Outpatient Psychiatry Service Research Articles

Seasonal variations in psychiatry outpatient service utilization in a tertiary health care center in subtropical arid regions of northwestern India

Background: Research on climatic parameters contributing to psychiatric disorder seasonality is limited, particularly in subtropical, arid climates like Rajasthan, necessitating investigation into seasonal variations in psychiatric disorder incidence in the region. This study investigates seasonal variations in psychiatric disorder prevalence over 2 years at a Rajasthan tertiary healthcare center, aiming to uncover links with climatic factors. Aims: To investigate seasonal variations in the utilization of outpatient psychiatry services and elucidate potential determinants contributing to these temporal variations. Settings and Design: This is a hospital-based study. A retrospective chart review of all new patients who utilized psychiatry outpatient services from July 2021 to July 2023 was conducted. Methods and Material: Data were gathered from psychiatric outpatient records of adults (July 2021 to July 2023), diagnosed using ICD-10. Seasons were categorized: winter (November–January), spring (February–April), summer (May–July), and rainy (August–October). Meteorological data, temperature, and day length were obtained. Statistical analyses, including Pearson correlation and Chi-square fitness, assessed seasonal associations with psychiatric disorders. Results: A total of 29,164 patient records were observed. Depression correlated with temperature and photoperiod. Mania peaked in August, linked to day length. Schizophrenia showed seasonal variation without environmental correlation. Anxiety peaked in March with no statistical significance. Obsessive compulsive disorder cases spiked in June, moderately correlated with temperature and photoperiod. Alcohol-related disorders peaked in December, while opioid dependence remained steady. Cannabis-induced psychosis peaked in summer, strongly correlated with temperature and day length. Headaches surged in August, positively correlated with temperature and day length. Conclusions: This study reveals complex relationships between seasonality, environmental factors, and psychiatric disorders, emphasizing their importance in mental health research and practice.

Comparative Effectiveness of Three Digital Interventions for Adults Seeking Psychiatric Services

There is a substantial gap between demand for and availability of mental health services. Digital mental health interventions (DMHIs) are promising tools for bridging this gap, yet little is known about their comparative effectiveness. To assess whether patients randomized to a cognitive behavioral therapy (CBT)-based or mindfulness-based DMHI had greater improvements in mental health symptoms than patients randomized to the enhanced personalized feedback (EPF)-only DMHI. SETTING, AND PARTICIPANTS This randomized clinical trial was conducted between May 13, 2020, and December 12, 2022, with follow-up at 6 weeks. Adult patients of outpatient psychiatry services across various clinics within the University of Michigan Health System with a scheduled or recent outpatient psychiatry appointment were recruited. Eligible patients were randomized to an intervention arm. All analyses followed the intent-to-treat principle. Participants were randomized to 1 of 5 intervention arms: (1) EPF only; (2) Silvercloud only, a mobile application designed to deliver CBT strategies; (3) Silvercloud plus EPF; (4) Headspace only, a mobile application designed to train users in mindfulness practices; and (5) Headspace plus EPF. The primary outcome was change in depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9; score range: 0-27, with higher scores indicating greater depression symptoms). Secondary outcomes included changes in anxiety, suicidality, and substance use symptoms. A total of 2079 participants (mean [SD] age, 36.8 [14.3] years; 1423 self-identified as women [68.4%]) completed the baseline survey. The baseline mean (SD) PHQ-9 score was 12.7 (6.4) and significantly decreased for all 5 intervention arms at 6 weeks (from -2.1 [95% CI, -2.6 to -1.7] to -2.9 [95% CI, -3.4 to -2.4]; n = 1885). The magnitude of change was not significantly different across the 5 arms (F4,1879 = 1.19; P = .31). Additionally, the groups did not differ in decrease in anxiety or substance use symptoms. However, the Headspace arms reported significantly greater improvements on a suicidality measure subscale compared with the Silvercloud arms (mean difference in mean change = 0.63; 95% CI, 0.20-1.06; P = .004). This randomized clinical trial found decreases in depression and anxiety symptoms across all DMHIs and minimal evidence that specific applications were better than others. The findings suggest that DMHIs may provide support for patients during waiting list-related delays in care. ClinicalTrials.gov Identifier: NCT04342494.

Magnitude of patient satisfaction and its associated factors at the outpatient psychiatry service of Dilla university referral hospital, Southern Ethiopia, Dilla, 2020.

BackgroundPatient satisfaction is a subjective attitudinal response of a client to a health institution’s services and a pillar of quality assurance. Patients who are happy with their treatment are much more likely to stick with it, improve quickly, and function normally. Satisfied patients are more compliant, improve faster, and are more functional. However, there haven’t been enough studies conducted across the country, and none have been conducted in this study area. As a result, the purpose of the study was to estimate the size of patient satisfaction and associated determinants at Dilla University Referral Hospital’s psychiatry unit in Dilla, 2020.MethodsThis was a hospital-based cross-sectional study design utilized using a simple random sampling technique. To assess patient satisfaction, we used the 24-item Mental Health Service Satisfaction Scale which was a validated tool in Ethiopia. The link between the outcome and the independent variable was determined using linear regression analysis (P< 0.05).ResultThis study enrolled 409 respondents with a response rate of 97%. The overall mean percentage score of patient satisfaction was 55.4% (95% CI (48.4%– 59.2%). Having bipolar disorder diagnosis [β = -2.93, 95% CI (-4.33, -1.96), p = .000], distance from the hospital [β = -2.34), 95% CI (-3.765, -1.735), P = .001], waiting time [β = -2.19, 95% CI (-3.49, -1.10), p = .000], monthly income (2.95, 95% CI (1.65, 5.23) and Urban residence (β = 1.43, 95% CI (1.03–3.43), p = 0.01) were variables significantly associated with perceived patient satisfaction.Conclusions and recommendationsIn this study, more than half of the respondents scored above the mean percentage score of patient satisfaction. The amount of time spent in the waiting area and the distance traveled to the hospital were identified as variables that could be improved by working with different stakeholders.

A STUDY OF PATIENTS PRESENTING WITH SUICIDAL ATTEMPT TO A TERTIARY CARE PSYCHIATRY DEPARTMENT DURING LOCKDOWN DUE TO COVID 19 PANDEMIC

Aim: To study cases presenting with suicidal attempt to Psychiatry set up of a tertiary care hospital to assess psychopathology and impact of the Covid pandemic, in precipitating suicidal attempts. Settings: Patients admitted with suicidality during lockdown in 2021,in department of Psychiatry of our tertiary care hospital. This hospital in urban Pune has a 30 bedded Psychiatry ward and outpatient psychiatry services. Methods And Material: Medical record-based study of the admitted patients in the stipulated period of time. Results: 71%(5) cases were new onset psychiatric illness with suicidal attempt precipitated due to various psychosocial, nancial or other unique factors secondary to pandemic situation or pre-morbid personality problems or interpersonal adjustment. Most common mode of suicide was consumption of easily available poisonous substance or medicines, followed by hanging. Conclusions: Vigilant suicidal ideation assessment, individual/family counselling would be important in management. Further larger studies are needed to assess harmful mental health effects of nationwide lockdown in the pandemic situation are necessary.

Insights from Expanded Adverse Childhood Experiences Screening in a Hospital-Based Outpatient Psychiatry Service.

Adverse childhood experiences (ACEs) are associated with poor mental health in adulthood. Comprehensive prevalence data encompassing all 10 ACE questionnaire items has not previously been described in a hospital-based outpatient psychiatric clinic. This study assessed the prevalence of 10 ACEs in such a clinic and correlated ACEs with indicators of case severity. For 252 patients newly evaluated in an urban clinic, a retrospective chart review was completed and data was collected on ACE questionnaire responses, psychiatric, substance-related, and medical diagnoses, psychiatric hospitalizations, suicide attempts, and suicide and violence risk. Patients in the clinic had an average of 3.4 ACEs, higher than national community sample averages of 1.6. The percentages of patients with at least one, two, and four ACEs were 82% (n = 207), 68% (n = 172), and 42% (n = 106) respectively (compared with 61%, 38%, and 15% nationally). ACEs had statistically significant correlations with an increased number of psychiatric diagnoses, substance use disorders, medical illnesses, suicide attempts, and suicide risk level. This study demonstrated that patients seeking psychiatric care from a hospital-based outpatient clinic are likely to be traumatized to a degree far exceeding what is typical in the general population. While a high prevalence of ACEs in a psychiatric population is an expected finding given the literature to date, this is the first study presenting data on the prevalence of ACEs in such a hospital-based community clinic. Additionally this study reinforces prior research correlating childhood adversity and case severity.

Assessment and Treatment of a Young Adult with Congenital Heart Disease and ADHD.

Phillip is a young man born with hypoplastic left heart syndrome referred to your practice for a range of mental health concerns. He underwent palliation to an extracardiac Fontan in infancy and experienced multiple complications over the next decade including valvular regurgitation and arrhythmias necessitating a pacemaker. Phillip continued to have systolic heart failure with New York Heart Association class II symptoms, managed with 4 medications and anticoagulation.Despite this complex history, Phillip had intact cognitive abilities, achieved typical milestones, and performed well academically in secondary school. His first year of college proved to be more challenging, and Phillip presented to the outpatient psychiatry service with an acute depressive episode. His family history included depression, without known attention-deficit/hyperactivity disorder (ADHD). Treatment, including a selective serotonin reuptake inhibitor, cognitive behavioral therapy, and family support, led to near resolution of his symptoms of depression.In subsequent appointments, Phillip described a long history of inattention and disorganization with onset in childhood. This contributed to the decision to leave college, despite remission of symptoms of depression. Phillip was unable to study for any extended period without "perfect conditions," described as the absence of potential distractions except for background music. Despite attempts to maintain "perfect conditions," Phillip was often off task and "hyperfocusing" on irrelevant topics. Phillip struggled with planning and time management and would misplace items daily. Moreover, although the importance of self-care was well understood, Phillip often forgot to take his cardiac medication or to exercise, and he admitted to inconsistent sleep habits because of losing track of time.Based on a comprehensive psychiatric evaluation including retrospective report from a parent, Phillip was diagnosed with ADHD, coexisting with major depressive disorder, in remission. Significant ADHD symptoms were documented by interview, self-report, and administration of an abbreviated neuropsychological battery.Considering concerns regarding use of stimulants in a patient with congenital heart disease, including death, stroke, and myocardial infarction,1,2 how would you assess the risks-benefits of use of stimulants with Phillip? 1. Wilens TE, Prince JB, Spencer TJ, et al. Stimulants and sudden death: what is a physician to do? Pediatrics. 2006;118:1215-1219.2. Zito JM, Burcu M. Stimulants and pediatric cardiovascular risk. J Child Adolesc Psychopharmacol. 2017;27:538-545.

Comparison of Self-Stigma and Subjective Recovery Status of Patients Receiving both Community Mental Health Service and Outpatient Psychiatry Service

Comparison of Self-Stigma and Subjective Recovery Status of Patients Receiving both Community Mental Health Service and Outpatient Psychiatry Service

2.37 TELETHERAPY IMPLEMENTATION IN AN OUTPATIENT CHILD PSYCHIATRY SERVICE AT AN ACADEMIC MEDICAL CENTER AND CHILDREN’S HOSPITAL

Technological advances coupled with increased access to care through the Patient Protection and Affordable Care Act have led to increases in the use of mental health services via real-time, secure, interactive videoconferencing. Telepsychiatry services for adults are increasingly well-supported, and mounting early evidence supports feasibility and acceptability for child telepsychiatry services and highlights improvements in access to care. However, data are limited describing the use of synchronous virtual psychotherapy visits with children. We will present data on the implementation and acceptability of child teletherapy in an outpatient psychiatry service at an academic medical center.

The pattern of problematic internet use and mental health-related internet use among psychiatric outpatients at a tertiary care center.

Objective:There is scarce literature available on the pattern of problematic internet use (PIU) and use of internet for mental health help-seeking among adult patients with psychiatric disorders in South-East Asian countries. The present study aimed to understand the pattern of PIU among adult patients attending the outpatient psychiatry services at a tertiary care center in India. Further, it aimed to explore the use of internet for seeking mental health-related information or services among them.Materials and Methods:This cross-sectional study recruited adult outpatients attending the outpatient psychiatry services following purposive sampling between June 2018 and December 2018. A semi-structured questionnaire was used to collect information regarding sociodemographic characteristics and internet use pattern of participants, including use of internet for various mental health-related purposes. The Generalized Problematic Internet Use Scale 2 (GPIUS-2) was used to assess the PIU. Statistical analysis was performed using SPSS version 23.0 software.Results:Among 155 study participants, 45 (29.03%) scored above 60 on GPIUS-2. Those with PIU were significantly younger, reported higher duration of daily internet use, and spent greater proportion of time online on activities related to social networking or social media than those with and without PIU. More than half of the participants reported internet use for seeking mental health-related information at least once in the past 1 month. There was no significant difference in the mental health-related internet use among adult patients with different psychiatric diagnoses, except for two situations. There was lesser use of internet for seeking information related to the symptoms of illness and various treatment modalities available among participants diagnosed with psychotic disorder. On the other hand, a greater use of internet for seeking information related to the symptoms of illness was reported by participants diagnosed with anxiety disorder.Conclusion:This study suggested that PIU is a frequently cooccurring condition among adult patients with primary psychiatric disorder. The importance of internet as a medium for seeking mental health information and services was observed among most of the study participants.

Patient, family and clinician preferences for the intensity and implementation of patient and family participation in healthcare design and delivery in psychiatry

Background and objectivesPatient and family participation is when the views and experiences of patients and family are sought and taken into account in healthcare. This research identifies patient, family and clinician preferences for the intensity and implementation of patient and family participation in healthcare design and delivery in an adult outpatient psychiatry service. MethodsA three round Delphi Technique Experiment (DTE) with 31 participants from an outpatient psychiatry service. Patients, family members and clinicians were included. ResultsThere was a strong level of agreement reached between patients, family members and clinicians with consensus achieved in 60/65 questions. Patient participation to the point of being involved in the decision making process (87%; n = 27/31) at all times (73%; n = 22/30) was supported. Family participation to the point of being involved in discussions (66%; n = 23/35) as problems arise (67%; n = 21/31) was supported. Participants agreed on the use of patient and family representatives with factors such as ability to dedicate time considered during selection. Personal experience, discussions with wider populations and pre-identified priorities should contribute to representative input. Training was identified as necessary for all stakeholders, including clinicians. ConclusionsThis is the first time that patients, family members and clinicians have all been included in a DTE on this topic. The inclusion of these groups is essential for the development of long-lasting sustainable participation. The focus on preferences for family participation is also novel. Given the role of family members in care and management of chronic illnesses, identification of their role is key.

Unplanned admissions to inpatient psychiatric treatment and services received prior to admission

BackgroundInpatient bed numbers are continually being reduced but are not being replaced with adequate alternatives in primary health care. There is a considerable risk that eventually all inpatient treatment will be unplanned, because planned or elective treatments are superseded by urgent needs when capacity is reduced. Aims of the studyTo estimate the rate of unplanned admissions to inpatient psychiatric treatment facilities in Norway and analyse the difference between patients with unplanned and planned admissions regarding services received during the three months prior to admission as well as clinical, demographical and socioeconomic characteristics of patients. MethodUnplanned admissions were defined as all urgent and involuntary admissions including unplanned readmissions. National mapping of inpatients was conducted in all inpatient treatment psychiatric wards in Norway on a specific date in 2012. Binary logit regressions were performed to compare patients who had unplanned admissions with patients who had planned admissions (i.e., the analyses were conditioned on admission to inpatient psychiatric treatment). ResultsPatients with high risk of unplanned admission are suffering from severe mental illness, have low functional level indicated by the need for housing services, high risk for suicide attempt and of being violent, low education and born outside Norway. ConclusionSpecialist mental health services should support the local services in their efforts to prevent unplanned admissions by providing counselling, short inpatient stays, outpatient treatment and ambulatory outpatient psychiatry services. Implications for health policiesThis paper suggests the rate of unplanned admissions as a quality indicator and considers the introduction of economic incentives in the income models at both service levels.

Preferred intensity and implementation of patient and family participation in an outpatient psychiatric service and an outpatient type 2 diabetes service

Introduction : Patient and family participation is when the views and experiences of patients and family are sought and taken into account in healthcare changes. Participation leads to improvements for health systems and services, patients and clinicians. However, the best way to involve patients and family members has not been identified. This study aims to establish preferences for the level of intensity and implementation of participation in healthcare design and delivery. Methods : Separate three-round Delphi Technique Experiments (DTEs) were conducted with a panel of 31 participants from an outpatient psychiatry service and a panel of 28 participants from an outpatient type 2 diabetes service, both in Ireland. Each panel included patients, family members and clinicians. Consensus was achieved when at least 65% of the panel were in agreement and there was less than a 15% change in opinions between rounds. Results : Consensus was achieved in 60/65 questions in the psychiatry DTE and 60/64 questions in the diabetes DTE. Patient participation at all times was supported by the psychiatry panel (73% n=22/30) while the diabetes panel agreed on patient participation as problems arise (83% n=24/29). Family involvement in discussions was supported by 66% (n=23/35) of the psychiatry panel and 72% (n=18/25) of the diabetes panel. Patients ‘voting’ on changes was supported by 87% (n=27/31) of the psychiatry panel and 72% (n=21/29) of the diabetes panel. Both panels agreed on representation through patient and family representatives with factors such as ability to dedicate time considered during selection and personal experiences, discussions with other patients and family members and pre-identified priorities taken into account when providing input. Strong consensus was reached on the need for training to be provided to all stakeholders, including clinical. Discussions : This is the first time patients, family members and clinicians are included together in the identification of the intensity and implementation of participation. The inclusion of these groups is essential for the development of long-lasting sustainable participation. This study is the first to focus on family participation establishing the preferred level of intensity and method of family participation. Given the role of family members in care and management of chronic illnesses identification of their role within services is key. Conclusions : Patients, family members and clinicians agreed on patients having a vote in changes and family being involved in discussions. Training needs to be provided to all stakeholder groups. Lessons learned : Consensus between key stakeholder groups in participation can be achieved. There is support for participation at all times in psychiatry but only as problems arise in diabetes. Greater intensity patient participation is supported with preference for patients having a vote in changes and family only being involved in discussions about changes. Limitations : Higher levels of education have been associated with support for participation. Both panels in this research are highly educated due to the inclusion of clinicians. Suggestions for future research : Develop and test an intervention to encourage participation based on the preferences indicated in this research. Conduct DTEs in a broader range of services to establish if similar patterns emerge.

Trouble de personnalité limite à l’adolescence : quelle réalité clinique ?

AimsTo better describe the population of adolescents diagnosed with “borderline personality disorder”, by identifying some distinct clinical profiles based on their psychopathology. Material and methodsThis retrospective study included both adolescents hospitalized between January 2013 and December 2014 in the adolescent inpatient psychiatry service of the University Hospital of Tours, and adolescents followed up between January 2014 and December 2014 in the adolescent outpatient psychiatry service of Chinon. After identification of the patients diagnosed with “borderline personality disorder” (screening using ICD-10 diagnoses codes and confirmation or invalidation of the diagnosis by the clinician in charge of the patient), we assessed for each of these patients their sociodemographic characteristics, their psychopathological characteristics, and the other psychiatric comorbidities (comorbid ICD-10 diagnoses). We identified different clusters of patients using ascending hierarchical classification, and compared them using univariate statistics. ResultsAmong the 823 eligible adolescents, 14.2% (n=117) had a borderline personality disorder, including two third of female (n=79) and one third of male (n=38), with a mean age of 15.5 years. Prevalence for borderline personality disorder was 9.0% for outpatients and 19.4% for inpatients. Cluster analysis identified three distinct groups of patients. The first group (called confirmed borderline personality disorder; 17.1%) included patients with higher symptom severity, intrapsychic symptoms and social isolation. The second group (called borderline crisis at adolescence; 35%) included patients that had lower symptom severity, and lower impulsivity. The third group (called expressive borderline disorder; 47.9%) included patients that were more oftenly female, and that had higher prevalence for behavioural manifestations but lower alexithymia and better social adjustment. ConclusionWe identified three distinct clinical profiles in patients diagnosed with a borderline personality disorder: confirmed borderline personality disorder, borderline crisis at adolescence and expressive borderline disorder.

Pedagogical Implications of Partnerships Between Psychiatry and Obstetrics-Gynecology in Caring for Patients with Major Mental Disorders

Because there are no formal reviews, the authors set out to identify and describe programs that serve female patients with major mental disorders by integrating mental health care with services in obstetrics and gynecology and to describe the pedagogical implications of those programs. The authors searched PubMed for all articles describing a program in which psychiatry was formally integrated with obstetric or gynecological services, other than standard consultation-liaison programs, in the care of patients with major mental disorders. The search terms used included interdisciplinary, interprofessional, integrated, collaborative care, psychiatry, and obstetrics-gynecology or psychosomatic obstetrics-gynecology. The authors found six distinct integrated programs. These included family planning clinics that were integrated into inpatient psychiatry services; inpatient and outpatient psychiatry services for pregnant mentally ill women in close collaboration with obstetric services; a day hospital for pregnant women with psychiatric disorders in an obstetric setting; an interdisciplinary training site providing care for predominantly depressed, low-income, and minority women; a primary care HIV service for women integrated with departments of obstetrics-gynecology and psychiatry; and an obstetrics-gynecology clinic-based collaborative depression care intervention for socially disadvantaged women. Residents' involvement was described in four of the programs. These innovative and integrated programs potentially enhance the care of vulnerable and culturally diverse women with major mental disorders. The authors discuss how these programs may contribute to the education of residents in psychiatry and obstetrics-gynecology.

A case of intentional asenapine overdose.

To the Editor: Asenapine, marketed as Saphris, is a relatively new psychopharmaceutical agent approved in 2009 for the treatment of acute mania or mixed episodes in the context of bipolar I disorder as well as schizophrenia.1 Asenapine has a unique receptor profile and has been shown to be effective and well tolerated by patients experiencing an acute manic episode.2,3 Adverse effects of long-term use are not yet known, but the incidence of cardiovascular disease and diabetes is expected to be substantially lower than with older neuroleptic agents.4 Here we present the first published case of asenapine overdose of known quantity and route. Case report. Mr A, a 49-year-old man, presented to the emergency department (ED) after having ingested 74 tablets of asenapine in the ED parking lot several minutes previously. He was currently undergoing a course of electroconvulsive therapy (ECT), having been diagnosed with bipolar disorder with mixed episodes and borderline personality disorder (both according to DSM-IV-TR criteria) and was 1 day postdischarge from the inpatient psychiatry unit. The quantity of ingested tablets was confirmed by the patient’s mental health outreach worker after examination of packages in the patient’s car. Mr A had made previous suicide attempts using ibuprofen and clonazepam in overdose. Because the ED physician was unfamiliar with asenapine toxicity, the patient was admitted to the intensive care unit (ICU) for observation. Examination in the ED and ICU revealed a drowsy, yet easily rousable man who was unwilling to answer questions. Blood pressure was maintained at 149/88 mm Hg, pulse was 99 bpm, respiratory rate was 19/min, oxygen saturation was 98% on room air. Findings of cardiac, respiratory, and abdominal examinations were unremarkable. Urine drug screen was positive for amphetamines, marijuana, opiates, and benzodiazepines. There was no nausea or vomiting, and activated charcoal was not administered. Electrolytes, troponin I, international normalized ratio, complete blood cell count, and creatinine were all within normal laboratory values. Electrocardiogram showed only normal sinus rhythm. Mr A was determined to be medically stable by the ICU physician, and care was transferred to the psychiatric unit approximately 24 hours later. This patient’s bilateral ECT course was continued for a total of 10 treatments with good therapeutic effect and minimal side effects. He was subsequently discharged and has been followed by the outpatient psychiatry service, has received cognitive-behavioral therapy to address coping skills, and is doing well as of last contact. Here we present the first documented case of asenapine overdose with a known quantity and route of administration. Six previous cases of asenapine overdose have been noted at doses up to 400 mg, but the exact dose and route were not known.4 Similar to those cases, no specific adverse drug effects were observed. Notably, the bioavailability of asenapine is less than 2% when administered orally, compared to approximately 35% when given sublingually; this patient did not administer his overdose sublingually.4 Thus, despite ingesting 740 mg of asenapine, he was exposed to only the equivalent of 4 sublingual doses. Despite the large number of tablets and considerable concern from the ED, asenapine appears to be safe in overdose situations, likely due to its pharmacokinetic profile.

Chronic Alcoholic Hallucinosis Masquerading as Schizophrenia

To the Editor: Alcoholic hallucinosis is a well-known phenomenon consisting of vivid auditory hallucinations that begin immediately following the reduction or cessation of alcohol consumption.1 The estimated prevalence of alcohol hallucinosis is 7.4% among alcohol-dependent inpatients,2 a subset of whom will develop chronic hallucinations that resemble paranoid schizophrenia.3 Here, we present a case of chronic alcohol hallucinosis previously diagnosed and treated as schizophrenia. Case report. Mr A, a 32-year-old man, was admitted recently to the inpatient psychiatry ward after several visits to the outpatient psychiatry service. Mr A complained of auditory pseudohallucinations that began in adolescence. These were described as 3 adult male voices with origin inside the head that are ego-dystonic and frequently attempt to persuade him to hurt himself. His hallucinatory experiences were identified during an inpatient stay for alcohol rehabilitation about 5 years earlier at another center. At the time of discharge, he was given the diagnosis of schizophrenia (DSM-IV-TR criteria) and was started on clozapine treatment. Mr A began drinking alcohol to excess at the age of 14 years, with self-report ranging from 7 to 48 standard drinks per day. Mr A smokes tobacco daily and cannabis occasionally and has been a heavy user of several other substances. Previously known treated diseases were unremarkable and stable. Mr A’s family history is significant for psychiatric illness, including mood disorders, substance use disorders, and suicide. There was no evidence of thought disorder. Results of physical examination and broad laboratory screens were unremarkable. Findings of noncontrast magnetic resonance imaging were similarly unremarkable. Outcomes of neuropsychological testing were remarkable for poor verbal memory, both immediate and delayed. A previous psychological report was obtained and noted third- to fifth-grade capabilities in reading, spelling, mathematics, and verbal comprehension as well as strong visuospatial ability. Clozapine therapy was ceased by slow taper. Mr A was monitored closely but was unable to notice any subjective changes. The nursing and medical staff were similarly unable to note any objective changes. Mr A was discharged 16 days following the cessation of clozapine therapy. He will be assessed for a therapeutic trial of a newer neuroleptic agent such as risperidone or lurasidone and anticraving medications such as acamprosate. Here, we present a unique case of what we believe to be persistent alcoholic hallucinosis occurring for many years. Our patient was initially diagnosed with schizophrenia; however, upon further inspection, we do not believe this to be the case. He has insight into his illness and has no evidence of thought disorder or negative symptoms, and his illness has not run the typical course of schizophrenia. Furthermore, he lacks the characteristic memory loss and confabulation typical of Korsakoff’s psychosis. Misdiagnosis resulted in exposing the patient to the risks of superfluous pharmacotherapy, in this case, metabolic syndrome, cardiac arrhythmias, and blood dyscrasia. We suggest that alcoholic hallucinosis should be suspected in patients who present with auditory hallucinations and significant alcohol use history and who are refractory to best-practice pharmacotherapy for schizophrenia.

The compliance to prescribed drug treatment and referral in a psychiatric emergency service: a follow-up study

To evaluate the compliance to the prescribed drug treatment and referral of patients discharged from a psychiatric emergency service (PES). From a total of 330 patients enrolled in the study, 175 (53%) agreed to a telephone inquiry 60 days after the PES visit regarding the status of the prescribed medication use and the outpatient referral. RESULTS 227 patients (68.8%) received prescription for a psychotropic medication and all patients were referred to an outpatient psychiatry service. Of the 175 patients who agreed to participate, 153 (87.4%) were successfully contacted by phone. Out of these, 97 patients (63.4%) were using the prescribed medication and 83 (54.2%) had scheduled a community appointment after 60 days. Patients who received a prescription had a greater chance of being on psychotropic medications at follow-up (OR 2.88; IC 95% 1.33-6.22; p = 0.007). However, the prescription was not associated with being in regular outpatient treatment (OR 0.76; IC 95% 0.036-1.61; p = 0.475). Psychotropic medications were routinely prescribed for PES patients, but this practice did not increase compliance to outpatient treatment referral after two months.

A National Survey of Psychiatric Mother and Baby Units in England

A National Survey of Psychiatric Mother and Baby Units in England

P02-247 Do patients follow-up with discharge advice after psychiatric assessment and discharge from emergency department?

Aims:To assess if patients follow-up with discharge advice after psychiatric assessment and discharge from Emergency Department (ED).Method:All patients with psychiatric complaint who presented at three ED's in Edmonton, Alberta, Canada were identified via ED Information System (EDIS). Patients presenting complaint were entered onto the EDIS by Triage Nurse along with demographic information. All charts were reviewed and clinical data was obtained. Patients who were assessed by Psychiatry and discharged home were contacted via telephone to determine if they followed-up with discharge advice of psychiatry team.Results:A total of 1420 patients have been identified during April and May 2008.Chart review has been completed. Data entry and follow-up is in progress. Preliminary data of 250 patients is presented here. 55% were male. Mean age 37 years (SD 12). 47% presented voluntarily. Psychiatry was consulted for 53% of patients. The presenting complaint was “Suicidal Ideation” in 29% and “Bizarre behaviour” in 24%. Primary diagnoses for those seen by Psychiatry were mood disorder (30%) and psychotic disorder (26%). Out of those seen by Psychiatry 36% were admitted. 44% of those admitted by psychiatry were diagnosed with psychotic disorder followed by mood disorder in 31%. The patients who were discharged home by Psychiatry were advised to follow up with their family doctor 7%, psychiatrist 15%, outpatient psychiatry services 16% and addiction services 16%.Conclusion:This is the first report of outcome of discharge advice and will help in developing and planning community follow-up system for psychiatric patients.

The Psychiatry Clerkship: Use of the “Split” Rotation in Clinical Training

Psychiatry clerkships traditionally place students on a single site for the duration of the rotation. This article describes an eight-week training model in which students rotate through two different sites during their clerkship. On one "track," students spend four weeks each on an inpatient mental health unit and consultation-liaison service. On the other "track," students spend four weeks each on an inpatient chemical dependency unit and an outpatient psychiatry service. The rationale for this split rotation is described and the "tracks" are compared via students' performance on clinical evaluations, oral exams, and a written exam (NBME Subtest in Clinical Psychiatry). Based on these outcome variables, both tracks appear to provide comparable and effective clinical training for junior clerks.