Outpatient Psychiatric Practice Research Articles

Factors predicting early treatment discontinuation among depressed patients of working age in a psychiatric outpatient practice

Depression is the greatest estimated cause of disability among people of working age. Preventing dropouts from depression treatment in the early stages of outpatient psychiatric care is important in avoiding poor outcomes. Since the long waiting time between appointment and consultation was one of the factors for dropout in previous studies, this study aimed to determine the early dropout rate and identify factors associated with early treatment discontinuation in depressed patients in a psychiatric outpatient practice, where immediate access to treatment is available. Of 563 participants, 184 (32.7%) stopped treatment within 1 month, which was as high as previous findings. Logistic regression analysis confirmed that younger age, ICD-10 F4 diagnosis, and lower attention-deficit/hyperactivity disorder (ADHD)-related characteristics predicted earlier treatment discontinuation. The current study suggests that immediate access to treatment might not significantly affect the rate of treatment discontinuation within 1 month for working-age depressed patients. Given the high rate of early treatment discontinuation, explaining the importance of continuing treatment might be necessary at the first visit, especially for patients with younger age, ICD-10 F4 diagnosis, and fewer complaints suggestive of ADHD.

Challenges in the Borderline Personality Disorder diagnostic in clinical practice in community: results of a pilot study

IntroductionBorderline personality disorder (BPD) has a significant presence in outpatient psychiatric practice worldwide, but data on the clinical features of patients with BPD in Russia are limited. Clinicians experience a number of difficulties in diagnosing BPD, which is also due to the high comorbidity of BPD with other mental disorders (affective, anxiety, other personality and addictive disorders).ObjectivesThe aim of this pilot study was to investigate clinical characteristics of mental health care for patients с BPD in real clinical practice in community in Saint-Petersburg, Russia.MethodsFifty patients (72% female; n=36; mean age 22.4±4.3) who were treated in an outpatient community care were included in the study. Diagnosis was made according to the ICD-10 criteria (F60.31), as it does in clinical practice in Russia. Research methods included a clinical-catamnestic method.ResultsThe age of onset of BPD symptoms was 14.9±2.7. It was found that 50% of patients had previously received inpatient (20%, n=10) and outpatient (30%, n=15) psychiatric care unrelated to the current mental condition, that is, not due to the BPD. 16% of patients (n=8) referred for the first time for psychiatric care in adolescence. The vast majority of patients (86%; n=43) were not diagnosed with BPD when they first consulted a psychiatrist. Prior to the diagnosis of BPD, patients were diagnosed with mental disorders due to organic brain injury (4%), affective disorders (44%), schizophrenia spectrum disorders (12%), anxiety disorders (20%) and other personality disorders (6%). On average, it took 7.5±4.0 years from the date of first psychiatric assessment before the diagnosis of BPD was confirmed. At the time of inclusion in the study, patients were diagnosed with the following comorbid mental health conditions: affective disorders (12%), anxiety disorders (6%), eating disorders (4%), and addictive disorders (2%).ConclusionsThe hypodiagnosis of BPD in the early stages of the disorder has been identified, making it challenging to obtain high quality mental health care in a timely manner. The frequent comorbidity between BPD and other mental disorders has been confirmed. The study demonstrates the relevance of introducing programs (including education) to improve the diagnosis and study of comorbidity of BPD in real clinical practice. The pilot study results provide the basis for a project to investigate approaches to differential diagnosis and evaluation of treatment strategies for patients with BPD.Disclosure of InterestNone Declared

Depressive disorders in adolescents in outpatient psychiatric practice

To clarify the clinical features of depressive states in adolescent boys and girls (taking into account age and sex) seeking help from primary care specialists in outpatient psychiatric care. The study included 158 patients (89 boys and 69 girls), aged 15-17, with depressive pathology of various genesis, observed in the adolescent office of one of the Moscow psychoneurological dispensary in 2015-2020. The main research methods were clinical-psychopathological, clinical-follow-up, statistical. An analysis of the data demonstrated that adolescent depression can be observed within different diagnostic categories. Most often they were noted in patients with affective disorders (43%, n=68), emerging personality disorders (29%, n=46), schizotypal disorder (13%, n=21). The nosological affiliation of depression and its severity were associated with sex. In young men, depressive states were more often detected in the structure of emerging personality disorder (59.6%) and schizotypal disorder (15.7%), depressive states within affective disorders were detected in 22.5% of cases. In girls, most of the depressive episodes (69.6%) developed in the structure of affective disorders, less often in personality disorders (20.3%), and schizotypal disorder (10.1%). Depressive episodes in girls were predominantly of moderate severity, in boys the most common were mild depressions. Adolescent depressions are a nosologically heterogeneous group of affective disorders, differing in clinical phenomenology and prognosis. They are noted within the pathology of the affective spectrum, affective phases and psychogenic reactions acting in the dynamics of emerging personality disorders, within the framework of psychopathological diathesis, schizotypal disorder. The influence of sex on the development of depressive disorders is determined by the nosological framework of the condition.

A Veterans Affairs' perspective in response to Best Practice Model Subcommittee attribute statements for outpatient psychiatric pharmacists.

We applaud the work published by Lee et al1 and the best practice model subcommittee in their attribute statements for defining the optimal recommendations for outpatient psychiatric pharmacy practice. This serves as an excellent foundation in standardizing the expectations for clinical pharmacist practitioners (CPP) within outpatient mental health (MH) settings and our group believes these defined statements are being applied at the Department of Veterans Affairs (VA).2 Measurement-based care, suicide assessment, and comprehensive medication management (CMM) are all standards of care for VA outpatient MH CPP.3 The goal of our letter is to highlight the VA MH CPP model and the advancements in access, quality impact, and standardization.Integrating the MH CPP into the team-based care model significantly improves access to care, primarily when the CPP is utilized as a primary MH provider. Many strong CPP practices within the VA have been identified, including CPP integration into primary care MH services, outpatient MH clinics, specialty MH, and residential rehabilitation programs. Other strategies utilized by VA MH CPP to optimize access include utilizing analytics to target specific clinical interventions (population management), posthospital discharge appointments, and enhanced patient care in suicide risk stratification.In October 2017, the VA Pharmacy Benefits Management (PBM) partnered with the Office of Rural Health to increase access to care for veterans by utilizing MH CPPs as MH prescribers. Within 2½ years from its inception, 40 MH CPPs were hired, which increased direct patient care access and quality by providing CMM for 51 210 rural-residing patients.4 Due to the initiative's positive impact on patient care, an additional 46 MH CPP were hired in FY20/21, which demonstrates the importance of optimizing the MH CPP role in the team-based care model.MH CPP within the VA have established guidance for how to create a positive impact in the VA's internal performance metrics, including population management, continuity of care, experience of care, behavioral health screenings, and suicide risk management. They are also instrumental in serving as facility champions for psychotropic stewardship and safety. One of the attribute statements proposed by Lee et al1 recommends prescriptive authority and/or a collaborative practice agreement. In collaboration with VA PBM, a care coordination agreement (CCA) was created for MH CPP and establishes a partnership between MH and pharmacy services. This CCA covers many of the attribute statements, including attribute statements 14-24 and 27. The CCA is approved by service leadership and the chief of staff to ensure these attribute statements are being upheld. The PBM has also developed a business rules document to guide standardization of MH CPP practice within the VA. This includes in-depth descriptions defining clinical pharmacy practice, patient care delivery, optimizing access and integration, and documentation of workload.Overall, the VA has taken great strides to advance the practice of MH CPPs. Current practice by VA MH CPPs incorporates many of the attribute statements. We are hopeful that these well-developed attribute statements will help foster all psychiatric pharmacists to practice at the highest level of care, achieve reimbursement for clinical services, and bolster patient and provider satisfaction.

Best practice model for outpatient psychiatric pharmacy practice, part 2: Confirmation of the attribute statements.

IntroductionThe American Association of Psychiatric Pharmacists (AAPP) used multiple modalities to develop and refine 28 attribute statements to describe a best practice model for outpatient psychiatric pharmacists. Before addressing implementation, assessment, and field testing, it was necessary to finalize and confirm the statements and their supporting narratives among stakeholders. The objective of this project was to confirm the attribute statements and supporting justifications for a best practice model for outpatient psychiatric pharmacists providing direct patient care.MethodsThe 4 phases that resulted in the 28 attribute statements and supporting narratives have been described and published elsewhere. As part of phase 5, the confirmation survey was distributed to pharmacists and resident members of AAPP in November 2021 for 3 weeks.ResultsThe survey respondents (n = 74; 6.1%) were licensed pharmacists for an average of 15.6 years (SD = 12.0) and had been practicing as psychiatric pharmacists for an average of 11.3 years (SD = 10.4). Slightly more than half (54.2%) of the respondents reported practicing in the outpatient setting and three-fourths (74.3%) were Board Certified Psychiatric Pharmacists. For each of the 28 statements, more than 90% of respondents either agreed or agreed with minimal reservations.DiscussionGiven the high degree of agreement on the proposed practice model statements, they will be used as the basis for the outpatient psychiatric pharmacist best practice model. Next steps in developing this model include establishing implementation guidance, determining appropriate metrics for evaluation of these statements in practice, and establishing appropriate field-testing methods.

Best practice model for outpatient psychiatric pharmacy practice, part 1: Development of initial attribute statements.

IntroductionA 2019 survey identified significant variability of practice characteristics among outpatient psychiatric pharmacists (OPPs). No published model establishes which attributes constitute best practice for OPPs. By developing a consensus for best practice model attributes, OPPs can work toward consistent, effective patient care. This project aimed to develop attribute statements for a best practice model for OPPs providing direct patient care.MethodsBoard Certified Psychiatric Pharmacists and American Association of Psychiatric Pharmacists (AAPP) members were questioned using a 5-phase (P1-P5) survey and summit approach. The phases were: P1, broad ideation survey; P2, 10-person summit to develop draft statements; P3, survey of the draft statements for acceptance; P4, summit to resolve review feedback; and P5, survey of AAPP membership to confirm the finalized statements.ResultsP1 survey results generated a list of 143 possible attributes that informed the P2 summit, which were refined to 28 statements. P3 survey results confirmed at least 70% agreement with each statement. The P4 summit evaluated all P3 survey results and made significant modifications to 4 statements. Informal feedback was sought with other stakeholders, and supporting narratives and references were developed to provide clarity regarding the intent of each statement. Finalized statements and supporting narratives were confirmed in the P5 survey.DiscussionThe 28 attribute statements were developed over 18 months by gathering input and consensus through multiple modalities, including 3 surveys, 2 summit meetings, and numerous informal feedback requests. The agreement on the attribute statements was consistently high across all phases. The final attribute statements are presented elsewhere in this issue.

Innovations in Psychopharmacology Education in U.S. Psychiatric Residency Programs.

Medications available to treat psychiatric illnesses continue to increase, in conjunction with a shifting of outpatient psychiatric practice from psychotherapy toward medication management. To be successful in this climate, a psychiatrist needs to select the appropriate pharmacologic option(s) for their patient, drawing from old and new psychotropics while accounting for variables such as a patient's comorbid medical conditions and potential drug-drug interactions. In the absence of any national psychopharmacology training guidelines, these skills are taught to varying degrees in American psychiatric residency training programs. The past 20 years have seen an increase in innovations in the areas of psychopharmacology curricula topics, teaching strategies, and assessments of psychopharmacology knowledge and skills. Psychiatric training programs can benefit from and build on these innovations, ensuring that all physicians graduating from a psychiatric residency program meet psychopharmacology-based learning objectives and that their learning can be measured in a valid and reliable way.

Comparison of the Metabolic Characteristics of Newer Second Generation Antipsychotics: Brexpiprazole, Lurasidone, Asenapine, Cariprazine, and Iloperidone With Olanzapine as a Comparator.

Extensive research has been conducted comparing the metabolic characteristics of older second-generation antipsychotics (SGAs); minimal data exist comparing the long-term metabolic effects of SGAs approved in the last 10 years. A retrospective chart review of patients treated with brexpiprazole, lurasidone, asenapine, cariprazine, and iloperidone (newer SGAs) for at least 6 weeks at an outpatient psychiatric practice was conducted. Patients treated with olanzapine, an older SGA, were included as a comparator. Metabolic characteristics were collected at baseline, approximately 6 weeks, 12 weeks, and for up to 12 months. Of the newer SGAs, there were statistically significant increases in patients' average weight at 12 weeks and 1 year or less with brexpiprazole (2.48 lb, P = 0.02; 5.97 lb, P = 0.01) and iloperidone (4.54 lb, P < 0.01; 5.13 lb, P = 0.02). Brexpiprazole and iloperidone resulted in significant increases in body mass index, up to a 0.90-kg/m2 average increase in patients taking brexpiprazole at 1 year or less. Minimal weight gain was seen with cariprazine (4.25 lb, P = 0.42) and asenapine (1.80 lb, P = 0.62) at 1 year or less after treatment initiation. Although not statistically significant, lurasidone showed an average weight loss of up to 0.60 lb at 1 year or less (P = 0.56). Although some weight gain was seen with the newer SGAs, all demonstrated significantly favorable metabolic characteristics compared with olanzapine. Monitoring of weight and metabolic parameters remain important in patients treated with SGAs.

Ten Years of Experience With Buprenorphine in a Private Psychiatric Outpatient Practice.

There have been few reports of buprenorphine treatment of opioid use disorder in private psychiatric practice. This report describes such a patient population and the outcomes obtained. Chart reviews were performed on 285 patients seen over a 10-year period in the author's solo private psychiatric practice. Quantitative and qualitative data were reviewed and analyzed. Comorbidity of psychiatric disorders was high (75%), while comorbidity of substance use disorders was low (5%, alcohol only). Fourteen percent of patients completed treatment (tapered off of buprenorphine and remained opioid-free for up to 7 years). Forty-eight percent of the sample had good outcomes (remaining on buprenorphine and abstinent of other opioids), 28% had poor outcomes, and 10% dropped out of prolonged successful treatment with unknown final outcomes. The group achieved a relatively high rate of smoking cessation during the study (22%). There were high rates of language disorder (21.6%) and autism spectrum disorder (8.6%) in children of mothers in the study. Outcomes were excellent compared with those reported in other treatment settings. Rates of smoking cessation were also notable. The treatment of comorbid psychiatric conditions, the setting to develop a strong physician-patient relationship, patients choosing whether to taper off of buprenorphine, and the slow rate of taper all likely contributed to successful outcomes. Further investigation is needed regarding possible increased rates of developmental disorders in children of mothers treated with buprenorphine. Private psychiatric practice is a highly successful domain for the treatment of opioid use disorder. (Am J Addict 2020;29:508-514).

Patterns of Vitamin D Deficiency in a Community Outpatient Psychiatric Practice: a Real-World Evaluation of Treatment Gaps.

Vitamin D is traditionally recognized for its role in bone mineralization but recent observations suggest additional pertinent functions in neuronal biology. The present study examines the rate and pattern of Vitamin D deficiency in the outpatient mental health clinic of a community teaching hospital as well as the vitamin D supplementation practices of outpatient psychiatrists. Participants include 148 consecutive psychiatric outpatients. Individuals with conditions that alter the metabolism of vitamin D were excluded from the study as are those who may be taking medications that influence Vitamin D metabolism. Statistical analysis was performed using the SPSS 25th edition, statistical significance set at p< 0.05. The majority of patients in the study were between 41 and 65years old (n= 91, 61.5%), African American (n= 120, 81.1%) and female (n= 80, 54.1%). The median level is 23.7ng/ml. As defined by the Endocrine Society's Clinical Practice Guidelines, 68.2% of the population had insufficient and deficient Vitamin D levels (32.4% and 35.8% respectively), 62.4% of whom were not prescribed any Vitamin D supplementation and of this untreated group, 84% were African Americans. No clinical or demographic characteristics showed any statistical difference in both the "treated" and "not treated groups". Logistic regression did not reveal any significant predictors for Vitamin D deficiency. Vitamin D deficiency remains a significant issue among patients with psychiatric disorders. Our findings show gaps in Vitamin D deficiency treatment and recommend that future studies examine physician prescription practices in light of the racial disparity in Vitamin D deficiency treatment oberved in this study.

Use of PHQ-9 and pharmacogenetic testing in clinical practice.

This project evaluated the clinical use of pharmacogenetic testing in an outpatient psychiatric practice, integrated a standardized measure for assessing depressive symptoms, and captured data regarding treatment efficacy. According to the Centers for Disease Control and Prevention (2016), more than 10% of all outpatient office visits include a depression-related diagnosis. Patients who require more medication trials to experience remission of depressive symptoms are more likely to relapse in the follow-up period than those who do not (National Institute of Mental Health, 2001). Baseline Patient Health Questionnaire-9 (PHQ-9) scores and medication regimens were recorded for 15 adults with major depressive disorder who completed pharmacogenetic testing. Repeat PHQ-9 scores and medication regimens were recorded at follow-up appointments within 6 weeks post-pharmacogenetic testing and compared with baseline data. The PHQ-9 scores ranged from a 5-point reduction to a 2-point increase in depressive symptoms at follow-up appointment. The PHQ-9 scores were lower at follow-up screening for 14 participants. Six of the 15 participants were on a single medication, with significant drug-gene interactions. Medications with significant drug-gene interactions were eliminated from the regimen for three of the six patients. For the remaining three patients, providers deemed it to be reasonable to continue the medications with significant drug-gene interactions. Pharmacogenetic testing is a useful clinical tool for guiding medication selection but does not replace provider judgment. Drug-gene interaction testing results should be considered in addition to patient preference, medication cost, possible side effects, and immediate clinical needs.

Clinical Impact of Pharmacogenetic-Guided Treatment for Patients Exhibiting Neuropsychiatric Disorders: A Randomized Controlled Trial.

Pharmacogenetic testing holds promise as a personalized medicine tool by permitting individualization of pharmacotherapy in accordance with genes influencing therapeutic response, side effects, and adverse events. The authors evaluated the effect on outcomes for patients diagnosed with neuropsychiatric disorders of pharmacogenetics (PGx)-guided treatment compared to usual standard of care. This was a prospective, randomized study of 237 patients at an outpatient community-based psychiatric practice conducted between April 2015 and October 2015. Baseline patient assessments and a buccal swab were collected for pharmacogenetic testing at study initiation. For the experimental group, PGx results were provided to the clinicians as guides to treatment. Control subjects were treated according to the usual standard of care with no clinician reference to their PGx results. Neuropsychiatric Questionnaire (NPQ) and Symbol Digit Coding Test (SDC) scores and adverse drug events, hospitalizations, and medication information were collected at 30, 60, and 90 days. More than half (53%) of patients in the control group reported at least 1 adverse drug event compared to 28% of patients with PGx-guided medication management (P = .001). NPQ and SDC scores improved for both groups, but no statistical difference in efficacy as measured by these assessments was observed within the 90-day observation period. Pharmacogenetic testing may facilitate psychiatric drug therapy with greater tolerability and similar efficacy compared to standard of care. ClinicalTrials.gov Identifier: NCT02411123​​.

Patterns of Psychiatric Outpatient Practice in Taiwan: A Nationwide Survey.

(1) Background: Limited studies have utilized nationwide data to assess the patterns of psychiatric practice in other countries. In this study, data from the National Health Insurance Research Database in Taiwan (NHIRD-TW) for 2012 was analyzed to determine the patterns of psychiatric outpatient practice in Taiwan; (2) Methods: To determine the patterns of psychiatric outpatient practice in Taiwan, the data were drawn from the datasets of Taiwan’s National Health Insurance Research Database for 2012, with 619,760 records of outpatient visits representing 1/500 of all the claims in Taiwan for that year. The analysis of psychiatric outpatient visits included patient demographics, diagnoses, and prescribed medications; (3) Results: Neurotic disorders were the most prevalent diagnoses (43.1%, n = 5714). Hypnotics-sedatives and anxiolytics were prescribed in 51.7% (n = 6850) and 39.1% (n = 5181) of psychiatric visits, respectively, with zolpidem being the most commonly prescribed drug (22.6%, n = 2998); and (4) Conclusion: Hypnotics and sedatives were widely prescribed for the outpatient population, and zolpidem had the highest annual prevalence of use. These findings deserve the attention of clinicians and policy makers for monitoring the abuse and dependence of these agents and subsequent adverse events.

Diagnostic profiles of adult psychiatric outpatients with and without attention deficit hyperactivity disorder

ObjectiveDespite growing recognition that attention deficit/hyperactivity disorder (ADHD) is a highly prevalent, impairing, and comorbid disorder that persists into adulthood, reports on the nature and extent of its psychiatric comorbidities have been mixed to date. This study compared the prevalence rates of all major Axis I disorders as well as borderline personality disorder in an unselected sample of adult psychiatric outpatients with and without ADHD. MethodsAs part of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we administered a DSM-IV-based semi-structured diagnostic interview assessing ADHD and other psychiatric disorders to 1134 patients presenting for initial evaluation at an outpatient psychiatric practice. Logistic regression analyses were used to compare the rates of each disorder in patients with versus without an ADHD diagnosis (both overall and by Combined and Inattentive type). ResultsPatients with (versus without) any ADHD diagnosis had significantly higher rates of bipolar disorder, social phobia, impulse control disorders, eating disorders, and BPD, and significantly lower rates of major depressive disorder and adjustment disorder (all p<.05). Patients with (versus without) ADHD-Inattentive type had significantly higher rates of social phobia and eating disorders, whereas those with (versus without) the ADHD-Combined type had significantly higher rates of bipolar disorder, alcohol dependence, and BPD (all p<.05). ConclusionIn this novel investigation of the psychiatric profiles of an unselected sample of treatment-seeking adult outpatients with versus without ADHD, a distinct pattern of comorbidities emerged across subtypes, with implications for the accurate assessment and treatment of patients presenting for psychiatric care.

Results of a Transpersonal, Narrative, and Phenomenological Psychotherapy for Psychosis

In our academically based, psychiatric outpatient practice, we have encountered those who wish to avoid medications for treatment for psychosis. This study is a qualitative/ quantitative study in progress of a patient population diagnosed with psychosis and managed primarily without medication. We reflect upon the transpersonal foundations of an approach in which voices and visions are accepted as real, given full ontological status, and addressed within a dialogical framework. We present interim data on a series of 51 patients over 20 years old who presented with psychosis and who remained with us for at least six months in their effort to reduce or eliminate medication. (An additional 201 patients presented themselves for treatment but did not continue for six months.) The practitioners use questionnaires to quantify symptom level, including the Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale, two depression rating scales, the Clinical Global Inventory, and the Revised Behavior and Symptom Identification Scale. In addition, narrative interviews are utilized in a review of symptoms. Of these 51 individuals, 38 managed psychosis without the use of medication (or with very occasional medication as sleeping assist). Another nine managed well on low dose medications. Three individuals required higher levels of medication and one became progressively worse despite all efforts and was eventually involuntarily placed in the State Hospital. The overall cost-benefit is favorable in creating fewer hospitalization, crises, and diminished suicidality. The results do not hint at one algorithmic solution, but suggest the need for individualized approaches that are client-centered and build upon the previous successes of the person, enroll family and friends in a community effort, and collaborate with those communities to apply those approaches desired by the people themselves. We are optimistic that this dialogical approach to psychosis in which lived experience is granted full ontological reality can facilitate recovery of function in the ordinary, consensual world. Each person’s narrative is unique and not necessarily transferable to any other person. How people arrive at successful solutions is varied and makes sense only within their local context and knowledge communities.

Reliability and validity of a semi-structured DSM-based diagnostic interview module for the assessment of Attention Deficit Hyperactivity Disorder in adult psychiatric outpatients

Despite growing recognition that the symptoms and functional impairments of Attention Deficit/Hyperactivity Disorder (ADHD) persist into adulthood, only a few psychometrically sound diagnostic measures have been developed for the assessment of ADHD in adults, and none have been validated for use in a broad treatment-seeking psychiatric sample. The current study presents the reliability and validity of a semi-structured DSM-based diagnostic interview module for ADHD, which was administered to 1194 adults presenting to an outpatient psychiatric practice. The module showed excellent internal consistency and interrater reliability, good convergent and discriminant validity (as indexed by relatively high correlations with self-report measures of ADHD and ADHD-related constructs and little or no correlation with other, non-ADHD symptom domains), and good construct validity (as indexed by significantly higher rates of psychosocial impairment and self-reported family history of ADHD in individuals who meet criteria for an ADHD diagnosis). This instrument is thus a reliable and valid diagnostic tool for the detection of ADHD in adults presenting for psychiatric evaluation and treatment.

Improving the No-Show Rate of New Patients in Outpatient Psychiatric Practice: An Advance Practice Nurse-Initiated Telephone Engagement Protocol Quality Improvement Project.

The aim is to improve the uptake of psychiatric services for new patients being referred from primary care, counseling, and hospital discharge follow-up care. A convenience sample of 18 new patients participated in a provider-initiated telephone protocol to increase knowledge related to psychiatric treatment and remind patients of appointments the day before the initial visit. Fifteen patients attended the initial visit, resulting in a 26% reduction rate of no-show rates from 27% the previous year to 20% in a 3-month period. Introduction and reminder calls by psychiatric providers improve no-show rates.

Search for sleep disorders in outpatient psychiatric practice

Search for sleep disorders in outpatient psychiatric practice

Continuity of Care in Psychiatric Outpatient Practice: Effect On Patient Satisfaction.

Evidence supports the hypothesis that the patient-psychiatrist relationship is a central feature of psychiatric care. It is also known that patient treatment satisfaction will result in improved adherence; therefore, the aim of this study was to investigate the relationship between patient treatment satisfaction and continuity of psychiatric care. The objective of this study was to evaluate the extent to which the continuity of psychiatric care is related to patient satisfaction. This research was conducted as an observational, non-experimental survey of all the patients who attend the NZOZ Centrum Terapii DIALOG in Warsaw, Poland. Patient satisfaction was assessed by using the 10-point subjective scale (1- lowest, 10 – highest level of satisfaction). A total of 160 patients met the inclusion criteria; 92 of them have visited a psychiatrist less than 5 times, 68 of them visited psychiatrist 5 times or more. The probability of the patient’s recommendation of the psychiatrist as calculated by the NPS method was 72,83% of the patients that have visited psychiatrist less than 5 times and 64,71% of the patients that have visited a psychiatrist 5 times or more. The average level of satisfaction was 9,16 points for the first group, and 8,89 points for the second group. The results of this study show the adverse correlation between continuity of psychiatric care and patient satisfaction. Further investigation should be made on how to prevent a decline in the level of patient satisfaction during continuous psychiatric care.

Problems of depressive insomnia

To evaluate the efficacy and safety of antidepressant agomelatine in relation to the normalization of circadian rhythms in a psychiatric outpatient practice. It was an open label, non-comparative observational study of 32 patients 18-55 years during the eight-week therapy of major depressive episode mild or moderate severity. For statistical analysis the obtained results were used software package Excel 97. On the background of treatment marked improvement in levels of depression and decreased intra-group scores of the indicators of the scale of Leeds. A statistically significant increase in the proportion of responders and remitters is achieved already in the first 2 weeks of therapy. Thus, in the course of the study, it was shown that along with antidepressant effects, agomelatine able to synchronize disturbed circadian rhythms and to correct sleep disorders in patients with depression.