Psychiatric Outpatient Population Research Articles

Hypothyroidism in a Psychiatric Outpatient Population of People With Intellectual Disabilities

ABSTRACTIntroductionHypothyroidism is a chronic health condition which causes physical, cognitive and psychiatric symptoms. The prevalence of hypothyroidism in adults with intellectual disabilities is under researched.MethodHypothyroidism was examined among 463 patients within an outpatient intellectual disability psychiatric team. Clinic records were utilised for this study, including sociodemographic, psychiatric and physical health diagnoses.ResultsAmong the 463 patients, 43 (9%) had hypothyroidism. Compared to those without hypothyroidism, the hypothyroid group were significantly older, more likely to be female, and had increased rates of high cholesterol, diabetes, Down's Syndrome and dementia.DiscussionRates of hypothyroidism within this cohort of patients with intellectual disabilities were high (9%). The results suggest hypothyroidism in intellectual disability should be the focus of prospective research, in larger, more representative samples. This study indicates a need for increased awareness of, and resources for hypothyroidism in health services.

Canonical correlation-based relationships between social support and sleep quality in a hospital psychiatric outpatient population with examining the mediating roles of anxiety and depressive symptoms

Objective: This study aims to examine the associations between various dimensions of social support and sleep quality in a hospital psychiatric outpatient population using canonical correlation analysis, while also investigating the potential mediating roles of anxiety and depressive symptoms. Methods: Employing a cross-sectional design, survey data were collected from 10,071 individuals visiting Hangzhou Seventh People’s Hospital between October 2020 and October 2023. After excluding invalid cases, a total of 10,063 participants were included for analysis. The survey encompassed gathering basic demographic information as well as administering the Social Support Rating Scale, Self-rating Depression Scale, Self-rating Anxiety Scale, and Pittsburgh Sleep Quality Index Scale. Data analysis was conducted using SPSS 27.0 statistical software with canonical correlation analysis employed to examine the relationships. Additionally, the mediating effects of anxiety and depression symptoms were examined using the SPSS PROCESS macro. Results: Canonical correlation analysis reveals a significant positive correlation between social support dimensions and various aspects of sleep quality. The first pair of canonical variables (r = 0.586, p < 0.001) accounts for an impressive 97% of the cumulative contribution. It is found that this pair of canonical variables explains 68.9% of the variance in social support and 49.0% in sleep quality. Mediation analysis revealed that anxiety and depressive symptoms significantly mediated the relationship between social support and sleep quality, accounting for 88% of the total effect. Specifically, anxiety accounted for 47% mediation while depression accounted for 41%. Conclusion: The study findings revealed a significant positive correlation between social support and sleep quality dimensions, indicating a robust association between increased social support and enhanced individual sleep quality. Furthermore, the results indicated that anxiety and depression partially mediated the relationship between social support and sleep quality, offering novel insights into the intricate connection between mental health and sleep quality.

The Thoughtful program: a randomized controlled study of a mentalization-based mental health education intervention in a psychiatric outpatient population

Background P-factor and mentalizing theory and research set perspectives for transdiagnostic psychiatric treatments. Aims To test the effects of a low-cost mentalization-based health education program (the Thoughtful program) in an unselected waiting list population, from a psychiatric outpatient clinic in North Norway. Methods Waiting list patients were randomized (1:1 allocation): 79 patients in the control group were offered standard individual assessment and treatment. Seventy-nine patients in the intervention group were offered a one-day (six-hour) group-based Thoughtful course, plus individual assessment, and treatment. Results During a 6-month follow-up period, the number of patients in active assessment and treatment was 66% higher in the control group than in the intervention group. Self-reported patient questionnaire scores on mentalizing, well-being and suicidal ideation scores showed no significant changes in the control group. In the intervention group, significant changes were reported: Mentalizing scores improved by 72% and well-being scores improved by 55%. Suicidal ideation scores were not significantly changed. No adverse effects were registered. Limitations The results from this study should be interpreted with caution because of a small population size and low questionnaire response rate. The follow up period was limited to 6 months. Transfer of program information from intervention group patients to control group patients could not be guaranteed. It may be considered a limitation that diagnostic pattern analysis was not included in the study. Conclusions A low-cost transdiagnostic mentalization-based educational program in an outpatient psychiatry clinic may improve patient mentalizing and wellbeing without adverse effects and reduce the use of hospital services.

Exploring the Relationship Between Psychological Constructs and Decision-Making Preferences in Psychiatric Outpatients.

This study aimed to elucidate the relationships among health locus of control, psychological reactance, attitudes toward psychiatric treatment, and patient decision-making preferences within a psychiatric outpatient population. A total of 200 consecutive psychiatric outpatients from a community mental health center in Tenerife, Spain, were approached for participation between September 2023 and March 2024. Of these, 151 patients consented to participate in this cross-sectional study. Participants were selected based on their willingness to participate and were provided with informed consent forms. Data were collected using the Patient's Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) and the Control Preferences Scale (CPS). The PHBQPT evaluates health beliefs impacting adherence to psychiatric treatment, while the CPS assesses the preferred level of involvement in medical decision-making. Sociodemographic data were also collected to contextualize the findings. Significant correlations were found between patients' control preferences and their attitudes towards medication, compliance with psychiatric advice, and perceptions of treatment control. A collaborative control preference was notably associated with positive attitudes toward medication and trust in the psychiatrist. These findings suggest that tailored treatment approaches prioritizing patient involvement could enhance adherence and outcomes. The study underscores the importance of considering psychological constructs in psychiatric care to foster a holistic, patient-centered approach. Recognizing and integrating patients' control preferences, attitudes towards medication, and psychological reactance can improve the therapeutic relationship and treatment adherence. Future research should explore longitudinal and interventional studies to further understand the impact of aligning treatment approaches with patient preferences and psychological profiles.

Development and validation of the ADHD Symptom and Side Effect Tracking - Baseline Scale (ASSET-BS): a novel short screening measure for ADHD in clinical populations

ObjectiveThe aim was to develop and test a novel screen of adult ADHD, with a specific focus on clinical use. We designed a series of three studies to accomplish this aim.MethodStudy One (n = 155) and Study Two (n = 591) collected data via surveys to conduct exploratory and confirmatory factor analyses, respectively. Study Three analyzed the scale’s psychometrics in a clinical sample (n = 151).ResultsStudy One and Study Two identified a 10-item scale with a two-factor structure. Study Three found good discriminant validity, sensitivity = 80.0%, specificity = 80.2%, and convergent validity with both the Brown Executive Function/Attention Scales, r (131) = .76, p < .001, and the Conner’s Adult ADHD Rating Scales r (131) = .71, p < .001.ConclusionThe scale demonstrated effectiveness in screening for ADHD in a psychiatric outpatient population. Its results may be used to identify patients that may benefit from thorough ADHD diagnostic procedures.

Contribution of Risk and Resilience Factors to Suicidality among Mental Health-Help-Seeking Adolescent Outpatients: A Cross-Sectional Study.

Peer victimization is an established risk factor for youth suicidal thoughts and behavior (suicidality), yet most peer-victimized youth are not suicidal. More data are needed pertaining to factors that confer resilience to youth suicidality. To identify resilience factors for youth suicidality in a sample of N = 104 (Mean age 13.5 years, 56% female) outpatient mental health help-seeking adolescents. Participants completed self-report questionnaires on their first outpatient visit, including the Ask Suicide-Screening Questions, a battery of risk (peer victimization and negative life events) and resilience (self-reliance, emotion regulation, close relationships and neighborhood) measures. 36.5% of participants screened positive for suicidality. Peer victimization was positively associated with suicidality (odds ratio [OR] = 3.84, 95% confidence interval [95% CI] 1.95-8.62, p < 0.001), while an overall multi-dimensional measure of resilience factors was inversely associated with suicidality (OR, 95% CI = 0.28, 0.11-0.59, p = 0.002). Nevertheless, high peer victimization was found to be associated with a greater chance of suicidality across all levels of resilience (marked by non-significant peer victimization by resilience interaction, p = 0.112). This study provides evidence for the protective association of resilience factors and suicidality in a psychiatric outpatient population. The findings may suggest that interventions that enhance resilience factors may mitigate suicidality risk.

Vaccination against COVID-19 and Clinical correlates among a population of psychiatric outpatients

IntroductionPatients suffering from psychiatric disorders represent a population that is particularly at risk of COVID-19-related morbidity and mortality. Vaccination was the most effective strategy to prevent the severe forms of the disease.ObjectivesWe aimed in our study to determine the rate of COVID-19 vaccination and to identify its correlated factors in psychiatric outpatients.MethodsThis is a descriptive and analytical cross-sectional study conducted on 178 outpatients at the department of psychiatry (Monastir, Tunisia) over a period of one month (from March 2022 to April 2022). Data was collected via a questionnaire focused on two main attributes: (1) sociodemographic and clinical characteristics; (2) questions about the flu vaccination history and its modalities.ResultsThe mean age of our patients was 44.9±13.7 years. The majority of them (81.5%) had a chronic evolution of their psychiatric disorder (&gt; 2 years). Psychosis was the most represented disorder with 57.3% compared to mood disorders and anxiety disorders. Among our population, 73% of the patients received vaccination against COVID-19. The majority got 2 doses (60%), were vaccinated on their own initiative (68%) and by making an appointment (71.4%). Patients with depressive disorders accessed to vaccination program in 100% of cases. The group of psychotic patients had a vaccination rate of 66%. Vaccination was significantly associated with gender (p=0.001), age (p=0.04), marital status (p&lt;10-3), number of children (p=0.002), housing situation (0.018), diagnosis (p&lt;10-3) and treatment (p=0.01)ConclusionsPatients with psychiatric disorders experience a distinct burden of the COVID-19 disease. They should therefore be prioritised in vaccine allocation strategies, especially among patients with psychotic disorders.Disclosure of InterestNone Declared

Toward an integrative model of transdiagnostic risk factors and suicide: A network comparison of psychiatric outpatients

Predictive models using traditional statistical methods have largely failed to describe suicide etiology. Network theory, which conceptualizes factors as mutually interacting, reinforcing elements of a complex outcome, can model relationships between transdiagnostic and neurocognitive vulnerability factors. The present study used a network approach to produce an atheoretical model of psychological factors and their interrelationships within a population of ideators and non-ideators. We developed two network models (i.e., suicidal ideators and psychiatric controls) describing the relationships between a diverse set of risk factors and symptom measures for a population of psychiatric outpatients. We compared networks using three measures of network structure (i.e., network structure invariance, global strength invariance, edge invariance) and described the differences. Network structures for ideators (N = 229) and non-ideators (N = 454) were stable and accurate. In non-ideators, cognitive-affective depression symptoms (Expected Influence [EI]: 2.06), trauma avoidance (EI: 1.08), and negative affect (EI: 0.81) were most influential to the psychological network. In ideators, cognitive-affective depression symptoms (EI: 1.77), intolerance of uncertainty-negative self-referent implications (EI: 1.29), and negative affect (EI: 1.19) were most influential. Invariance testing did not indicate significant differences in overall network structure between ideators and non-ideators (p = .111), but did indicate significant differences in node strength (p = .013). Significant differences in node EI were detected for intolerance of uncertainty-negative self-referent implications, anxiety sensitivity physical concerns, thwarted belongingness, worry, and negative affect. These findings indicated differences in network structures for suicidal psychiatric outpatients and provide crucial directions for future research on therapeutic targets for suicidal thoughts and behaviors.

0647 DSM-V Diagnosed Post-traumatic Stress Disorder (PTSD) is Associated with Reported Dream Enactment Independently from Gender, Race or Education in a Psychiatric Outpatient Population

Abstract Introduction PTSD has been associated with PSG-derived measurements of REM without atonia suggestive of RBD (Elliott et al, Sleep 2020 Mar 12;43(3):zsz237). Those findings have been reported in men in their mid-50’s. In a relatively younger, diverse, help-seeking, psychiatric outpatient population enriched with PTSD, we examined the impact of demographics (self-reported gender, race, education) on the association between primary diagnosis of PTSD and probable RBD assessed with a validated questionnaire. Methods Patients (n = 1,658) were enrolled in a non-VA based treatment program for veterans. Patients underwent detailed diagnostic interviews and psychometrics. About 48% (549 men, 251 women; mean age 40.0 [SD = 9.6] years; 381 non-white) met criteria for PTSD. Typical other diagnoses included Axis I defined major depression and various anxiety disorders (without re-experiencing). Dream enactment was assessed with the previously validated University of Michigan RBD Questionnaire (UMRBDQ), completed either by patient or bedpartner. Mean (SD) and 50th% UMRBDQ scores were 0.52 (SD = 0.26) and 0.50. We defined likelihood of RBD by the 90th% of UMRBDQ score (&amp;gt; .80), based on previously published psychometrics, and used multiple logistic regression to define predictors of high vs low UMRBDQ scores. Predictors were diagnosis, self-reported gender (male), race (non-white [vs white]) and education (at least partial college). Results PTSD diagnosis was strongly associated with positive UMRBDQ (31.5% vs 22.0%; OR = 1.77; 95% CI 1.40-2.23). Significant predictors were male gender (OR = 1.93, 95% CI 1.45-2.58) and non-white race (OR = 1.81; 95% CI 1.03-1.65) but not education (OR = 0.86; 95% CI 0.68-1.09). Models of 2-way interactions were all non-significant. Linear models employing UMRBDQ as continuous scores yielded similar results. Conclusion These results confirmed that PTSD may be associated with higher likelihood of reported dream enactment and that these results were not dependent on self-reported gender, race or education. Support (If Any) Wounded Warrior Project

Putting mindfulness-based cognitive therapy to the test in routine clinical practice: A transdiagnostic panacea or a disorder specific intervention?

BackgroundOver the past two decades there has been a growing number of randomized clinical trials supporting the efficacy of mindfulness-based cognitive therapy (MBCT) in the treatment of several psychiatric disorders. Since evidence for its effectiveness in routine clinical practice is lagging behind, we aimed to examine adherence, outcome and predictors of MBCT in a well-characterized, heterogeneous outpatient population in routine clinical practice. MethodsData were collected from a naturalistic uncontrolled cohort of 998 patients formally diagnosed with mainly depression, anxiety disorders, personality disorders, somatoform disorders and/or ADHD. Patients received protocolized MBCT and completed self-report questionnaires pre- and post-treatment on overall functioning (Outcome Questionnaire, primary outcome), depressive symptoms, worry, mindfulness skills and self-compassion. Pre-to post-treatment changes were analysed for the overall sample and each diagnostic category separately with paired sample t-tests, reliable change indices (only overall sample) and repeated measures ANOVA for groups with and without comorbidity. Multiple linear regression was carried out to assess possible predictors of adherence and change in overall functioning. ResultsAdherence was high (94%) but negatively affected by lower levels of education, more comorbidity and presence of ADHD. Outcome in terms of improvement in overall functioning was good in the overall sample (Cohen's d = 0.50, 30% showed reliable improvement vs. 3.5% reliable deterioration) and within each diagnostic category (Cohen's d range = 0.37–0.61). Worse overall functioning at baseline was the only predictor for a larger treatment effect. ConclusionsAfter MBCT, overall functioning improved in a large heterogeneous psychiatric outpatient population independent of diagnosis or comorbidity.

Abstract 060: Cardiovascular Disease Burden In A Psychiatric Outpatient Population

Objective: To understand the burden of cardiovascular diseases (CVDs) in a psychiatric outpatient population. Methods: We used baseline data from the ongoing Penn State Psychiatry Clinical Assessment and Rating Evaluation System (PCARES) Registry, which is comprised of adult patients who were seen at a psychiatric outpatient clinic affiliated with the Department of Psychiatry and Behavioral Health and the Penn State Milton S. Hershey Medical Center. The Electronic Medical Record (EMR) data from 3,024 patients who sought psychiatric care between 02/17/2015 and 09/18/2019 were included in this report. We compared the prevalence of CVDs and the mean levels of major CVD risk factors in our sample with that reported in the 2013-2016 National Health and Nutrition Examination Survey (NHANES). Results: The mean age of the study population was 42.7 (16.7) years, with 63% female and 85% Caucasians. The most common psychiatric diagnoses at baseline were Major Depressive Disorder [ICD-10: F32 &amp; F33] (45%), Generalized Anxiety Disorder [ICD-10: F41.1] (20%), and Bipolar Disorder [ICD-10: F31] (12%). Eighteen percent of patients reported using tobacco products and 1.7% reported using alcohol. The prevalence (%) of CVDs, type 2 diabetes, hypertension, and dyslipidemia in our sample were 9.1, 20, 48, and 41%, respectively (all significantly higher than the NHANES reports, all p &lt; 0.0001). The baseline means (mg/dl) of total cholesterol (C), LDL-C, HDL-C, and triglycerides (TG) were 186, 108, 48, and 156, respectively (all are significantly lower than that reported from the NHANES, except for TG, which was higher than that of the NHANES, all p &lt; 0.0001), while 22% of all patients had prescriptions for lipid-lowering medications. Baseline mean level of glucose and HbA1C were 111 mg/dl and 6.2% (both significantly higher than that from the NHANES, p &lt; 0.0001). Conclusions: In this systematic registry of psychiatric outpatients from a mid-Atlantic academic medical center, the baseline CVD burden as measured by common cardiovascular diseases, comorbidities and risk factors are significantly higher than the CVD burden in the general US population. Considering that the mean age of this patient population is 5 years younger than that of the NHANES population, our data underscores the need for control and prevention of CVD in patients with psychiatric conditions, and suggests the potential of integrating mental and physical health care in this type of special population.

Psychometric evaluation of the Swedish self-rated 36-item version of WHODAS 2.0 for use in psychiatric populations – using classical test theory

Aim The aim of this study was to evaluate the reliability and validity of the Swedish version of the self-rated 36-item WHODAS 2.0 in patients from Swedish psychiatric outpatient settings, using classical test theory. Methods The 36-item WHODAS 2.0, together with the Sheehan Disability Scale (SDS), was filled in by a sample of 780 participating psychiatric patients: 512 (65.6%) women, 263 (33.7%) men, and 5 (0.6%) who did not report any sex. Results The internal consistency, measured by Cronbach’s alpha, for the different domains of functioning were between 0.70 and 0.94, and interpreted as good. The confirmatory factor analysis (CFA) revealed two levels: the first level consisted of a general disability factor, while the second level consisted of the six domains of the scale, respectively. The model had borderline fit. There was a significant correlation between WHODAS 2.0 36-item and SDS (n = 395). The WHODAS 2.0 differed significantly between diagnostic groups. Conclusion The present study demonstrates that the Swedish self-rated 36-item version of WHODAS 2.0, within a psychiatric outpatient population, showed good reliability and convergent validity. We conclude that the self-rated 36-item Swedish version of WHODAS 2.0 can be used for valid interpretations of disability in patients with psychiatric health conditions.

A cross-sectional study of gastrointestinal symptoms, depressive symptoms and trait anxiety in young adults

Background>Patients with functional gastrointestinal disorders have a high psychiatric co-morbidity. This study aimed to investigate and characterise gastrointestinal symptoms in relation to depressive symptoms and trait anxiety in a well-defined population of young adult psychiatric outpatients and healthy controls.MethodsGastrointestinal symptoms were assessed with the Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome (GSRS-IBS). Depressive symptoms were assessed with the Montgomery-Åsberg Depression Rating Scale- Self assessment (MADRS-S). Trait anxiety was estimated with three of the Swedish universities of Personality (SSP) scales: Somatic trait anxiety, Psychic trait anxiety and Stress susceptibility. Self-ratings were collected from 491 young adult psychiatric outpatients and 85 healthy controls. Gastrointestinal symptom severity was compared between patients with and without current psychotropic medication and controls. Associations between gastrointestinal symptoms, depressive symptoms and trait anxiety were assessed using Spearman’s coefficients and generalized linear models adjusting for possible confounders (sex, body mass index, bulimia nervosa).ResultsPatients, with and without current psychotropic medication, reported significantly more gastrointestinal symptoms than controls. In the generalized linear models, total MADRS-S score (p < 0.001), Somatic trait anxiety (p < 0.001), Psychic trait anxiety (p = 0.002) and Stress susceptibility (p = 0.002) were independent predictors of the total GSRS-IBS score. Further exploratory analysis using unsupervised learning revealed a diverse spectrum of symptoms that clustered into six groups.ConclusionGastrointestinal symptoms are both highly prevalent and diverse in young adult psychiatric outpatients, regardless of current psychotropic medication. Depressive symptom severity and degree of trait anxiety are independently related to the total gastrointestinal symptom burden.

Consecuencias psicológicas en mujeres víctimas de violencia de pareja

El estudio tuvo como objetivo general determinar las consecuencias psicológicas de las mujeres víctimas de violencia por parte de su pareja. El diseño de estudio fue no experiental, transversal de alcance descriptivo. Se trabajo con una muestra de 108mujeres que denunciaron a sus parejas por violencia en la provincia constitucional del Callao durante los años 2018 y 2019, cuya muestra estuvo constituida por 108 mujeres víctimas de violencia por parte de su pareja. Se utilizó la Lista de Chequeo de Síntomas de Distrés SCL-90 R de Derogatis, la cual identifica síntomas psicológicos mediante nueve dimensiones y tres índices globales de distrés. Entre los resultados en cuanto al sufrimiento psicológico en las víctimas de maltrato por parte de sus parejas: esta es superior a la de los pacientes psiquiátricos ambulatorios. Por otra parte, en cuanto a las dimensiones de síntomas primarios, sobresalen: la depresión (X=1,81), la obsesión – compulsión (X=1,74), la ansiedad (X=1,70) y la somatización (X=1,69). En tanto que los índices globales totales: las mujeres víctimas de maltrato presentan en promedio 56 síntomas positivos. Y se llegói a concluir que los síntomas psicológicos que presentan las mujeres víctimas de violencia por parte de su pareja se encuentran por encima de la población psiquiátrica ambulatoria (52,03), la cual se respalda con la cantidad promedio de síntomas positivos encontrados (56). Las dimensiones que sobresalen en estas mujeres víctimas por parte de su pareja son: la depresión, obsesión – compulsión, ansiedad y somatización.

Prevalence, Clinical Features and Comorbidities of Alcohol and Substance Use Disorders Among Patients Admitted to Psychiatry Outpatient Clinic

Objective: Comorbidity of substance use disorders and other psychiatric disorders is common. However, data on the prevalence of substance use disorders in general psychiatric outpatient population is rather scarce. Method: In order to investigate the prevalence of substance use disorders among the patients who admitted to the general psychiatric outpatient unit and followed with any psychiatric diagnosis, 734 consecutive adult patients were included in this study. Michigan Alcoholism Screening Test–AD was administered to these patients. Substance screening form and SCID-I dependence module were administered to 47 patients (6.4%) who had a MAST-AD score above 4. Later, SCID-II and the rest of SCID-I were administered to 33 patients (4.5%) who met any diagnostic criteria on this module. Results: From these 734 patients, 33 (4.5%) had alcohol or substance use disorder: Five patients (0.7%) had alcohol dependence, 26 patients (3.5%) had alcohol abuse and 3 patients (0.4%) had multiple substance dependence. There were 9 patients (1.2%) with cannabis abuse, 4 patients (0.5%) with ecstasy abuse, 1 patient (0.1%) with heroin abuse, 1 patient with (0.1%) biperiden abuse and 9 patients (1.2%) with benzodiazepin abuse. From this 33 patients, 7 (1.0%) patients were diagnosed with borderline personality disorder, 2 (0.3%) with antisocial personality disorder, 1 patient (0.1%) with paranoid personality disorder, 1 patient (0.1%) with narcissistic personality disorder, 2 patients (0.3%) with avoidant personality disorder, 1 patient (0.1%) with schizoid personality disorder and 1 patient (0.1%) with dependent personality disorder. With SCID-I, we found 5 (0.7%) major depressive disorder, 3 (0.4%) bipolar I, 1 (0.1%) distimic disorder, 2 (0.3%) paranoid schizophrenia, 1 (0.1%) delusional disorder, 3 (0.4%) generalized anxiety disorder, 3 (0.4%) panic disorder, 1 (0.1%) panic disorder with agoraphobia, 1 (0.1%) anxiety disorder not otherwise specified, 1 (0.1%) social phobia and 1 (0.1%) post traumatic stress disorder. Conclusion: These results suggest that substance use disorders are prevalent among general psychiatric outpatients. Substance use disorders should be carefully assessed in the patients with diagnoses of mood disorders, anxiety disorders or personality disorders.

Childhood trauma, stressful life events, and suicidality in Danish psychiatric outpatients

Background: Increasing evidence points to an association between adverse life experiences and suicide risk, which include childhood trauma and maltreatment as well as recent stressful life events. Accordingly, the assessment of childhood trauma and recent stressful life events might contribute to the detection of suicidal risk in a clinical setting.Aim: To investigate the association of childhood trauma and current stressful life events with suicidal behavior and improve identification of suicidality in psychiatric outpatients.Method: The Childhood Trauma Questionnaire (CTQ), the Stressful Life Events (SLE) questionnaire, and the Suicide Behaviors Questionnaire-Revised (SBQ-R) were administered to 103 psychiatric outpatients (77% women). We employed binary logistic regression analysis to estimate the statistical risk of suicide attempt for patients being exposed to childhood trauma and the influence of recent stresssful life events. A ROC-analysis was used to estimate the ability of CTQ to predict suicidal behavior.Results: A substantial association between suicidal behavior and severe childhood trauma was found (OR = 3.68), whereas no significant association was found for recent stressful life events. The result was tested against possible confounding demographic factors (sex, age, job status, educational level and marital status). Childhood trauma was found to explain around 15% of the total variance in suicidality.Conclusion: The findings partially supported our hypothesis that childhood traumas (but not recent stressful life events) may play a substantial role in suicidality, and therefore assessment of childhood trauma may contribute to the detection of suicidal behavior in a psychiatric outpatient population. However, longitudinal research and replication in other populations are warranted for more conclusive findings.

Prevalence of Mild Behavioral Impairment and Risk of Dementia in a Psychiatric Outpatient Clinic.

Background:Mild behavioral impairment (MBI) has been proposed as risk factor for dementia, and for some, an early manifestation of dementia.Objective:We examined the prevalence of MBI in the psychiatric outpatient clinic, and compared the incidence of dementia in MBI with that in other psychiatric diseases.Methods:Retrospective chart review was conducted in 2,853 consecutive outpatients over the age of 50. MBI was diagnosed according to the International Society to Advance Alzheimer’s Research and Treatment research diagnostic criteria. The incidence rate of dementia was examined in the patients who were followed up for at least 1 month. Kaplan-Meier survival analyses and Cox proportional hazards regression models were performed to compare the time to onset of dementia between MBI and other psychiatric diseases.Results:The prevalence of MBI was 3.5% and the incidence of dementia was 30.7 cases per 1000 person-years. The hazard ratio (HR) for dementia was higher for MBI than other psychiatric diseases (HR: 8.07, 95% confidence interval: 4.34–15.03, p < 0.001). In MCI patients, the cumulative survival in MCI with affective dysregulation tended to be lower than that in MCI without (p = 0.090).Conclusions:Psychiatric outpatients often meet MBI criteria. MBI, especially the affective dysregulation domain, increases the risk of dementia in this psychiatric outpatient population. Since late-onset psychiatric and behavioral symptoms may be prodromal symptoms of dementia in some, careful observation is needed, and psychiatric clinicians should keep prodromal dementia on their differential diagnosis when assessing those with new onset psychiatric symptomatology in older adults.

Development and validation of the 9-item Concise Mental Health Checklist (CMHC-9) for suicide risk assessment

Early detection of suicide risk is a challenge in suicide prevention. A comprehensive yet efficient tool providing timely identification of key risk factors allows healthcare providers to initiate interventions. The study aims to validate the 9-item Concise Mental Health Checklist (CMHC-9). A series of cross-sectional surveys were conducted in 3982 participants from psychiatric outpatient (n=931), medical outpatient (n=931) and community (n=2120) populations. The factor analysis with internal consistency coefficients (Cronbach's α) and receiver operating characteristic (ROC) analysis were performed to evaluate the scale's reliability and validity. The internal consistency of the CMHC-9 was satisfactory based on Cronbach's α values for the total sample (α=0.79) and the three sub-samples (i.e., α=0.76 for psychiatric subjects; 0.67 for community subjects; and 0.69 for medical outpatient subjects). Hierarchical exploratory factor analysis revealed that the CMHC-9 was a single-dimensional scale with two-factor structure of psychopathology and suicidality. The two-factor solution was confirmed by confirmatory factor analysis. The optimal cut-off of 3/4 obtained from the ROC analysis represented a satisfactory sensitivity (92%) and specificity (82%) in identifying recent suicide ideation. This large-scale study confirmed the CMHC-9 as a brief and effective tool for suicide risk detection. It is recommended that CMHC-9 can be used for care engagement and risk identification in both medical and community settings among people at risk for suicide.

ADHD: a hidden comorbidity in adult psychiatric patients

Adult attention-deficit/hyperactivity disorder (aADHD) has recently been better recognized and treated in many European countries. In spite of this development, aADHD still features as a “hidden” comorbidity, often not diagnosed even in patients under psychiatric treatment for other psychiatric disorders. The aim of this study was to establish the prevalence rates of unrecognized aADHD in academic centers providing regular psychiatric services in the Czech Republic and Hungary. In a population of psychiatric in-and outpatients, Adult ADHD Self-Report Scale was administered. All positively and about half of the negatively screened subjects were clinically interviewed and the DSM diagnosis of ADHD was determined based on the symptom list and Conners’ Adult ADHD Rating Scale. The estimated point prevalence rate of unrecognized comorbid aADHD among psychiatric in-and out patients was 6.99% (95% lower CI: 5.11, 95% upper CI 8.86) according to the DSM-IV-TR criteria and 9.27% (95% lower CI: 7.13, 95% upper CI 11.40) according to the DSM-5 criteria. Current suicide risk was significantly associated with the presence of undiagnosed aADHD; however, life time suicide attempts, depression, dysthymia, alcohol and substance dependence, anxiety and stress related disorders were not. Further educational efforts are needed to improve the recognition and treatment of aADHD in adults

An Empirical Study of the Cut-Off Point for the Iranian Version of Alcohol Use Disorders Identification Test (AUDIT)

Background: AUDIT is constructed to be able to identify hazardous drinking and less severe alcohol-related problems. The original AUDIT was shown to have a cut-off score of 8 and above for identifying hazardous or harmful alcohol consumption. The aim of this study was to establish the optimal cut-off point of the Persian version of Alcohol Use Disorders Identification Test (AUDIT) in psychiatric out-patients. Methods: Participants were a sample of consecutive patients at Imam Hossein Hospital (Tehran/Iran). They consisted of 99 patients, 49 of them diagnosed with alcohol dependency and 50 patients randomly selected from a sample of patients using alcohol but with other primary diagnoses. All statistics including means and standard deviations as well as medians and interquartile range were calculated in SPSS 24 software environment. Results: A Receiver Operating Curve analysis showed that by using a 20-point cut-off, the AUDIT had an optimal combination of sensitivity (.92) and specificity (.74). The rate of discrimination was .88. Conclusions: Given the high sensitivity and acceptable specificity of the AUDIT, the test can be used as an effective instrument for identification of alcohol use disorders in the Persian psychiatric out-patient population. Furthermore, the receiver operating curve found in this study resembles the one found in previous studies despite the differences in alcohol cultures between Iran and countries with higher alcohol consumption.