Clinical Methods Research Articles

Depression among Patients with an Implanted Left Ventricular Assist Device: Uncovering Pathophysiological Mechanisms and Implications for Patient Care.

Depression is a common and devastating mental illness associated with increased morbidity and mortality, partially due to elevated rates of suicidal attempts and death. Select patients with end-stage heart failure on a waiting-list for a donor heart undergo left ventricular assist device (LVAD) implantation. The LVAD provides a circulatory flow of oxygenated blood to the body, mimicking heart functionality by operating on a mechanical technique. LVAD improves functional capacity and survivability among patients with end-stage heart failure. However, accumulating data suggests that LVAD recipients suffer from an increased incidence of depression and suicide attempts. There is scarce knowledge regarding the pathological mechanism and appropriate treatment approach for depressed LVAD patients. This article summarizes the current evidence on the association between LVAD implantation and occurrence of depression, suggesting possible pathological mechanisms underlying the device-associated depression and reviewing the current treatment strategies. The summarized data underscores the need for a rigorous pre-(LVAD)-implantation psychiatric evaluation, continued post-implantation mental health assessment, and administration of antidepressant treatment as necessary.

Monozygotic twins with concordant female-to-male gender dysphoria with different temperament characteristics: a case report

Gender Dysphoria (GD) is defined as a marked incongruence between one’s experienced/expressed gender and assigned gender that the individual feels a strong desire for having the sex characteristics of the other gender. Twin studies could be helpful in making decisive conclusion on the relative role of genetics and environment on GD. Therefore, we hereby present a case of monozygotic twins with concordant female-to-male GD. Seventeen-year-old twins are introduced in this case report. The second pair attended to our clinic for psychiatric evaluation. She was suffering from GD by overwhelmed desire for having masculine features, wearing their cloths, and at the same time revolting being a girl. Although she preferred spending time with male friends, she was sexually attracted to females. Although the first pair had similar characteristics of GD, she presented apposite temperament. While temperament has been considered to be genetically inherited, the incidence of GD in our cases with different temperaments raises the question about genetic role in inheriting temperament and GD. Further twin studies will help understanding the extent of genetic influence on these features.

Şanlıurfa'da bir eğitim ve araştırma hastanesine özel gereksinim raporu için başvuran çocukların sosyodemografik ve klinik özelliklerinin değerlendirilmesi

Purpose: This study aimed to evaluate the sociodemographic and clinical characteristics of cases who have applied to a research and training hospital for special needs reports for children. Materials and Methods: Retrospective analysis was performed on the medical records of children and adolescents aged 0 to 18 who applied to the Medical Board of the Şanlurfa Mehmet Akif İnan Training and Research Hospital and underwent psychiatric evaluations between June 2022 and December 2022. Results: The research covered 600 cases, of whom 39% (n=234) were female and 61% (n=366) were male, and the mean age at the time that patients applied to the child psychiatry outpatient clinic was 7.87±4.43. When the child psychiatry diagnoses in the special needs reports were examined, it was found that 78% of the cases (n=468) had at least one psychiatric diagnosis, and 86.3% (n=518) of all patients had no previous psychiatric drug use. The most common psychiatric disorder was Borderline Intellectual Functioning (n=110), followed by Specific Learning Disorder (n=64). Autism Spectrum Disorder was more common in boys whereas Severe Intellectual Disability was significantly more common in girls. There was no significant difference between the 3 different age groups in terms of the frequency of Mild Intellectual Disability, Severe Intellectual Disability, and Autism Spectrum Disorder diagnoses. Conclusion: Psychiatrists and other medical professionals can greatly benefit from knowing the characteristics of children and adolescents who apply to the medical boards for special needs reports in various parts of Turkey. To fully address this matter, further research with larger numbers of samples from various centers are required

Définitions, épidémiologie et démarche diagnostique clinique dans les troubles neurologiques fonctionnels

Functional neurological disorders (FND) are symptoms that can affect a variety of functions including motor, sensory and cognitive. These symptoms are genuinely experienced by the patient and are related to a functional disorder rather than a structural one. There is little epidemiological data on these disorders, but their frequency is well established in clinical practice, it is the second most frequent reason for consultation in Neurology. Despite of the frequency of the disorder, general practitioners and specialists are insufficiently trained in the disease, and patients often suffer from stigmatization and/or unnecessary investigations. It is therefore important to be aware of the diagnostic approach to FND, which mostly relies on positive clinical signs. Psychiatric evaluation can help with the characterization of predisposing, precipitating and perpetuating factors of the symptoms (according to the 3P biopsychosocial model related to FND), and guide their management. Finally, diagnosis explanation is a crucial step in the management of the disease, which can in itself have a therapeutic effect, and allow the patient to adhere to the treatments.

Juvenile Competency Complications: Protocol, Unmet Needs, Developmental Immaturity, FASD, and Comorbidity.

This Article focuses on unifying the protocol for state competency evaluations, but with special concerns about undiagnosed FASD and developmental immaturity in adolescents. States do not mandate any process whereby psychometric tests are first performed prior to psychiatric mental status evaluations, often causing disparities in evaluations which might easily be avoided in court proceedings. Adding to the complications in current competency evaluations are recent studies from Canada and Australia identifying exceptionally high rates of FASD in incarcerated adolescents following multi-disciplinary teams' studies directed at identifying FASD. If these studies' rates of FASD turn out to be similar for children in the U.S. juvenile justice system, then systemic reform is called for as we are failing to identify this congenital condition when adolescents enter the system and then continue on into the adult criminal system without recognition of their prenatal exposure to alcohol.

Psychiatric morbidities among patients with type-2 diabetes mellitus attending outpatient department in a rural area of North India.

Both diabetes mellitus and psychiatric morbidities are widely prevalent diseases which show a discerning upward trend globally. Coexistence of diabetes and psychiatric morbidities usually manifests as impaired quality of life and poor treatment adherence. The study aimed to estimate the prevalence of psychiatric morbidities among rural diabetic patients and to determine their association with different variables. The present cross-sectional study was conducted in CHC of Rural Health Block attached with PG Department of Community Medicine GMC (Government Medical College) Jammu. The eligible diabetic patients attending medical outpatient department services were enrolled using a consecutive sampling method. DAS scale was used to assess psychiatric morbidity among the study subjects. The findings revealed that the prevalence of psychiatric morbidity in the study participants was 38.9%, 68.5% and 25.64% for depression, anxiety and stress, respectively. Psychiatric morbidities were slightly higher in female patients and were significantly associated with age, marital status, sedentary lifestyle, history of substance abuse, duration of diabetes, presence of complications and underlying morbidities (P < 0.05). The prevalence of anxiety and depression among rural diabetic patients was found to be quite high. Diabetic patients need thorough screening for psychiatric evaluation, and there is an urgent need for psychiatric counselling at regular intervals.

Investigation of Sociodemographic and Clinical Characteristics of Forensic Cases Admitted to a Child and Adolescent Psychiatry Outpatient Clinic in Şanlıurfa

Objective: In this study, we aimed to evaluate the sociodemographic and clinical characteristics of children and adolescents for whom forensic reports were requested by judicial authorities for various reasons. Materials-Methods: The records of 110 cases referred to our hospital’s Child and Adolescent Psychiatry Department for forensic psychiatric evaluation between January 2022 and December 2022 were evaluated retrospectively. Sociodemographic data of the cases, clinical diagnoses, contents of forensic events, and forensic report decisions were included in the analyses. Results: The mean age of the 110 patients participating in the study was 14.5 ± 2.9 years and 68.2% (n=75) of the cases were male. The judicial authorities directed the cases most frequently (n=53) for evaluating discrimination under the Turkish Penal Code 31/2, and it was determined that crime against property (41.5%) was committed most frequently. Considering the distribution of perpetrator and victim status by gender, a significant difference was found between the two genders (p&amp;lt;0.001). Conclusion: Determining regional differences regarding individual and familial characteristics of child and adolescent forensic cases may contribute to the determination of factors that may adversely affect children's mental health and to the development of preventive mental interventions.

A Validation Study of Mental Health Monitoring Through a Mobile Application.

Face-to-face evaluation is the most important in psychiatric evaluation, but smart healthcare, including non-face-to-face evaluation, can be beneficial considering the situation in which face-to-face evaluation is limited or the preventive aspect of mental illness. In this paper, we aimed to check whether mental health screening tests have the same significance as paper-based tests even when collected through mobile applications. A smart mental healthcare screening test was conducted on the 1,327 community subjects. We measured two indicators of depression (Patient Health Questionnaire 9-item scale, PHQ-9) and anxiety (Generalized Anxiety Disorder 7-item scale, GAD-7) to check mental health conditions. The average Cronbach's alpha value of the PHQ-9 questionnaire was good at 0.870. As a result of PHQ-9's principal component analysis, one component with an eigenvalue of 1 or more was identified, which is suitable to be described as a single factor. The average Cronbach's alpha value of the GAD-7 was 0.919. The structural validity of the GAD-7 was confirmed through principal component analysis. Our results show that PHQ-9 and GAD-7 scales performed through mobile applications can have the same meaning as paper-based tests. Surveys using a tablet PC, or smartphone application can monitor residents' mental health and accumulate data. Based on these data, smart mental health management can check the mental health of residents and treat mental illness in connection with medical services.

A Systematic Evaluation of Risk Predictors for COVID-19 Sequelae.

Background Multisystem involvement in coronavirus disease 2019 (COVID-19) is known since the beginning of the pandemic, and post-COVID-19 sequelae have often been reported. The term 'long Covid' encompasses these signs and symptoms. The aim of our study was to study different after-effects which patients endured within 12 months after recovery from acute COVID-19 and to study the various risk predictors. Methods This was a longitudinal observational study of a cohort of 146 patients who recovered from COVID-19 illness. Patients were enrolled during the first four weeks of the onset of their illness, and a monthly follow-up assessment was done for six months that included a detailed history of persistent or new symptoms, new illnesses diagnosed, and complete biochemical, pulmonary, cardiac, neurological and psychiatric evaluation, both objective and subjective. A final follow-up was also done at the end of one year of enrolment. Based on the patient's self-reported history and our multi-system assessment, recorded sequelae were classified according to the involved organ system. These were correlated with possible risk predictors and statistically significant associations were established. Results One hundred and twenty subjects out of 146 total subjects qualified for final analysis. Pulmonary sequelae (48/120; 40%) were the most followed by psychiatric (30/120; 25%), neurological (26/120; 21.7%), and opportunistic infections (7/120; 5.8%). A total of 39/120 (32.1%) cases complained of prolonged dyspnoea. Six out of 120 i.e. 5% of study participants had new-onset diabetes. Twenty-six out of 120 (21.7%) had radiological signs of pulmonary fibrosis. Patients with co-morbidities, older age, higher body mass index, and patients with severe disease were found to be at higher risk of developing these sequelae. Poor nutrition, female gender, and hospitalization were predictors of psychiatric sequelae. Diabetes and liberal steroid use during COVID-19 management were predictors of opportunistic fungal infections. Conclusion This study evaluated post-COVID-19 sequalae in-depth both objectively and subjectively. Some specific predictors for specific sequelae were confirmed on statistical correlation. Long-term follow-up of high-risk persons is therefore recommended after the cure of COVID-19.

Introducing brief admissions by self-referral in child and adolescent psychiatry: an observational cohort study in Sweden

Brief admission by self-referral, a novel crisis intervention designed to reduce suicide and self-harm in adults, was adopted for adolescents in paediatric psychiatry in Malmö, Sweden, in 2018. We aimed to investigate changes in utilisation of emergency psychiatric care. We did an observational longitudinal cohort study in The University Hospital in Malmö, Sweden, which provides the only psychiatric emergency unit with 24 h psychiatric facilities in Region Skåne. Eligible patients were those aged 13-17 years who were admitted to the psychiatric facility, who had at least one emergency visit or admission during the 6 months before admission, and had prominent features of instability and self-harm, corresponding to at least three of the nine criteria for borderline personality disorder as per the DSM-5 as assessed by a paediatric psychiatrist during the admission. Patients with intellectual disabilities, psychosis, or language barriers were excluded. Patients who signed a brief admissions contract between April 1, 2018, and April 30, 2021, were eligible for inclusion in the study. A brief admissions contract allows patients to admit themselves to psychiatric emergency care for a transitory time. The primary outcome measures were the number of emergency visits, emergency admissions, inpatient days, and episodes of coercive (involuntary) care, compared at individual level before and after signing the brief admissions contract until end of follow-up. The number of visits and days were modelled using random-effects Poisson regression models, and the relative changes in the expected numbers of days per time unit were reported as rate ratios (RRs). Of the 928 patients admitted to the psychiatric facility between April 1, 2018, and April 30, 2021, 60 were excluded, and a further 801 did not meet the inclusion criteria for age, previous emergency visits, or having at least three of the nine criteria of borderline personality disorder. 67 patients were eligible for inclusion, but four patients did not sign a contract. 63 patients were included in the study, including 60 females (95%) and three (5%) males, with a mean age of 14·8 years (SD 1·7). Ethnicity data were not collected. Patients were followed up for a median of 13·5 months (IQR 9·2 -19·6). After signing the contract, there was a decrease in the number of emergency visits (RR 0·22 [95% CI 0·15-0·32]; p<0·0001), emergency admissions (RR 0·26 [0·19-0·35]; p<0·0001), inpatient days (RR 0·29 [0·26-0·32]; p<0·0001), and inpatient days including brief admissions (RR 0·44 [95% CI 0·40-0·48]; p<0·0001). Episodes of coercive care did not change significantly (RR 0·99 [95% CI 0·40-2·43]; p=0·98). Psychiatric evaluation due to persistent suicidal ideations immediately after discharge was required for five patients. Our findings suggest that brief admissions can be successfully implemented in paediatric psychiatry and appear to be an effective crisis management method for adolescents, associated with reduced demand for emergency care. Future randomised controlled trials are warranted. Region Skåne Health Care Authority.

Psychodynamic psychotherapy in the diagnosis and treatment of gender dysphoria

Relevance. In this article, we consider the possibilities of a psychodynamic psychotherapeutic approach in the diagnosis and treatment of gender dysphoria on the example of a clinical case. Gender dysphoria refers to the distress that may accompany a mismatch with the patient's biological sex and assigned gender. In the past few years, there has been an increase in the number of patients requesting the restoration of congenital anatomical sex characteristics due to regret after genderaffirmation surgery (GAS). Recent studies have shown that one of the key regrets after GAS is inadequate psychological and psychiatric evaluation in determining whether GAS is an indication.Case study. In this article, we explored how psychodynamic psychotherapy can be used to diagnose and treat disorders associated with gender dysphoria in the case of a 21-year-old man who presented with symptoms that met the diagnostic criteria for two conditions: unspecified gender dysphoria 302.85 (F64.1) and transvestic disorder with autogynephy 302.3 (F65.1) according to DSM-5. The main symptom appeared when the patient was at pre-school age and has been a constant concern ever since. The symptoms disappeared after psychodynamic psychotherapy, which lasted 11 months. Evaluation of psychotherapeutic effects 2 years after the completion of psychotherapy showed the stability of the results achieved.Conclusion. Based on our analysis, we concluded that the use of psychodynamic psychotherapy for patients with gender dysphoria helps recognize neurotic conflicts that may underlie transgender symptoms, and thereby reduce the likelihood of a diagnostic error in determining the presence of indications for GAS. Looking at cases of gender dysphoria in Balint groups can also be of great help in understanding the etiology of gender dysphoria symptoms.

Music to prevent deliriUm during neuroSurgerY (MUSYC): a single-centre, prospective randomised controlled trial

ObjectivesDelirium is a serious complication following neurosurgical procedures. We hypothesise that the beneficial effect of music on a combination of delirium-eliciting factors might reduce delirium incidence following neurosurgery and subsequently...

General Review on the Forensic Psychiatric Evaluation for PTSD (III)

General Review on the Forensic Psychiatric Evaluation for PTSD (III)

1020 Modafinil Induced Psychosis

Abstract Introduction Modafinil has been used for the treatment of numerous different conditions, including daytime somnolence (EDS). Modafinil is a non-amphetamine central nervous system (CNS) stimulant with wakefulness-promoting properties. There have been few reported cases of psychosis associated with modafinil use, however a large majority of those were seen in patients with a history of primary psychiatric disturbances. Report of case(s) We present a case of a 48 year old female coming for evaluation of excessive daytime somnolence. She completed polysomnography and a multi sleep latency test (MSLT) which revealed mildly elevated AHI, but no sleep onset rapid eye movements (SOREMPs). A diagnosis of idiopathic hypersomnia was subsequently made and 200mg of modafinil up to twice daily was prescribed for her. Patient initially tolerated the modafinil well, however she began having delusions and she subsequently required psychiatric evaluation. These delusions primarily consisted of her believing she was under surveillance and had conspiracy theories against her. She also described having auditory hallucinations as well, especially voices telling her about these conspiracy theories. She also demonstrated poor insight into her medical condition as she refused to discontinue modafinil. Upon evaluation, routine labs including complete blood count, chemistry profile and urine drug screens were completed to rule out any secondary causes of psychosis. It was therefore recommended by psychiatry to discontinue modafinil as there was concern that the delusions were occurring secondary to medication use. The patient's psychotic delusions seemed to dissipate after this. A multidisciplinary meeting was held regarding management of patients' excessive daytime sleepiness (EDS) and a decision was made to begin the patient on pitolisant, a histamine receptor antagonist. The patient was able to achieve great benefit with this medication. Conclusion The presented case illustrates a patient who began having psychosis after beginning modafinil 200mg twice daily. Psychosis is a much more rare side of modafinil and providers should become aware of it. Therefore, patients who are prescribed modafinil should be carefully followed for psychosis development, even when they are previously healthy and have no history of any primary psychiatric conditions. Support (if any)

Cognitive impairment in long-COVID and its association with persistent dysregulation in inflammatory markers.

To analyze the potential impact of sociodemographic, clinical and biological factors on the long-term cognitive outcome of patients who survived moderate and severe forms of COVID-19. We assessed 710 adult participants (Mean age = 55 ± 14; 48.3% were female) 6 to 11 months after hospital discharge with a complete cognitive battery, as well as a psychiatric, clinical and laboratory evaluation. A large set of inferential statistical methods was used to predict potential variables associated with any long-term cognitive impairment, with a focus on a panel of 28 cytokines and other blood inflammatory and disease severity markers. Concerning the subjective assessment of cognitive performance, 36.1% reported a slightly poorer overall cognitive performance, and 14.6% reported being severely impacted, compared to their pre-COVID-19 status. Multivariate analysis found sex, age, ethnicity, education, comorbidity, frailty and physical activity associated with general cognition. A bivariate analysis found that G-CSF, IFN-alfa2, IL13, IL15, IL1.RA, EL1.alfa, IL45, IL5, IL6, IL7, TNF-Beta, VEGF, Follow-up C-Reactive Protein, and Follow-up D-Dimer were significantly (p<.05) associated with general cognition. However, a LASSO regression that included all follow-up variables, inflammatory markers and cytokines did not support these findings. Though we identified several sociodemographic characteristics that might protect against cognitive impairment following SARS-CoV-2 infection, our data do not support a prominent role for clinical status (both during acute and long-stage of COVID-19) or inflammatory background (also during acute and long-stage of COVID-19) to explain the cognitive deficits that can follow COVID-19 infection.

Objectively assessed sleep and physical activity in depression subtypes and its mediating role in their association with cardiovascular risk factors

The aims of this study were to investigate the associations of major depressive disorder (MDD) and its subtypes (atypical, melancholic, combined, unspecified) with actigraphy-derived measures of sleep, physical activity and circadian rhythms; and test the potentially mediating role of sleep, physical activity and circadian rhythms in the well-established associations of the atypical MDD subtype with Body Mass Index (BMI) and the metabolic syndrome (MeS). The sample consisted of 2317 participants recruited from an urban area, who underwent comprehensive somatic and psychiatric evaluations. MDD and its subtypes were assessed via semi-structured diagnostic interviews. Sleep, physical activity and circadian rhythms were measured using actigraphy. MDD and its subtypes were associated with several actigraphy-derived variables, including later sleep midpoint, low physical activity, low inter-daily stability and larger intra-individual variability of sleep duration and relative amplitude. Sleep midpoint and physical activity fulfilled criteria for partial mediation of the association between atypical MDD and BMI, and physical activity also for partial mediation of the association between atypical MDD and MeS. Our findings confirm associations of MDD and its atypical subtype with sleep and physical activity, which are likely to partially mediate the associations of atypical MDD with BMI and MeS, although most of these associations are not explained by sleep and activity variables. This highlights the need to consider atypical MDD, sleep and sedentary behavior as cardiovascular risk factors.

Factors associated with objective and subjective cognitive impairment in Chinese patients with acute major depressive disorder

BackgroundPatients diagnosed withmajor depressive disorder (MDD) usually experience impaired cognitive functioning, which might negatively impact their clinical and functional outcomes. This study aimed to investigate the association of specific clinical factors with cognitive dysfunction in a group of MDD patients.MethodsA total of 75 subjects diagnosed with recurrent MDD were evaluated during the acute stage. Their cognitive functions were assessed using the THINC-integrated tool (THINC-it) for attention/alertness, processing speed, executive function, and working memory. Clinical psychiatric evaluations, such as the Hamilton Anxiety Scale (HAM-A), the Young Mania Rating Scale (YMRS), the Hamilton Depression Scale (HAM-D), and the Pittsburgh Sleep Quality Index(PSQI), were used to assess patients’ levels of anxiety, depression and sleeping problems. The investigated clinical variables were age, years of education, age at onset, number of depressive episodes, disease duration, presence of depressive and anxiety symptoms, sleep problems, and number of hospitalizations.ResultsThe results revealed that significant differences were observed between the two groups in the THINC-it total scores, Spotter, Codebreaker, Trails, and PDQ-5-D scores (P < 0.001). The THINC-it total scores, Spotter, Codebreaker, Trails, and Symbol Check were significantly associated with age and age at onset(P < 0.01). In addition, regression analysis found that years of education was positively associated with the Codebreaker total scores (P < 0.05). the THINC-it total scores, Symbol Check, Trails, and Codebreaker were correlated with the HAM-D total scores(P < 0.05). Additionally, the THINC-it total scores, Symbol Check, PDQ-5-D and Codebreaker significantly correlated with the PSQI total scores (P < 0.05).ConclusionWe found a significant statistical association between almost all cognitive domains and different clinical aspects in depressive disorder, such asage, age at onset, severity of depression, years of education, and sleep problems. Additionally, education was shown to be a protective factor against processing speed impairments. Special considerations of these factors might help outline better management strategies to improve cognitive functions in MDD patients.

The New Hampshire Hospital Screening and Referral Algorithm (NHHSRA) for Substance Use in People With Serious Mental Illness

Objective: Substance use is a common co-occurrence among psychiatrically hospitalized adults, yet it is especially difficult to identify in those with serious mental illness. Existing screening instruments are not feasible for individuals with serious mental illness, as they rely heavily on subjective self-report. This study aimed to develop and validate an objective substance use screening instrument for use in seriously mentally ill patient populations.Methods: Objective elements were extracted from existing substance use screening instruments and used to develop a new, data-driven referral tool, the New Hampshire Hospital screening and referral algorithm (NHHSRA). Descriptive statistics were employed to compare NHHSRA summed score and individual patient data elements in a convenience sample of patients who were referred to the Addiction Services by expert addiction psychiatrist evaluation to those who were not referred. Pearson correlation coefficients and logistic regression models assessed the association between patient referral and the overall NHHSRA score and individual items. The NHHSRA was then piloted in a smaller convenience sample of patients against the standard clinical-based identification for substance use treatment needs.Results: The instrument consists of 5 objective items. These were tested in a sample of 302 sequentially admitted adults with serious mental illness. Three of the items were significantly associated with likelihood of benefitting from referral for substance use interventions (maximum likelihood estimate and standard deviation [SD] for positive non-tetrahydrocannabinol [non-THC] toxicology screen or > 0% blood alcohol level = 3.61 [0.6]; diagnosis of a substance use disorder = 4.89 [0.73]; and medication-assisted treatment or relapse prevention = 2.78 [0.67]), and these were prioritized in building a decision tree algorithm. The area under the receiver operating characteristic (ROC) curve for the NHHSRA was 0.96, indicating that the NHHSRA has high overall sensitivity and the algorithm was capable of distinguishing between patients needing substance use intervention versus those who do not with 96% accuracy. In the pilot implementation study of another 20 patient admissions, the NHHSRA accurately identified 100% (n = 6) of patients deemed to benefit from substance use interventions by expert addiction psychiatric evaluation. The standard clinical-based referral process identified only 33% (n = 2) and erroneously identified another 4 for referral to substance use intervention that would not have been warranted.Conclusions: The NHHSRA holds promise in its ability to improve objective and timely identification of substance use in a seriously mentally ill inpatient population, helping to facilitate treatment.

An exploratory structural equation modelling (ESEM) of the Eating Disorders Examination Questionnaire (EDE-Q) in bariatric patients.

Several studies in clinical and non-clinical populations indicate differences between rationally and empirically derived subscales for the Eating Disorder Examination Questionnaire (EDE-Q), including samples of patients seeking bariatric surgery. This study aimed to use exploratory structural equation modelling (ESEM) to estimate the factor structure of the EDE-Q and assess for the additive value of alternative measurement of eating disorder symptoms. Adolescents and adults completed the EDE-Q and a psychiatric evaluation prior to bariatric surgery. Data from 330 participants were analysed using the original four-factor and modified three-factor structure of the EDE-Q using both confirmatory factor analysis (CFA) and exploratory structural equation modelling (ESEM). Age, ethnicity, and body mass index were examined as covariates in the best fitting model, and model subscales used to generate a predictive model of clinician screened DSM-5 eating disorder diagnoses for criterion validity. A CFA of the four-factor EDE-Q provided poor model fit for a pre-surgical bariatric population, but the three-factor EDE-Q and an ESEM of the four-factor EDE-Q provided excellent model fit. The Eating Concern subscale of the four-factor ESEM model significantly predicted eating disorder diagnosis and was positively correlated with age. Our results suggest the ESEM derived factors of the EDE-Q offered some improvements to the original empirically derived factor structure, as subscale scores based on the original items and cross-loading items yielded an adequate prediction of clinician diagnoses.

Utilization of the Fordham Risk Screening Tool (FRST) for Violence Risk Assessment in an Emergency Department.

Violence is a critical problem in the emergency department (ED) and patients experiencing mental health crises are at greater violence risk; however, tools appropriate for assessing violence risk in the ED are limited. Our goal was to evaluate the utility of the Fordham Risk Screening Tool (FRST) in reliability assessing violence risk in adult ED patients with acute mental health crises through evaluation of test characteristics as compared to a reference standard. We evaluated performance of the FRST when used with a convenience sample of ED patients undergoing acute psychiatric evaluation. Participants underwent assessment with the FRST and an established reference standard, the Historical Clinical Risk Management-20, version 3 (HCR-20, v3). Diagnostic performance was assessed through evaluation of test characteristics and area under the receiver operating characteristic (AUROC) curve. Psychometric assessments examined the measurement properties of the FRST. 105 participants were enrolled. In comparison to the reference standard, the AUROC for the predictive ability of the FRST was 0.88 (SE 0.39), 95% CI: 0.81-0.96. Sensitivity was 84% (95% CI: 69-94%) while specificity was 93% (95% CI: 83-98%). The positive predictive value was 87% (95% CI: 73-94%) and negative predictive value was 91% (95% CI: 83-86%). Psychometric analyses provided reliability and validity evidence for the FRST when used in the ED setting. Findings support the potential utility of the FRST when used to assess violence risk in adult ED patients experiencing a mental health crisis. Future research with more diverse populations and ED settings is warranted.