Primary Psychiatric Diagnosis Research Articles

Psychiatric Illness and Mortality in Hospitalized ESKD Dialysis Patients.

Limited existing data on psychiatric illness in ESKD patients suggest these diseases are common and burdensome, but under-recognized in clinical practice. We examined hospitalizations with psychiatric diagnoses using inpatient claims from the first year of ESKD in adult and pediatric Medicare recipients who initiated treatment from 1996 to 2013. We assessed associations between hospitalizations with psychiatric diagnoses and all-cause death after discharge in adult dialysis patients using multivariable-adjusted Cox proportional hazards regression models. In the first ESKD year, 72% of elderly adults, 66% of adults and 64% of children had at least one hospitalization. Approximately 2% of adults and 1% of children were hospitalized with a primary psychiatric diagnosis. The most common primary psychiatric diagnoses were depression/affective disorder in adults and children, and organic disorders/dementias in elderly adults. Prevalence of hospitalizations with psychiatric diagnoses increased over time across groups, primarily from secondary diagnoses. 19% of elderly adults, 25% of adults and 15% of children were hospitalized with a secondary psychiatric diagnosis. Hazards ratios of all-cause death were higher in all dialysis adults hospitalized with either primary (1.29; 1.26 to 1.32) or secondary (1.11; 1.10 to 1.12) psychiatric diagnoses than in those hospitalized without psychiatric diagnoses. Hospitalizations with psychiatric diagnoses are common in pediatric and adult ESKD patients, and are associated with subsequent higher mortality, compared with hospitalizations without psychiatric diagnoses. The prevalence of hospitalizations with psychiatric diagnoses likely underestimates the burden of mental illness in the population.

Assessing the Rate of Antipsychotic Use in Ambulatory Care Patients With a Venous Thromboembolism.

Background: Evidence regarding the use of antipsychotics and associated venous thromboembolism (VTE) risk is inconclusive. Studies finding a relationship lack in-depth analysis; thus, the VTE risk among those treated with antipsychotic remains largely unknown. Objectives: The primary objective of this investigation was to compare the incidence of antipsychotic use in patients who developed a VTE versus those who did not. Methods: Data were collected via retrospective chart review from an ambulatory care clinic between January 2012 and August 2017. All active clinic patients within the study period were included unless they met the following criteria: age <18 years, pregnancy within the study period, and/or current or historical malignancy. The odds ratio (OR) of developing a VTE was determined using multivariate regression analysis controlling for age, gender, obesity, and smoking. Secondary end points were reviewed for participants who were exposed to an antipsychotic and subsequently developed a VTE within the study period. Results: A total of 7079 patients were included in the analysis, of whom 314 developed a VTE. Of these, 45 were exposed to an antipsychotic prior to VTE development. Nearly 25% of patients receiving an antipsychotic did not have a primary psychiatric diagnosis. Results suggest that antipsychotic use was significantly associated with increased risk of VTE development (OR = 1.481 [95% CI = 1.067 to 2.055]). Conclusion and Relevance: The results of this study suggest an association between antipsychotic use and VTE development. This association should be considered when prescribing antipsychotics and treating patients who develop a VTE after antipsychotic exposure.

Characterizing e-cigarette use in veteran smokers with mental health conditions

AbstractIntroductionThe use of electronic cigarettes (e-cigarettes) in smokers with mental health conditions (MHC) is not well understood.AimsThis study aims to compare e-cigarette users and non-users among veteran smokers with MHC to characterize differences in smoking behavior, motivation to quit, psychological distress, primary psychiatric diagnosis, and other factors.MethodsBaseline survey data were used from a randomized smoking cessation trial enrolling smokers with MHC from four Veterans Health Administration hospitals. Participants were categorized as current, former (having ever tried an e-cigarette), or never e-cigarette users. Pearson's χ2 and ANOVA Type-3 F-tests were used to test the bivariate associations between e-cigarette use and variables measured.ResultsAmong 1,836 participants, mean age was 58 years (STD ± 12.5), 87% were male, 15% were current e-cigarette users (n = 275), and 27% were former users (n = 503). Sixty-five percent of e-cigarette users reported ‘wanting to quit smoking’ as a primary reason. Mean readiness to quit smoking (1–10) was 7.2, 6.8, and 6.4 for current, former, and never e-cigarette users, respectively (P = 0.0002). Sixty-three percent of current and former users and 55% of never-users reported some mental distress on Kessler-6 scale (P = 0.0003, OR = 1.4, 95% CI 1.1–1.7). A primary psychiatric diagnosis of alcohol or substance use disorder was recorded for 50% of current or former users and 60% of never-users (P = 0.0003, OR = 0.69, 95% CI 0.56–0.84).ConclusionsE-cigarette users were more ready to quit and most often reported using e-cigarettes to assist with quitting. E-cigarette users had more psychological distress and were less likely to have substance use disorders as their primary psychiatric diagnosis.

Postpartum Psychiatric Admissions in the United States.

This study aimed to assess risk for postpartum psychiatric admissions in the United States. This study used the 2010 to 2014 Nationwide Readmissions Database to identify psychiatric admissions during the first 60 days after delivery hospitalization. Timing of admission after delivery discharge was determined. We fit multivariable log-linear regression models to assess the impact of psychiatric comorbidity on admission risk, adjusting for patient, obstetrical, and hospital factors. Of 15.7 million deliveries from 2010 to 2014, 11,497 women (0.07%) were readmitted for a primary psychiatric diagnosis within 60 days postpartum. Psychiatric admissions occurred relatively consistently across 10-day periods after delivery hospitalization discharge. Psychiatric diagnoses were present among 5% of women at delivery but 40% of women who were readmitted postpartum for a psychiatric indication. In the adjusted model, women with psychiatric diagnoses at delivery hospitalization were 9.7 times more likely to be readmitted compared with those without psychiatric comorbidity. Women at highest risk for psychiatric admission were those with Medicare and Medicaid, in lower income quartiles, and of younger age. While a large proportion of psychiatric admissions occurred among a relatively small proportion of at-risk women, admissions occurred over a broad temporal period relative to other indications for postpartum admission.

Childhood adversity and psychosis in detained inpatients from medium to high secured units: Results from the Scottish census survey

BackgroundThere is limited data available regarding the most common forms of psychiatric illness, the occurrence of childhood adversity, and the link between childhood adversity and criminal and psychiatric outcomes amongst forensic inpatients. AimsUsing census data for all Scottish forensic inpatients, we investigated the most common primary psychiatric diagnoses in forensic settings, the occurrence of childhood adversity amongst forensic inpatients, and whether childhood adversity experiences significantly predict a range of criminal and psychiatric outcomes. MethodData for the current study were drawn from ‘The Scottish Forensic Network Inpatient Census’ (N = 422). The Responsible Medical Officers and other members of the clinical team collected all data from official patient records. All forensic inpatients across high, medium, and low security sites were surveyed. ResultsThe majority of patients had a psychotic disorder as their primary diagnosis (86.4%), with schizophrenia being the most common (70.0%). Childhood adversity was highly prevalent (79.2%), with physical abuse being the most common adverse experience (40.1%). Increased levels of childhood adversity were significantly associated with an increased risk of criminal convictions, self-reported abuse of animals, suicidal and self-injurious behaviour, and problematic use of drugs or alcohol. ConclusionsConsidering the association between adversity and psychosis, trauma informed care is essential for the mental health and forensic needs of this population.

Clinical profiles of late-onset psychiatric patients exhibiting incidental REM sleep without atonia.

Rapid eye movement (REM) sleep without atonia (RWA), which is a hallmark of REM sleep behavior disorder (RBD) on polysomnography (PSG), may represent specific characteristics of prodromal Parkinson's disease (PD)/dementia with Lewy bodies (DLB), even when dream-enactment behavior is absent. We investigated the clinical profiles associated with PD/DLB in late-onset psychiatric patients exhibiting incidental RWA. Among patients who underwent PSG in our psychiatric ward, eight with incidental RWA, nine with idiopathic RBD, and seven with PD or DLB who had preceding RBD were included. Clinical variables, including the percentage of RWA in the total REM sleep (%RWA), were compared among the three groups. The frequency of depressive disorders as a primary psychiatric diagnosis and antidepressant usage were significantly higher in the incidental RWA group than in the other groups. There were no differences in the prevalence of supportive features of DLB among the three groups. The median %RWA was significantly lower in the incidental RWA group than in the other groups. Although the cardiac 123I-metaiodobenzylguanidine uptake was significantly higher in the incidental RWA group compared with the other groups, the groups showed overlap in the specific binding ratios on dopamine transporter imaging. All patients in the three groups exhibited cingulate island sign ratios on brain perfusion single-photon emission computed tomography within a threshold of 0.281, which is the optimal cut-off value for a diagnosis of DLB. In this series, late-onset psychiatric patients with incidental RWA partially shared common clinical profiles with idiopathic RBD and PD/DLB.

High-Risk Phenotypes of Early Psychiatric Readmission in Bipolar Disorder With Comorbid Medical Illness

Individuals with co-existing serious mental illness and non-psychiatric medical illness are at high risk of acute care utilization. Mining of electronic health record data can help identify and categorize predictors of psychiatric hospital readmission in this population. This study aimed to identify modifiable predictors of psychiatric readmission among individuals with comorbid bipolar disorder and medical illness. This goal was accomplished by applying objective variable selection via machine learning techniques. This was a retrospective analysis of electronic health record data derived from 77,296 episodes of care from 2006 to 2016 within the University of California Health Care System. Data included 1,250 episodes of care involving patients with bipolar disorder and serious comorbid medical illnesses (defined by transfer between medicine and psychiatry services or concomitant primary medical and psychiatric admission diagnoses). Machine learning (classification trees) was used to identify potential predictors of 30-day psychiatric readmission across hospital encounters. Predictors included demographics, medical and psychiatric diagnoses, medication regimen, and disposition. The algorithm was internally validated using 10-fold cross-validation. The model predicted 30-day readmission with high accuracy (98% unbalanced model, 88% balanced model). Modifiable predictors of readmission were length of stay, transfers between medical and psychiatric services, discharge disposition to home, and all-cause acute health service utilization in the year before the index hospitalization. Among bipolar disorder patients with comorbid medical conditions, characteristics of the index hospitalization (e.g., duration, transfer, and disposition) emerged as more predictive than static properties of the patient (e.g., sociodemographic factors and psychiatric comorbidity burden). Findings identified phenotypes of patients at high risk for rehospitalization and suggest potential ways of modifying the risk of early readmission.

Attitudes toward assisted suicide requests in the context of severe and persistent mental illness: A survey of psychiatrists in Switzerland.

Switzerland is among the few countries worldwide where a request for assisted suicide (AS) can be granted on the basis of a primary psychiatric diagnosis. Psychiatrists play an increasingly important role in this regard, especially when the request for AS arises in the context of suffering caused by severe and persistent mental illness (SPMI). The objective of the survey was to assess general attitudes among psychiatrists in Switzerland regarding AS requests from patients with SPMI. In a cross-sectional survey of 1,311 German-speaking psychiatrists in Switzerland, participants were asked about their attitude to AS for patients with SPMI, based on three case vignettes of patients diagnosed with anorexia nervosa, treatment-refractory depression, or severe persistent schizophrenia. From a final sample of 457 psychiatrists (a response rate of 34.9%) whose mean age was 57.8 years, 48.6% of respondents did not support access to AS for persons diagnosed with SPMI, 21.2% were neutral, and 29.3% indicated some degree of support for access. In relation to the case vignettes, a slightly higher percentage of respondents supported the patient's wish to seek AS: 35.4% for those diagnosed with anorexia nervosa, 32.1% for those diagnosed with depression, and 31.4% for those diagnosed with schizophrenia. Although a majority of the responding psychiatrists did not support AS for SPMI patients, about one-third would have supported the wishes of patients in the case vignettes. In light of the increasing number of psychiatric patients seeking AS and the continuing liberalization of AS practices, it is important to understand and take account of psychiatrists' perspectives.

Ethanol normalizes glutamate-induced elevation of intracellular sodium in olfactory neuroepithelial progenitors from subjects with bipolar illness but not nonbipolar controls: Biologic evidence for the self-medication hypothesis.

Alcohol use disorders are quite common in bipolar patients with a prevalence of comorbidity that exceeds all other primary psychiatric diagnoses other than other substance use disorders1; over 60% of people with bipolar disorder type I (BD I) have comorbid alcohol dependence at some point in their lives.1 This intimate relationship has served as the basis of the proposed idea of “self-medication.”2 However, biological confirmation of “self-medication,” specifically, the correction of an abnormal biologic marker with alcohol, has never been demonstrated. Recently, we have succeeded in utilizing olfactory neuroepithelium biopsy to produce permanent cell lines of olfactory neuroepithelial progenitors (ONPs) from patients with BD and matched nonbipolar controls.3 These cells possess the genetic heritage of BD I and can be used for investigation of differential biological responses to ethanol. Ionic regulatory abnormalities have repeatedly been documented in patients with BD I.4 Most notably, intracellular sodium and calcium are elevated during both mania and depression, this distribution of cations alters transmembrane potential of lymphocytes—a phenomenon which may be a useful diagnostic marker (reviewed in references 4). Both pharmacologic and genetic animal models which inhibit the sodium pump to elevate intracellular sodium and calcium concentrations create mania-like behaviors (reviewed in 4). Similarly, altered-glutamate metabolism is a consistent finding in BD (reviewed in 4). Importantly, brain glutamate and glutamine are elevated in most brain areas in patients with bipolar illness during mania, depression, and euthymia. By extension, treating ONP cells with glutamate to increase both intracellular sodium and calcium may be a cellular model of bipolar illness, mania, and/or bipolar depression.

77 Long-term Valbenazine Treatment in Patients with Schizophrenia/Schizoaffective Disorder or Mood Disorder and Tardive Dyskinesia

AbstractBackgroundPatients treated with antipsychotics, regardless of psychiatric diagnosis, are at risk for developing tardive dyskinesia (TD), a potentially debilitating drug-induced movement disorder. Valbenazine (INGREZZA; VBZ) is a novel vesicular monoamine transporter 2 (VMAT2) inhibitor approved to treat TD in adults. Data from KINECT 4 (NCT02405091) were analyzed to evaluate the long-term effects of VBZ in adults with schizophrenia/schizoaffective disorder (SZD) or mood disorder (MD) and moderate or severe TD.MethodsKINECT 4 included open-label treatment (48weeks) followed by washout (4weeks). Entry requirements included: moderate or severe TD, qualitatively assessed at screening by a blinded, external reviewer; DSM diagnosis of SZD or MD; psychiatric stability (Brief Psychiatric Rating Scale score &lt;50). Stable concomitant psychiatric medications were allowed. Dosing was initiated at 40mg, with escalation to 80mg at Wk4 if participants had a Clinical Global Impression of Change-TD score of ≥3 (minimally improved to very much worse) and tolerated 40mg. A reduction to 40mg was allowed if 80mg was not tolerated (80/40mg); participants unable to tolerate 40mg were discontinued. Safety was the primary focus, but the Abnormal Involuntary Movement Scale (AIMS) total score (sum of items 1–7) was used to evaluate changes in TD. Mean changes from baseline (BL) in AIMS total score (rated by on-site investigators) were analyzed descriptively. Safety assessments included treatment-emergent adverse events (TEAEs) and psychiatric scales (Positive and Negative Syndrome Scale [PANSS], Calgary Depression Scale for Schizophrenia [CDSS], Montgomery-Åsberg Depression Rating Scale [MADRS], Young Mania Rating Scale [YMRS], and Columbia-Suicide Severity Rating Scale [C SSRS]).ResultsOf 163 participants in the analyses, 103 completed the study. Adverse events (n=26) was the most common reason for discontinuation. Analyses included 119 participants with SZD (40mg=37; 80mg=76; 80/40mg=6) and 44 with MD (40mg=8; 80mg=31; 80/40mg=5). At Wk48, mean improvements from BL in AIMS total score were: SZD (40mg, –10.1; 80mg,–10.7); MD (40mg, 10.2; 80mg: –11.6). AIMS total scores at Wk52 (end of washout) indicated a return toward BL levels. Compared to SZD, the MD subgroup had a higher incidence of any TEAE (84% vs 61% [all doses]) but fewer TEAEs leading to discontinuation (7% vs 18%). Urinary tract infection was the most common TEAE in the MD subgroup (18%); somnolence and headache were most common in the SZD subgroup (7% each). Psychiatric status remained stable from BL to Wk48: SZD (PANSS positive, –0.7, PANSS negative, –0.6; CDSS, –0.7); MD (MADRS, –0.3; YMRS, –0.3). Most participants (95%) had no change in C-SSRS score during the study.ConclusionSustained and clinically meaningful TD improvements were observed with VBZ, regardless of primary psychiatric diagnosis. VBZ was generally well tolerated and no notable changes in psychiatric status were observed.Funding Acknowledgements: Supported by Neurocrine Biosciences, Inc.

Factors Associated With Length of Stay in Emergency Departments for Pediatric Patients With Psychiatric Problems

Length of stay (LOS) and boarding for pediatric psychiatric patients presenting in the emergency department (ED) have been understudied, despite evidence that children with psychiatric disorders experience longer LOS relative to those without. This investigation examined correlates of LOS and boarding among youth with psychiatric disorders presenting to the ED in a large, statewide database. Using the 2010 to 2013 Florida ED discharge database, generalized linear mixed models were used to examine for associations between LOS and patient and hospital characteristics among pediatric patients (<18 years) who presented with a primary psychiatric diagnosis (N = 44,328). Patients had an overall mean ± SD ED LOS of 5.96 ± 8.64 hours. Depending on the definition used (ie, 12 or 6 hours), between 23% and 58% of transferred patients were boarded. Patient characteristics associated with a longer LOS included female sex, being 15 to 17 years old, Hispanic ethnicity, having Medicaid or VA/TriCare insurance, having impulse control problems, having mood or psychotic disorders, and exhibiting self-harm behaviors. Patient transfer, large hospital size, and rural designation were associated with longer LOS. Teaching hospital status and profit status were not significantly associated with LOS. These data suggest that LOS for pediatric psychiatry patients in the ED varies significantly by psychiatric presentation, patient disposition, and hospital factors. Such findings have implications for quality of care, patient safety, and health outcomes.

Patient Characteristics Should Determine Response to Threatening Behavior

Back to table of contents Previous article Next article Professional NewsFull AccessPatient Characteristics Should Determine Response to Threatening BehaviorTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:11 Jan 2019https://doi.org/10.1176/appi.pn.2019.1a14AbstractConfronting patients directly may backfire depending on the patient’s motivation and diagnosis.The most effective responses to stalking, threatening, or harassing behavior (STHB) directed toward mental health professionals depend on the patient’s motivation and personality organization, suggests a study published in the American Journal of Psychotherapy.Direct confrontation can make the situation worse if the patient is motivated by resentment. —Aaron Kivisto, Ph.D., H.S.P.P.In the study, researchers at the University of Indianapolis School of Psychological Sciences analyzed data from a questionnaire completed by 112 board-certified psychologists who had experienced at least one episode of STHB. The questionnaire covered the types of STHB the psychologists had experienced, the risk management strategies they used, and whether they felt those strategies had been effective in addressing the behavior.“Our participants defined ‘effective’ based on their subjective sense that their response had improved the situation. This could mean a complete cessation of the STHB, but not necessarily,” lead author Aaron J. Kivisto, Ph.D., H.S.P.P., co-director of doctoral programs in psychology and an associate professor of clinical psychology told Psychiatric News. “One could imagine, for example, a situation where a patient continued to engage in harassing behavior, although the clinician felt the situation had improved as a result of improving her office security.”The questionnaire also covered the primary psychiatric diagnoses of the patients who engaged in the STHB, what their motivations were (resentment or infatuation), and whether the patients had higher- or lower-level personality organization. Patients who had internalizing personality disorders, neurotic personality disorders only, or no personality diagnosis were coded as having higher-level personality organization. Those who had externalizing, borderline, or dysregulated personality disorders were coded as having lower-level personality organization.Upon reviewing the data, the researchers found that the most common strategy, seeking assistance from colleagues or supervisors, was also deemed most effective by the respondents regardless of patient characteristics. However, the effectiveness of the second most common response, confronting the patient directly, was deemed effective by only about half of respondents, and in many cases it backfired.“For patients motivated by resentment, direct confrontation made the situation worse in nearly two-thirds of cases,” Kivisto said. “By contrast, direct confrontation with [patients] with higher-level personality organization was perceived as improving the situation in about two-third of cases.”In the paper, the researchers offer possible reasons why.“The perceived effectiveness of these strategies may reflect these higher-functioning clients’ ego strength, which allowed them to tolerate direct conversations about the psychologist-client relationship and modify their behavior in response to minimally intrusive limit setting,” they wrote.Conversely, when addressing STHB by patients with lower-level personality organization, protective strategies like increasing workplace security and seeking assistance from an attorney were seen as especially effective.The bottom line is that risk management is not one-size-fits-all.“Our study suggests that risk management responses should take into account patients’ motivations for engaging in STHB and level of personality pathology. There’s no single response likely to work for all patients all of the time, but the likelihood of responding productively might be increased when clinicians are sensitive to these contextual factors,” Kivisto said.Prior research by Kivisto and others suggests that most mental health professionals, including psychiatrists, will be subjected to STHB at some point in their careers.“Where the differences [among mental health professionals] likely emerge is in the variation in risk management resources available … in different settings. It’s one thing … to experience STHB in a secure inpatient setting, and another thing altogether in a home office,” Kivisto said.To that end, Kivisto encourages all mental health professionals to be proactive in reducing risk. “This includes seeking out training on managing potentially dangerous patients; developing a network for consultation that includes clinical, legal, and law enforcement professionals; and developing clinic policies that facilitate clear limit setting to protect clinicians confronted with patients engaging in STHB,” he said.This study was funded by the University of Indianapolis. ■“Risk Management With Clients Who Stalk, Threaten, and Harass Mental Health Professionals” can be accessed here. ISSUES NewArchived

Rates and trends of psychiatric inpatient and postdischarge suicides in Taiwan, 2002-2013: a national register-based study.

In contrast to the downsizing trend of psychiatric beds in the Western world, the psychiatric bed capacity in Taiwan has steadily increased in recent decades. This study aimed to assess the suicide rates and their variations over time among psychiatric inpatients and recently discharged patients. Data on psychiatric inpatients admitted from 2002 to 2013 were extracted from the psychiatric inpatient registry of the National Health Insurance and merged with information from the Cause of Death data by means of unique identified numbers. Suicides occurring during admission and within 90days after discharge were defined as inpatient and postdischarge suicides, respectively. Calendar year was fitted as a continuous variable in multivariate Poisson regression models to evaluate these rates over time. The analyses were adjusted for sex, age, primary psychiatric diagnosis, and number of admissions in the preceding year. The overall inpatient suicide rate was very low (81 per 100,000 person-years). It decreased significantly from 146 to 74 per 100,000 person-years over the study period. This fall was observed among both genders and across all psychiatric diagnoses. The postdischarge suicide rate was comparatively high (1108 per 100,000 person-years) and did not show statistically significant change over the study period. Our results suggest that efforts to increase public awareness of mental disorders and efficient utilization of psychiatric inpatient care are essential for suicide prevention despite the comparatively high bed capacity. The discharge plans of inpatients should be bridged with population suicide prevention programs for continuity of care after discharge.

Tobacco and Substance Use among Psychiatric Inpatients in a Community Hospital: Cessation Counseling, Correlates, and Patterns of Use.

Background Epidemiological and experimental models have been applied to describe the disproportionately high prevalence of tobacco use in patients with mental illness. This observed association has become a dire public health concern. The main objective of the present study was to examine the provision of tobacco treatment strategies in a community teaching hospital serving a predominantly underserved African American population. Methods The study was designed as a retrospective review of eight hundred and thirty patients admitted to the inpatient psychiatric units. Results 52.2% of the entire cohort described themselves as current smokers. Gender, primary psychiatric diagnosis, and urine toxicology showed significant differences in the tobacco smoking and nontobacco smoking groups (P<0.05). Almost all current tobacco smokers (91.9%) had tobacco cessation counseling during the course of their hospitalization, but only 64% were offered treatments for tobacco dependence. More than half (57.9%) of the 680 participants who had urine toxicology reports were positive for any illicit substance with cannabis and cocaine being the most frequently used (32.4% and 23.2%). Direct logistic regression revealed gender, psychiatric diagnosis, and substance use as the only significant predictors of tobacco smoking among our cohort (P= 0.021, 0.001, and 0.001, respectively). Conclusions Tobacco screening, cessation counseling, and treatment continue to be a challenge in community psychiatric hospitals and need increased focus in the comprehensive management of patients with psychiatric disorders. The strong association between tobacco smoking and other substance use lends itself to the hypothesis that tobacco smoking debut prevention may be an effective public health strategy for addressing illicit drug use.

Prevalence of psychiatric morbidities in two tertiary health institutions North west Nigeria

Abstract&#x0D; Background: Mental illnesses constitute a significant fraction of the global burden of diseases. Currently evaluated at 11.5% and an expected burden of 15% by 2020, it accounts for 40% of the leading health conditions contributing to the disability adjusted life years (DALYS). Worldwide, 340 million people suffer from mental illnesses, the majority living in the developing world. The aim of this study therefore was to assess the prevalence and socio-demographic distribution of psychiatric disorders in the psychiatric outpatient department of two tertiary health institutions in Nigeria.&#x0D; Method: This was a descriptive cross-sectional study. All patients attending the psychiatric outpatient clinic of the two hospitals from January to June 2014, diagnosed with psychiatric disorders according to the diagnostic and statistical manual of mental disorders (DSM-5) were included in the study. The sample size was determined using single population proportion formula and 250 respondents were selected using systematic random sampling. Data was collected manually through proformas and analyzed using SPSS version 20.&#x0D; Result: The prevalent age group of persons with psychiatric disorders from this study was 21-30 years constituting 35.1% of respondents at FNPHK and 36% at UDUTH. In the rural hospital 57.3% of respondents diagnosed with psychiatric disorders were men while in the urban hospital 64% were women. Depression (38% and 25.5%) was the prevalent diagnosis. The leading primary psychiatric diagnosis in both institutions was comparable - depression, generalized seizure and schizophrenia. &#x0D; Conclusion: The prevalence of depression and schizophrenia is well documented in this study. The educational and geographic distribution of respondents suggests that high socio-economic status does not translate into less predisposal to psychiatric disorders. Policy makers and concerned government officials should enact and enforce laws that will help minimize associated social problems.

Gender Differences in Self Reported Worrying and Emotional Regulation Deficits in Generalized Anxiety Disorder (GAD) Patients

Background: Studies of gender differences in GAD have revealed female preponderance in the epidemiology, co morbidity, and symptom severity in GAD. Relatively less explored are gender differences in the cardinal feature of GAD, i.e. excessive worrying and in the underlying emotional regulation deficits, the presence of which is evidenced in GAD sufferers. Objective: To assess gender differences in the self reported worrying and emotional regulation difficulties in Generalized Anxiety Disorder (GAD) patients. Method: Data were derived from a 150 patients (75 male and 75 female patients) with a primary psychiatric diagnosis of GAD (DSM-V, 2013); who were under treatment from various psychiatric centers based in Haryana. The tools used were Penn State Worry Questionnaire (PSWQ) and Difficulties in Emotion Regulation Scale (DERS). Results: Women with GAD had significantly higher self reported worrying levels and greater emotional regulation deficits than men with GAD. Conclusion: The current study provides evidence for gender differences in worrying and emotional regulation deficits in GAD patients. Women GAD patients worry more and have more emotional regulation deficits as compared to male GAD patients.

Psychiatric Consultations at an Emergency Department in a Metropolitan University Hospital in Northern Japan.

Many patients with mental disorders visit emergency departments (EDs). However, the majority of these patients do not receive psychiatric assessment. In the present study, we investigated the detailed proportion of patients with mental disorders visiting an urban ED in the largest northern city in Japan. A retrospective chart review study was performed at a University Hospital from January 2012 to December 2015. The reasons for psychiatric consultations made by ED staff, and the primary psychiatric diagnoses were investigated. Among all living patients, 20% of them received consultations. The most common reason for consultation was suicide attempt followed by agitation or insomnia. Of all diagnoses, organic mental disorder was the most frequent and the mean age was significantly higher than the other diagnostic groups. Our study indicated that the frequency of psychiatric consultation was high. This indicates the high demand for mental health services at the ED. A thorough psychiatric assessment can provide adequate psychiatric services to acute patients; thereby possibly preventing suicide attempters from later actually dying by suicide.

An Update on Repetitive Transcranial Magnetic Stimulation for the Treatment of Co-morbid Pain and Depressive Symptoms.

Review recent meta-analyses and clinical trials investigating the therapeutic use of repetitive transcranial magnetic stimulation (rTMS) for concurrent pain and depressive symptoms. Recent meta-analyses have included both pain and depression outcomes in fibromyalgia and chronic pain. Randomized controlled trials have also been conducted in post-herpetic neuralgia, trauma-related headache, and neuropathic pain with attention to both pain and depressive symptoms. In general, studies have demonstrated reduction in pain in patients with fibromyalgia as an add-on treatment, post-herpetic neuralgia, trauma-related headache, and neuropathic pain. There are variable findings for reduction in depressive symptoms in patients with co-morbid pain disorders. Theta burst stimulation (TBS) is a novel rTMS protocol that has recently been investigated in patients with depression and some smaller trials in patients with co-morbid pain disorders. These emerging treatment options may have similar or greater therapeutic potency and may be delivered with greater efficiency. There is evidence to support the use of rTMS for its analgesic effects in various pain syndromes. The variable results between trials for treatment of concurrent depressive symptoms may be due to heterogeneity in treatment protocols including parameters such as site of stimulation (primary motor cortex versus dorsolateral prefrontal cortex) and restrictions in the patient population which usually exclude primary psychiatric diagnoses. Future trials should work to standardize these protocols, investigate novel protocols like TBS, and continue to include standardized assessment of concurrent psychiatric outcomes such as depression and anxiety.

S189. CARVING A MORE SPECIFIC SUBTYPE OF SCHIZOPHRENIA FOR GENETIC STUDIES: SPORADIC SCHIZOAFFECTIVE BIPOLAR TYPE

BackgroundSchizophrenia is a heterogeneous group of disorders. The familial-sporadic distinction has been considered under a range of genetic models. Research supports a strong association of de novo copy mutations with sporadic schizophrenia. The aim of the study was to determine a more homogenous phenotype for genetic research via comparison of various clinical and socio-demographic variables in familial and sporadic schizophrenia.MethodsA cross-sectional observational design was used. This study included 384 participants with schizophrenia/schizoaffective disorder from an Afrikaner founder population in South Africa that previously participated in genetic research. A comprehensive data capturing sheet was completed from a pre-existing database that contains information obtained from the Diagnostic Interview for Genetic Studies, chronological clinical summary reports and additional sources of information. The study protocol was approved by the Research Ethics Committee from the Faculty of Health Sciences at the University of Pretoria. Logit models were fitted using the backward elimination procedure to investigate relationships where the dependent variable was binary. Odds ratio estimates were calculated for independent variables that were significant in the model. The Kruskal-Wallis test was conducted to compare the means of groups. For cases where there were significant differences a post-hoc test with a Bonferroni correction was done to determine which groups differ significantly.ResultsThere were 214 familial and 170 sporadic subjects. 279 had a diagnosis of schizophrenia, 66 schizoaffective, bipolar type and 39 schizoaffective disorder, depressive type. 242 were male and 142 female. The age at onset of the primary psychiatric diagnosis, season of birth, co-morbid diagnoses, symptomatology, suicidality history and marital status weren’t significantly different when considering the combined schizophrenia/schizoaffective disorder group and its relationship to familiality. Early deviant behaviour was however decreased in the sporadic group. These findings were replicated when analysing schizophrenia independently from schizoaffective disorder. The sporadic schizoaffective disorder, bipolar type did however have a significantly lower age at onset (mean 20.18 versus 25.07 years), 8.8 times more hallucinations, 6.6 times more odd behaviour before the age of 10 and were 2.8 times more likely to be single. The bipolar type also had 2.9 times more suicide attempts as opposed to ideation. This finding wasn’t statistically significant. The sporadic schizoaffective group overall was 2.2 times more likely to abuse substances. The depressive type didn’t differ significantly with regards to age at onset, season of birth, co-morbidities, early deviant behaviour, symptomatology, suicidality or marital status.DiscussionThe combined schizophrenia/schizoaffective group didn’t differ significantly, nor did schizophrenia and schizoaffective disorder depressive type when analysed independently. The sporadic schizoaffective bipolar type differed significantly on multiple important variables that suggest a poorer prognosis and increased disease severity. The sporadic schizoaffective bipolar type forms a more homogenous group, with genetic studies hinting at relatively specific genetic risk factors. Studies elucidating the genetic architecture of this group could prove invaluable in clarifying the aetiology of schizophrenia.

Performance of the Adult ADHD Self-Report Scale-v1.1 in Adults with Major Depressive Disorder.

Attention deficit/hyperactivity disorder (ADHD) is an under-recognized comorbid disorder among patients with mood disorders. ADHD is an independent risk factor for suicidal ideation and behavior and contributes to many aspects of impaired function in adults. Diagnosis of ADHD in Major Depressive Disorder (MDD) patients is challenging due to the overlap in cognitive symptoms between the two disorders. The ADHD Self-Report Scale, version 1.1 (ASRS-v1.1) is a widely used screening instrument for ADHD in adults but its accuracy has not been evaluated previously in treatment-seeking MDD patients. We administered the ASRS-v1.1 to 55 healthy controls and 40 adults with a primary psychiatric diagnosis of MDD who were participating in clinical research studies. ADHD diagnosis was assessed via structured interview with the adult ADHD module of the Mini International Neuropsychiatric Interview Plus version 6.0.0 (MINI) along with a psychiatrist’s assessment. Overall, full-syndrome ADHD was diagnosed in 12.5% of the MDD patients. MDD patients endorsed all 18 items of the ASRS-v1.1 more frequently than the healthy controls and the number of ASRS-v1.1 items endorsed correlated with levels of anxiety in the MDD patients. The ASRS-v1.1 demonstrated fair performance for identifying full syndrome DSM-IV ADHD diagnosis, with sensitivity 60%, specificity: 68.6%, positive predictive value 21.4%, negative predictive value 92.3% and total classification accuracy of 67.5%. Positive predictive value improved substantially when the ADHD criterion requiring symptom onset before age 7 was omitted. In adult MDD patients, a negative ASRS-v1.1 screen strongly suggests the absence of ADHD but positive screen results require careful evaluation to determine whether self-reported ADHD symptoms simply emerge from depression or whether comorbid ADHD is present.