Psychiatric Interview Research Articles

An approach to teaching the psychiatric interview

The psychiatric interview serves as the cornerstone of psychiatric practice. It is therefore essential that we find effective ways of teaching students how to conduct a psychiatric interview. The present paper arises from two faculty members at Memorial University of Newfoundland and Labrador considering how to improve the quality of teaching of the psychiatric interview to preclerkship undergraduate medical students, before they begin the clinical portion of their training. The interview is taught in discrete pieces initially (e.g., discussing confidentiality, screening for suicidal ideation, taking a history for depressive disorders, etc.) before being assembled into a whole interview.The sessions are led by psychiatrists and residents who play the role of the patient. They use prewritten cases but can improvise to challenge or direct the students. Students receive real time feedback. The flexibility allows for students to repeat and vary their approach in response to feedback.Anonymous course evaluations showed improvement in student satisfaction with the new psychiatry clinical skills teaching. Prior to implementing the new approach student satisfaction was at 3.9/5. With the new method scores improved to 4.7/5 and 4.5/5 in the following two years. Clinical skills OSCE scores remained stable with modest improvement following implementation. The class average was 8.5 in the year prior to implementation and were 9.1, 8.6 and 8.8 in the years following. As a side benefit, the approach lent itself well to being delivered remotely so it continued to function well during the disruption resulting from COVID-19.

Children With Sydenham Chorea and Psychiatric Disorders Had Variable Long-Term Outcomes and Required Multidisciplinary Management.

Sydenham chorea (SC) is a globally significant, post-streptococcal, childhood neuropsychiatric condition that is rare in western Europe. This retrospective single-centre study focused on children with neuropsychiatric features of SC. Participants were recruited from neuropsychiatry referrals to a regional paediatric neurology department in Glasgow, Scotland, from 2009 to 2012. Interviews established the course of SC and the children's medical and family histories. Semi-structured psychiatric interviews explored current and past episodes of psychopathology. We studied 12 children (seven girls) with a mean age of 13 (range 10-15) years, and an average of six (range 4-10) years after their SC symptoms began. Before they displayed symptoms, seven children had been suspected or diagnosed neurodevelopmental problems and four had separation anxiety. Their physical symptoms were often debilitating. Psychopathology was most severe during their first episode and SC diagnoses were sometimes delayed. Educational problems were frequent. Multiple psychiatric conditions were diagnosed in 11 children and anxiety and attention deficit hyperactivity disorder were the most common. Relapses occurred in nine cases. Additional services that were accessed included cardiology, rheumatology, physiotherapy, occupational therapy and speech therapy. Medication included prophylactic penicillin and symptomatic treatment. Children with SC and psychiatric disorders had variable long-term outcomes and required multidisciplinary management.

Improving the Diagnosis of Post-traumatic Stress Disorder and Anxiety-depressive Disorders Using the Methods of Phenomenological Philosophy: Experience of Interdisciplinary Practices in Ukraine

The article discusses the potential advantages of using phenomenological psychopathology methods to improve the diagnosis of post-traumatic stress disorder (PTSD) and anxiety-depressive disorders, especially in the context of the ongoing war in Ukraine. It highlights the limitations of relying solely on the diagnostic criteria set out in International statistical classification of diseases and related health problems, 10th revision (ICD-10), arguing that they may not reflect the subjective, lived experience of mental disorders. The authors note a significant increase in the number of diagnosed mental and behavioural disorders in Ukraine since the Russian invasion. The number of cases of PTSD has quadrupled compared to pre-war levels. Common triggers include fear, anxiety, witnessing violence, personal harm, loss of loved ones, isolation, and displacement. The study used analytical, comparative, and interdisciplinary methods to explore how the approaches of phenomenological philosophy and phenomenological psychopathology can complement traditional psychiatric interviewing. Phenomenological psychopathology is an interdisciplinary field that aims to study changes in dimensions such as lived time, space, body, and self that manifest in mental illness. The main methods include semi-structured phenomenological interviews that allow patients to describe their subjective experiences. The authors argue that the combination of phenomenological methods with standard psychiatric diagnostic methods in Ukraine will allow for a more complete and accurate diagnosis of PTSD, anxiety, depression, and other conditions exacerbated by the war. This interdisciplinary, patient-centred approach promises to improve the quality of mental health care as the country recovers. However, they acknowledge that the application of these methods in Ukraine is currently fragmented. The authors suggest that the methods of phenomenological psychopathology are a valuable but underutilised tool for addressing the challenges facing the mental health system in Ukraine.

Development and Validation of a Screening Tool for Generalized Anxiety and Major Depressive Disorder in Patients with Chronic Obstructive Pulmonary Disease.

Anxiety and depression are often underdiagnosed in patients with chronic obstructive pulmonary disease (COPD). This study aimed to develop and validate a screening tool for anxiety and depression in COPD patients. Stable COPD patients were consecutively recruited from November 2021 to October 2023 and underwent a psychiatric interview to diagnose generalized anxiety disorder (GAD) and/or major depressive disorder (MDD) based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Patients were split into training and validation sets according to their recruitment time. We assessed known risk factors and used core items from the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) to develop a prediction nomogram. Multivariable logistic regression with least absolute shrinkage and selection operator (LASSO) were used to construct the nomogram. Among the enrolled COPD patients (n = 329), 58 (25.6%) in the training cohort and 33 (32.4%) in the validation cohort were diagnosed with GAD and/or MDD. Three variables were identified in the prediction nomogram: COPD Assessment Test score and two core items from PHQ-ADS. The under the curve (AUC) value for the nomogram was 0.826 (95% CI: 0.755-0.897) and 0.855 (95% CI: 0.767-0.942) in the training and validation cohorts, respectively. The calibration curve was close to the diagonal. The discriminatory power of the screening nomogram was comparable to that of PHQ-ADS (AUC: 0.826 vs. 0.831, P = 0.832). The new screening tool for GAD and MDD in COPD patients is concise and valid, with discriminatory power comparable to existing anxiety/depression screening questionnaires.

Increased serum EGF but not SDF-1 levels are associated with the pathophysiology and development of generalized anxiety disorder

Generalized anxiety disorder (GAD) is a common and persistent mental illness accompanied by uncontrollable worries for daily staff. Physiological, environmental, genetic, and daily stress from surroundings is involved in developing GAD. Here, we aimed to assess the association of stromal cell-derived factor-1 (SDF-1) and epidermal growth factor (EGF) in the pathophysiology of GAD and their role as diagnostic tools. This case-control study recruited 50 GAD patients from the psychiatry department of a tertiary care teaching hospital in Dhaka city and 38 age-sex-matched healthy controls (HCs) from the surrounding areas. A qualified psychiatrist conducted standardized psychiatric interview to diagnose GAD patients and evaluate HCs by applying the diagnostic and statistical manual for mental disorders, 5th edition (DSM-5) and used the GAD-7 scale to assess the severity of the GAD symptoms. After confirming the inclusion and exclusion criteria, we collected 5 ml blood samples from each participant. We measured serum SDF-1 and EGF levels using ELISA techniques. We observed increased serum levels of EGF in GAD patients compared to HCs (5.91 ± 3.90 ng/ml vs. 1.59 ± 1.08 ng/ml; p < 0.001). Also, this increment is positively associated with the severity of GAD in patients (r = 0.479, p = 0.002). The receiver operating characteristic analysis showed good diagnostic performance (AUC 0.869, p < 0.001) with high sensitivity (82.5%), and specificity (81.1%) at cut off value of 2.31 ng/ml. However, we didn’t find significant differences in serum SDF-1 levels between GAD patients and HCs (11.96 ± 4.50 ng/ml vs. 12.70 ± 11.76 ng/ml; p = 0.337). The present study suggests that GAD patients have increased serum EGF levels but not SDF-1 levels compared to HCs and that increased EGF levels are associated with increased GAD symptoms as well. Moreover, EGF levels could serve as a biomarker for GAD However, further interventional studies with larger and homogeneous samples are suggested to confirm and establish these findings.

Effect of Depression in The Elderly on Glaucoma and Pharmacotherapy Options

Introduction: Depression in the elderly is often not detected because elderly people who are depressed show more somatic or cognitive complaints than affective complaints. The relationship between depression and the progression of glaucoma has been studied and taken into consideration in the selection of therapy to be given. Methods: This report is a case report from a patient who has been given an explanation and received consent regarding a psychiatric interview, physical examination and support, interventions, case discussion presentations, and the confidentiality of all patient personal information. Case: Education was carried out on a 72-year-old patient with a Major Depressive Episode without psychotic symptoms who also had glaucoma a few months after complaining of depression. The education provided includes knowledge about depression and its relationship to glaucoma, a management plan in the form of advice for hospitalization in a hospital that has a psychiatrist and an ophthalmologist. Conclusion: Depression in the elderly can affect the progression of glaucoma. The choice of psychopharmacological therapy needs to be adjusted by considering its side effects on the possibility of glaucoma or the risk of aggravating the progression of glaucoma.

Attention deficit hyperactivity disorder and specific learning disability co-occurring in a case with Silver-Russell syndrome

This case presentation discusses the management of comorbid attention deficit hyperactivity disorder (ADHD) and specific learning disability (SLD) in a female adolescent diagnosed with Silver-Russell syndrome (SRS). A 13-year-old female patient presented to the child psychiatry outpatient clinic eight months ago with complaints of reading and writing difficulties and forgetfulness. When she was four years old, she was diagnosed with SRS. Somatotropin therapy was initiated for the patient. Based on psychiatric examination, family interviews, psychometric assessments, and information obtained from school, the patient was diagnosed with ADHD and SLD. The patient was started on methylphenidate treatment, gradually titrated to a dose of 27 mg/day. She was also referred for special education for the SLD diagnosis. In the literature, it has been reported that in most children with SRS, intelligence is within the normal range, and they often receive diagnoses of ADHD and/or SLD. Studies have shown that although, executive function disorders are not significantly associated with SRS in comparison to control groups, there is an increased risk. Children and adolescents with this rare congenital disorder are at risk for psychiatric disorders, and periodic evaluation by a child psychiatrist is recommended.

Clinical and Sociodemographic Characteristics that May Affect Delays in Child Sexual Abuse Disclosures: Ten Years in Practice.

This study covers Child Sexual Abuse (CSA) survivors who had never disclosed the abuse until their psychiatric interview. There is a clear lack of understanding of which factors contribute to delays in the disclosure of CSA. Thus, we aimed to examine the risk factors and sociodemographic variables that may inhibit CSA disclosures. We retrospectively analyzed the files of patients who presented to a child and adolescent psychiatry clinic with diferent complaints between 2010 and 2020 in a tertiary hospital. All of these sexual assaults were ofcially reported by a child and adolescent psychiatrist to the competent authorities. The mean period of time from abuse to disclosure was 28.4 ± 32.5 months. The time from abuse to disclosure was significantly negatively correlated with mothers' education years (r=-.430, P < .01) and with the age of onset of sexual abuse (r=-.589, P < .001). Results of multiple linear regression showed that female sex and the earlier age of onset of sexual abuse were significant predictors of increased duration from abuse to disclosure. Our results provide insights into several risks that may afect the time from abuse to disclosure for CSA survivors. Studies with larger samples are needed to understand the factors afecting the time from abuse to disclosure.

Adaptive Hyperactivity and Biomarker Exploration: Insights from Elders in the Blue Zone of Sardinia.

Background/Objectives: Adaptive hyperactivity characterized by increased activity levels and novelty-seeking traits without mood disorders is prevalent among older adults in Sardinia's "blue zone," an area with high longevity. This study aims to evaluate the adaptive nature of hyperactivity concerning quality of life, social rhythms, and mood symptoms in individuals from this region, particularly among elderly adults over 80. Methods: This observational cross-sectional study included adults and older adults over 80 from Sardinia's blue zone. This study included a sample of patients followed at the Center for Consultation Psychiatry and Psychosomatics for Bipolar Disorder of the University Hospital of Cagliari and a homogeneous comparison sample of patients without psychiatric pathologies, referred to the Dermatology Clinic of the same hospital, for a period of 6 months, from February to August 2024. The general sample, divided into two parts-cases, represented by patients with psychiatric pathology, and controls, patients without psychiatric pathology-was divided in turn into three sub-groups: "adults" (18-64 years), young elders (65-79), and old elders (over 80 years). The participants underwent psychiatric interviews and completed the Mood Disorder Questionnaire (MDQ), Patient Health Questionnaire (PHQ-9), SF-12, and Brief Social Rhythm Scale (BSRS). Data were compared with national and regional normative data. Results: Older adults in the blue zone demonstrated higher MDQ positivity (22.58%) compared to the national averages (0.87%), without corresponding increases in dysregulated rhythms, depressive symptoms, or reduced quality of life. Younger old persons (65-79 years) showed increased rhythm dysregulation (BSRS score: 20.64 ± 7.02) compared to adults (17.40 ± 6.09, p = 0.040), but this trend was not observed in the oldest group (80+ years). No significant differences were found in the CH3SH and (CH3)2S levels between groups. Conclusions: The hyperactivity observed in older adults from Sardinia's blue zone appears adaptive and not linked to social rhythm dysregulation, depressive symptoms, or a diminished quality of life, suggesting resilience factors which may contribute to longevity. These findings support the potential classification of such hyperactivity as beneficial rather than pathological, warranting further research into biomarkers and psychoeducational interventions to prevent the onset of bipolar disorders in predisposed individuals.

Aligning Large Language Models for Enhancing Psychiatric Interviews Through Symptom Delineation and Summarization: Pilot Study.

Recent advancements in large language models (LLMs) have accelerated their use across various domains. Psychiatric interviews, which are goal-oriented and structured, represent a significantly underexplored area where LLMs can provide substantial value. In this study, we explore the application of LLMs to enhance psychiatric interviews by analyzing counseling data from North Korean defectors who have experienced traumatic events and mental health issues. This study aims to investigate whether LLMs can (1) delineate parts of the conversation that suggest psychiatric symptoms and identify those symptoms, and (2) summarize stressors and symptoms based on the interview dialogue transcript. Given the interview transcripts, we align the LLMs to perform 3 tasks: (1) extracting stressors from the transcripts, (2) delineating symptoms and their indicative sections, and (3) summarizing the patients based on the extracted stressors and symptoms. These 3 tasks address the 2 objectives, where delineating symptoms is based on the output from the second task, and generating the summary of the interview incorporates the outputs from all 3 tasks. In this context, the transcript data were labeled by mental health experts for the training and evaluation of the LLMs. First, we present the performance of LLMs in estimating (1) the transcript sections related to psychiatric symptoms and (2) the names of the corresponding symptoms. In the zero-shot inference setting using the GPT-4 Turbo model, 73 out of 102 transcript segments demonstrated a recall mid-token distance d<20 for estimating the sections associated with the symptoms. For evaluating the names of the corresponding symptoms, the fine-tuning method demonstrates a performance advantage over the zero-shot inference setting of the GPT-4 Turbo model. On average, the fine-tuning method achieves an accuracy of 0.82, a precision of 0.83, a recall of 0.82, and an F1-score of 0.82. Second, the transcripts are used to generate summaries for each interviewee using LLMs. This generative task was evaluated using metrics such as Generative Evaluation (G-Eval) and Bidirectional Encoder Representations from Transformers Score (BERTScore). The summaries generated by the GPT-4 Turbo model, utilizing both symptom and stressor information, achieve high average G-Eval scores: coherence of 4.66, consistency of 4.73, fluency of 2.16, and relevance of 4.67. Furthermore, it is noted that the use of retrieval-augmented generation did not lead to a significant improvement in performance. LLMs, using either (1) appropriate prompting techniques or (2) fine-tuning methods with data labeled by mental health experts, achieved an accuracy of over 0.8 for the symptom delineation task when measured across all segments in the transcript. Additionally, they attained a G-Eval score of over 4.6 for coherence in the summarization task. This research contributes to the emerging field of applying LLMs in psychiatric interviews and demonstrates their potential effectiveness in assisting mental health practitioners.

Cognitive performance, mental health, and quality of life in β-thalassemia individuals: a comprehensive analysis

IntroductionBeta-thalassemia is a prevalent autosomal recessive haemolytic disorder, particularly in the Middle East. Patients with beta-thalassemia major (βTM) require iron chelation therapy and regular blood transfusions, while those with beta-thalassemia intermedia (βTI) exhibit milder symptoms. This study aimed to evaluate cognitive function, behavioural problems, quality of life, and related aspects in individuals with βTM and βTI.MethodsThe cross-sectional study included 20 βTM participants, 20 βTI participants, and 19 healthy controls. Participants underwent psychiatric interviews, the Wechsler Adult Intelligence Scale (WAIS-III), Symptom Checklist-90 Revised (SCL-90R), and Short-Form Health Survey (SF-36). Clinical data and laboratory investigations were also collected.ResultsβTM participants exhibited lower vocabulary and picture completion scores on the WAIS-III compared to other groups. βTI participants had significantly higher scores on SCL-90R subscales for somatization, depression, anxiety, paranoid ideation, and psychoticism. Both patient groups reported poorer quality of life across all SF-36 domains compared with controls. Longer disease duration correlated with lower levels of somatization, interpersonal sensitivity, depression, anxiety, and paranoid ideation. Less frequent blood transfusions were associated with better physical and mental health summary scores but also higher somatization. Elevated serum iron levels corresponded with increased anxiety, hostility, and psychoticism symptoms, while higher serum ferritin related to more obsessive–compulsive behaviours but less somatization and psychoticism.ConclusionsIndividuals with thalassemia exhibit cognitive deficits, psychological disturbances, and diminished quality of life, with distinct patterns depending on disease severity. Regular monitoring and appropriate interventions are crucial for optimizing their overall well-being and functioning.

Early life health adversity and internalizing disorders in the transition from adolescence to adulthood.

Early life adversity (ELA) and youth chronic health conditions have been examined as separate contributors to psychopathology. However, little work has specifically examined early life health adversity (ELHA) and its association with risk for internalizing disorders. This study seeks to examine the relationship between ELHA and internalizing disorders across adolescence. A sample of 705 Australian mother-youth dyads participated in a prospective longitudinal study. Mothers reported child health indicators at youth ages three-to-four days, six months, and five years and completed a psychiatric interview at 15 years. Youth completed a psychiatric interview, as well as measures of current health status, at age 20. ELHA was positively associated with both youth anxiety and depressive disorders from ages 15 to 20. When independently accounting for the role of (a) current health status and (b) exposure to traditionally conceptualized forms of ELA, these findings remained statistically significant for anxiety but not depressive disorders. ELHA interacted with maternal depression, such that ELHA was only associated with youth depressive disorders in cases where mothers themselves had experienced depression. Routine mental health screenings may be warranted for youth who experience ELHA and their mothers. Pediatric primary care may be an ideal setting for implementing prevention and intervention efforts.

The Association between Suicidal Ideation and Subtypes of Comorbid Insomnia Disorder in Apneic Individuals.

Background/Objectives: Given the existence of higher suicidality in apneic individuals, this study aimed to determine the potential role played by subtypes of the comorbid insomnia disorder (CID) in the occurrence of suicidal ideation for this specific subpopulation. Methods: To perform our analyses, 1488 apneic individuals were retrospectively extracted from the Sleep Laboratory hospitalization register. Only apneic individuals with suicidal ideation highlighted during the psychiatric interview and/or with a score ≥1 on item G of the Beck Depression Inventory confirmed during the clinical interview were included in the group with suicidal ideation. The likelihood of suicidal ideation associated with CID subtypes was investigated using logistic regression analyses. Results: The prevalence of suicidal ideation was 9.3% in our sample of apneic individuals. After hierarchically introducing the significant confounders for adjustment, multivariate logistic regression analyses demonstrated that unlike short sleep duration alone and CID without short sleep duration, the likelihood of suicidal ideation was only higher for CID with short sleep duration in apneic individuals. Conclusions: Thus, we highlighted in this study that CID with short sleep duration could play a major role in higher suicidality for apneic individuals, which seems to require systematic screening and appropriate treatment of this comorbid sleep disorder to enable better management of suicidal risk in this specific subpopulation.

Mental Health Problems Among Indonesian Adolescents: Findings of a Cross-Sectional Study Utilizing Validated Scales and Innovative Sampling Methods

PurposeThis study aimed to estimate the prevalence of mental health problems and identify potential risk and protective exposures for adolescents in Indonesia. MethodsAn innovative sampling approach was applied to simultaneously recruit school- and community-based adolescents aged 16–18 years old from Jakarta (urban megacity) and South Sulawesi (remote province). We used multistage cluster sampling for in-school (N = 1,337) and respondent driven sampling for out-of-school (N = 824) adolescents. Mental health was measured using two validated scales: Kessler-10 and Center for Epidemiologic Studies Depression Scale-Revised. Psychiatric interviews were conducted in a subsample (N = 196) of students from Jakarta to validate the self-report scales. ResultsThe estimated population prevalence of psychological distress and depression were 24.3% (95% CI = 21.5–27.2) and 12.6% (10.5–14.4) for in-school and 23.7% (20.7–26.7) and 23.5% (20.4–26.5) for out-of-school adolescents, respectively. In participants who completed a psychiatric interview, common psychiatric morbidities were social anxiety, depression, and suicidality. Compared to in-school females, male in-school adolescents reported a lower prevalence of psychological distress (16.9% (13.1–20.7) vs. 30.4% (26.4–34.4)) and depression (10.1% (7.2–13.1) vs. 14.6 (11.4–17.8)). By contrast, for out-of-school adolescents, males reported a higher prevalence of psychological distress (25.2% (21.6–28.9) vs. 20.2% (15.1–25.3)) and depression (26.3% (22.5–30.1) vs. 16.9% (11.8–21.9)). In-school adolescents who did not seek healthcare despite a perceived need were more likely to report psychological distress and depression. DiscussionAdolescent mental health problems are highly prevalent in Indonesia, with substantial variation by gender, geography, and school enrolment. This study and its approach to sampling and measurement may serve as a model to improving mental health surveillance across other settings.

The Effect of Levetiracetam and Valproic Acid Treatment on Anger and Attention Deficit Hyperactivity Disorder Clinical Features in Children and Adolescents with Epilepsy: A Prospective Study.

Antiseizure medications (ASMs) can potentially trigger psychobehavioral adverse events associated with the onset or exacerbation of psychiatric symptoms such as irritability, aggression, and hyperactivity. The objective of this study was to evaluate the effects of levetiracetam and valproic acid on changes in clinical features of anger, attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). The purpose was to furnish guidance on rational drug selection in children and adolescents with epilepsy to minimize psychiatric comorbidity in the treatment of epilepsy. This was a prospective, observational, cohort study involving treatment-naïve children aged 7-18 years with newly diagnosed generalized or focal epilepsy who were prescribed levetiracetam or valproic acid as monotherapy for a 6-month period and regularly followed up. Psychiatric assessment was conducted at the time of the new epilepsy diagnosis and at the six-month follow-up. These assessments were performed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Current and Lifetime Version (DSM-5), a structured psychiatric interview, as well as the State-Trait Anger Expression Style Inventory and Turgay DSM-IV Based Disruptive Behaviour Disorders Screening and Rating Scale. Anger subscores, ADHD symptoms, change in diagnosis, focal and generalized epilepsy groups, continuous seizures and seizure-free periods before and 6 months after treatment with valproic acid and levetiracetam were compared. A total of 50 children, 25 in the valproic acid group and 25 in the levetiracetam group, with a mean age of 11.92 ± 3.08 years, were included in the study. There was a statistically significant increase in the ADHD subscale score post-treatment among patients receiving levetiracetam (p = 0.045) and valproic acid (p = 0.034) compared with pre-treatment. The change in both anger-in and anger-out expression scores with treatment was significantly higher in patients receiving levetiracetam (p = 0.035) compared with those receiving valproic acid (p = 0.026). Statistically, there was a significant difference in the diagnostic criteria of the levetiracetam group pre- and post-treatment (p = 0.026). The proportion of patients in whom the diagnostic criteria for ADHD+ODD were fulfilled increased from 16% before treatment to 48% after treatment, a statistically significant increase (p = 0.026). This study found an increase in internalized anger features and ADHD symptom severity in children with epilepsy treated with valproic acid and levetiracetam. In those prescribed levetiracetam, there was a statistically significant rise in the proportion meeting the diagnostic criteria for ADHD + ODD. Our research is one of the first to prospectively examine the psychiatric assessment of children diagnosed with epilepsy. The remarkable results demonstrate changes in psychiatric diagnoses associated with the treatment of levetiracetam and valproic acid. Furthermore, a considerable rise in ADHD symptoms was observed in those treated with valproic acid.

Consensus-based recommendations for the diagnosis and treatment of anxiety and depression in children and adolescents with epilepsy: A report from the Psychiatric Pediatric Issues Task Force of the International League Against Epilepsy.

The Psychiatric Pediatric Issues Task Force of the International League Against Epilepsy (ILAE) aimed to develop recommendations for the diagnosis and treatment of anxiety and depression in children and adolescents with epilepsy. The Task Force conducted a systematic review and identified two studies that assessed the accuracy of four screening measures for depression and anxiety symptoms compared with a psychiatric interview. Nine studies met the eligibility criteria for treatment of anxiety and depressive disorders or symptoms. The risk of bias and certainty of evidence were assessed. The evidence generated by this review followed by consensus where evidence was missing generated 47 recommendations. Those with a high level of agreement (≥80%) are summarized. Diagnosis: (1) Universal screening for anxiety and depression is recommended. Closer surveillance is recommended for children after 12 years, at higher risk (e.g., suicide-related behavior), with subthreshold symptoms, and experiencing seizure worsening or therapeutic modifications. (2) Multiple sources of ascertainment and a formal screening are recommended. Clinical interviews are recommended whenever possible. The healthcare provider must always explain that symptom recognition is essential to optimize treatment outcomes and reduce morbidity. (3) Questioning about the relationship between symptoms of anxiety or depression with seizure worsening/control and behavioral adverse effects of antiseizure medications is recommended. Treatment: (1) An individualized treatment plan is recommended. (2) For mild depression, active monitoring must be considered. (3) Referral to a mental health care provider must be considered for moderate to severe depression and anxiety. (4) Clinical care pathways must be developed. (5) Psychosocial interventions must be tailored and age-appropriate. (6) Healthcare providers must monitor children with epilepsy who are prescribed antidepressants, considering symptoms and functioning that may not improve simultaneously. (7) Caregiver education is essential to ensure treatment adherence. (8) A shared-care model involving all healthcare providers is recommended for children and adolescents with epilepsy and mental health disorders. We identified clinical decisions in the management of depression and anxiety that lack solid evidence and provide consensus-based guidance to address the care of children and adolescents with epilepsy.

The Role of Transgenerational Transmission in the Psychological Adjustment of Women With Breast Cancer

Introduction: Getting sick with cancer is a traumatic event for the affected person and can result with various psychological difficulties, and invasive methods of treatment further deepen them. The previously experienced psychological trauma of a close person can influence the response of a person who is currently experiencing trauma, because the far-reaching power of posttraumatic consequences extends through a natural biological barrier far into the next generation (the so called "transgenerational impact of traumatization"). Objective: To assess the impact of transgenerational transmission on the development of PTSD in women with breast cancer. Methods: The sample consisted of 120 women treated at the Oncology Department of University Hospital Center Osijek, included in liaison psychiatric treatment. A detailed clinical examination with a psychiatric interview was used with the application of DSM-IV diagnostic criteria, a specially structured non-standardized questionnaire for the assessment of etiological factors and the Los Angeles Symptom Checklist of PTSD symptoms (LASC) for determining PTSD. Results: No statistical significance was obtained between the presence of a family member with cancer and the average total score on the LASC in women with newly diagnosed breast cancer. Conclusion: Although there was no correlation between the existence of a family member suffering from cancer and the development of PTSD in the test subjects, during psychotherapy procedures we observed the existence of symptoms that did not meet the criteria for establishing a diagnosis of PTSD, but could interfere with the development of various psychological responses. By including cancer patients in psychotherapy procedures, we can prevent the development of more severe psychological responses in the second generation, which due to the genetic influence in the inheritance of the disease, will develop cancer, and the psychological disorder associated with it, and achieve a far reaching effect on strengthening adaptation mechanisms.

Clinical Predictors of Mood Disorders and Prevalence of Neuropsychiatric Symptoms in Patients with Systemic Lupus Erythematosus.

Background/Objectives: We aimed to determine the prevalence and clinical correlations of mood disorders in a sample of systemic lupus erythematosus (SLE) patients. Hence, we hypothesized that the prevalence of mood disorders would be lower than reported in the literature and that patients would remain clinically stable and show less damage accrual despite low-dose corticosteroid prescription. Methods: In total, 92 SLE outpatients gave informed consent to participate in this cross-sectional study. Psychiatric and autoimmune clinical data were obtained, and a structured psychiatric interview was performed. The main clinical scales for the assessment of clinical symptomatology were included. To examine the potential relationships of presenting a mood disorder in SLE, clinical correlations and multivariate analyses were performed. Results: Mood disorders were the most prevalent disorder reported by SLE patients (16%), followed by adjustment disorders (5%). A significant proportion of patients presented psychosocial disturbances that did not meet the ICD-10 criteria for psychiatric diagnosis. According to the cut-off criterion for the Montgomery-Åsberg Depression Rating Scale (MADRS), up to 27% of the sample met the clinical criteria for depression. The multivariate analysis revealed a relationship between the presence of a mood disorder with total scores of the MADRS and the Young Mania Rating Scale (YMRS). Conclusions: The prevalence of mood disorders in patients with SLE was lower than previously reported. Although self-report clinical scales are useful for assessing clinical symptomatology, they should not be used in place of a comprehensive standardized interview conducted by a trained mental health specialist. Multidisciplinary teamwork is required for the early identification and therapeutic management of autoimmune patients with neuropsychiatric disorders.

Return to Work After Release From Prison.

Work preservation is crucial for the reintegration of ex-prisoners and the prevention of recidivism. We describe the application of an interdisciplinary diagnostic protocol (occupational health visit, psychiatric interview, psychological counselling and testing) in the case of a dairy industry worker (female, 45-year-old), released on half-freedom after approximately a year of detention in prison for attempted murder. This crime can seriously hamper job resumption. The evaluation revealed a slightly depressed mood (consistent with recent life events), in the absence of major psychiatric disorders or other disturbances that could compromise working abilities or represent a danger for the coworkers. The patient was, therefore, judged able to resume her job. At six months follow-up, she had fully served her sentence and had returned to her previous job, with good relations with her colleagues. However, she encountered hostility from her employer, which induced her to find a new job as a secretary. Her mental health status was improved. The interdisciplinary approach described here may allow ex-prisoners to return to work by helping the company physician to formulate the judgement of job fitness, offering at the same time suggestions for a rational occupational reintegration.

Psychobabble: A Preliminary Study of the Novel Educational Game to Teach Psychiatric Interviewing Techniques.

This article details a novel intervention for teaching psychiatric interviewing techniques implemented at McGovern Medical School at UTHealth Houston. Forty medical students played the newly developed educational game Psychobabble to enhance their assessment of auditory hallucinations. Pre-session and post-session surveys assessed students' inquiry methods, competence, training relevance, and exercise efficacy. Paired t-tests compared pre-session and post-session data. Qualitative analysis identified emergent themes from participant comments. There was an average increase of 12.11 questions between the estimated number of questions (mean = 9.57; SD = 6.00) and the actual number of questions formulated during the game (mean = 21.68; SD = 5.40; p < 0.01). There was a significant increase from the pre-session (mean = 1.82; SD = 0.97) to the post-session (mean = 3.72; SD = 0.76) self-reported competence levels, which more than doubled on average (p < 0.01). The themes that emerged from the qualitative data demonstrate that Psychobabble encourages creativity, broadens assessment methods, has educational significance for learners, and may ultimately lead to improved patient care by enhancing the understanding and diagnosis of psychiatric symptomatology. Medical schools and residency training programs should consider incorporating educational games such as Psychobabble to enhance the interviewing techniques of trainees and their self-efficacy in these skills.