Outpatient Psychiatry Research Articles

Culture, stigma, and inequities creating barriers in alcohol use disorder management in alcohol-associated liver disease.

Culture, stigma, and inequities creating barriers in alcohol use disorder management in alcohol-associated liver disease.

The Psychometric Properties of the General Phubbing Scale in Adolescents

Purpose: Numerous studies indicate that the use of smartphones among adolescents has increased recently. Studies on phubbing generally focus on how parental phubbing affects adolescents. This study aims to contribute to the literature by revealing the validity and reliability of the scale measuring phubbing behavior in adolescents.
 
 Material and Methods: The sample included 206 adolescents aged 12-17 who applied to Pamukkale University Medical Faculty Hospital Child and Adolescent Psychiatry Outpatient Clinics and Kırıkkale Yüksek İhtisas Hospital Child and Adolescent Psychiatry Outpatient Clinic.
 
 Results: To evaluate the construct validity of the General Phubbing Scale (GPS) in adolescents, first and second level confirmatory factor analyses were performed. The data model fit was shown to be at an acceptable level. The general phubbing was negatively related to social connectedness and positively related to internet addiction. Test-retest analysis indicated that the subdimensions nomophobia, interpersonal conflict, self-isolation, problem acceptance, and total score were 0.82, 0.80, 0.71, 0.66 and 0.81, respectively. The coefficients of internal consistency for the subdimensions of nomophobia, interpersonal conflict, self-isolation, problem acceptance, and total score were 0.78, 0.85, 0.92, 0.77, and 0.94. Furthermore, it has been shown that the GPS structure was identical for both genders.
 
 Conclusion: This study demonstrated that the GPS can be used as a valid and reliable measurement tool for determining general phubbing levels for the clinical adolescent sample.

Predicting benzodiazepine prescriptions: A proof-of-concept machine learning approach.

Benzodiazepines are the most commonly prescribed psychotropic medications, but they may place users at risk of serious adverse effects. Developing a method to predict benzodiazepine prescriptions could assist in prevention efforts. The present study applies machine learning methods to de-identified electronic health record data, in order to develop algorithms for predicting benzodiazepine prescription receipt (yes/no) and number of benzodiazepine prescriptions (0, 1, 2+) at a given encounter. Support-vector machine (SVM) and random forest (RF) approaches were applied to outpatient psychiatry, family medicine, and geriatric medicine data from a large academic medical center. The training sample comprised encounters taking place between January 2020 and December 2021 (N = 204,723 encounters); the testing sample comprised data from encounters taking place between January and March 2022 (N = 28,631 encounters). The following empirically-supported features were evaluated: anxiety and sleep disorders (primary anxiety diagnosis, any anxiety diagnosis, primary sleep diagnosis, any sleep diagnosis), demographic characteristics (age, gender, race), medications (opioid prescription, number of opioid prescriptions, antidepressant prescription, antipsychotic prescription), other clinical variables (mood disorder, psychotic disorder, neurocognitive disorder, prescriber specialty), and insurance status (any insurance, type of insurance). We took a step-wise approach to developing a prediction model, wherein Model 1 included only anxiety and sleep diagnoses, and each subsequent model included an additional group of features. For predicting benzodiazepine prescription receipt (yes/no), all models showed good to excellent overall accuracy and area under the receiver operating characteristic curve (AUC) for both SVM (Accuracy = 0.868-0.883; AUC = 0.864-0.924) and RF (Accuracy = 0.860-0.887; AUC = 0.877-0.953). Overall accuracy was also high for predicting number of benzodiazepine prescriptions (0, 1, 2+) for both SVM (Accuracy = 0.861-0.877) and RF (Accuracy = 0.846-0.878). Results suggest SVM and RF algorithms can accurately classify individuals who receive a benzodiazepine prescription and can separate patients by the number of benzodiazepine prescriptions received at a given encounter. If replicated, these predictive models could inform system-level interventions to reduce the public health burden of benzodiazepines.

Effectiveness of personalized tobacco cessation intervention package among patients with schizophrenia and related psychotic disorders - A two-group experimental study.

Persons with schizophrenia and related psychotic disorders (PwS) smoke more, and have twice the rate of mortality, with 10-25 years lower life expectancy than the general population. Evidence-based tobacco cessation interventions would help in quitting. To evaluate the effectiveness of a personalized tobacco cessation intervention package for patients attending the outpatient psychiatry department. The study adopted a two-group experimental design in PwS, using a simple randomization method. Eligible participants were randomly allocated to either the intervention group (n=85) receiving the intervention package or the control group (n=85) receiving brief advice to stop tobacco. The study outcomes were measured at baseline, 1, 3, and 6 months. SPSS 23 was used for data analysis. Intention-to-treat analysis was used to manage missing data. The p-value of <0.05 is considered statistically significant. At 6 months, there was a significant difference (p<0.001) in 7 days point-prevalence abstinence (28 % vs 10.8 %), reduction of tobacco by at least 50 % (62.4 % vs 40.9 %) with an attrition rate of 15.3 % vs 30.5 % in intervention and control group respectively. Reduction in nicotine dependence and tobacco craving, an increase in motivation level, quit attempts and clinical improvement favored the intervention group. 16.5 % of participants expressed interest in pharmacotherapy for tobacco cessation, 3.5 % were referred to a specialized tobacco cessation center, two control group participants were hospitalized for drug default, and withdrawal symptoms reported were mild. Implementing a tobacco cessation intervention based on the stage of motivation aids in abstinence and reduction of tobacco use in PwS.

Improving the Rates of Objective Monitoring of Patients with Depression with the PHQ-9 in an Outpatient Psychiatry Clinic: A Quality Improvement Initiative.

Despite evidence that measurement-based care (MBC) can help identify nonresponse and residual depressive symptoms and could improve treatment, it is underused. The aim of this study was to improve the percentage of patients with depression who received symptom monitoring using the Patient Health Questionnaire-9 (PHQ-9) from 5% to 90%. The research team conducted a quality improvement project employing an uncontrolled before [January to September 2020] and after [October 2020 to May 2021] approach. Researchers used the Model for Improvement (MFI) methodology framework to design the project. The interventions included two education sessions for physicians and the flagging of charts of patients with depression as a visual reminder. Data on the rate of monitoring were collected prospectively each month and extracted after reviewing the paper charts (to determine whether the PHQ-9 was completed by the physician and part of the chart or the PHQ-9 score was documented in the physicians' follow-up note). Prior to the start of the quality improvement initiative the rate of objective monitoring using a rating scale in the clinic was 5.1%. A total of 230 patients were included in the initiative. All physicians attended the educational sessions. By June 2021 the rate of monitoring patients' depressive symptoms and illness severity using the PHQ-9 improved to an average of 51.3% (over the intervention period of October 2020 until May 2021). This initiative reiterates that education strategies, alone or in tandem with visual reminders, could be used to improve the rates of objective symptom monitoring and illness severity of patients with depression. Future studies should aim to determine if the improvement in PHQ-9 utilization is associated with better outcomes for this population.

Bilateral pretibial edema associated with risperidone: A case report

IntroductionRisperidone is a benzisoxazole derivative and is an antipsychotic drug that is frequently used in psychiatric disorders with high binding to 5HT-2A, D2, α1-adrenergic and α2-adrenergic receptors. It is a second generation antipsychotic and the most common side effects are known as extrapyramidal symptoms, weight gain, sedation, hyperprolactinemia, dizziness, insomnia, anxiety and nausea. Edema has been reported in a few cases as a side effect of risperidone in the literature.Objectives In this case report, we aimed to present a case of peripheral edema developed in a patient using escitalopram combined with risperidone and to review the literature on this subject.Methods A 48-year-old male presented to the outpatient psychiatry clinic with symptoms of difficulty in controlling his irritability and anger, damaging the things around him, depression, loss of interest and desire, sleep disturbance, fatigue, and feelings of worthlessness. The patient also applied to the psychiatry outpatient clinic with similar symptoms 5 months ago, and had been on sertraline 50 mg/day and quetiapine 25 mg/day since then. But it was learned that he did not benefit, so his treatment was adjusted as escitalopram 10 mg/day and risperidone 1 mg/day. The patient, who came to the outpatient clinic control after 1 month and did not describe a similar complaint before, described peripheral edema that developed approximately 2 weeks after he started using psychiatric medication. On examination, 3+ pretibial peripheral edema was detected. Since the patient had a previous history of escitalopram use, it was recommended to continue escitalopram 10 mg/day treatment, and risperidone 1 mg/day was discontinued and he was called for control.ResultsIt was observed that the edema completely resolved within 2 weeks following the discontinuation of risperidone treatment.ConclusionsIn conclusion, risperidone is an antipsychotic frequently used in clinical practice, and edema is a rare but important side effect and can be encountered even at low doses. Despite the low incidence, this side effect should be considered by clinicians. There is a need for controlled studies that explain the relationship between risperidone and edema, elucidate the mechanism of edema and investigate its incidence.Disclosure of InterestNone Declared

A retrospective data analysis of psychiatric cases in Hargeisa, Somaliland between 2019 and 2020.

In Somaliland, an estimated one person in every two households suffers from psychiatric disorders. Despite this, access to mental health care is limited because of shortages in facilities, human resources, funding and stigma. To present the proportion of psychiatric disorders encountered in outpatient psychiatry clinics. The University if Hargeisa (UoH), Hargesisa, Somaliland. De-identified data on patients accessing psychiatric care from doctor trainees in the dual psychiatry-neurology residency program at UoH from January 2019 to June 2020 were included in the analysis. The Institutional Review Board from UoH approved data collection and analysis. The most common psychiatric diagnoses were summarised overall and by sex and age. A total of 752 patients were included in the analysis. Most were male (54.7%), with an average age of 34.9 years. The most common psychiatric diagnoses were schizophrenia (28.0%), major depressive disorder (MDD) (14.3%) and bipolar disorder type 1 (BD1) (10.5%). When stratified by sex, patients with schizophrenia and BD1 were more likely to be male (73.5% and 53.3%, respectively), and those with MDD were more likely to be female (58.8%). Trauma- and stressor-related disorders accounted for 0.4% of cases, while 0.8% of patients presented with substance use disorders (alcohol and khat), which is an underestimate of the widespread use in Somaliland. Additional research using structured clinical interviews is needed to determine the epidemiology of psychiatric disorders and promote policies aiming to decrease neuropsychiatric mortality and morbidity. This work presents the first data collection related to neuropsychiatric disorders in Somaliland.

All Mixed Up!! Challenges Faced and Lessons Learned in the Outpatient Management of Bipolar Disorder in Older Adults

This session will highlight several challenging and complicated cases of bipolar disorder treated in an outpatient geriatric psychiatry clinic. We will share our lessons learned from these clinical encounters with the assistance of Dr. Tawny Smith, a clinical psychiatric pharmacist. Dr. Garcia-Pittman will provide background information regarding bipolar disorder in older adults and lead the group discussion at the conclusion of the session. Dr. Polackal will present a case highlighting how proper recognition of mixed features lead to a new diagnosis of late life bipolar disorder. Dr. Polackal will provide guidance for accurate screening and diagnosis of mixed symptoms, focusing on how these symptoms can present differently in the geriatric patient. She will then discuss treatment, focusing on recent literature updates. Dr. Bovio will discuss a case of a patient with bipolar I disorder treated on dual therapy with valproic acid and quetiapine. Dr. Bovio will discuss management considerations when using valproic acid in older adults and the available evidence for the use of dual agents. Dr. Donley will present a clinical case highlighting the use of cariprazine in a patient with bipolar disorder. He will focus on consequences of rapid dose escalation, and review clinical pearls related to the unique mechanism, pharmacokinetics, and further treatment considerations in older adults. Dr. Good will discuss a case of a patient with newly diagnosed bipolar disorder with mixed features who achieved early remission of symptoms with lithium until experiencing lithium toxicity subsequent to a COVID-19 infection. He will review challenges associated with managing patients on lithium in a virtual outpatient clinic during the COVID-19 pandemic and discuss additional clinical factors to consider for patients on lithium who are diagnosed with COVID-19. Dr. Smith will review clinical pearls related to the cases presented. In addition, we will share knowledge regarding literature updates, as well as guidelines for treatment of the aging patient with bipolar disorder.

The impact of social isolation and loneliness on resilient older adults with remitted depressive disorders during the COVID-19 pandemic: two case studies

AuthorsCatherine Gonzalez M.D. and Nancy Donovan M.D. IntroductionSocial Isolation and loneliness (SI/L) representing objective and subjective deficits in social relationships and interactions, are important factors affecting the mental health of older adults. They are also major risk factors for cognitive decline, cardiovascular disease, and premature mortality. During the COVID-19 pandemic, instituted measures such as social distancing, stay-at-home regulations, public closures, and activity limitations, increased social isolation and loneliness for many. It is important for clinicians to recognize how SI/L contributed to worsening psychiatric symptoms during the acute pandemic, the extent to which they still persist and their potential long lasting sequelae. Method/CaseThese case presentations will highlight the impact of SI/L in two elderly patients receiving psychiatric care in an academic outpatient geriatric psychiatry clinic during the COVID-19 pandemic.The first case is a 75-year-old man with history of depression following the death of his wife who was euthymic and stable on a low dose of an SSRI since 2017. Between 2017-2020, he was active, well-functioning, attended religious services weekly, engaged in group grief counseling at his temple, took university extension classes, and visited regularly with family and friends. Due to the COVID-19 pandemic and social restriction measures, he lost all in person connections (counseling, classes, services), and stopped seeing others out of fear of infection and increasing depression. As restrictions eased, many of his former activities returned, albeit virtually but he has been struggling to reconnect, continuing to experience SI/L and depression. Symptoms have only partially improved with CBT and supportive therapy.The second case is a 77-year-old woman with a history of major depression since adulthood, well controlled on low dose SSRI and as needed sleep medication. In the fall of 2019, she had a brief recurrence of depressive symptoms in context of adult son's alcohol abuse and his need to live with her. Symptoms improved as she was active in her church, had many friends and had future trips plans to complete as part of her ‘bucket list’. In spring/summer 2020, depression relapsed as she felt isolated and unsupported during the pandemic and being a witness to son's ETOH and mental health problems without a clear treatment plan/next step. Throughout the last two years, she has been grieving the loss of her ‘pre-covid life’ and the realization that she might not complete her ‘bucket-list’ items. Furthermore, her physical health has been worsening, which has been difficult for her overall well-being. ResultsThese cases highlight the ongoing challenges of the COVID-19 pandemic, in particular its negative impact on geriatric mental health via worsening of SI/L. Even after multiple pandemic surges, vaccines and new treatments, the effects of isolation and social distancing have long lasting effects. In these two cases, high functioning and resilient older adult patients were negatively impacted by isolating public health measures during the pandemic. Recovery, while slow, has been based on re-establishing the quality and quantity of social relationships, re-engagement in meaningful activities and coming to terms with the unique stresses and losses during the pandemic.

Sleep Disorders and Associated Factors in Children Who Admitted to the Child and Adolescent Psychiatry Outpatient Clinics During the Pandemic

Sleep Disorders and Associated Factors in Children Who Admitted to the Child and Adolescent Psychiatry Outpatient Clinics During the Pandemic

Ciddi Ruhsal Hastalık Tanısı Konmuş Olan Bireylerde Öz Yeterlilik, Algılanan Sosyal Destek ve Yaşamda Anlamın Değerlendirilmesi

Objective: It was aimed to determine the levels of self-sufficiency, perceived social support, and meaning in life of individuals diagnosed with serious mental illnesses and to evaluate the relationships between these parameters. Methods: The sample of this descriptive study consisted of 168 individuals who were diagnosed with serious mental illnesses and volunteered to participate in the study, who applied to the Psychiatry Outpatient Clinic in July-October 2021. The data were collected with the Introductory Information Form, the Multidimensional Perceived Social Support (MDPSS), the General Self-Sufficiency (GSS), and the Meaning in Life Scales (MLS). The data were evaluated with Mann-Whitney U, Kruskall Wallis tests, Spearman Correlation, and Regression analysis, and the confidence interval was accepted as 95 and significance as p&amp;lt;0.05 in all analyzes. Results: The participants' levels of meaning in life, social support, and self-sufficiency were found to be moderate. When the ML and MDPSS scores were examined, a significant positive strong (p&amp;lt;0.05) relationship was found between all sub-dimensions of the scales. When the ML and GSS scores were examined, no relationship was found between the sub-dimension of seeking meaning in life and the sub-dimension of persistence, while a strong positive relationship was found between all other sub-dimensions (p&amp;lt;0.005). When the MDPSS and GSS scores were examined, a strong positive (p&amp;lt;0.05) relationship was found between all sub-dimensions of the scales. When the mediating role of Social Support was examined, it was concluded that social support was a partial mediator between self-sufficiency and feelings of meaning in life. Conclusion: It was seen that the concepts examined in the study affected each other in a positive way and social support played a mediating role. The treatment processes of individuals should be supported within the scope of these relationships, and the relationships between meaning in life and self-sufficiency levels of individuals diagnosed with serious mental illnesses should be examined in detail.

An initial investigation of the role of depressive and anxious syndromes in Problematic Internet Use in adolescence and young adults

Depressive and anxious syndromes have been proposed as risk factors and as consequences of Problematic Internet Use (PIU). There has been no study relating affective symptoms in subjects with Problematic Internet Use and those with major depressive and anxious syndromes. In this study, three samples were collected: two from ambulatory clinical settings of the North Lisbon Hospital Centre (1. Centre for PIU and 2. Out-patient psychiatry consultation for adolescents and young adults) and a control group from Faculdade de Medicina da Universidade de Lisboa. Internet use profile and affective psychopathology were assessed and socio-demographic characteristics were controlled. The results revealed that both the PIU group and the clinical group presented significantly higher depression and anxiety scores than the control group while there was no significant difference between them. Also, Problematic Internet Users, similarly to the clinical group, tend to live in less functional families. We speculate that the similitude between samples and yet such different clinical presentations could be explained if Internet acted as a buffer to affective psychopathology. These findings warrant exploring the possibility of PIU as new (and generation biased) psychopathology of depressive or anxious states.

Second-generation antipsychotic medications and metabolic disturbance in children and adolescents

BackgroundThe second-generation antipsychotics (SGAs) are a group of antipsychotic drugs, used to treat psychiatric conditions. SGAs have been shown to precipitate rapid weight gain and dyslipidemia, as well as to promote insulin resistance, leading to the emergence of type 2 diabetes and metabolic syndrome. Prescriptions of SGAs in children have increased 6- to 10-fold during the last decade. This research work designed to find correlation between duration of second-generation antipsychotics (SGA) use, in children and adolescent, and the increase in metabolic syndrome disturbance components including weight gain, hypertension, hyperlipidemia and diabetes mellitus. This is cross-sectional analytic study was carried out in Suez Canal University Hospital, Psychiatry Outpatient Clinic on Children and adolescent aged 4–17 years. It included 151 children and adolescents diagnosed by Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). They were divided into two groups, 72 patients who regular on (SGA) as treated group and 79 patients who did not receive pharmacological medication as control group.ResultsThe overall prevalence of metabolic syndrome in the current study was high 27.81% in SGA-treated children compared to 0.60% in control group. In the SGA-treated group, 22.22% had type 2 diabetes, compared with 2.53% in the control group. SGA-treated patients showed a highly significant increase in their weight, body mass index and waist circumference compared to their control group patients. The correlation of different metabolic syndrome indices and SGAs duration showed positive correlation with body mass index, fasting blood sugar, and blood lipids (low density lipoproteins and cholesterol) but negative correlation with high density lipoproteins. Blood pressure did not correlate with SGA-duration in the studied patients. Indices which showed correlation could be predictors of the metabolic syndrome developments. Although the correlation and regression model showed moderate degree of association, this is considered important issue for the young patients.ConclusionSGA treatment in children and adolescence confers a significantly increased risk for metabolic syndrome and SGA-treatment duration is important for MtS development.

Community-guided measurement-based care for autistic youth and adults receiving psychotherapy: A conceptual overview and pilot implementation study of MBC-AUT.

Autistic youth and adults are more likely to experience psychiatric symptoms (e.g. depression, anxiety) and to use psychiatric services than non-autistic people, yet research on evidence-based approaches to enhance psychiatric care for autistic people is limited. Measurement-based care is an evidence-based approach to psychotherapy that improves outcomes for clients, clinicians, and organizations by routinely administering and evaluating measures to clients. Despite this, research on measurement-based care systems for autistic clients is sparse. To address this gap, we developed an autism-adapted measurement-based care (MBC-AUT) system for and with autistic people and pilot tested the system in an outpatient psychiatry clinic to investigate the preliminary feasibility, acceptability, benefits, and barriers to this system for clients and clinicians. Findings suggested that the MBC-AUT system was a feasible and acceptable system for the first 18 autistic youth, their caregivers, and autistic adults to use the system. In semi-structured interviews, clients and clinicians discussed the benefits of the MBC-AUT system to various therapeutic processes, as well as several important barriers to the use of the system. We offer potential solutions to address these barriers and to reduce client and clinician burden, and propose future directions for this line of research to increase access to more autistic people. As autistic clients continue to seek psychological services amid social landscapes of increasing complexity (e.g. COVID-19 pandemic), efforts to enhance the delivery of psychotherapy for this population are critical.

Impulsivity in Alcohol Dependence among Male Patients in Tamil Nadu: A Cross-sectional Study

Introduction: Alcohol is one of the major substances used in our country, affecting people of young age to old age. It has become a significant concern as a public health burden across all of India. Although the consequences of alcohol dependence in terms of impulsivity are widely assessed, the depth of the burden of alcohol dependence changes with respect to place, time, and socio-economic conditions. Aim: To understand the role of impulsivity and Adverse Childhood Events (ACE) in alcohol dependence among male patients. Materials and Methods: A hospital-based cross-sectional study was conducted between January 2020 and December 2020 among 190 male cases of alcohol dependence syndrome based on ICD-10 criteria. These patients visited the outpatient or inpatient psychiatry department at SRM Medical College Hospital and Research Centre, Potheri, Chengalpattu, Tamil Nadu, India. During the first visit, socio-demographic and clinical details were collected, along with the Barratt Impulsiveness Scale (BIS) and ACE Questionnaire. During the second visit, the Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Scale and Severity of Alcohol Dependence Questionnaire (SADQ) scales were used. Pearson’s correlation was used for analysis using statistical software Statistical Package for Social Sciences (SPSS) version 21.0. Results: Out of the 190 patients enrolled in the study, the majority had completed middle school level education (34.2%). Among the alcoholics, 63.7% were married, and approximately 73.2% were from the lower and middle socio-economic class. A family history of alcoholism was found in nearly 78% of the participants. The maximum number of participants had 1-3 months of abstinence. Pearson’s correlation showed a positive correlation between impulsivity and its subscales with alcohol dependence score and ACE (p&lt;0.05). Conclusion: This study concludes that both impulsivity and alcohol dependence have a bidirectional relationship. ACE also has a positive relationship with impulsivity and alcohol use.

Prevalence, Clinical Correlates and Explanatory Models of Substance Use among Patients with Schizophrenia: A Cross-sectional Study from a Tertiary Care Hospital, Southern India

Introduction: Prevalence rates of Substance Use Disorders (SUDs) in patients with schizophrenia are reported to be about twice of that of the general population. Co-morbid SUDs in these patients can affect the natural course of the illness, quality of life and treatment compliance. Increased rates of hospital admissions, longer duration of inpatient stay, more severe psychopathology, increased rates of criminal activity and violent behaviour have also been reported in this group of patients. Data from the region on substance use in patients with schizophrenia is sparse. Aim: To study the prevalence of SUD’s in patients with schizophrenia and the risk factors associated with SUD’s and patient Explanatory Models (EM) regarding the same. Materials and Methods: The present cross-sectional study was conducted in the Psychiatry Outpatient Clinic at Christian Medical College, Vellore, Tamil Nadu, India, from November 2016 to May 2017 in 103 consecutive patients with schizophrenia. Symptom severity was assessed using the Positive and Negative Symptom Scale (PANSS), substance use patterns with the Drug Abuse Screening Test (DAST), Alcohol Use Disorders Identification Test (AUDIT) and Fagerstrom’s Test for Nicotine Dependence (FTND) and patient EMs for substance use with a semistructured questionnaire. Socio-demographic and clinical details were also recorded. Data was analysed using Statistical Package for Social Sciences (SPSS) software version 16.0.1. Chi-square test and the student’s t-test were used to assess the significance of association for categorical and continuous variables respectively. The Pearson’s correlation coefficient was employed to assess the statistical significance of the association between two continuous variables. A p-value &lt;0.05 was considered as statistically significant. Results: The mean age of the participants was 37.54 years. The majority of the participants were males (n=60, 58.3%), 62 (60.2%) were married, 97 (94.2%) were literates and 54 (52.4%) participants were employed. The prevalence of substance use was seen in 30 (29.1%) participants. Nicotine was the most common substance of abuse (n=21, 20.4%) followed by alcohol (n=19, 18.4%). Male gender, being employed and a family history of substance use were factors significantly associated with any substance use with p-values 0.001, 0.001 and 0.01, respectively. Patient’s explanations for the use of the nicotine included the feeling of relaxation it produced (n=13, 61.9%), and feeling more energetic and active (n=12, 57.1%). Making one more relaxed and social (n=14, 73.7%) was the most common patient explanation for alcohol use. Conclusion: Alcohol and nicotine were common substances of abuse among the participants in this study. It is useful to understand patient’s explanations for substance use in order to develop effective intervention programmes tailored to the individual patient’s beliefs.

Psychosexual Dysfunctions in Male Patients With Diagnosis of Depression and/or Anxiety Disorders Attending Psychiatry Outpatient Clinic in Chhatrapati Shivaji Subharti Hospital, Meerut

Background: Sexual dysfunction (SD) among male psychiatric patients is common and may be the result of various bio- psycho-social factors. This study aimed to assess the proportion of men with depression and/or anxiety disorders having SD and evaluate its association with sociodemographic and clinical variables. Methods: This cross-sectional study conducted from November 2018 to June 2020 included 100 men attending the psychiatry outpatient department of a tertiary care hospital. Sociodemographic and clinical variables, including diagnosis based on International Classification of Diseases 10th Revision criteria, were assessed. Sexual functioning was measured by the Change in Sexual Functioning Questionnaire-Male Version (CSFQ-M). Results: In the study, sexual pleasure dysfunction, sexual desire dysfunction, sexual desire/interest dysfunction, sexual arousal/erection dysfunction, and sexual orgasmic dysfunction were 71%, 71%, 66%, 68%, and 73%, respectively. Pearson correlation between Hamilton Depression Rating Scale score and sexual desire/interest component of CSFQ-M was r = 0.209 ( P = .008). Correlation between Hamilton Anxiety Rating Scale score and sexual desire/frequency component was r = 0.095 ( P = .012), sexual desire/interest component yielded r = 0.114 ( P = .029) and sexual arousal/erection component yielded r = 0.134 ( P = .052). Conclusions: Certain areas of sexual functioning are impacted by depression and/or anxiety disorders symptoms. The hypothesis that those with depression and/or anxiety would have lesser overall sexual functioning is supported in some areas by the results. Clinicians should be vigilant of this association and should plan treatment to enhance compliance and outcome.

COVID-19 vaccine acceptance, hesitancy, and associated factors among patients attending an outpatient psychiatry clinic at a teaching hospital in North Central Province, Sri Lanka

Background: Vaccination of people against COVID-19 infection has shown success in limiting the complications of the infection. Certain populations such as people with psychiatric illnesses are found to be vulnerable to develop COVID-19 and its complications. Aims: The objectives of this study were to determine the vaccine acceptance or hesitancy and their determinants among patients taking treatment for psychiatric disorders at the psychiatry clinic of a teaching hospital in North Central Province, Sri Lanka. Methods: Consenting patients among those who were attending the psychiatry clinic were administered a semi-structured questionnaire to determine the vaccine acceptance or hesitance in obtaining the vaccination, and their determinants. Results: The majority (&gt;89%) of the study population had accepted the COVID vaccine. The majority (&gt;90%) of the patients who rejected the vaccine were less than 25 years and had refused it due to the fear of its side effects and doubts about the safety of the vaccine. Conclusions: All stakeholders should take extra efforts to target the younger population with psychiatric illnesses to educate them regarding the safety and side effects of the COVID vaccines to maximize the vaccination rates and also prevent the occurrence of COVID-19 infection and its complications.

Sleep and psychiatric symptoms in young child psychiatric outpatients - a Follow-up study.

Knowledge of the continuity of sleep problems and the associations between sleep and psychiatric symptoms in child psychiatric patients is scarce. To investigate the persistency of sleep problems and how sleep at preschool age predicts sleep problems and psychiatric symptoms at school age in child psychiatric patients. Participants (n = 68) were child psychiatry outpatients at Helsinki University Hospital in 2015-2017. Caregivers evaluated sleep with the Sleep Disturbance Scale for Children (SDSC) and psychiatric symptoms with the Child Behavior Checklist (CBCL) at baseline (age 4-7years) and again at follow-up (age 8-13 years). Family background information was collected at both time points. Sleep problems at preschool age predicted sleep problems at school age (R2Adjusted = .48, p < .001). Persistent sleep problems associated strongly with the intensity of psychiatric symptoms (p = .001). Internalizing symptoms were predicted by sleep problems (p = .038) even after controlling for age, sex, and psychiatric symptoms at preschool age. Sleep problems are prevalent and persistent and relate to psychiatric symptoms in children treated at child psychiatry clinics. These results emphasize the need for identification and treatment of sleep problems in these children.

What does it mean to flourish? Piloting the flourishing measure with adolescents and young adults with mood and anxiety disorders.

Introduction: Treatment for adolescents and young adults with mood and anxiety disorders typically focuses on recovery of symptoms and improvement in functioning. Measuring positive states of health-using self-report surveys such as the Flourishing Measure-may help to promote holistic treatment. We piloted the Flourishing Measure-Adolescent Version in a clinical sample of adolescents and young adults with mood and/or anxiety disorders to determine appropriateness and acceptability in this population.Methods: We recruited adolescents (age 12-18) and young adults (age 19-25) with mood and/or anxiety disorders from an outpatient psychiatry clinic associated with an academic hospital. We used cognitive interviewing, a method used in survey development that determines whether respondents' understanding aligns with instrument intention. Participants completed the Flourishing Measure and answered questions about their impressions of items.Results: Sixteen participants (10 adolescents and 6 young adults) participated in the study. Participants generally understood the concept of flourishing and the intention of individual items. The items were generally considered clear and participants offered minor suggestions for improvement in wording of the items.Discussion: Participants in our study understood the meaning of flourishing, as well as individual items in the measure. The Flourishing Measure may be suitable for use in clinical and research settings for adolescents and young adults, though piloting with larger, more diverse samples is needed.