Psychiatric Outpatient Clinic Research Articles

Intellectual Profiles of Clinic-Referred Preschoolers.

Intellectual impairments in preschoolers have been widely studied. A regularity that emerges is that children's intellectual impairments have an important impact on later adjustments in life. However, few studies have looked at the intellectual profiles of young psychiatric outpatients. This study aimed to describe the intelligence profile of preschoolers referred to psychiatry for various cognitive and behavioral problems in terms of verbal, nonverbal, and full-scale IQ and to examine their association with diagnoses. Three hundred four clinical records from young children aged under 7 years and 3 months who consulted at an outpatient psychiatric clinic and who had one intellectual assessment with a Wechsler Preschool and Primary Scale of Intelligence were reviewed. Verbal IQ (VIQ), Nonverbal IQ (NVIQ), and Full-scale IQ (FSIQ) were extracted. Hierarchical cluster analysis using Ward's method was employed to organize data into groups. The children had, on average, a FSIQ of 81, which is significantly lower than that expected in the general population. Four clusters were identified by the hierarchical clusters analysis. Three were characterized by low, average, and high intellectual ability. The last cluster was characterized by a verbal deficit. Findings also revealed that children's diagnoses were not related to any specific cluster, except for children with an intellectual disability with, as expected, low abilities. Children referred to an intellectual assessment in an early childhood mental health clinic showed an altered intellectual development, more specifically in the verbal domain.

Psychometric evaluation of the 9-item Concise Health Risk Tracking - Self-Report (CHRT-SR9) (a measure of suicidal risk) in adolescent psychiatric outpatients in the Texas Youth Depression and Suicide Research Network (TX-YDSRN)

BackgroundThis study evaluated the psychometric properties of the 9-item Concise Health Risk Tracking Self-Report (CHRT-SR9), a measure of suicidality, in adolescent psychiatric outpatients. MethodsAltogether, 933 depressed or suicidal adolescents (12–20 years of age), receiving treatment at psychiatric outpatient clinics in Texas, completed the 16-item CHRT-SR at baseline and one month later. CHRT-SR9 was extracted from CHRT-SR16 using multigroup confirmatory factor analysis. Sex and age measurement invariance, classical test theory, item response theory (IRT), and concurrent validity analyses (against the suicidal ideation Item 9 of Patient Health Questionnaire-Adolescent (PHQ-A)) were conducted. ResultsThe CHRT-SR9 demonstrated excellent model fit with four factors (pessimism, helplessness, despair, and suicidal thoughts). Measurement invariance was upheld. Acceptable item-total correlations (0.56–0.80) and internal consistency (Spearman-Brown 0.78–0.89) were revealed. IRT analyses showed a unidimensional instrument with excellent item performance. Using the CHRT-SR9 total score as a measure of overall suicidality and comparing it against levels of PHQ-A Item 9, the mean (standard deviation) of CHRT-SR9 total score was 8.64 (SD = 5.97) for no-risk (0 on Item 9), 17.05 (SD = 5.00) for mild, 23.16 (SD = 5.05) for moderate, and 26.96 (SD = 5.24) for severe-risk (3 on Item 9). Significant differences (p-value<0.0001) indicated that CHRT-SR9 total score distinguished between levels of suicidal risk. Furthermore, CHRT-SR9 was sensitive to change over a one-month period. LimitationsWhether CHRT-SR9 predicts actual suicidal attempts in adolescents is not well defined. ConclusionThe CHRT-SR9 is an easy-to-administer, user-friendly self-report with good psychometric qualities which makes it an excellent screening measure of suicidal risk in adolescent psychiatric outpatients.

Effectiveness of Internet-based cognitive-behavioural therapy for obsessive-compulsive disorder (OCD-NET) and body dysmorphic disorder (BDD-NET) in the Swedish public health system using the RE-AIM implementation framework

ObjectivesTherapist-guided internet-delivered cognitive behaviour therapy (ICBT) is an efficacious treatment for obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD), but it is unclear if the results obtained in controlled trials can be reproduced in clinical settings. We evaluated the implementation of ICBT for OCD (OCD-NET) and BDD (BDD-NET) in the Swedish public health system. MethodsConsecutive referrals to an outpatient psychiatric clinic providing ICBT, with a primary diagnosis of OCD or BDD, were included in the study. Four hundred and thirty-four participants started OCD-NET and 163 started BDD-NET. The primary outcome measures were the Yale Brown Obsessive Compulsive Scale (Y-BOCS) and the Y-BOCS for BDD (BDD-YBOCS), respectively. Participants were assessed before treatment, weekly during treatment, and after treatment. The study used the RE-AIM implementation framework, and the elements of reach, effectiveness, adoption, and implementation for the evaluation. ResultsIntention to treat analysis of the OCD-NET sample (n = 434) showed a significant decrease in OCD symptoms from pre-treatment to post-treatment (mean reduction = −8.77 [95 % CI -9.48 to −8.05] p < .001, d = 1.94 [95 % CI 1.75 to 2.13]). Forty-nine percent (95 % CI 43 % to 56 %) of the participants in OCD-NET were classified as treatment responders and 21 % (95 % CI 16 % to 27 %) were in remission. Participants in BDD-NET (n = 163) also showed a significant decrease in BDD symptoms from pre-post treatment (mean reduction = −11.37 [95 % CI -12.9 to −9.87] p < .001, d = 2.07 [95 % CI 1.74 to 2.40]) and 69 % (95 % CI 58 % to 79 %) of the participants were classified as treatment responders and 48 % (95 % CI 38 % to 58 %) were in full or partial remission. Eighty-seven percent of the participants in OCD-NET and 78 % in BDD-NET were treatment completers and participants in both treatment groups reported a high treatment satisfaction at post treatment (OCD-NET = 87 %, BDD-NET = 79 %). The most reported negative effects attributed to the treatments were transient experiences of unpleasant feelings (52 %) and anxiety (50 %). The implementation also influenced treatment delivery and dramatically decreased the mean number of patients waiting to receive face-to-face treatment at the clinic. ConclusionsOur results indicate that OCD-NET and BDD-NET are suitable treatments for implementation in a Swedish public health service.

COVID-19, DEHB'li çocuk ve ergenlerin ruh sağlığı ve yaşam kalitesini etkiledi mi?

Aim: COVID-19 pandemic has had negative effects on the lives of many children and adolescents with psychiatric disorders. This research aims to investigate the effects on the mental status and quality of life of children with ADHD during the COVID-19 pandemic. Material and Method: This study was conducted at the child and adolescent psychiatric outpatient clinic of a university hospital, between April and May 2020. The research group consisted of 113 children and adolescents with ADHD, and the control group consisted of 45 children and adolescents. The depression and anxiety symptoms of the children were assessed using the Child Depression Inventory (CDI) and the Screen for Child Anxiety-Related Emotional Disorders (SCARED), respectively. Child-reported and parent-reported Pediatric Quality of Life Inventories (PedsQL) were used to evaluate the health-related quality of life of the children. Result: Depressive symptoms and anxiety levels were found to be statistically higher in the ADHD group. According to PedsQL-P scale, psychosocial and scale total scores were statistically significantly lower. According to the regression analysis, the SCARED scores predicted negative physical, psychosocial, and total scores of the PEDsQL-C scale. The CDI scores, however, predicted negative physical, psychosocial, and total scores of the PEDsQL-P scale. Conclusion: This study revealed that in the COVID-19 pandemic, children with ADHD are more affected in terms of depression, anxiety and quality of life than children without any psychiatric disease. The study findings suggest that further studies are needed to better understand the psychological conditions and difficulties that children with ADHD experience during the COVID-19 pandemic.

Adherence to Typical Antipsychotics among Patients with Schizophrenia in Uganda: A Cross-Sectional Study.

There has been a recent transition from typical to atypical antipsychotics in managing schizophrenia. This has been attributed to the acute side effects experienced by patients on typical antipsychotics that lead to nonadherence. However, the treatment cost with typical antipsychotics is cheaper (preferred in low-income settings), and there is no difference in the effectiveness, efficacy, discontinuation rate, or side effect symptom burden with atypical antipsychotics. This study is aimed at determining the prevalence of nonadherence and the associated factors to typical antipsychotics among patients with schizophrenia attending a psychiatric outpatient clinic at a rural tertiary facility in Uganda. A cross-sectional study among 135 patients with schizophrenia for at least six months on typical antipsychotics (mean age of 39.7 (±11.9) and 55.6% were female) from a rural tertiary facility in Uganda. Data were collected regarding sociodemographics, adherence, insight for psychosis, attitude towards typical antipsychotics, side effects, satisfaction with medications, and explanations from health workers about medications and side effects. Logistic regression was used to determine the factors associated with nonadherence. The prevalence of nonadherence was 16.3%, and the likelihood of being nonadherent was more among the poor (monthly earning below the poverty line). However, having reduced energy was associated with reducing the likelihood of having nonadherence. The prevalence of nonadherence was lower than many previously obtained prevalence and was comparable to nonadherence for atypical antipsychotics. However, to reduce nonadherence, we need all stakeholders (such as the government, insurance companies, and caregivers) to assist patients living in poverty with access to medication.

I Don’t Wanna Die: Punk Rock Music and Culture as Critical Social Work Practice

Punk is a music genre and counter-culture that has provided community and empowerment to generations of traumatized youth. This article is a case study on the use of punk rock counter-culture through the expression of music as a critical social work practice within a psychiatric outpatient clinic. The clinic, Lane County Behavioral Health, was founded during the deinstitutionalization era of psychiatric care for the treatment of “severe and persistent mental illness.” The article describes the formation of the group, the shared personal and cultural history of the therapist with group members, and the critical engagement with psychiatric violence generated through the composition of punk music. In this, the process of composition and the lyrical content of four songs are provided. Each of these four songs demonstrate a connection of the personal experiences of psychiatric violence to a political protest against psychiatric violence. While the article focuses on the experience of punks in the psychiatric clinic, the implementation of relationality and personal-political experience are applicable beyond the punk counter-culture. The article concludes with discussion elaborating ways in which a relational analytic group can be implemented within tight knit counter-cultural communities.

Early-Onset Insomnia among Patients with Hemifacial Spasm in South Korea: A Nationwide Cohort Study

This study aimed to investigate mental illnesses among patients with hemifacial spasms (HFS) based on nationwide claims data from the South Korea Health Insurance Review and Assessment Service. In this retrospective study, we defined the HFS group as subjects aged between 20 and 79 years with newly diagnosed HFS between January 2011 and December 2019 and set the date of diagnosis of HFS as the index date. Mental illnesses were defined through the International Classification of Diseases, the tenth revision from 90 days before to after the index date. Of these patients, we enrolled the participants who had visited a psychiatric outpatient clinic more than twice or had been admitted to a psychiatric department more than once diagnosed with psychiatric diseases. To select the control group, which was four times larger than the HFS group, propensity scores were used among those not diagnosed with HFS. The patients with HFS were more likely to have a mental illness than the control group (8.5% and 6.5%, respectively, p < 0.001) within 90 days before and after diagnosis. Among mental illnesses, insomnia (46.2% vs. 13.0%, p < 0.001) was significantly more prevalent in the HFS group. Other mental illnesses were significantly more prevalent in the control group or were not statistically significant. The results of this study suggest that patients diagnosed with HFS were significantly more likely to develop insomnia within a relatively short period than the controls.

Exploring mediational roles for self-stigma in associations between types of problematic use of internet and psychological distress in youth with ADHD

BackgroundSeveral studies have linked the problematic use of the Internet (PUI) to psychological distress. Youth with attention deficit hyperactivity disorder (ADHD) are considered a particular disadvantaged population with a high risk of developing PUI, psychological distress, and self-stigma. Nonetheless, the interrelationships of PUI, self-stigma, and psychological distress in adolescents with ADHD are not well understood. AimsThis study investigated whether self-stigma mediates relationships between different forms of PUI, such as problematic gaming (PG), problematic social media use (PSMU), problematic smartphone use (PSPU), and psychological distress (i.e., depression, anxiety, and stress), in children with ADHD. Methods and proceduresWe recruited 100 youth with ADHD (mean age=10.80 [SD=3.07] years; 84 boys) from psychiatric outpatient clinics in Taiwan. All participants were assessed for PUI (via Internet Gaming Disorder-Short Form for PG, Bergan Social Medica Addiction Scale for PSMU, and Smartphone Application-Based Addiction Scale for PSPU), self-stigma (via Self-Stigma Short-Scale), and psychological distress (via Depression, Anxiety, Stress Scale). Outcomes and resultsThe results of path and bootstrapping analyses indicated that self-stigma mediated the associations between PSMU and PSPU, but not PG, and depression, anxiety, and stress. Conclusions and implicationsThis study expands the extant literature by revealing that self-stigma mediates the association between specific forms of PUI and psychological distress in adolescents with ADHD. Interventions aimed at reducing self-stigma and PUI, particularly PSMU and PSPU, may help decrease psychological distress among adolescents with ADHD.

Profile of nonattending patients at psychiatric outpatient clinics before (in-person model) and during COVID-19 pandemic (telepsychiatry model): A comparison study

Abstract: BACKGROUND: Missed appointments in mental health services have been a concern; as nonattendance may be associated with various clinical risk factors. AIMS: We intended to compare the profile of nonattenders at psychiatric outpatient clinics before (in-person model) and during the COVID-19 pandemic when the services changed to remote consultations (telepsychiatry model). MATERIALS AND METHODS: Clinical features (diagnosis, medical and psychological treatment, care program approach, and first contact), risk to self and others, and demographic variables (age, gender, ethnicity, accommodation, occupation, and benefits) were collected from the electronic records. The outcomes after the missed appointment were also noted. RESULTS: The sample consisted of 23 nonattenders in January 2020 (pre-COVID-19) and 32 nonattenders in November 2020 (during COVID-19); with an overall rate of nonattendance of 20% and 22%, respectively. Nonattenders during COVID-19 were significantly (P &lt; 0.05) younger (36.4 ± 10.2 vs. 45.3 ± 15.0), and had more male patients (68.8% vs. 31.3%) compared to pre-COVID-19. There were no differences in other demographic variables, diagnoses, treatment received, or level of care. Risk to self was significantly more during COVID-19 (34.4% vs. 8.7%, P &lt; 0.05) and risk to others was less (0.0% vs. 17.4%, P &lt; 0.05). Significantly more (P &lt; 0.05) nonattenders were contacted by letters during COVID-19 (81.3%) than pre-COVID-19 (52.2%); a higher (P &lt; 0.05) proportion of nonattenders were discharged from services during COVID-19 (34.4%) compared to pre-COVID-19 period (8.7%). CONCLUSIONS: During COVID-19, when psychiatric outpatient services changed to remote consultations, there were differences in the profile of nonattenders and their risks. The results suggest that telepsychiatry services should explore the profile of nonattenders and their risks for arranging appropriate support.

Approach to acute psychosis in older adults.

Approach to acute psychosis in older adults.

PS-C28-1: EARLY DETECTION OF DEMENTIA AT COMMUNITY PHARMACIES USING SIMPLE TOUCH PANEL SCREENING CHECK

Objective: The purpose of this study was to examine whether a simple touch panel screening check for dementia (TPCD) would be effective for early detection of dementia at community pharmacies. Design and Methods: This was a prospective study of adult visitors presenting to a pharmacy adjacent to a university hospital (Project 1) or to a general physician clinic (Project 2). Participants were voluntarily recruited in the pharmacies and were registered after written informed consent. To evaluate the cognitive function of participants, we scored immediate and recent memories of words, time orientation, figure recognition using a Forgetfulness Consultation Program MSP-1100 (Nihon Kohden, Tokyo). When the score was or less than 12 out of 15 points, participants were suspected as having dementia and recommended to visit the psychiatric outpatient clinic of the university hospital (Project 1) or to visit the general physician (Project 2). On the next visit to the pharmacy, the participants were asked whether they had received the consultation of the psychiatric specialists. Results: [Project 1] TPCD was conducted on 81 individuals (35 men) from January 2019 to January 2020. One was excluded because of agreement withdrawal and another was excluded because he had already been treated for dementia at another clinic. Of 79 participants, 17 (21.5%, 8 men) were suspected as having dementia and were recommended to visit the psychiatric clinic. Two participant visited psychiatric specialists and were diagnosed as having mild cognitive impairment. Four consulted with their family physicians but have not yet visit the psychiatric clinic. Eleven refused the consultation. [Project 2] Currently, TPCD was conducted on 30 individuals (8 men) and 10 (33.3%, 3 men) were suspected to having dementia from January 2021 to April 2022. The recruitment is now ongoing. Conclusion: This preliminary analysis suggests that TPCD in pharmacies may be effective for early detection of dementia. It is necessary to strengthen the pass to support the consultation visit to psychiatric specialists.

Health care costs and changes in subjective health-related quality of life among Finnish adolescents referred to secondary psychiatric out-patient services: a one-year follow-up study.

There has been growing interest in economic evidence regarding treatment of mental disorders. The purpose of this one-year follow-up study was to evaluate the secondary health care costs and changes in health-related quality of life (HRQoL) in three common adolescent psychiatric disorder groups. Further, HRQoL of patients was compared to that of population controls. Twelve- to fourteen-year-old adolescents with behavioral and emotional disorders (n = 37), mood disorders (n = 35), and anxiety disorders (n = 34), completed the 16D HRQoL questionnaire when they entered the adolescent psychiatric outpatient clinics (baseline) and at follow-up. The direct secondary health care costs were calculated using a clinical patient administration system. Population controls included 373 same-aged pupils from randomly selected 13 comprehensive schools. The direct secondary health care costs did not differ significantly between the three patient groups. However, in adolescents with mood disorders, this investment generated a significant and clinically important improvement in HRQoL, which was not observed in the other two patient groups. The costs of health care alone do not necessarily reflect its quality.

Effect of Acupuncture on Physical Symptoms and Quality of Life in Treatment-Resistant Major Depressive Disorder and Bipolar Disorder: a Single-Arm Longitudinal Study.

Acupuncture is a non-pharmacological therapy used clinically for mood disorders. Relief of physical symptoms with acupuncture treatment may lead to relief of depressive symptoms and improvement of quality of life (QoL). Few studies have examined the effect of acupuncture on the physical symptoms and QoL of patients with mood disorders. To examine the effect of acupuncture on physical symptoms and QoL of patients with treatment-resistant major depressive disorder (MDD) and bipolar disorder (BD). This prospective, single-arm, longitudinal study included patients with MDD and BD from an outpatient psychiatric clinic. Acupuncture was performed weekly for 12 weeks in combination with regular treatment, with fixed acupoints and individualized treatment for each patient. Psychiatric symptoms were evaluated using the Himorogi Self-Rating Depression Scale (HSDS) and Himorogi Self-Rating Anxiety Scale (HSAS). Physical symptoms such as physical pain, gastrointestinal symptoms, and sleep disorders were evaluated using the Japanese version of the Somatic Symptom Scale-8 (SSS-8) and Visual Analog Scale (VAS). QoL was evaluated using the 8-item Short-Form (SF-8) Health Survey. A total of 36 patients (15 MDD and 21 BD patients) were analyzed. After 12 weeks of acupuncture, HSDS and HSAS scores significantly decreased (p < 0.05). Physical symptoms evaluated using SSS-8 and VAS scores also significantly improved (p < 0.05). In particular, neck pain and insomnia improved at an early stage. Among the SF-8 subscales, scores of bodily pain, general health perception, role limitations due to emotional problems, and mental health significantly increased (p < 0.05). Acupuncture may improve not only psychiatric symptoms but also physical symptoms and QoL in patients with treatment-resistant mood disorders. Further studies are required for confirmation of the preliminary data collected thus far.

Psychotherapy readiness domains as predictors of psychotherapy outcome in trauma-affected refugees

IntroductionLittle is known about predictors of psychotherapy outcome in trauma-affected refugees. Knowledge on outcome predictors can help clinicians identify patients prior to treatment who are not likely to benefit from standardized psychotherapy and take additional measures to adjust treatment to the individual patient. Given the dynamic nature of psychotherapy readiness domains, they represent potential targets to be worked with in therapy in order to improve outcomes. MethodsPsychotherapy readiness domains (locus of control, cognitive functioning, motivation for therapy, and personality functioning) were examined as potential predictors of psychotherapy outcome in trauma-affected refugees. Secondary analyses were conducted on data from a pragmatic randomized controlled trial. Study participants (N = 190) were refugees with PTSD who received flexible manual-based Cognitive Behavioral Therapy (CBT) at a psychiatric outpatient clinic in Denmark. Psychotherapy readiness domains were assessed via semi-structured interviews at the beginning of psychotherapy. Outcome variables were pre-post change in PTSD symptomology and global level of functioning. ResultsMultiple regression analyses revealed that higher motivation for psychotherapy predicted improvement in PTSD symptomology and global level of functioning. Moreover, higher cognitive functioning predicted improvement in global level of functioning. LimitationsThe predictor rating scales need further psychometric evaluations in cross-cultural contexts. ConclusionsThese findings highlight the importance of considering motivation in psychotherapy offered to trauma-affected refugees. Further research is needed to identify potential barriers to motivation in this diverse patient population and to determine whether motivational interventions can lead to improved treatment outcomes.

Comparison of Psychiatric Service Utilization Prior, During, and After COVID-19 Lockdown: A Retrospective Cohort Study.

Background COVID-19 pandemic represents a significant risk factor for developing, relapsing, or exacerbating pre-existing mental health conditions. This negative impact on mental health results in increasing demand for psychiatric services. This study aimed to explore the effects of COVID-19 pandemic lockdown on the utilization of mental health services in three periods - prior, during, and after the lockdown - compared to the matched weeks in the previous years 2018 and 2019. Materials and Method In this retrospective cohort, quantitative, single-center study, data were collected from electronic medical records, including all patients with referrals\consultations to the psychiatric section prior, during, and after COVID-19 lockdown. Results In total, 2,454 patients were either referred to psychiatric outpatient clinics or needed consultation as inpatients during the study periods. Only 2,326 patients were included in our study. The total number of inpatient consultations was 1,410, with a statistically significant increase during the lockdown (p-value<0.001) and post-lockdown (p<0.016) in comparison to previous years. A significant reduction in outpatient referrals was observed during the lockdown (p=0.005) and post-lockdown period. Psychiatric disorders were identified in most patients (N=1,599), representing 65%, 54%, and 74% of patients in pre-lockdown, lockdown, and post-lockdown periods compared to 71%, 71%, and 76%, respectively, in the previous years. A total of 821 patients manifested symptoms of depression, constituting the largest proportion among all reasons for referral\consultations. The number of patients referred for substance/alcohol use disorders during the lockdown increased compared to patients in the same period in 2019. Suicidal behavior was identified in 70 patients across all study periods, with the lowest number observed in 2020. Conclusion Our findings indicate that during the COVID-19 lockdown, a significant increase in inpatient psychiatric services utilization was observed. Outpatient psychiatric service utilizations were significantly reduced. Implementation of evidence-based policy and protocol to guide mental health challenges in future health emergencies is needed.

Residual symptoms and their associated factors among Thai patients with depression: a multihospital-based survey

BackgroundDepression is a common and debilitating disease, and even residual symptoms of depression can cause significant functional impairment. To achieve normal functioning, residual symptoms should also be identified and targeted by a competent treatment strategy. Thus, this study aimed to examine residual symptoms of depression and their associated factors among patients with depression.MethodsA cross-sectional study surveyed Thai patients with depression at two psychiatric outpatient clinics, Songklanagarind Hospital, and Songkhla hospital; from June to October 2021. The questionnaires inquired about: (1) demographic information, (2) the PHQ-9 Thai version, (3) a questionnaire focusing on depressive symptoms that impacted daily life, and were originally expected to be improved due to antidepressants. All data were analyzed using descriptive statistics, and associated factors concerning depressive symptoms were analyzed by a Chi-square and a logistic regression.ResultsOf all 566 respondents, the majority of them were female (75.4%). The overall mean age was 43.8 ± 18.1 years. The depressive symptoms that had high frequency, high impact on daily life, and that the participants expected that they are resolved or get better via antidepressants were: sleeping problems (81.6%), feeling depressed (79.9%), and lack of pleasure (75.4%). Most of the participants (65.7%) received one type of antidepressant, and the most prescribed antidepressants were selective serotonin reuptake inhibitors (51.1%). In regard to objectives, 45.4% of participants reported having residual depressive symptoms which included sleeping problems (71.2%), feeling down (62.6%), lack of pleasure (62.3%), and poor appetite (61.9%). The associated factors relating to residual depressive symptoms were younger age, high education level, and having physical illness.ConclusionAlmost half of patients with depression had residual symptoms, and they showed symptoms with high individual variability. Further to receiving effective treatment, a focused and individualized approach aiming for symptomatic remission, functional recovery, and quality of life improvements is key to recovery. Therefore, shared decision-making, and taking into account drug efficacy based on symptom profiles are both highly recommended.

The Mental Health Benefits of Religion and Spirituality in People Living With Bipolar Disorder in Malaysia

Introduction: The taxonomy of spirituality is fraught with complexities concerning mental health studies, due to contextual variables such as religion. While many studies on spirituality have reported positive mental health outcomes, little is known concerning spirituality’s effects on bipolar disorder. This study aims to provide a contextual understanding of spirituality from the religious worldview of people with bipolar disorder. Method: This is a qualitative study involving semi-structured and one-to-one in-depth interviews. 25 participants diagnosed with bipolar disorder were recruited from two psychiatric outpatient clinics. All interviews were audio-taped and transcribed verbatim by the researcher. Thematic analysis is used to analyse the data and Bourdieu’s concept of habitus is used to explore the findings in relation to participants’ subjective account of their religious form of spirituality. Results: The theme ‘Maintaining a positive sense of self’ mainly comprises the religious element in the participants’ everyday life: faith in God, religious practices and a sense of spiritual harmony (i.e. peacefulness and connectedness). The role of religion and social agency was inclusive in promoting spirituality among the study sample Conclusion: Through Bourdieu’s lens of religious habitus, this study provides the understanding of religious-spirituality and a healthy mental state in such a way that it implies a relationship with God through religious beliefs and practices. This study invites others to pay attention to the dynamic roles of religious agency and society in promoting religious faith and practices among individuals diagnosed with bipolar disorder.

Which Clinical and Demographic Factors are Related to Incarceration in Male Patients With Antisocial Personality Disorder?

Antisocial Personality Disorder (APD) is a condition largely represented in detention centers where can reach a prevalence of 60% in male prisoners. The objective of this study is to identify the clinical and demographic factors that differentiate subjects with APD and hosted in penitentiary with respect to those are treated in outpatient psychiatric clinics. We recruited 65 male patients affected by APD, whose 26 were followed up in community mental health services and 39 were serving their sentence in a detention center located in Monza. Socio-demographic and clinical data were obtained through a review of the clinical charts, and interviews with patients or their relatives (if available). We performed descriptive analyses on the total sample, then we compared the two groups identified by the type of setting (outpatient clinic vs. penitentiary) by independent sample t tests (quantitative variables) or χ2 tests (qualitative ones). For qualitative variables odds ratios (ORs) were also calculated. Outpatients with APD (with respect to those hosted in the detention center) resulted: to be older (p = .02), to be less likely married (p = .01), to have more pre-onset psychiatric comorbidity (p = .05), to have more pre-onset substance poly-misuse (p = .01), to have more previous psychiatric hospitalizations (p < .01), and to be less likely to have received lifetime psychotherapy (p < .01). Globally, the results of this study show how the presence of psychiatric comorbidity or substance abuse (with the probable access to psychiatric services) before the onset of APD prevents imprisonment. This aspect is even more surprising when we consider that the two groups of patients show no differences in the frequency of crimes. Future research will have to confirm if early mental health care can really limit the access to penitentiary of subjects affected by APD.

Relations between clinical characteristics and cognitive deficits among adult patients diagnosed with major depressive disorder

Objective The present study examined the relations between clinical characteristics and cognitive deficits in adult patients with major depressive disorder (MDD) from a local outpatient psychiatric clinic in Malaysia. Methods The present sample included 110 participants aged 20–60 years old. Participants were invited to provide their information on sociodemographic variables (age, gender, and educational level) and clinical characteristics (age at onset of depression and duration of illness) and to complete a series of cognitive performance measures including the Trail Making Tests A (psychomotor speed) and B (executive function), the Digit Symbol Substitution Test (attention), and the Auditory Verbal Learning Test (immediate free recall, acquisition phase, and delayed recall). The Mini International Neuropsychiatric Interview Version 6.0 was used to confirm the diagnosis of MDD and the Montgomery–Åsberg Depression Rating Scale was used to assess illness severity. Results At the bivariate level, relations of age and educational level to all cognitive deficit domains were significant. At the multivariate level, only educational level and illness severity consistently and significantly predicted all cognitive deficits domains. Conclusions Therapeutic modalities should be individualised whilst considering the impacts of cognitive deficits in an attempt to prevent further deterioration in psychosocial functioning of MDD patients. KEY POINTS Cognitive deficits are an elemental component of Major Depressive Disorder (MDD) persisting during a current major depressive episode or during remission, altering individuals’ ability to process information and changes the way they perceive and interact with the environment. Cognitive deficits in MDD are evident among the upper-middle income groups in South-Eastern Asian countries warranting more local research as such deficits could lead to functional decline and work performance such as absenteeism and presenteeism. Therapeutic modalities should be individualised by taking the impacts of cognitive deficits into consideration to promote psychosocial functioning of MDD patients.

Undersupply of child and adolescent psychiatric outpatient clinics in Austria that can meet minimum requirements

This article is intended to provide an overview of the supply situation with independent outpatient clinics and dislocated Hospital ambulances for Child and Adolescent Psychiatry, taking into account minimum professional standards. The level of care, the mandate to provide care, requirements, structural quality criteria and implementation recommendations are described. 13outpatient clinics and dislocated Hospital ambulances are described in a data matrix.Acomprehensive Austria-wide survey of the staffing and care offerings identified 13 outpatient clinics and outpatient clinics that meet minimum standards. This proves a difference between the current situation and the number of outpatient clinics required nationwide of 26 to 36 (depending on the assessment 1/350k or 1/250k)Thus, the findings provided here, lead us to the conclusion that the patient care in Austria's child and adolescent psychiatric outpatient clinics is not sufficiently guaranteed due to the largely tolerated but technically incorrect interpretation of the legally valid minimum standards.If the current deficiencies are retained, acentral child and adolescent psychiatric care level remains with an effectiveness of less than 50% of the Austrian health structure plan (OSG).