” and “Impaired function but overestimating their performance”. The amount of received community support were investigated and related to patients′ actual performance and self-perception.ResultsAnalyzes showed that patients who had an impaired function and a realistic view of their ability had more support than those who were impaired but overestimated their ability. Also, patients with good functioning but underestimating their performance had more support than those who had a good ability and a realistic perception. Finally, there were no difference in community support to the patients in the two groups “Good function with realistic perception” and “Impaired function but overestimating their performance”.DiscussionOur results indicate that patients with impaired functioning who overestimate their ability risk an insufficient community support. This in combination with earlier findings, that staff-members in psychiatric out-patient settings are likely to base their judgement on patients′ report consequential leading to false positive conclusions, may have both short- and long-term implications. Not achieving symptomatic remission, as a consequence of inability to follow medical prescriptions, and sub-optimal social functioning with isolation are two possible implications. The findings once again raises the need for the testing of patients′ function instead of only conducting interviews.

Assessment of incidence, causality, severity, and preventability of suspected adverse drug reactions to antidepressant medications in a psychiatry outpatient setting of a secondary care hospital.

ABSTRACTBackground:Antidepressant medications are primarily used in the management of depression and various anxiety disorders. Antidepressant medications are known to cause adverse drug reactions (ADRs). Reporting ADRs can help in the rational use of medication and better patient drug management.Objective:The aim of this study was to monitor the incidence and nature of ADRs to antidepressant medications in a psychiatric outpatient setting of a secondary care hospital of the UAE.Materials and Methods:It was a cross-sectional study conducted in the psychiatric outpatient setting of a secondary care hospital. Patients attending psychiatry outpatient department and prescribed with antidepressant medications were included. All clinical side effects or ADRs noted by physician and reported by patients were documented and assessed according to causality, severity, and preventability scales.Results:A total of 131 patients were screened for the presence or occurrence of ADRs. During the study duration, an aggregate of 29 patients reported at least one ADR. Incidence of suspected ADR to antidepressant medications was found to be 22.1%. Most commonly documented suspected ADR was found to be weight gain in eight (18.1%) patients followed by somnolence in four (9.1%) patients. Escitalopram was the most common drug implicated with ADR in 13 (29.6%) patients followed by fluoxetine in 6 (13.6%) patients. According to World Health Organization-The Uppsala Monitoring Centre causality assessment, the predominance of the suspected ADRs was of “possible” type in 27 (61%) patients, and “mild” in severity in 40 (91%) patients, and “not preventable” in 37 (84%) patients. A statistically significant association (P = 0.019) was observed only between the presence of drug-interaction and the occurrence of ADR (relative risk: 0.429, confidence interval: 0.211–0.872).Conclusion:Most of the suspected ADRs related to antidepressants were “mild,” “predictable,” and “not preventable” in nature. Continuous monitoring may help in identifying, reducing, and preventing the risk of ADRs.

CHALLENGES IN EATING DISORDER TREATMENT: INPATIENT, OUTPATIENT, COMORBID, AND BEYOND

Eating disorders are potentially fatal and highly impairing disorders that can present with medical and psychiatric acuity and complexity. Additionally, comorbidity is common. This Clinical Perspectives will explore specific challenges in treating eating disorders, including discussions from both medical and psychiatric inpatient and outpatient treatment settings, and the impact of comorbid substance abuse.

Psychometric Properties of Scale to Assess the Therapeutic Relationship-JapaneseVersion (STAR-J).

Background: A good therapeutic relationship between patient and psychiatrist is vital for effective mental health care. However, no instruments to assess this relationship are available in Japan. This study aimed to develop a Japanese version of a Scale To Assess Therapeutic Relationship (STAR-J), which measures such relationships from the viewpoints of both the patient (STAR-J-P) and clinician (STAR-J-C). We examined the tool’s psychometric properties, including factor structure, internal consistency, convergent validity, and test-retest reliability among psychiatric outpatients and psychiatrists. Methods: Study participants comprised 139 outpatients and 10 psychiatrists. Exploratory factor analysis was conducted to investigate factor structure; to confirm cross-validity, confirmatory factor analysis was conducted using a different sample constituting 195 participants in an assertive community treatment program and their 91 case managers. Cronbach’s alpha was used to assess internal consistency. For STAR-J-P only, the intra-class correlation coefficient (ICC) was computed for 17 patients to determine test-retest reliability. Spearman’s correlation coefficients were calculated to examine convergent validity with service satisfaction, empowerment, and medication adherence. Results: We identified a two-factor structure for STAR-J-P and a one-factor structure for STAR-J-C. Cronbach’s alphas for the two STAR-J-P factors were 0.897 and 0.645, and that for the STAR-J-C factor was 0.949. The ICCs for STAR-J-P factors 1 and 2 were 0.765 and 0.630, respectively. STAR-J-P and STAR-J-C were not significantly correlated. STAR-J-P factors 1 and 2 showed significant correlations with service satisfaction (factor 1: ρ = 0.648, p < 0.001; factor 2: ρ = 0.238, p = 0.005) and medication adherence (factor 1: ρ = 0.508, p < 0.001; factor 2: ρ = 0.347, p < 0.001), but only factor 1 showed a significant relationship with empowerment (ρ = 0.283, p = 0.001). STAR-J-C was significantly correlated only with empowerment (ρ = 0.207, p = 0.017). Conclusions: STAR-J appears to be a useful instrument for assessing therapeutic relationships in the Japanese psychiatric outpatient setting. Further studies should test its validity and applicability in different mental health service settings.

Psychiatry Outpatients' Willingness to Share Social Media Posts and Smartphone Data for Research and Clinical Purposes: Survey Study.

BackgroundPsychiatry research has begun to leverage data collected from patients’ social media and smartphone use. However, information regarding the feasibility of utilizing such data in an outpatient setting and the acceptability of such data in research and practice is limited.ObjectiveThis study aimed at understanding the outpatients’ willingness to have information from their social media posts and their smartphones used for clinical or research purposes.MethodsIn this survey study, we surveyed patients (N=238) in an outpatient clinic waiting room. Willingness to share social media and passive smartphone data was summarized for the sample as a whole and broken down by sex, age, and race.ResultsMost patients who had a social media account and who were receiving talk therapy treatment (74.4%, 99/133) indicated that they would be willing to share their social media posts with their therapists. The percentage of patients willing to share passive smartphone data with researchers varied from 40.8% (82/201) to 60.7% (122/201) depending on the parameter, with sleep duration being the parameter with the highest percentage of patients willing to share. A total of 30.4% of patients indicated that media stories of social media privacy breaches made them more hesitant about sharing passive smartphone data with researchers. Sex and race were associated with willingness to share smartphone data, with men and whites being the most willing to share.ConclusionsOur results indicate that most patients in a psychiatric outpatient setting would share social media and passive smartphone data and that further research elucidating patterns of willingness to share passive data is needed.

Pilot Study of Let's Get Organized: A Group Intervention for Improving Time Management.

There is a need for evidence-based occupational therapy interventions to enhance time management in people with time management difficulties. To pilot test the first part of the Let's Get Organized (LGO) occupational therapy intervention in a Swedish context by exploring enhancements of time management skills, aspects of executive functioning, and satisfaction with daily occupations in people with time management difficulties because of neurodevelopmental or mental disorders. One-group pretest-posttest design with 3-mo follow-up. Outpatient psychiatric and habilitation settings. Fifty-five people with confirmed or suspected mental or neurodevelopmental disorder and self-reported difficulties with time management in daily life. Swedish version of Let's Get Organized (LGO-S) Part 1, with structured training in the use of cognitive assistive techniques and strategies using trial-and-error learning strategies in 10 weekly group sessions of 1.5 hr. Time management, organization and planning, and emotional regulation were measured with the Swedish version of the Assessment of Time Management Skills (ATMS-S). Executive functioning was measured with the Swedish version of the Weekly Calendar Planning Activity, and satisfaction with daily occupations was assessed with the Satisfaction With Daily Occupations measure. Participants displayed significantly improved time management, organization and planning skills, and emotional regulation, as well as satisfaction with daily occupations. Aspects of executive functioning were partly improved. ATMS-S results were sustained at 3-mo follow-up. LGO-S Part 1 is a promising intervention for improving time management skills and satisfaction with daily occupations and should be investigated further. This study shows that LGO-S Part 1 is feasible for use in psychiatric and habilitation outpatient services. The results are promising for improved time management skills, organization and planning skills, and satisfaction with daily occupations and need to be confirmed in further studies.

Interventions delivered by nurses in adult outpatient psychiatric care: An integrative review.

WHAT IS KNOWN ON THE SUBJECT?: In many countries, the majority of psychiatric care is being delivered in an outpatient setting and the proportion of outpatients is increasing on a global level. Nurses are the largest workforce in psychiatric care, but their role has been said to be difficult to define. According to our knowledge, there are no previous reviews focusing on nurse-delivered interventions in the adult psychiatric outpatient setting. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This review summarizes nurse-delivered interventions identified in the research literature and describes these systematically. Analysing all the identified interventions using the Nursing Interventions Classification, we conclude that the emphasis of nurse-delivered interventions in psychiatric outpatient care is on interventions aiming at improving the functioning of both patients and their family members by building on their own strengths. These findings differ from those presented in a review on inpatient psychiatric nursing. There are several clinical trials describing nurse-delivered evidence-based treatments, such as psychoeducation for patients and their family members in the case of patients diagnosed with schizophrenia and bipolar disorder. The quality of randomized controlled trials was higher than in earlier reviews describing psychiatric nursing interventions in general or in connection with a specific patient group. Further clinical trials are needed to describe the role of nurses in the care of patients diagnosed with depression and in the use of web-based interventions. Additionally, it would be important to study what supports, and on the other hand hinders, the role of nurses in delivering evidence-based treatments at the clinical level. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses can play a central role in responding to the growing demand for evidence-based practices in adult outpatient psychiatry, by delivering treatments for patients and family members. It is important that both nursing education and clinical practices recognize and support this role. Abstract Introduction According to our knowledge, there are no previous reviews on nurse-delivered interventions in the adult psychiatric outpatient setting. Aim To identify and systematically describe and analyse nurse-delivered interventions based on research literature. Method An integrative review. Results This review included 60 studies, of which 46 were intervention studies, including 40 clinical trials. The most common patient groups were patients diagnosed with schizophrenia and bipolar disorder. The nursing interventions described in the studies resembled a total of 68 interventions from the Nursing Interventions Classification. The treatment delivery methods varied and treatments often lacked a clear theoretical background. Implications for practice The core of nurse-delivered interventions identified in research literature in psychiatric outpatient care is on interventions aiming at improving the functioning of both patients and their family members by building on their own strengths. These findings differ from the interventions identified in a review describing nursing in the inpatient setting. There are high-quality clinical trials describing nurse-delivered treatments for patients diagnosed with schizophrenia and bipolar disorder. These include evidence-based treatments such as psychoeducation. Understanding of how these treatments are transferred in clinical practice is missing. Clinical trials describing nurse-delivered web-based interventions and interventions for patients diagnosed with depression are needed.

Nursing interventions in adult psychiatric outpatient care. Making nursing visible using the Nursing Interventions Classification.

To describe and to clarify the work of nurses in psychiatric outpatient care using a standardized nursing terminology and to describe the potential benefits and challenges in the use of the terminology. A qualitative study of ethnographically grounded fieldwork in four adult outpatient units located in three major cities in Finland. A two-phase ethnographically oriented study, consisting of observations and focus group interviews in four psychiatric outpatient care units (in January-March 2018). During this process, the identified nursing interventions were mapped into the Nursing Interventions Classification. We identified 93 different nursing interventions, covering all seven domains. Categories describing potential benefits and challenges were as follows: giving words to nurses' work and the challenge of overlapping interventions. Our findings indicate that the Nursing Interventions Classificationis a suitable means to describe nursing in the psychiatric outpatient care setting. Our findings support the theory that describing nurses' work using a nursing terminology can make nursing visible and further empower nurses and help them to structure their work. The lack of other professionals, especially physicians, has led to nurses taking over new tasks officially and unofficially and we suggest that the issue needs to be studied further. Nurses' role in the psychiatric outpatient care has been described as invisible and difficult to describe. Our findings suggest that a nursing terminology can make nursing visible, not only from the perspective of patient health records but is also a way to conceptualize nurses' work.

Psychosocial Profiles of Adults with ADHD: A Comparative Study of Prison and Outpatient Psychiatric Samples

This study aimed to describe and compare the educational, social, and family profiles of adults with and without ADHD from two different settings: a prison and an outpatient psychiatric setting. A total of 542 participants, aged between 17 and 69 years, took part in the study. The participants consisted of four groups: a prison sample with ADHD (n = 69) and without ADHD (n = 183), and an outpatient psychiatric sample with ADHD (n = 218) and without ADHD (n = 72). The results showed that, firstly, there were some statistically significant differences between the groups in academic history, social and family situation, and the adoption of risk behaviors during adolescence and early adulthood. Secondly, some of these differences were related to diagnosis (ADHD versus non-ADHD) while others were related to the sample being examined (prison versus psychiatric). The findings from the study showed the presence of significant implications in social, family, educational, and employment achievements both for adults with ADHD (both prison and psychiatric samples) and for adults without ADHD.

Predictors of the co-occurrence of posttraumatic stress disorder and depressive disorder in psychiatric outpatients

IntroductionWe explored the predictors of co-occurring depressive disorder (DD) in individuals with posttraumatic stress disorder (PTSD) in an outpatient psychiatric setting. MethodsParticipants (N = 170; mean age = 40.78, SD = 16.15 years; 58.8% women) included 71 adult patients who met the criteria for a PTSD diagnosis and 99 adult patients who met the criteria for a comorbid PTSD/DD diagnosis. Potential predictors included trauma types (focusing on trauma characteristics), history of previous traumatic experiences (i.e., the number of lifetime traumatic events before current trauma and childhood maltreatment), and post-trauma variables (i.e., elapsed time since the current traumatic event and the severity of PTSD symptoms). ResultsA logistic regression analysis—including demographic variables, trauma types, history of previous traumatic experiences, and post-trauma variables that showed significant differences between the two groups—was conducted. The effects of repeated trauma (OR = 13.18, 95% CI [3.44, 50.48], p < .001), the number of lifetime traumatic events (OR = 1.04, 95% CI [1.01, 1.51], p = .044), and childhood maltreatment (OR = 1.23, 95% CI [1.01, 1.51], p = .004) were associated with a greater likelihood of concurrent PTSD/DD. ConclusionCumulative characteristics such as maltreatment and the number of lifetime traumatic events before the current trauma as well as repetitive properties of the most recent trauma present a key risk factor for co-occurring PTSD/DD.

Metabolic Syndrome in Dutch Patients With Bipolar Disorder: A Cross-Sectional Study.

To characterize the prevalence of metabolic syndrome (MetS) among Dutch patients with bipolar disorder (BD), identify factors associated with MetS, and estimate the rate of pharmacologic treatment of MetS in this population. A cross-sectional analysis of medical records of adult patients (≥ 18 years) with BD receiving psychotropic drug treatment was performed in a Dutch psychiatric outpatient setting. MetS was determined according to National Cholesterol Education Program Adult Treatment Panel III-Adapted (NCEP ATP III-A) criteria. Data collection via review of medical records from 2015 was conducted in 2016. The prevalence of MetS in the sample (N = 71) was 42.3%. Multivariate analysis showed sex and body mass index were independently associated with MetS. Males had an almost 8-fold higher risk of MetS than females (OR = 7.7, 95% CI, 1.5-39.6), and with every point of increase on BMI, the risk of MetS increased by 40% (OR = 1.4, 95% CI, 1.2-1.8). Of the patients with hyperglycemia, hypercholesterolemia, and hypertension, 81%, 72.4%, and 65.0%, respectively, did not receive drug treatment for these conditions. The study found a high prevalence rate of MetS and substantial undertreatment of the components of MetS in patients with BD in a Dutch outpatient clinic. Follow-up investigation in larger samples is warranted.

Hypomania Symptoms Across Psychiatric Disorders: Screening Use of the Hypomania Check-List 32 at Admission to an Outpatient Psychiatry Clinic.

Introduction: Hypomania symptoms are best described as a continuum, ranging beyond Bipolar Spectrum Disorders (BSD). Other nosological entities, such as major depressive disorder, schizoaffective disorder, or borderline personality disorder, may also share symptoms with BSD, raising challenges for differential diagnosis. While the Hypomania Checklist-32 is one of the most widely used tools for screening hypomania, there is limited evidence describing its use in a real-world outpatient psychiatric clinical setting.Methods: Here we tested the psychometric properties of a European Portuguese adaptation of the HCL-32, establishing its factor structure, reliability and construct validity. Furthermore, we analyzed differences in hypomanic symptoms among several clinical groups and in a non-clinical sample. Data was obtained retrospectively in an ecological setting from a clinical sample of an outpatient psychiatry and psychology clinic, comprising 463 Portuguese individuals, 326 of whom had a psychiatric diagnosis, namely BSD (n = 66), major depressive disorder (n = 116), or other psychiatric disorders (n = 144). A separate non-clinical sample was also collected among healthy volunteers (n = 62). A battery of self-report measures of affective symptoms was applied, and in a subset of patients, diagnosis was established using a structured diagnostic interview.Results: Psychometric properties of the HCL-32 were adequate, with good internal consistency (Cronbach's α = 0.86) and test-retest stability (ICC = 0.86), and two subscores (“active/elated” and “risk-taking/irritable”) defined by Principal Component Analysis. Receiver Operating Characteristic curve analysis demonstrated that the test score discriminated moderately between patients with BSD and other clinical samples as well as healthy volunteers, with a cut-off score of 17 for the total score of the HCL-32 rendering the best combination of sensitivity and specificity. When compared to the HCL-32 total score, the risk-taking/irritable subscore seems to provide additional benefit in discriminating between different clinical groups, namely regarding specificity in the discrimination from patients with a diagnosis of major depressive disorder that was low for the full scale and the alternate subscale.Conclusions: HCL-32 can be used as a screening tool for BSD among adult patients presenting in an outpatient psychiatric clinical setting.