Outpatient Psychiatric Services Research Articles

Emergency conversion to telehealth in hospital-based psychiatric outpatient services: Strategy and early observations

Balancing public health physical distancing guidelines and the need to provide critical mental health services for risky and psychiatrically complex patient populations without disruption, many systems swiftly pivoted to telehealth to provide care during COVID-19. Leveraging technology, Yale New Haven Psychiatric Hospital's ambulatory services designed and deployed virtual intensive outpatient (IOP) and outpatient (OP) group-based services rapidly. Strategies for rapid deployment of group-based services, including action steps transitioning to telehealth, clinical protocols, and remote workforce training, early observations and challenges to implementation are described as helpful tools for clinical settings with similar needs to prevent infectious spread while addressing the mental health needs of patients.

Multiple Psychiatric Morbidity and Continued Use of Naltrexone for Alcohol Use Disorder.

Despite substantial evidence of the efficacy of naltrexone in treating alcohol use disorder (AUD), naltrexone is used infrequently and often for short durations. Understanding factors related to the initiation and continued use of naltrexone could identify targets for improving its use in clinical practice. We used the Fiscal year 2012 national data from the Veterans Health Administration to identify the proportion of veterans diagnosed with AUD who initiated and then continued to receive naltrexone for AUD over a 6-month period (N = 67,788). We further examined correlates of any use and continued use, and patterns of use in inpatient and outpatient mental health services and psychotropic prescription fills. Comparisons were made using bivariate analyses and multinomial logistic regression. Among the veterans diagnosed with AUD, 2.02% initiated treatment with naltrexone. Naltrexone initiation was associated with recent homelessness, concurrent psychiatric disorders, receipt of psychiatric outpatient services, psychotropic prescription fills, residential treatment, and psychiatric and medical-surgical hospitalization. Of the 1,366 patients initiating naltrexone, 43.2% (590) received 2 to 5 prescriptions and 16.3% (223) received more than 5 prescriptions for naltrexone. Use of naltrexone beyond one prescription was associated with homelessness, major depressive disorder, schizophrenia, psychotropic medication use, and psychiatric hospitalization. Veterans with AUD who used and continued naltrexone were primarily those with multimorbidity and extensive involvement in psychiatric treatment. Prior studies examined the correlates of initiation of naltrexone but retention in treatment has received less attention. This study identified the frequency and important patient and service correlates of continued use of naltrexone. (Am J Addict 2021;30:55-64).

Rapid design and deployment of intensive outpatient, group-based psychiatric care using telehealth during coronavirus disease 2019 (COVID-19).

COVID-19 has demanded unprecedented actions in the delivery of outpatient psychiatric services, including the rapid shift of services from in-person to telehealth in response to public health physical distancing guidelines. One such shift was to convert group-level intensive outpatient psychiatric (IOP) interventions to telehealth. Historically, telehealth in psychiatric care has been studied in provider-patient interactions, but has not been as well studied for group telehealth service delivery. During the COVID-19 outbreak, providing group-based interventions was important in order to care for high-risk individuals who needed structured psychotherapy group support. However, the delivery of services via telehealth led to special challenges that were unable to be fully accommodated by the preexisting telehealth infrastructure. Rapid feasibility testing and adoption of technology was needed to support IOP services to minimize infectious spread while delivering group services to high-risk psychiatric patients. This article describes the processes and workflows for service delivery and early results of telehealth for IOP services in 2 adolescent treatment programs. In addition, the article highlights early observations around safety and quality and the role of telehealth policy and payment.

Pilot Study of Let’s Get Organized: A Group Intervention for Improving Time Management

Abstract Date Presented 03/27/20 The Let’s Get Organized–Swedish Part 1 pilot study shows feasibility for use in psychiatric and habilitation outpatient services. Participants took part in a 10-week manual-based group intervention for 1 ½ hours weekly. Each session has a separate theme, a common structure and goal (to implement use of a calendar), and cognitive strategies for managing time. This study uses OT standardized tools to measure results that were promising and need confirmation in further studies. Primary Author and Speaker: Suzanne White Additional Authors and Speakers: Kajsa Lidström Holmqvist, Marie Holmefur Contributing Authors: Gunnel Janeslätt, Afsaneh Roshanay, Patrik Arvidsson

Is intensive case management screening sheet score associated with service intensity?

AimsSince April 2020, the new Japanese mental health system has used the Intensive Case Management Screening Sheet (ICMSS) to identify patients’ needs for case management services. This study aimed to examine the association between ICMSS score and service intensity and compare the magnitude of association between ICMSS score and service intensity with other scales.MethodsWe recruited patients who received case management services from a staff member in a psychiatric outpatient service, psychiatric day‐care program, or outreach team based at one psychiatric hospital. Case management service needs and functioning were assessed using ICMSS, Global Assessment Functioning (GAF), and Personal and Social Performance (PSP). The case manager also documented all services received by the participant for 2 months. The association between each scale and service duration was examined. Furthermore, the magnitude of the association between each scale and service intensity was compared.ResultsOverall, 138 participants were included in the analysis. The most common diagnosis was schizophrenia. Mean total service duration was weakly but significantly correlated with ICMSS (Spearman's ρ = 0.320), GAF (ρ = −0.198), and PSP (ρ = −0.275) scores. Poisson's regression models and postestimation testing showed that the coefficient for ICMSS score (B = 0.144; 95% CI = 0.141, 0.148) was significantly larger than the coefficients for GAF (B = −0.017, 95% CI = −0.017, −0.016, χ2 = 15.70, P < 0.001) and PSP (B=−0.016, 95% CI = −0.017, −0.016, χ2 = 14.64, P < 0.001) scores.ConclusionICMSS may provide preliminary information on case management service needs, but the level of service should be based on the individual needs of each patient and shared decision‐making between the patient and case manager.

Adults with Intellectual Disability and Mental Disorder Respectively Challenging Behaviour: System-Related Strategies for Coping with Aggressive Incidents

A large interview study, evolved from the clinical research project SYMPA-ID (Systemic Methods in Acute Psychiatry for People with Intellectual Disability), focused on adults with cognitive impairment and mental disorder who lived in a residential home and were in need of intensive psychiatric treatment. With the objective of analysing the interactions between the patients and their carers as well as the cooperations within the multi-carer system, both patients with mild to severe ID and their carers (relatives, legal guardians, professional carers of residential group homes as well as in- and outpatient psychiatric services) were surveyed several times between 2015 and 2018. Qualitative Data Analysis of 188 interviews with 67 participants resulted in a collection of 43 strategies concerning both attitudes and activities to prevent or cope with aggressive incidents. The results reached high interrater-reliability. Many of the strategies can be linked to systemic theory and practice and underline the importance of a (multi-)systemic approach. The tool-box was called SMILE: Systemic-inspired Methods for the Interaction and SoLution of Escalative Patterns.

The Impact of a New On-site Inpatient Psychiatric Unit in an Urban Pediatric Emergency Department.

The objective of this study was to describe the impact of opening an inpatient child psychiatric unit in an urban tertiary care pediatric emergency department (PED). A retrospective chart review was performed of pediatric patients seen in the PED at a large tertiary care center who presented for a primary psychiatric concern before opening of the inpatient psychiatric unit within the same hospital and 6 months following, allowing for a 6-month adjustment period. Patients were identified via query of the ED Cube model, an institutional database by a "behavioral health" flag that is documented in triage. Patients were excluded if subsequent chart review did not reveal a psychiatric concern and the patient did not undergo psychiatric evaluation during the PED visit. Charts were reviewed for baseline patient demographics, psychiatric interventions performed, and disposition. Additional flow metrics obtained were PED volume, percentage of psychiatric visits, and length of stay for both psychiatric-related visits compared with the general population. Visits to the PED for psychiatric evaluation increased 135% from 91 to 226 after initiation of an inpatient psychiatric unit. There was no difference in baseline patient demographics or rate of medical/mechanical restraints used. Percentage of behavioral health patients admitted to medical units decreased, although overall admission rate remained stable. Length of stay for behavioral health patients was longer after opening of the unit and remained significantly higher than the general population before opening of the inpatient unit, 363 minutes versus 177 minutes, respectively, and further lengthened after to 418 minutes versus 188 minutes. Patients presenting for psychiatric evaluation are a significant burden to PED flow both in volume and time for evaluation and boarding. This is to the detriment of patients seeking appropriate mental health services and to the rest of patients in the PED. Both inpatient and outpatient psychiatric services are overwhelmed creating a downstream affect; limited resources delays disposition and increases boarding in the PED. Further resources are needed to appropriately address psychiatric concerns, such as dedicated psychiatric holding units and brief PED interventions targeted to safety planning and interventions.

Prevalence and Epidemiological Profile of Smokers in the Psychiatric Population and General Population: Smokers in Psychiatric Population.

This study aims to estimate the prevalence of smokers living in Brazil who use outpatient and hospital psychiatric services and outpatient services in primary health care services. It also aims to identify the sociodemographic and clinical factors associated with current smoking in these samples. This is a cross-sectional study with 378 participants from a Brazilian city: P1, persons from the mental health outpatient service; and P2, persons from the psychiatric hospital; P3, general population from the primary healthcare center. A Poisson multiple regression model for current smoking was adjusted. The prevalence of smokers was greater in the psychiatric population than those in the primary health care population (mental health outpatient service = 27%, psychiatric hospital = 60.3%, primary healthcare center = 19%). Current smoking is associated with younger groups (15-29 years old: PRadjusted = 3.35; 30-39 years old: PRadjusted = 2.28), Roman Catholicism (PRadjusted = 1.60), not having a religion (PRadjusted = 2.45), severe psychiatric illness (PRadjusted = 3.04), anxiety disorders/other disorders (PRadjusted = 3.96), and the previous and current use of alcohol (PRadjusted = 2.27 and 2.25, respectively) and illicit substances (PRadjusted = 1.81 and 2.00, respectively). In conclusion, the independent factors associated with current smoking are age, religion, psychiatric diagnosis, and use of alcohol/illicit substances.

Employment functioning in people with severe mental illnesses living in urban vs. rural areas in India.

Research on employment in people with severe mental illnesses (SMI) in developing countries is sparse and largely limited to employment rates. We conducted a comprehensive study of work, interest in work, and perceived benefits and barriers to work in people with SMI in India. Semi-structured interviews were conducted with 550 individuals with SMI receiving private psychiatric outpatient services in two districts in western India, one urban (Pune) and the other rural (Ahmednagar). More than half of the participants were employed, with significantly more men working (79.4%) than women (35.9%). Higher rates of work were found in rural areas (77.8%), where most work was in family agricultural businesses, than in urban areas (48.9%), where most work was for independent employers. Participants in rural areas worked fewer hours and earned less money, and reported fewer benefits and fewer problems related to work than urban participants. Over 45% of participants working for independent employers found jobs with help from families and extended social networks. Most unemployed participants wanted to work, and desired a variety of supports, including assistance with job finding and illness management. Gender-specific social role expectations and families play an important role in work in people with SMI in India. Despite higher rates of work in this sample than most studies from developed countries, a significant subgroup was unemployed but wanted to work. Persons with SMI in developing countries may benefit from the adaptation of validated vocational rehabilitation approaches in developed countries to their cultural context.

Coronavirus pandemia as a challenge to the mental health system

Background. Humanity is experiencing a collective mental trauma associated with the COVID 19 pandemic, which has immediate and delayed mental health consequences. The predicted is an increase in the number and severity of mental illness in the country, a decrease in the availability of medical and psychiatric care and social support for people with special needs. The pandemic is developing against the backdrop of the reform of specialized medical care, the reduction in funding for outpatient psychiatric services and psychiatric hospitals in the country. In addition, the SARS-CoV-2 coronavirus, causes COVID-19, along with the acute respiratory syndrome, can infect the brain, cause immune reactions, disrupt blood clotting, and small blood vessel thrombosis, further adversely affecting the brain functions and mental health of patients.&#x0D; Objective – to analyze the influence of the coronavirus disease pandemic on mental health, the course of mental and neurological disorders and the availability of psychiatric and general medical care for specialized patients, according to literature and the results of a survey of experts in mental health.&#x0D; Materials and methods. Using the information-analytical method, publications from MEDLINE, Embase, Pubmed, Web of Science and other open sources by keywords were selected and analyzed, and the results of a survey of doctors, heads of medical institutions and people representing patient and parent organizations were analyzed. acting in the interests of persons with mental disorders.&#x0D; Results and conclusions. The results indicate that the COVID-19 pandemic affects all aspects of the life of Ukrainian society, is accompanied by massive lesions of the respiratory, gastrointestinal, cardiovascular, nervous systems, mental disorders and is fraught with the development of a global crisis in the field of mental health.&#x0D; Multicenter studies of the effect of COVID-19 on the central and peripheral nervous systems, on the course of mental and neurological diseases in infected people, the study of the long-term psychological, psychological and neurological consequences of coronavirus disease, and the effect on the mental health of the entire population and vulnerable groups are needed. There is an urgent need for research to find out how to mitigate the psychological consequences of prolonged isolation in a pandemic, to develop tools for specific prevention in risk groups. It is necessary to develop mechanisms to increase the effectiveness of psychiatric care in a pandemic, mass social exclusion, demoralization of psychiatric and social support systems in the face of a high level of infection and a reduction in specialized services and medical workers. It is concluded that to solve this problem, integration between disciplines and sectors and new funding for research are needed.

Attitude Towards Drug Therapy in a Community Mental Health Center Evaluated by the Drug Attitude Inventory.

IntroductionNegative attitude towards drug therapy can foster limited adherence to treatment, which remains one of the biggest obstacles for implementing effective treatments, especially long term.PurposesThe purposes of the study were 1) to evaluate the attitude towards drug therapy among a representative sample of patients treated in a community psychiatric service using 30-item Drug Attitude Inventory (DAI-30); 2) to evaluate the DAI-30 dimensions, applying factorial analysis; and 3) to highlight the socio-demographic and clinical variables correlated to DAI-30 score and factors.MethodsThe DAI was administered, over a 7-month period, to all patients treated in our psychiatric outpatient services who agreed to participate in this study and provided their informed consent. Data were statistically analyzed.ResultsWith a response rate of 63.3%, 164 females and 136 males completed the DAI-30 with an average score of 14.24 (±10.46 SD), indicating moderately positive attitude towards drug therapy. The analysis of DAI-30 internal consistency confirmed its reliability (Cronbach’s alpha=0.84). Our factorial analysis highlighted three factors: Factor 1 (Cronbach’s alpha=0.81), composed of 7 items which indicate positive, trustful attitude; Factor 2 (Cronbach’s alpha=0.78), composed of 5 items indicating negative attitude of suspiciousness; and Factor 3 (Cronbach’s alpha=0.66), composed of 4 items suggesting defensive and control attitude towards drug therapy.DiscussionAmong the selected variables, “monotherapy” and “total number of hospitalizations” were negatively correlated to the final score of DAI-30, whereas being “married” was positively correlated to it, in a statistically significant way, using the multiple linear regression model. These correlations suggest that positive attitude towards drug therapy could be reinforced by the condition of being married and reduced by relapses with hospitalization, as literature highlighted, and, paradoxically, by a monotherapy, which could suggest a sort of psychological dependence on therapy and, indirectly, on psychiatric service, potentially correlated to the long-term treatments of our patients.

T240. DOES SCHEDULING A POST-DISCHARGE OUTPATIENT MENTAL HEALTH APPOINTMENT INCREASE THE LIKELIHOOD OF SUCCESSFUL TRANSITION FROM HOSPITAL TO COMMUNITY-BASED CARE?

BackgroundScheduling timely appointments for outpatient follow-up care is a discharge planning practice widely accepted as a standard of care for inpatient treatment. Despite these endorsements, however, rates of hospital providers completing these practices vary widely. Timely scheduling of initial outpatient visits following discharge has been associated with improved rates of attending outpatient psychiatric services, although negative findings have also been reported. Nearly all prior studies were single-site case reports that did not use an experimental design and more rigorous research is needed.In this report, we aimed to examine the association between receiving care transition practices and attending outpatient care after controlling for patient, hospital, and system characteristics in a large cohort of inpatient psychiatric admissions in New York State. We hypothesized that patients for whom hospital providers scheduled a mental health outpatient appointment had a higher likelihood of receiving an initial outpatient psychiatric service following discharge after controlling for the aforementioned covariates.MethodsThis is a retrospective cohort study that used 2012–2013 New York State Medicaid claims data for psychiatric inpatients, who were under 65 years, admitted to an inpatient psychiatric unit with a principal diagnosis of a mental disorder and discharged to the community. The outcome variable was defined as attending to outpatient psychiatric services within 7 and 30 days following discharge from an inpatient psychiatric unit. Scheduling a mental health outpatient appointment as a discharge planning was the primary independent variable. To address the wide range of potentially confounding covariates, propensity scores for regression models were estimated based on patient, hospital, and service system factors.ResultsBefore matching by propensity scores, those who had an outpatient mental health appointment scheduled were less likely to be homeless at admission, have a co-occurring substance use diagnosis, and live in large central metro areas, and were more likely to be previously engaged in psychiatric outpatient services. After matching, however, most systematic differences between those who had and those who did not have a mental health outpatient appointment scheduled were substantially diminished (standardized differences of <20%).In the adjusted models including propensity scores, patients who had a mental health outpatient appointment scheduled were more likely to be in treatment in aftercare services compared to patients who did not have an outpatient appointment at both 7 and 30 days following discharge.DiscussionScheduling an outpatient mental health appointment increases aftercare attendance following a psychiatric discharge. This effect was noted across all 5 propensity strata, indicating that discharge planning has a positive impact regardless of the presence of other factors highly predictive of failure to attend aftercare appointments.

A comparison of patients with somatic symptom disorder attending psychiatric services and those unwilling to attend psychiatric services.

The present study aimed to compare the symptom profile, psychological correlates, public stigma, quality of life and disability of patients with somatic symptom disorder attending the psychiatric outpatient services and those who refuse to attend the psychiatry outpatient services. For this, patients were recruited from both Psychiatry outpatient services (N = 62) and Rheumatology outpatient services (N = 41). Participants were assessed on Screening for Somatoform Disorders Instrument, Beck's Depression Inventory, Somatosensory Amplification Scale, Whitley Index, Twenty-item Toronto Alexithymia Scale-Hindi version, Community Attitudes toward the Mentally Ill Scale, World Health Organization-Quality of Life Scale-BREF version (Hindi) and Indian Disability Evaluation and Assessment Scale. Both the groups were comparable on socio-demography and symptom profile. Compared to the patients attending the psychiatry outpatient services, patients attending the rheumatology outpatient services had higher level of somatosensory amplification, hypochondriasis, alexithymia (in the subscales of difficulty in identifying and describing feelings), higher stigmatizing attitude towards mental illness, poorer quality of life and higher disability. To conclude, present study suggests that, patients of somatic symptom disorder, who refuse to attend the psychiatry outpatient services differ from those attending the psychiatry outpatient services in terms of somatosensory amplification, alexithymia, hypochondriasis, public stigma held towards mental illnesses, disability and quality of life. There is a need to develop a treatment model to address these issues in the medical setting to improve the outcome of patients with somatic symptom disorders attending the medical outpatient setting.

Challenges of facing coronavirus disease 2019: Psychiatric services for patients with mental disorders

As a public health emergency of international concern as declared by the World Health Organization (WHO), the current outbreak of coronavirus disease (COVID-19) in China has captured the world's attention.1 The global COVID-19 outbreak can now be characterized as a pandemic, and the number of confirmed cases all over the world has increased to 416 686 as of 04:34 hours, 26 March 2020, according to data released by the WHO.1 International journals for general medical and specialty fields are working closely with experts across the globe to raise comment and provide advice on measures to protect mental health in this epidemic.2, 3 We have enormous respect for those who have most recently published the latest content on this new virus; however, it is time for a change in focus. In addition to the challenges faced by medical professionals and the general public, the mental health services for patients suffering from mental disorders have several challenges to face. To this end, a guideline document was recently issued by the government of the People's Republic of China with respect to strengthening the management of treatment for patients with severe mental disorders during the outbreak of COVID-19.4 Afterwards, an expert consensus on the managing pathway and coping strategies for patients with mental disorders during prevention and control of the outbreak of a serious infectious disease (novel coronavirus pneumonia) was published by the Chinese Society of Psychiatry together with other psychiatry-related academic organizations.5 However, we are under challenging conditions to effectively deal with the realistic problems in the psychiatric domain caused by the COVID-19 outbreak. A nationwide epidemiological survey reported that the lifetime prevalence of any psychiatric disorder is 16.6% in China.6 Many patients need ongoing support in outpatient clinics, and many require repeated readmissions to inpatient wards, and vice versa. Psychiatrists assess patients, advise them and their guardian, and provide long-term treatments at hospitals. The difficulty in maintenance treatment of individual patients with mental disorders is currently increased for several reasons. First, under strict control due to the epidemic, most of the general hospitals in Hubei province and elsewhere are temporarily unable to care for psychiatric patients to lower the possibility of COVID-19 transmission. Second, because of the need to establish special wards for patients who have a fever, specialized hospitals have had to reduce the number of ordinary hospitalizations. Third, patients undergoing hospitalization and outpatients seeking help or undertaking follow up have had to discontinue their treatment due to suspended public transport in a number of areas. At present, there are few measures as to how long maintenance treatment in mental disorders should last after an episode. Failure to directly resolve these problems prevents us from achieving our goal, despite its importance in the clinical management of mental disorders. Given that many more medical comorbid factors occur in patients with mental disorders, another challenge is addressing the effects of medical comorbidity in patients; for instance, respiratory diseases are more common in schizophrenia patients than in the general population, and patients with schizophrenia and concomitant influenza or pneumonia have higher mortality rates (see Wang et al.7 for a review). There so far appears to be no attention paid to these vulnerable individuals, that is, psychiatric patients with comorbid COVID-19. Here, we would like to share response suggestions. The World Health Assembly in 2013 endorsed an action plan, the WHO's ‘Comprehensive Mental Health Action Plan 2013–2020.’8 A key recommendation is to shift services from institutions to the community, highlighting the steps required to provide appropriate psychiatric services for patients in the current COVID-19 epidemic. In addition to this, the development of artificial intelligence techniques in clinical settings, attempts to speed up constructing the framework of online consultation and Internet hospitals, and the provision of telemedicine are all valuable. As a fundamental component of mental health services, psychiatric health-care professionals based in large top-class tertiary hospitals play critical roles in the comprehensive health of the population with mental disorders. This can be leveraged through large data analyses and harnessed via updated clinical practice guidelines and algorithms to improve policy-making. The COVID-19 epidemic has now spread across China and affected the world for almost 3 months. It poses many problems not only with the provision of psychiatry care, but also public health, prevention and control, preclinical and clinical research, health policy, and even health law. We are writing to draw attention to the challenges regarding maintenance treatment and concomitant COVID-19 in patients with mental disorders. The positive response is increasingly expected to explore and address the issues that affect patients with mental disorders on the basis of available evidence. The authors declare no conflicts of interest.

Implementation of Key Components of Evidence-Based Family Therapy for Eating Disorders in Child and Adolescent Psychiatric Outpatient Care.

BackgroundRestrictive eating disorders with pronounced starvation are serious psychiatric conditions that often begin during childhood or adolescence. An early and efficient intervention is crucial to minimize the risk of the illness becoming longstanding and to limit the consequences. There is good evidence that weight gain during the first month of treatment provides a better prognosis. Only a limited amount of young people suffering from severe restrictive eating disorder receive an evidence-based treatment at present in Sweden. The ROCKETLAUNCH project intends to implement key components of the evidence-based family therapy during the first month of treatment in child and adolescent psychiatric outpatient care.MethodsFrom the southern part of Sweden, 12 local child and adolescent psychiatric outpatient services will take part. All patients with a restrictive eating disorder and pronounced starvation together with their families will be asked to take part in the study. We expect that one hundred 50 patients will be assessed every year. The patients and their families will receive 1 month of intense manualized treatment. Body weight, days in inpatient care, eating disorder, and other psychopathology-related symptoms, will be evaluated after one month and at 12-month follow-up. Economic evaluation of ROCKETLAUNCH will also be carried out alongside the intervention. At each outpatient clinic, data from the 10 previous patients will be gathered to compare the treatment provided at ROCKETLAUNCH with the standard treatment in Sweden.DiscussionWe expect that by implementing the key components of the evidence-based family therapy during the first month of treatment, the prognosis of young newly diagnosed patients with severe restrictive eating disorders, primarily anorexia nervosa will improve, which, in turn, will reduce the need for psychiatric inpatient care.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT04060433.

Quantifying the level of difficulty to treat major depressive disorder with antidepressants: Treatment Resistance to Antidepressants Evaluation Scale.

BackgroundThe present study aimed to develop a new scale to evaluate the level of difficulty in treating major depressive disorder with antidepressants based on the lifetime treatment profile.MethodsIn addition to evaluating the difficulty of treatment with antidepressants (A subscale), the Treatment Resistance to Antidepressants Evaluation Scale (TRADES) is comprised of a subscale to account for the attributes that compromise the efficacy of treatment (B subscale). One hundred and six participants aged 18 to 65 years with remitted major depressive disorder were enrolled. Eligible cases were those with at least 2 years from disease onset until the scoring date of the TRADES (the index date), with a complete treatment record. Various psychosocial and clinical features, such as neuroticism, harm avoidance, and utilization of psychiatric services, were used to validate the TRADES.ResultsThe mean duration of the course before and after the index date were 5.5 ± 3.5 and 3.1 ± 1.7 years, respectively. In a multiple regression analysis, the final total scores of the TRADES independently correlated with higher levels of neuroticism and harm avoidance. Total scores were also associated with a higher utilization of psychiatric outpatient and admission services before the index date. Furthermore, it is thought that total scores could predict a higher number of visits to psychiatric outpatient, emergency, and admission services following the index date.ConclusionsThe TRADES has acceptable validity and could help to quantify the level of treatment difficulty with antidepressants in major depressive disorder.

Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination.

BACKGROUND: A fully integrated Obstetric Mental Health Clinic (OBMHC) was established in 2007 in the rural northwest United States to address perinatal depression. AIMS: The purpose of this mixed methods study was to examine depression outcomes in women receiving outpatient psychiatric services between 2007 and 2017 at a fully integrated OBMHC and to explore patient and obstetric team perceptions of OBMHC experiences. METHOD: A retrospective database study was employed; depression was measured at baseline and follow-up visits using the Edinburgh Postnatal Depression Scale. Descriptive statistics, regression models, and trend analysis were employed to determine effectiveness. A subset of patients participated in telephone interviews; the obstetric team was surveyed regarding perceptions of the service. RESULTS: The sample included 192 women (195 pregnancies). Approximately 72% experienced less depression by the first follow-up visit. Patients taking three or more psychiatric medications attended more OBMHC visits. Trend analysis indicated that women with the highest levels of depression had the best response to the intervention. Three qualitative themes emerged: Safe Place, Mental/Emotional Stability, and Integrated Personalized Approach. Obstetric team members (n = 11) perceived the clinic to be helpful and noted improved access to mental health care. CONCLUSION: OBMHCs can be effective when psychiatric nurses are embedded within an outpatient obstetric service. Improved access, timely services, and patient reassurance can lead to an improved pregnancy experience and reduced depressive symptoms. The longevity of this clinic's experience serves as a role model for other centers to replicate this successful integrated model of care.

Reasons for initiating long-acting antipsychotics in psychiatric practice: findings from the STAR Network Depot Study.

Background:Long acting injectable (LAI) antipsychotics have been claimed to ensure treatment adherence and possibly reduce the daily burden of oral formulations. So far, only surveys investigating the theoretical prescribing attitudes of clinicians have been employed. On this basis, we aimed to investigate reasons for prescribing LAIs in a real-world, unselected sample of patients.Methods:The STAR Network Depot Study is an observational, multicentre study consecutively enrolling adults initiating a LAI over a 12-months period. Clinical severity was assessed with the Brief Psychiatric Rating Scale, and patient’s attitude toward medications with the Drug Attitude Inventory 10 items. Psychiatrists recorded reasons for LAI prescribing for each study participant. Responses were grouped into six non-mutually exclusive categories: aggressiveness, patient engagement, ease of drug taking, side-effects, stigma, adherence.Results:Of the 451 patients included, two-thirds suffered from chronic psychoses. Improving patient engagement with the outpatient psychiatric service was the most common reason for prescribing LAIs (almost 80% of participants), followed by increasing treatment adherence (57%), decreasing aggressiveness (54%), and improving ease of drug taking (52%). After adjusting for confounders, logistic regression analyses showed that reasons for LAI use were associated with LAI choice (e.g. first-generation LAIs for reducing aggressiveness).Conclusion:Despite the wide availability of novel LAI formulation and the emphasis on their wider use, our data suggest that the main reasons for LAI use have remained substantially unchanged over the years, focusing mostly on improving patient’s engagement. Further, clinicians follow implicit prescribing patterns when choosing LAIs, and this may generate hypotheses for future experimental studies.

Mental health services provided by medical officers in primary health centres in Kolar district in Karnataka, India: A situational assessment.

Context:Mental health services are integrated into primary healthcare and delivered by medical officers (MOs). Assessment of mental health services provided by MOs and their ability to manage mental disorders in primary health centers (PHCs) would provide evidence to strengthen the quality of this integration.Aims:To conduct a situational assessment of mental health services provided by medical officers in PHCs in Kolara district in terms of availability and nature of services. To assess the ability of MOs to diagnose and treat mental disorders in PHCs.Materials and Methods:We interviewed all eligible and available PHC medical officers (45). The nature of mental health services provided (diagnosis, treatment, counseling and referral) was enquired. A case-vignette based assessment of the ability of MOs to diagnose and treat mental disorders was conducted.Results:Nearly 87% of MOs delivered psychiatric out-patient services on all working days. MOs were significantly better in diagnosing compared to providing treatment (P = 0.04). In spite of being trained in mental health, concerns exist in translating training into quality service delivery. MH drugs were available in regular supply and utilised to great extent.Conclusion:MOs are providing psychiatric out-patient services in PHCs regularly but their ability is limited. The study recommends the reorientation of existing training from a service delivery perspective.

Clinical-epidemiological and social-demographic characteristics of patients newly diagnosed with schizophrenia in 2013-2017

To evaluate the dynamics of clinical-epidemiological and social-demographic characteristics in a continuous sample of patients with newly diagnosed schizophrenia in 2013-2017. An analysis of the continuous study of medical records of 4708 patients, aged 14 to 77 years, with newly diagnosed schizophrenia, who referred to Moscow psychoneurological dispensaries, was performed. Patients of young working age prevailed in the sample; the onset of symptoms of the disease in men was noted at an earlier age than in women. The disease at an early stage was accompanied by a professional decline and a significant disability. Schizophrenia was most frequently diagnosed in the first visit. There was a clear correlation between an increase in the number of compliance violations and an increase in the duration of the disease. Assessment of the frequency of visits to primary care psychiatrists and admissions to hospitals and day hospitals indicates the increased effectiveness of outpatient psychiatric services in Moscow.