Psychiatric Outpatient Setting Research Articles

Impact of animal-assisted therapy on subjective anxiety ratings and objective blood pressure measurements in children at an outpatient psychiatric setting

Impact of animal-assisted therapy on subjective anxiety ratings and objective blood pressure measurements in children at an outpatient psychiatric setting

Effectiveness of an add-on brief group behavioral activation treatment for depression in psychiatric care: a randomized clinical trial.

Behavioral activation (BA) is an effective treatment for depression. We investigated the effectiveness of add-on group-format BA and peer support (PS) with treatment as usual (TAU) in a registered randomized clinical trial in psychiatric outpatient settings (ISRCTN10647845). Adult outpatients (N = 140) with major depressive disorder (MDD) and Patient Health Questionnaire (PHQ-9) score ≥10 were randomized into a) group BA, consisting of eight 90-minute weekly group sessions plus TAU; b) group PS, including eight 90-minute weekly group sessions plus TAU; or c) TAU alone. The primary outcome was a within-individual change in PHQ-9 score between baseline and 8 weeks. Secondary outcomes were 1) response, 2) remission, and 3) functional impairment at 8 weeks, plus 4) change in PHQ-9 at 6 months. Of the randomized patients, 100 (71.4%) completed treatments, including 29/45 (64.4%) patients in the BA group, 39/49 (79.6%) in the PS group, and 32/46 (69.6%) in the TAU group. By 8 weeks, PHQ-9 scores declined most in the TAU group [BA -0.28 (95% CI -2.48, 1.92), PS -0.58 (-2.09, 0.94) vs. TAU -3.32 (-5.21, -1.44); group-difference test, p = 0.034]. The secondary outcomes in the BA or PS arms did not significantly differ from those in TAU. Videotaped sessions revealed marked variation in briefly trained therapists' adherence to the treatment manual. In this randomized trial, the effectiveness of treatments with the added BA and PS groups did not exceed that of TAU alone. The preconditions in which brief BA or PS group interventions benefit outpatients with depression in psychiatric settings warrant critical investigation.

Relationship Between Insomnia and Continued Outpatient Treatment in Psychiatric Patients.

Sleep plays an essential role in maintaining both physical and mental well-being. Many patients in psychiatric outpatient settings complain of insomnia. However, the causal relationship between insomnia and depressive symptoms in all mental illnesses remains unclear. Moreover, research on insomnia and the continuation of outpatient treatment is lacking. We hypothesize a high correlation between depression and insomnia among patients with diverse mental illnesses. Additionally, we posit that insomnia significantly influences the continuity of outpatient visits. To this end, we evaluated insomnia and depression symptoms in psychiatric patients both at their initial visit and one year later. We also examined factors related to insomnia at the outset and factors associated with the ongoing utilization of outpatient treatment. The participants of the study consisted of patients who made their first visit to the outpatient department of psychiatry and neurology at Showa University East Hospital between June 1, 2021, and March 31, 2023, and who continued attending the outpatient clinic for one year. Clinical characteristics were assessed using the Self-rating Depression Scale (SDS) and the Athens Insomnia Scale (AIS). The study's findings were collected from a cohort of 1106 patients and revealed that more than 70% experienced insomnia at the time of their initial visit. In total 137 patients continued to receive outpatient treatment for one year, and their AIS scores improved from 9 points to 5 points. A multivariate analysis revealed that the SDS items of depressed mood and insomnia were confounding factors influencing AIS improvement. Given that 70% of patients complained of insomnia at the time of their first visit and that sleep improved in many of the 12.4% of patients who continued to receive outpatient treatment for at least one year, the results suggest that sleep status is an important determinant of whether a patient continues to attend outpatient clinics.

Translating an integrative metacognitive model of psychotherapy for serious mental illness into a group format: A pilot investigation on feasibility.

Metacognitive reflection and insight therapy (MERIT) is an one-on-one intervention that targets insight with the aim to help people with serious mental illness develop more integrated ideas about themselves and others in order to respond to their psychological and social challenges more adaptively. There is a growing body of evidence on MERIT's effectiveness. Considering the clinical demand for more cost-effective group psychotherapies, we modified the original individual MERIT format to a group-based intervention (MERITg) for application in inpatient and outpatient psychiatric settings. Thirty-one participants (inpatient = 10; outpatient = 21) with serious mental illness were surveyed on their experience of MERITg, which was offered adjunctively to their routine clinical care. Program evaluation measures were used to assess the feasibility and acceptance of the group. Across locations, more than half of all participants attended more than one group. Participants reported attending the group initially because they thought writing would be helpful, and further reported that they liked the group because they enjoyed writing and the discussion, and that they found it interesting to hear the perspectives and writings of others. Findings further support the need for future research on the efficacy and effectiveness of the group and its relationship to changes in metacognitive capacity and recovery. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A feasibility study of provider-level implementation strategies to improve access to colorectal cancer screening for patients with schizophrenia: ACCESS2 (N-EQUITY 2104) trial

BackgroundPeople with schizophrenia have a lower colorectal screening rate than the general population. A previous study reported an intervention using case management to encourage colorectal cancer screening for patients with schizophrenia in psychiatric outpatient settings. In this feasibility study, we developed provider-level implementation strategies and evaluated the feasibility of conducting a definitive trial in terms of the penetration of the intervention assessed at the patient level. Additionally, we examined the fidelity of strategies to implement the intervention at the provider level in a routine clinical psychiatric setting.MethodsThis was a multicenter, single-arm feasibility study with medical staff at psychiatric hospitals in Japan. The provider-level implementation strategies developed in this study included three key elements (organizing an implementation team appointed by the facility director, interactive assistance using a clear guide that outlines who in the hospital should do what, and developing accessible educational materials) to overcome major barriers to implementation of the intervention and four additional elements (progress monitoring, joint meetings and information sharing among participating sites, adaptation of encouragement methods to specific contexts, and education of on-site staff), with reference to the elements identified in the Expert Recommendations for Implementing Change (ERIC). The feasibility of the strategies was evaluated by the proportion of patients who were eligible for encouragement (patients with schizophrenia aged 40, 50, or 60) who received encouragement. We set the goal of providing encouragement to at least 40% of eligible patients at each site.ResultsTwo public and four private psychiatric hospitals in Okayama and Shimane prefectures participated in this study. Regarding fidelity, all elements of the strategies were conducted as planned. Following the procedures in the guide, each team prepared and provided encouragement according to their own facility and region. Penetration, defined as the proportion of eligible patients who received encouragement, ranged from 33.3 to 100%; five of the six facilities achieved the target proportion.ConclusionsThe provider-level implementation strategies to implement encouragement were feasible in terms of penetration of the intervention assessed at the patient level. The results support the feasibility of proceeding with a future definitive trial of these strategies.Trial registrationjRCT, jRCT1060220026. Registered on 06/04/2022.

Patient-reported experience measures (PREMs) in outpatient psychiatry - is there an association to perceived discrimination and devaluation?

Patient-Reported Experience Measures (PREMs) are gaining significance in the field of psychiatry, with patient satisfaction being a key measure. However, it is unclear if patient satisfaction in psychiatry is influenced by variables outside the treatment setting. This brief report thus examines the possible impact of perceived discrimination and devaluation (PDD) on patient satisfaction in the psychiatric outpatient setting. Data from 1,126 individuals who were undergoing or had recently completed treatment at 15 outpatient centers of the Psychiatric University Clinic in Basel, Switzerland, was analyzed. Patient satisfaction was assessed using the Münsterlingen Patient Satisfaction Questionnaire (MüPF), and perceived stigma was measured with the Perceived Discrimination Devaluation Scale. The results revealed a positive small effect size relationship between MüPF and PDD, suggesting that patients who perceived less stigma report higher treatment satisfaction. This relationship may affect most ratings, with the total MüPF score remaining relatively robust against this potential influence. Linear regression analysis indicated that a one-unit increase in PDD score could lead to a maximum change of 1.8 points on the 7-point Likert scale for the MüPF item correlating highest with PDD and 0.4 points on the total MüPF score. These findings highlight the importance of considering perceived stigma when evaluating patient satisfaction with psychiatric outpatient treatment. Future research should investigate associations between stigma, patient satisfaction, treatment outcome, as well as other external factors that may influence patient satisfaction in psychiatric settings.

Facilitating In-House Mobile App Development Within Psychiatric Outpatient Services for Patients Diagnosed With Borderline Personality Disorder: Rapid Application Development Approach.

Mobile app development within mental health is often time- and resource-consuming, challenging the development of mobile apps for psychiatry. There is a continuum of software development methods ranging from linear (waterfall model) to continuous adaption (Scrum). Rapid application development (RAD) is a model that so far has not been applied to psychiatric settings and may have some advantages over other models. This study aims to explore the utility of the RAD model in developing a mobile app for patients with borderline personality disorder (BPD) in a psychiatric outpatient setting. The 4 phases of the RAD model: (1) requirements planning, (2) user design, (3) construction, and (4) cutover, were applied to develop a mobile app within psychiatric outpatient services for patients diagnosed with BPD. For the requirements planning phase, a short time frame was selected to minimize the time between product conceptualization and access within a clinical setting. Evidenced-based interactive content already developed was provided by current staff to enhance usability and trustworthiness. For the user design phase, activity with video themes and a discrete number of functions were used to improve the app functionality and graphical user interface. For the construction phase, close collaboration between clinicians, researchers, and software developers yielded a fully functional, in-house-developed app ready to be tested in clinical practice. For the cutover phase, the mobile app was tested successfully with a small number (n=5) of patients with a BPD. The RAD model could be meaningfully applied in a psychiatric setting to develop an app for BPD within a relatively short time period from conceptualization to implementation in the clinic. Short time frames and identifying a limited number of stakeholders with relevant skills in-house facilitated the use of this model. Despite some limitations, RAD could be a useful model in the development of apps for clinical populations to enable development and access to evidence-based technology.

Improvement of anxiety in ADHD following goal-focused cognitive remediation: a randomized controlled trial.

Despite the high prevalence and detrimental consequences of cognitive and executive dysfunction in ADHD, the evidence base of cognitive remediation in the adult ADHD population is sparse. Executive problems can increase both anxiety and depression in ADHD. Thcus, it is important to develop treatment options for adults with ADHD, aiming to improve goal-directed behavior and mood. Goal Management Training (GMT) is an intervention that has received empirical support in improving executive functions and mood in normal aging and for various neurological and psychiatric conditions. The present randomized controlled trial investigated the effects of a goal-focused intervention combining 1) group-based GMT incorporating psychoeducation about ADHD and 2) guidance in implementing individual goals for coping with executive problems in everyday life, compared to treatment as usual (TAU). The primary outcome was perceived executive functioning in everyday life. Secondary outcomes included psychological well-being (anxiety, depression, and coping with ADHD symptoms). We recruited 81 adult participants with a verified ADHD diagnosis (Mage = 31 years). Inclusion was based upon the presence of executive functioning complaints. The participants were randomly assigned to either the intervention or TAU. The intervention group (n = 41) received 16 hours of GMT and psychoeducation, in addition to 4 individual sessions focusing on formulating goals. The goals were assessed in 6 bi-weekly phone calls in the first three months following the group sessions. Participants in the TAU group (n = 40) received standard, individually-adapted follow-up in an outpatient psychiatric health care setting. All participants were assessed at baseline, post-intervention, and at 8-month follow-up (main measurement time point). Significant improvements in everyday executive functioning, psychological wellbeing, and symptoms of ADHD from baseline to 8-month follow-up were reported in both groups. The intervention group reported a significantly higher reduction in symptoms of anxiety compared to TAU. Conclusions. Our findings provide support for considering cognitive remediation as a treatment option for patients with ADHD.Clinical Trial Registration: https://clinicaltrials.gov/study/NCT04638283?term=NCT04638283&rank=1, identifier: NCT04638283.

Implementing Video Consultations in a Rural Psychiatric Outpatient Clinic: A Feasibility Study

Introduction. Multiple efficacy studies have shown that treatment provided via video consultation (VC) can be equivalent to in-person (IP) consultation for people with psychiatric diagnoses. However, despite the great promise of VC, it has not been widely implemented in psychiatric outpatient services. This study investigated the feasibility aspects of VC in clinical practice and examined a range of factors associated with the implementation of this modality of treatment within psychiatric outpatient services. Methods. This study had a pragmatic design, where 40 consecutive referrals for people with anxiety, personality, or depressive disorders were given the choice to receive eight weekly treatment sessions via VC or IP modality within an outpatient psychiatric setting. Information on demand, acceptance, engagement, implementation, and potential negative effects for treatment conducted via VC were collected to help identify factors that may impact on the uptake of VC within the psychiatric outpatient service. Results. There was a high demand and acceptance for VC, with 44% (n = 15) of the patients choosing to receive eight weekly treatment sessions via VC, and acceptance was rated highly. Engagement with VC modality was good, with only a very small percentage (13%, n = 2) not completing treatment. A good level of working alliance was established and largely maintained throughout treatment for patients and case managers. There were differences in the utilization of VC compared to the IP modality, with the VC modality having a greater focus on supportive counseling and IP modality having a greater focus on psychotherapy. Overall, the duration of treatment conducted via VC was also slightly shorter than that of IP consultations. There were no negative effects registered for consultations via video. Conclusions. Findings suggest a high patient demand and acceptance for VC within psychiatric services, with good levels of engagement and alliance reported. Differences in focus and duration in VC compared to IP may reflect clinicians’ different attitudes and/or approaches to providing treatment, depending on whether it is VC or IP consultations.

Acceptability, feasibility, and user satisfaction of a virtual reality relaxation intervention in a psychiatric outpatient setting during the COVID-19 pandemic.

The COVID-19 pandemic was particularly difficult for individuals with mental disorders. Due to governmental restrictions, face-to-face offers for psychiatric outpatients like therapies, psychoeducational groups or relaxation courses were limited. Virtual reality (VR) might be a new possibility to support these patients by providing them with a home-based relaxation tool. The aim of this study was to evaluate the acceptability, feasibility, and user satisfaction of a supportive therapy-accompanying, relaxation VR intervention in psychiatric outpatients during the COVID-19 pandemic in Germany. The four-weeks VR intervention consisted of regular watching of relaxing videos in the participants' home environment. Sociodemographics, feasibility (frequency of use, user-friendliness), satisfaction (Client Satisfaction Questionnaire-8), depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), and credibility and expectancy (Credibility Expectancy Questionnaire-8) were measured in an intention-to-treat (ITT) analysis and a per-protocol (PP) analysis of completers. In total, N = 40 patients participated in the study. Most of the participants in the ITT analysis (n = 30, 75.0%) used the VR device three or 4 weeks. A majority of the N = 29 completers (PP: n = 18, 62.1%) used it all 4 weeks. Most participants used the device two or more times a week (ITT: n = 30, 83.3%; PP: n = 26, 89.7%) and described the user-friendliness as rather or very easy (ITT: n = 33, 91.7%; PP: n = 26, 89.7%). User satisfaction was high (ITT: 19.42, SD = 4.08; PP: M = 20.00, SD = 4.19) and did not correlate with participants' sex or age (all p < 0.05). Depressive symptoms and psychological quality of life improved significantly from pre-to post-intervention (ITT and PP, all p < 0.05). Higher pre-intervention credibility significantly correlated with a better outcome of satisfaction (ITT and PP), depressive symptoms, physical, psychological, and social quality of life (PP; all p < 0.05). A supportive therapy-accompanying VR relaxation intervention is feasible and acceptable in a psychiatric outpatient setting. Due to the high satisfaction and user-friendliness, VR can be an easy to implement relaxation tool to support psychiatric outpatients. https://clinicaltrials.gov/, DRKS00027911.

Using a Quality Improvement Approach to Implement Measurement-Based Care (MBC) in Outpatient General Psychiatry.

Measurement-based care (MBC) is the clinical practice of using patient-reported symptom measurement to inform treatment decisions. MBC has been shown to improve patient outcomes and quality of care in outpatient psychiatry. Despite these benefits, MBC is not routinely used in most psychiatric outpatient settings. This quality improvement (QI) project aimed to achieve 75% completion of symptom scales using an online MBC platform in a general psychiatry clinic in Toronto, Canada, by June 2022. The QI team used the Model for Improvement methodology. The main outcome measure was completion of symptom scales using an online MBC platform. Process measures included counts of invitations to join the MBC platform, counts of online MBC account creation, and counts of symptom scale assignment by clinicians. Balancing measures included administrative task completion and physician workload assessment. Stakeholder interviews explored barriers and facilitators to MBC utilization. Completion of symptom scales increased from 7/65 (10.8%) preintervention to 40/70 (57.1%) during the 26-week intervention. Clinician reminders and coaching clinicians about how to incorporate MBC into the care process facilitated uptake of MBC. Stakeholders identified several barriers to implementation, particularly physician attitudes toward MBC and perceived administrative burden. Completion of symptom scales increased over the course of this QI initiative. Successful implementation of MBC in general psychiatry outpatient settings requires the availability of a broad range of measurement scales given the diversity of mental health diagnoses. Implementation must also consider health equity, including access to technology and availability of symptom scales in multiple languages.

“It’s ok that I feel like this”: a qualitative study of adolescents’ and parents’ experiences of facilitators, mechanisms of change and outcomes in a joint emotion regulation group skills training

BackgroundEmotion regulation difficulties underlie several psychiatric conditions, and treatments that focus on improving emotion regulation can have an effect on a broad range of symptoms. However, participants’ in-depth experiences of participating in emotion regulation treatments have not been much studied. In this qualitative study, we investigated participants’ experiences of a joint emotion regulation group skills training in a child and adolescent psychiatric outpatient setting.MethodsTwenty-one participants (10 adolescents and 11 parents) were interviewed about their experiences after they had participated in a seven-session transdiagnostic emotion regulation skills training for adolescents and parents. The aim of the skills training was to decrease emotion regulation difficulties, increase emotional awareness, reduce psychiatric symptoms, and enhance quality of life. The skills training consisted of psychoeducation about emotions and skills for regulating emotions. The interviews were transcribed and analysed using reflexive thematic analysis.ResultsThe analysis resulted in three overarching themes: Parent – Child processes, Individual processes, and Group processes. The result showed that participants considered an improved parent-child relationship to be the main outcome. Increased knowledge, emotion regulation skills and behavioural change were conceptualised as both mechanisms of change and outcomes. The group format, and the fact that parents and adolescents participated together, were seen as facilitators. Furthermore, the participants experienced targeting emotions in skills training as meaningful and helpful.ConclusionThe results highlight the potential benefits of providing emotion regulation skills training for adolescents and parents together in a group format to improve the parent-child relationship and enable the opportunity to learn skills.

Enhancing educational and vocational recovery in adolescents and young adults with early psychosis through Supported Employment and Education (SEEearly): study protocol for a multicenter randomized controlled trial

BackgroundPsychotic disorders often develop a chronic course with devastating consequences for individuals, families, and societies. Early intervention programs for people in the first 5 years after the initial psychotic episode (early psychosis) can significantly improve the outcome and are therefore strongly recommended in national and international guidelines. However, most early intervention programs still focus on improving symptoms and relapse prevention, rather than targeting educational and vocational recovery. The aim of the present study is to explore the effects of Supported Employment and Education (SEE) following the Individual Placement and Support (IPS) model in people with early psychosis.MethodsThe SEEearly trial compares treatment as usual (TAU) plus SEE to TAU alone in outpatient psychiatric settings. The study is a six-site, two-arm, single-blinded, superiority randomized controlled trial (RCT). Participants are randomly assigned (1:1) to the intervention or control group. Aiming to recruit 184 participants, with an assumed drop-out rate of 22%, we will be able to detect a 24% difference in the main outcome of employment/education with 90% power. We make assessments at baseline and at 6- and 12-month follow-ups. Outcome data on employment/education, medication, and current psychiatric treatment is obtained monthly through phone based short assessments. The primary outcome is steady participation for at least 50% of the 12-month follow-up in competitive employment and/or mainstream education. Secondary employment outcomes capture length of employment/education, time to first employment/education, monthly wages/educational attainment, and social return on investment (SROI). Secondary non-employment outcomes include subjective quality of life, psychopathology, substance use, relapse, hospitalization, and functional impairment. To be eligible, participants must be between 16 and 35 years, fulfill diagnostic criteria for early psychosis, and be interested in competitive employment and/or mainstream education.DiscussionIn SEEearly, we hypothesize that participants with psychosis, who receive TAU plus SEE, present with better primary and secondary outcomes than participants, who receive TAU alone. Positive results of this study will justify SEE as an evidence-based strategy for clinical routine treatment in people with early psychosis.Trial registrationSEEearly was registered nationally and internationally in the German Clinical Trials Register (DRKS; identifier: DRKS00029660) on October 14, 2022.

Clinical utility of new cut-off scores for the world health organization ADHD self-report scale among adolescents in psychiatric outpatient care

Previous analyses of the proposed cut-off score for the 18-item World Health Organization ADHD Self-Report Scale (ASRS-18) among psychiatrically referred adolescents have shown limited clinical utility. This prospective study examined the diagnostic accuracy and clinical utility of new cut-off scores of the ASRS-18 in a consecutive sample of 111 Swedish adolescent psychiatric outpatients. Using the Kiddie Schedule of Affective Disorders and Schizophrenia (K-SADS) as the reference standard and based on predefined sensitivity and specificity criteria, multiple new general and sex-specific cut-off scores were evaluated. Results showed that clinical utility was greater for sex-specific cut-off scores than for general cut-off scores. The greatest change in pre-test to post-test probability of ADHD diagnosis was observed with a balanced, high-specificity diagnostic cut-off score for girls, where the probability of ADHD increased from 40% pre-test to 82% post-test. The proposed new cut-off levels for the ASRS-18 are useful for the detection and identification of ADHD among adolescents in general psychiatric outpatient settings.

Enhancing Quality of Care Through Evidence-Based Practice: Training and Supervision Experiences.

Evidence-based practice (EBP) is the preferred approach to treatment in mental health settings because it involves the integration of the best available research, clinical expertise, and patient values to optimize patient outcomes. Training on empirically supported treatments (ESTs) in mental health settings is an important component of EBP, and supervision of therapists' implementation of ESTs is critical for therapists to develop and maintain a strong EBP skill set. This study aimed to evaluate training and supervision histories of therapists in outpatient and inpatient psychiatric care settings as an essential first step in improving patient outcomes. Electronic surveys were completed by 69 therapists, most of whom had a master's degree, within a psychiatry and behavioral sciences department at an academic institution. Participating therapists were recruited from several outpatient and inpatient mental health settings serving children, adolescents, and adults. Although most therapists reported completing some form of EST-related coursework, a majority did not receive any supervision related to implementation of ESTs (51% for cognitive-behavioral therapy cases, 76% for dialectical behavior therapy cases, and 52% for other EST cases) during graduate and postgraduate training. Although research from the past decade has supported the need for improvements in training on ESTs, and especially in supervision, problems related to limited exposure to training and supervision among therapists still exist. These findings have implications for how mental health centers can evaluate staff members' EST training and supervision experiences, training needs, and associated training targets to improve the quality of routine care.

Cognitive Behavioral Therapy for Late-Life Depression (CBTlate): Results of a Multicenter, Randomized, Observer-Blinded, Controlled Trial

Introduction: Different psychotherapeutic interventions for late-life depression (LLD) have been proposed, but their evaluation in large, multicenter trials is rare. Objective: The present study evaluated the efficacy of a specific cognitive behavioral therapy (CBT) for LLD (LLD-CBT) in comparison with a supportive unspecific intervention (SUI), both administered in a specialist psychiatric outpatient setting. Methods: In this randomized, controlled, parallel group trial, we recruited participants (≥60 years) with moderate to severe depression at 7 trial sites in Germany. Participants were randomly assigned to the LLD-CBT or SUI group. The primary outcome was depression severity at the end of treatment measured by change on the Geriatric Depression Scale (GDS). Secondary outcomes included change in observer-rated depression, anxiety, sleep ratings, and quality of life throughout the treatment phase and at 6-month follow-up. Results: Between October 1, 2018, and November 11, 2020, we randomly assigned 251 patients to either LLD-CBT (n = 126) or SUI (n = 125), of whom 229 provided primary-outcome data. There was no significant between-group difference in the change in GDS scores at the end of treatment (estimated marginal mean difference: −1.01 [95% CI: −2.88 to 0.86]; p = 0.287). Secondary analyses showed significant improvements in several outcomes after 8 weeks and at follow-up in both treatment arms. Conclusions: Our data suggest that LLD-specific CBT and a supportive unspecific treatment both provide clinical benefit in patients with moderate to severe LLD without evidence for superiority of LLD-CBT.

Patient experience with telehealth service in a mental health setting

The purpose of the quality improvement project is to explore the patient experience of telehealth services in a mental health setting during the COVID-19 pandemic. A cross-sectional survey design was deployed in an outpatient psychiatric setting. Forty-five participants completed the survey, and the smartphone was the most frequently used and preferred device for their telehealth service. Participants exhibited a high level of usability for telehealth services (Mean = 5.82, SD = 1.21). Telehealth can be a way to solve the problem of not having enough mental health services available, even though there are potential barriers such as digital literacy and human engagement.

Group cognitive behavioural therapy for insomnia: impact on psychiatric symptoms and insomnia severity in a psychiatric outpatient setting

ABSTRACT Objective Insomnia, even when comorbid with other diagnoses is an independent health issue that warrants treatment. Cognitive behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment. Although the science is clear that CBT-I supports outcomes for those with mental ill health, the routine use of CBT-I in mental health contexts is rare. Implementation research on CBT-I in the psychiatric context is urgently needed. This study evaluated group CBT-I as routinely delivered in a psychiatric hospital service. Methods Adult outpatients (N = 76; M age = 50.20 years; female = 57; psychiatric comorbidity = 69.74%; using sleep medication = 76%) referred for insomnia treatment attended four sessions of group CBT-I. Standardised questionnaires were administered pre- and post-treatment. Results Intent-to-treat analysis revealed statistically significant and clinically meaningful improvements with large effect sizes in insomnia severity (d = 2.5, r = 0.8), depression (d = 1.4, r = 0.5), anxiety (d = 1.2, r = 0.5) and stress (d = 1.2, r = 0.5) symptoms, quality of life (d = 1.4, r = 0.6), and functional impairment (d = 2.2, r = 0.7). Regression analyses indicated pre-post changes in dysfunctional beliefs about sleep accounted for significant variance in post-treatment insomnia severity. Conclusions Results supported feasibility of implementation and real-world effectiveness of CBT-I in a psychiatric setting. Cognitive models of insomnia, emphasising the role of unhelpful beliefs about sleep in insomnia treatment were supported. Future directions include the dissemination of CBT-Insomnia to improve its uptake in psychiatric care.

Somatoform disorders in out-patient psychiatric setting: An overview

IntroductionThe somatoform disorders are a group of psychiatric disorders that present with unexplained physical symptoms.ObjectivesThis study aimed at assessing the prevalence and risk factors of somatoform disorders (SD) and their types among patients attending a major psychiatric clinic in Duhok Governorate/Kurdistan Region of Iraq. Our secondary aim was to assess the common presenting symptoms of conversion disorder (CD).Methods637 subjects were randomly selected from the outpatient psychiatric clinic at Azadi Teaching Hospital in Duhok Governorate/Kurdistan Region of Iraq. Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (Version 2.0) was applied to diagnose patients with SDs.ResultsIn our sample the prevalence of SD was 24%. CD comprised the vast majority of SD at 75.8%, followed by somatization disorder at 7.8% and undifferentiated SD at 5.2%. SD was most common (60.1%) in adolescents and young adults (ages 15-25 y.o.); (p &lt;0.05), and female gender comprised most of the SD in our sample (75.8%; p &lt;0.001)Although, more than two-third of the cases were from lower educational levels (illiterate and primary educational level) (67.3%), more than fifty percent were married (52.3%), majority were housewives (39.2%) and more than half of the cases were from urban areas (52.3%), but no significant association were found between SD and educational level, marital status, occupation, and residence (p-values were 0.218, 0.659, 0.072, 0.090 respectively). Regarding the symptomatic presentation of CD, vast majority of the cases presented with pseudo-seizures which comprised (81%), followed by motor symptoms which comprised (17.2%), and sensory symptoms which constituted (1.7%) only.ConclusionsSD was highly prevalent among patients attending a major outpatient psychiatric clinic in Duhok Governorate/Kurdistan Region of Iraq, and CD was the most common presenting form of SD. Younger age (adolescents and young adults) and female gender comprised the majority of cases. Interestingly, the most common presenting symptom of CD in our sample was pseudo-seizures.Disclosure of InterestNone Declared

The Brief Multidimensional Assessment Scale (BMAS): A Broad Measure of Patient Well-Being.

This article discusses the development and initial clinimetric and psychometric properties of the Brief Multidimensional Assessment Scale (BMAS). The BMAS is an ultrabrief multidimensional measure of global patient well-being that can be used at every clinic visit to assess several facets of patients' perception of themselves, regardless of their diagnosis, at a moment in time and over the course of treatment. Data were collected from 499 adults in the community as well as from psychiatric and medical inpatient and outpatient settings. Participants completed questionnaires as part of their standard care at inpatient and outpatient medical and psychiatric settings or completed them online (community sample). Results indicate that the BMAS measures four discrete dimensions: the ability to get things done, emotional support in important relationships, quality of life, and sense of purpose in life. The scale demonstrates concurrent validity with other measures and discriminates between nonclinical participants and participants from most clinical contexts. The BMAS demonstrates promising initial psychometric properties. It offers clinicians a multidimensional measure of their patients' well-being, regardless of diagnosis, that can be used to monitor well-being at each routine appointment and over time.