Patients In Psychiatric Services Research Articles

High Incidence of Copy Number Variants in Adults with Intellectual Disability and Co-morbid Psychiatric Disorders

A genetic analysis of unexplained mild-moderate intellectual disability and co-morbid psychiatric or behavioural disorders is not systematically conducted in adults. A cohort of 100 adult patients affected by both phenotypes were analysed in order to identify the presence of copy number variants (CNVs) responsible for their condition identifying a yield of 12.8% of pathogenic CNVs (19% when including clinically recognizable microdeletion syndromes). Moreover, there is a detailed clinical description of an additional 11% of the patients harbouring possible pathogenic CNVs—including a 7q31 deletion (IMMP2L) in two unrelated patients and duplications in 3q29, 9p24.2p24.1 and 15q14q15.1—providing new evidence of its contribution to the phenotype. This study adds further proof of including chromosomal microarray analysis (CMA) as a mandatory test to improve the diagnosis in the adult patients in psychiatric services.

Interventions designed to improve therapeutic communications between black and minority ethnic people and professionals working in psychiatric services: a systematic review of the evidence for their effectiveness.

Black and minority ethnic (BME) people using psychiatric services are at greater risk of non-engagement, dropout from care and not receiving evidence-based interventions than white British people. To identify effective interventions designed to improve therapeutic communications (TCs) for BME patients using psychiatric services in the UK, to identify gaps in the research literature and to recommend future research. Black African, black Caribbean, black British, white British, Pakistani and Bangladeshi patients in psychiatric services in the UK, or recruited from the community to enter psychiatric care. Some studies from the USA included Hispanic, Latino, Chinese, Vietnamese, Cambodian and African American people. Any that improve TCs between BME patients and staff in psychiatric services. The published literature, 'grey' literature, an expert survey, and patients' and carers' perspectives on the evidence base. Databases were searched from their inception to 4 February 2013. Databases included MEDLINE, Applied Social Sciences Index and Abstracts, The Cochrane Library, Social Science Citation Index, Allied and Complementary Medicine Database, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, EMBASE, The Campbell Collaboration and ProQuest for dissertations. Studies were included if they reported evaluation data about interventions designed to improve therapeutic outcomes by improving communication between BME patients and psychiatric professionals. Qualitative studies and reports in the grey literature were included only if they gave a critical evaluative statement. Two members of the team selected studies against pre-established criteria and any differences were resolved by consensus or by a third reviewer, if necessary. Data were extracted independently by two people and summarised in tables by specific study designs. Studies were subjected to a narrative synthesis that included a thematic analysis contrasting populations, countries and the strength of evidence for any intervention. The components of the interventions were compared. Patient perspectives on acceptability were considered alongside quality scores and methodological strengths and weaknesses. Twenty-one studies (19 from the published literature and two from the grey literature) met the inclusion criteria. There were 12 trials, two observational quantitative studies, three case series, a qualitative study and three descriptive case studies. Only two studies, one a pilot trial and one a case series, included economic data; in both, a favourable but weak economic case could be made for the intervention. The trials tested interventions to prepare patients for therapeutic interventions, variable levels of ethnic matching (of professional to patient), cultural adaptation of therapies, and interventions that included social community systems in order to facilitate access to services. Empowering interventions favoured by patients and carers included adapted cognitive-behavioural therapy, assessments of explanatory models, cultural consultation, ethnographic and motivational interviews, and a telepsychiatry intervention. Studies tended to have small sample sizes or to be pilot studies, and to use proxy rather than direct measures for TCs. Empowering interventions should be further researched and brought to the attention of commissioners. Several promising interventions need further evaluative research and economic evaluations are needed. The study is registered as PROSPERO CRD42011001661. The National Institute for Health Research Health Technology Assessment programme.

O-58 - Suicide and suicide attempts during use of antidepressants: high risk at young age?

Introduction Since 2003, the Food and Drug Agency (FDA) issued a number of advisory warnings regarding the association between use of antidepressants (ADs) and suicidal behavior, especially among young people. These warnings have led to a more restrictive use of ADs, also among adults. Objectives We investigated the rates of (fatal) suicide attempts associated with different classes of ADs at different ages. Aims To contribute to finding a favorable balance between safety and the challenge to offer efficacious treatment. Methods By linking the Psychiatric Case Register Middle-Netherlands, which contains patients of psychiatric services in the Utrecht region, Agis Health Database, which contains registered insurance claims, and the death register of Statistics Netherlands, rates of (fatal) suicide attempts were estimated. Results For 7,725 patients with a depressive disorder (mean age 43.2 years) and with at least one AD delivery, 35,224 episodes of use, 23,840 episodes of no use, 32 suicide events, and 357 suicide attempts were established. No significant differences were found in suicide and suicide attempt rates between the different classes of ADs. Compared to episodes of no use, episodes of use of ADs were significantly associated with higher frequency of suicide attempts but suicide rates were similar. A trend towards an unfavorable effect of ADs on suicide risk at younger age was found (P = 0.0718). Conclusion Our results support the FDA advisories in which ADs are treated alike. Use of ADs is indicative of a high risk of suicide, which reiterates the need for close monitoring of patients, especially at young age.

A comorbid anxiety disorder does not result in an excess risk of death among patients with a depressive disorder

Several studies have demonstrated increased mortality associated with depression and with anxiety. Mortality due to comorbidity of two mental disorders may be even more increased. Therefore, we investigated the mortality among patients with depression, with anxiety and with both diagnoses. By linking the longitudinal Psychiatric Case Register Middle-Netherlands, which contains all patients of psychiatric services in the Utrecht region, to the death register of Statistics Netherlands, hazard ratio's of death were estimated overall and for different categories of death causes separately. We found an increased risk of death among patients with an anxiety disorder (N=6919): HR=1.45 (95%CI: 1.25-1.69), and among patients with a depression (N=14,778): HR=1.83, (95%CI: 1.72-1.95), compared to controls (N=103,824). The hazard ratios among both disorders combined (N=4260) were similar to those with only a depression: HR=1.91, (95% CI: 1.64-2.23). Among patients with a depression, mortality across all important disease-related categories of death causes (neoplasms, cardiovascular, respiratory, and other diseases) and due to suicide was increased, without an excess mortality in case of comorbid anxiety. The presented data are restricted to broad categories of patients in specialist services. No data on behavioral or intermediate factors were available. Although anxiety is associated with an increased risk of death, the presence of anxiety as comorbid disorder does not give an additional increase in the risk of death among patients with a depressive disorder. The increased mortality among patients with depression is not restricted to suicide and cardiovascular diseases, but associated with a broad range of death causes.

Prevalence of depression among patients seen in community health centres and community mental health centres.

Depression is a common disorder in the general population. However, its prevalence among patients attending various health-care facilities is less well known. There have been very few Finnish studies of this topic. The Tampere Depression Project (TADEP) dealt with the prevalence of depression and factors associated with it in individuals seen in community health centres (CHC) and in psychiatric-service (PS) patients. The diagnosis of depression was based on a standardized Present State Examination interview and a DSM-III-R assessment, carried out on 436 CHC patients and 428 PS patients. The severity of depression was assessed using the Hamilton Rating Scale of Depression. About 10% of CHC patients and 50% of PS patients suffered from clinical depression. In addition to these, some depressive symptoms were displayed by just under 10% of subjects. Similar prevalence rates were obtained by the various methods used. The 1-year prevalence rate of clinical depression was 20% for the CHC patients and almost 60% for the PS patients. Mild depression represented the largest group. In the CHC group, depression was found more often in middle-aged and widowed subjects and in patients with a lower educational level and blue-collar workers than in others. In the PS group, depression was found more often in women, the oldest subjects and the widowed than in others.