Psychiatric Outpatient Visits Research Articles

Impact of moderate-to-high-suicide-intent in major depressive disorder: a retrospective cohort study on patient characteristics and healthcare resource utilisation in England

BackgroundMajor depressive disorder (MDD) is a disabling mental illness that can affect all aspects of daily life and is a leading cause of healthcare resource utilisation (HCRU).AimsWe aimed to characterise patients with MDD with moderate-to-high-suicide-intent, compare their HCRU to patients with MDD without moderate-to-high-suicide-intent, and better understand their patient pathways.MethodsThis retrospective cohort study used data collected from primary care electronic health records from Clinical Practice Research Datalink (CPRD), linked to Hospital Episode Statistics, Mental Health Services Data Set, and Office for National Statistics in England. Adults diagnosed with ≥ 1 MDD diagnosis between 04/2007 and 11/2015 were categorised by suicide intent.Results307,476 patients with MDD were included (294,259 patients without moderate-to-high-suicide-intent and 13,217 with moderate-to-high-suicide-intent). Patients with MDD with moderate-to-high-suicide-intent were younger on average (39.0 vs. 44.8 years) and included a lower percentage of females (58% vs. 65%) compared to patients without moderate-to-high-suicide-intent. HCRU was greater among patients with moderate-to-high-suicide-intent than patients without moderate-to-high-suicide-intent during the first follow-up year for general practitioner consultations (38.5 vs. 29.4), psychiatric outpatient visits (1.5 vs. 0.1), psychiatrist visits (3.6 vs. 0.3), emergency visits (1.5 vs. 0.3), and hospitalisations (86% vs. 26%). Overall, 56% of patients with moderate-to-high-suicide-intent had an antidepressant prescription within 30 days from the initial moderate-to-high-suicide-intent.ConclusionsPatients with MDD and moderate-to-high-suicide-intent were younger, included more males and incurred greater HCRU than those without moderate-to-high-suicide-intent. These results suggest a greater need for effective medical care and appropriate treatments for patients with moderate-to-high-suicide-intent, which could help reduce associated symptoms, mortality, and HCRU.

Outpatient visits for psychiatric disorders in Peru: a nationwide analysis using administrative data

Objective: To quantify the frequency of psychiatric disorders in the outpatient setting in Peru, from 2018 to 2021. Methods: Observational cross-sectional study using outpatient morbidity data from Perú’s National Superintendence of Health. Psychiatric diagnoses were identified using ICD-10 codes. The frequency of major psychiatric disorder groups is described by demographic variables. Monthly trends, as well as the number of outpatient visits per 10,000 population at the subnational level, are also presented. Results: Between 2018-2021, psychiatric disorders accounted for 3,142,685 outpatient visits (2.3% of all) in Peru. Across working age groups, anxiety and depressive disorders comprised approximately 6 out of 10 psychiatric outpatient visits in women, and 4 out of 10 in men. Monthly trends showed two peaks in the absolute number of psychiatric outpatient visits during the pre-pandemic period: April-Mayand September. Provinces in the Highlands had the lowest outpatient visits per 10,000 population. Conclusions: Psychiatric disorders represent a small fraction of the outpatient visits in Peru, with anxiety and depressive disordersas the most frequent. National strategies targeting outpatients with psychiatric disorders should consider demographic differences, monthly trends, and the impact of the COVID-19 pandemic.

Long-term physical and psychiatric morbidities and mortality of untreated, deferred, and immediately treated epilepsy.

In Australia, 30% of newly diagnosed epilepsy patients were not immediately treated at diagnosis. We explored health outcomes between patients receiving immediate, deferred, or no treatment, and compared them to the general population. Adults with newly diagnosed epilepsy in Western Australia between 1999 and 2016 were linked with statewide health care data collections. Health care utilization, comorbidity, and mortality at up to 10 years postdiagnosis were compared between patients receiving immediate, deferred, and no treatment, as well as with age- and sex-matched population controls. Of 603 epilepsy patients (61% male, median age = 40 years) were included, 422 (70%) were treated immediately at diagnosis, 110 (18%) received deferred treatment, and 71 (12%) were untreated at the end of follow-up (median = 6.8 years). Immediately treated patients had a higher 10-year rate of all-cause admissions or emergency department presentations than the untreated (incidence rate ratio [IRR] = 2.0, 95% confidence interval [CI] = 1.4-2.9) and deferred treatment groups (IRR = 1.7, 95% CI = 1.0-2.8). They had similar 10-year risks of mortality and developing new physical and psychiatric comorbidities compared with the deferred and untreated groups. Compared to population controls, epilepsy patients had higher 10-year mortality (hazard ratio = 2.6, 95% CI = 2.1-3.3), hospital admissions (IRR = 2.3, 95% CI = 1.6-3.3), and psychiatric outpatient visits (IRR = 3.2, 95% CI = 1.6-6.3). Patients with epilepsy were also 2.5 (95% CI = 2.1-3.1) and 3.9 (95% CI = 2.6-5.8) times more likely to develop a new physical and psychiatric comorbidity, respectively. Newly diagnosed epilepsy patients with deferred or no treatment did not have worse outcomes than those immediately treated. Instead, immediately treated patients had greater health care utilization, likely reflecting more severe underlying epilepsy etiology. Our findings emphasize the importance of individualizing epilepsy treatment and recognition and management of the significant comorbidities, particularly psychiatric, that ensue following a diagnosis of epilepsy.

Real-World Evidence of Aripiprazole Tablets with Sensor: Treatment Patterns and Impacts on Psychiatric Healthcare Resource Utilization.

Maintaining adherence to antipsychotic (AP) medication is often challenging. Aripiprazole tablets with sensor (AS) contain an ingestible event marker and communicate with wearable patches and a smartphone app to provide objective medication ingestion data. This study evaluated real-world treatment patterns of AS usage and its impact on psychiatric healthcare resource utilization (HCRU). This retrospective, observational cohort study identified individuals who initiated AS between 1/1/2019 and 6/30/2020 with 3 months baseline and 6 months of follow-up data using a commercial medical and pharmacy claims database (Clarivate). Controls were propensity score-matched (4:1) to AS initiators based on age (±2 years), sex, diagnosis (major depressive disorder [MDD], schizophrenia, bipolar I disorder [BP-I], other), insurance, and baseline oral AP use (yes/no). Days of AP supply were evaluated using a general regression model. The frequency of psychiatric HCRU during follow-up was compared between groups using a zero-inflated regression model. Most AS initiators were diagnosed with MDD (61.2%) and were women (61.2%); mean age was 37.7 years (standard deviation: 14.1). Most AS initiators (53.1%) continued treatment for >60 days (mean days of supply = 77). After adjusting for covariates, AS initiators had 41% more days of AP supply during follow-up compared with controls (P <0.0001) and significantly lower adjusted odds ratios (ORs) for psychiatric outpatient visits (adjusted OR = 0.80; P <0.05), emergency department visits (adjusted OR = 0.11; P <0.05), inpatient visits (adjusted OR = 0.42; P <0.05), and other medical services (adjusted OR = 0.25; P <0.05). Participants who implemented AS had significantly more days of AP supply and fewer psychiatric care visits. These preliminary results suggest AS usage can help build regular medication-taking habits and holds promise for reducing psychiatric HCRU. Additional studies with larger sample sizes are warranted to inform clinical practice and coverage decisions.

Increased suicide risk of psychiatric patients following the recent utilization of health care services: results from a nationwide cohort study in South Korea.

This study aimed to examine whether and to what degree the suicide risk of psychiatric patients is associated with psychiatric and non-psychiatric health service utilization. We selected incident psychiatric patients, including schizophrenia, bipolar disorders, borderline personality disorder, depressive disorders, other affective disorders, and post-traumatic stress disorder patients, in 2007-2010 and followed them up until 2017 based on the data linkage between the Korean National Health Insurance and National Death Registry. We analyzed the time-dependent association between suicide and four types of health service (psychiatric vs. non-psychiatric and outpatient vs. inpatient) utilization using a time-dependent Cox regression. The suicide risk of psychiatric patients was significantly increased with recent psychiatric and non-psychiatric admission and psychiatric outpatient visits. The adjusted suicide hazard ratios for recent outpatient visits were similar to or even higher than those for recent psychiatric admission. The adjusted suicide hazard ratios of schizophrenia patients for psychiatric admission, psychiatric outpatient visits, and non-psychiatric admission within the recent 6 months were 2.34 (95% confidence interval [CI]: 2.12-2.58, p < 0.001), 2.96 (95% CI: 2.65-3.30, p < 0.001), and 1.55 (95% CI: 1.39-1.74, p < 0.001), respectively. Suicide risk was not associated with recent non-psychiatric outpatient visits in patients, except for the depressive disorders group showing a negative association. Our results highlight the priority of suicide prevention for psychiatric patients in the clinical setting. Additionally, our results warrant the precaution against increased suicide risk of psychiatric patients after psychiatric and non-psychiatric discharge.

Longitudinal Associations of Psychiatric Risk Factors with Non-psychiatric Hospitalization in a Large Cohort of People Living with HIV in New York City

Hospitalizations among people living with HIV (PLWH) are frequent and costly. This study examined the association between psychiatric, HIV-related, and demographic factors and hospitalization rates among PLWH using data from the Einstein–Rockefeller-City University of New York Center for AIDS Research Clinical Cohort Database. Of the 10,215 PLWH included in the sample, 45% had at least one non-psychiatric hospitalization between 2009 and 2018, with significant risk factors including prior psychiatric outpatient visits, depression, or alcohol-related disorder diagnoses, female sex, older age, CD4 count < 500 cells/uL, and detectable viral load. Additionally, 14% had an HIV-related hospitalization, with significant risk factors including prior psychiatric outpatient visits, alcohol- and substance-related disorder diagnoses, female sex, older age, CD4 count < 500 cells/uL, and detectable viral load. The study emphasizes the need for tailored interventions, including integrated treatment and comprehensive case management, for PLWH with comorbid psychiatric disorders, women, and older adults.

Obsessive-Compulsive Disorder and Risk of Parkinson Disease: A Nationwide Longitudinal Study.

Several small-scale studies have suggested a biological link between obsessive-compulsive disorder (OCD) and Parkinson disease (PD). However, the temporal association of OCD and subsequent PD remained unclear. Here, we used Taiwan National Health Insurance Research Database and included the data of 28,722 patients with OCD ( International Classification of Diseases, Ninth Revision, Clinical Modification code: 300.3) and 287,220 matched controls between 2001 and 2009. They were followed until the end of 2011 to identify diagnosis of new-onset PD ( International Classification of Diseases, Ninth Revision, Clinical Modification code: 332.0). The frequency of psychiatric outpatient visits for OCD per year (<5, 5-10, and >10) was identified as a proxy of OCD severity. Using the stratified Cox regression model, the hazard ratio of developing PD among patients with OCD was 2.70 (95% confidence interval = 1.74-4.18) compared with matched controls. Among patients with OCD, those with >10 psychiatric outpatient visits per year for OCD (hazard ratio = 3.18, 95% confidence interval = 2.06-4.93) were more likely to develop PD during the follow-up period compared with those with <5 psychiatric outpatient visits per years for OCD. OCD was found to be an independent risk factor for PD. The mechanisms underlying the temporal association between OCD and subsequent PD require further investigation.

Stability of diagnostic coding of psychiatric outpatient visits across the transition from the second to the third version of the Danish National Patient Registry.

ObjectiveIn Denmark, data on hospital contacts are reported to the Danish National Patient Registry (DNPR). The ICD‐10 main diagnoses from the DNPR are often used as proxies for mental disorders in psychiatric research. With the transition from the second version of the DNPR (DNPR2) to the third (DNPR3) in February–March 2019, the way main diagnoses are coded in relation to outpatient treatment changed substantially. Specifically, in the DNPR2, each outpatient treatment course was labelled with only one main diagnosis. In the DNPR3, however, each visit during an outpatient treatment course is labelled with a main diagnosis. We assessed whether this change led to a break in the diagnostic time‐series represented by the DNPR, which would pose a threat to the research relying on this source.MethodsAll main diagnoses from outpatients attending the Psychiatric Services of the Central Denmark Region from 2013 to 2021 (n = 100,501 unique patients) were included in the analyses. The stability of the DNPR diagnostic time‐series at the ICD‐10 subchapter level was examined by comparing means across the transition from the DNPR2 to the DNPR3.ResultsWhile the proportion of psychiatric outpatients with diagnoses from some ICD‐10 subchapters changed statistically significantly from the DNPR2 to the DNPR3, the changes were small in absolute terms (e.g., +0.6% for F2—psychotic disorders and +0.6% for F3—mood disorders).ConclusionThe change from the DNPR2 to the DNPR3 is unlikely to pose a substantial threat to the validity of most psychiatric research at the diagnostic subchapter level.

Rationale and Description of Implementation of Regional Collaborative Service Model for Enhancing Psychosocial Wellbeing of Children and Families-Oulu Collective Impact Study.

BackgroundThe psychosocial wellbeing of children and adolescents is an ongoing global concern. Despite positive outcomes of child- and family-focused programs, the fragmentation of services presents challenges. To enhance harmonization and diminish fragmentation of service policies, we implement a preventive collaborative service model for children and families. The rationale for our study is based on analyses of national and local data before implementing the service model in the pilot area.MethodsThe need for a preventive service model for children and families was demonstrated using national and local data sources. First, a national school health survey was utilized to screen adolescents' perceptions of their depressive symptoms and support. Second, time trends in child and adolescent psychiatric and child protection service use were investigated. For these aims, epidemiological data of the study area (city of Oulu) were compared with data from the whole country (Finland). Third, local usage data of the preventive stand-alone Let's Talk About Children (LT) intervention before the service model implementation were evaluated. After these analyses, Let's Talk About Children Service Model (LT-SM) implementation in the pilot area is described in detail.ResultsThe background data showed that 17% of the adolescents in the study area had reported depressive symptoms, and almost half of them had not received professional help. Child and adolescent psychiatric outpatient visits had increased during the last decade, but the number of visits remains lower in the study area compared with the country as a whole. The number of adolescent psychiatric inpatient days had increased contrary to a decreasing national trend. The number of urgent child welfare placements was also higher compared with the whole country. The local LT intervention data revealed very low utilization rates. These results indicated a necessity to enhance preventive and collaborative support for children and their families. This article describes the implementation of the LT-SM.DiscussionWe demonstrated excessive use of curative services in social and health care and insufficient usage of the stand-alone preventive intervention. The LT-SM is now piloted in one regional service area of the city of Oulu. Its effectiveness will be evaluated when enough data have been accumulated for statistical analyses.

Elevated Risk of Mood Disorders after the Occurrence of Recurrent Retinal Detachment: A Population-Based Cohort Study

Introduction: The aim of this study was to investigate the risk of mood disorders in patients who experienced retinal detachment (RD) by using the National Health Insurance Research Database in Taiwan. Methods: Participants with a diagnosis of RD were regarded as the study group, and an age- and sex-matched group without a diagnosis of RD served as the control group. The outcomes related to mood disorders after RD included: (1) psychiatric outpatient department visits; (2) behavioural therapy; (3) sleep or anxiety-related disorders; and (4) major depressive disorder (MDD). Results: A total of 4,129 participants diagnosed with RD and 16,516 non-RD individuals were enrolled in the study. There were no significant differences in the four mood disorder-related outcomes between the study and control groups. However, the patients with recurrent RD who received more than two treatments and female patients with RD who needed surgical treatment showed a higher probability of developing MDD than did the non-RD subjects (incidence rate: 0.96 vs. 0.36; adjusted hazard ratio [aHR]: 2.382, 95% confidence interval [CI]: 1.032–5.496, log-rank p = 0.0325; and aHR: 6.895, 95% CI: 1.659–28.656, log-rank p = 0.0060, respectively). Conclusion: Patients with recurrent RD and multiple surgeries and females with RD who needed surgical treatment were at greater risk for developing MDD.

Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults

BackgroundIndividuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown.MethodsThe study is based on Finnish administrative register data on all individuals born 1986–1994. Adolescents and young adults with an episode of self-harm treated in specialised healthcare at ages 16–21 in 2002–2015 (n=4280, 64% female) were identified and followed 2 years before and after the episode. Probabilities of specialised psychiatric inpatient admissions and outpatient visits and purchases of psychotropic medication at different time points relative to self-harm were estimated using generalised estimation equations, multinomial models and cumulative averages. Socioeconomic differences were assessed based on parental education, controlling for income.ResultsAn educational gradient in specialised treatment and prescription medication was observed, with the highest probabilities of treatment among the adolescents and young adults with the highest educated parents and lowest probabilities among those whose parents had basic education. These differences emerged mostly after self-harm. The probability to not receive any treatment, either in specialised healthcare or psychotropic medication, was highest among youth whose parents had a basic level of education (before self-harm 0.39, 95% CI 0.34–0.43, and after 0.29, 95% CI 0.25–0.33 after) and lowest among youth with higher tertiary educated parents (before self-harm: 0.22, 95% CI 0.18–0.26, and after 0.18, 95% CI 0.14–0.22). The largest differences were observed in inpatient care.ConclusionsThe results suggest that specialised psychiatric care and psychotropic medication use are common among youth who self-harm, but a considerable proportion have no prior or subsequent specialised treatment. The children of parents with lower levels of education are likely to benefit from additional support in initiating and adhering to treatment after an episode of self-harm. Further research on the mechanisms underlying the educational gradient in psychiatric treatment is needed.

POSA152 Characterising Patients with Major Depressive Disorder with Moderate-to-High Suicide Intent and Their Healthcare Resource Utilisation in England

To characterise patients with major depressive disorder (MDD) with moderate-to-high-suicide-intent in England, compare their healthcare resource utilisation (HCRU) to MDD patients without moderate-to-high-suicide-intent, and better understand their patient pathways. This retrospective cohort study used primary care electronic health records from the Clinical Practice Research Datalink (CPRD), linked to Hospital Episode Statistics (HES) and the Mental Health Dataset in England. Adults with ≥1 MDD diagnosis between 4/2007-11/2015 were included and categorised by suicide intent. MDD patients with moderate-to-high-suicide-intent were followed from their initial suicide intent diagnosis, whereas MDD patients without moderate-to-high-suicide-intent were followed from their first MDD diagnosis. Patients with psychosis, schizophrenia, mania, bipolar disorder, or dementia were excluded. 307,476 patients were included (294,259 MDD patients without moderate-to-high-suicide-intent and 13,217 MDD patients with moderate-to-high-suicide-intent). MDD patients with moderate-to-high-suicide-intent were younger on average and had a lower proportion of females than patients without moderate-to-high-suicide-intent (age: 39.0 versus 44.8 years; female: 58% versus 65%). The average number of outpatient visits was greater among MDD patients with moderate-to-high-suicide-intent than patients without moderate-to-high-suicide-intent during the first follow-up year for the following: general practitioner consultations (38.5 versus 29.4), psychiatric outpatient visits (1.5 versus 0.1), psychiatrist visits (3.6 versus 0.3), and accident and emergency visits (1.5 versus 0.3). Approximately 86% of MDD patients with moderate-to-high-suicide-intent were hospitalised during the first follow-up year compared with 26% of patients without moderate-to-high-suicide-intent (average duration: 3.2 and 2.8 days, respectively). A total of 56% of MDD patients with moderate-to-high-suicide-intent had an antidepressant prescription within 30 days of the index date, with citalopram being the most frequently prescribed. This study provides novel results on the patient characteristics, healthcare resource utilisation, and patient pathways among MDD patients with moderate-to-high-suicide-intent in England. These results indicate the need for new treatments that can achieve a rapid therapeutic response and reduce HCRU.

Increased medical utilization and psychiatric comorbidity following a new diagnosis of methamphetamine use disorder

ABSTRACT Background: Evidence of patterns of medical utilization and distribution of comorbidities among individuals using methamphetamine remains limited Objective: This study aims to investigate changes in medical utilization and comorbidities before and after a diagnosis of methamphetamine use disorder. Methods: A total of 3321 cases (79% were male) of methamphetamine use disorder between January 1, 1996, and December 31, 2012, were identified from Psychiatric Inpatient Medical Claims database in Taiwan. Information was collected on demographics, diagnoses, and medical utilizations. The date of newly diagnosed with methamphetamine use disorder was defined as the baseline. Mirror-image study design was used to compare changes in medical utilization and comorbidities between the pre-baseline period (within 1 year before diagnosis) and the post-baseline period (within 1 year after diagnosis). Conditional logistic regression was used to estimate changes in medical utilization and comorbidities. Results: Most cases (77%) were first identified in a psychiatric department. There is a significant increase (P < .001) in psychiatric admission (odds ratio[OR] = 2.19), psychiatric emergency visits (OR = 1.31), and psychiatric outpatient visits (OR = 1.15) after diagnosis. Multivariable analysis revealed significantly increased risks (P < .001) of non-methamphetamine drug induced mental disorders (adjusted OR[aOR] = 29.47), schizophrenia (aOR = 2.62), bipolar disorder (aOR = 2.14), organic mental disorder (aOR = 1.82), and upper respiratory tract infection (aOR = 2.03) after diagnosis. Conclusions: We found significant increases of medical utilization and psychiatric comorbidities after diagnosed with methamphetamine use disorder. These findings may reflect the problem of delayed diagnosis and treatment. Enhancement of early identification of methamphetamine use disorder in general practice is required for early intervention and decreased subsequent morbidities.

Healthcare utilization and costs of psychiatric and somatic comorbidities associated with newly diagnosed adult ADHD.

Psychiatric and somatic problems in young adulthood have been found to be main drivers of costs in individuals with childhood ADHD. However, knowledge of the patterns of healthcare utilization and costs of comorbidities in middle-aged adults with newly diagnosed ADHD is very limited. We studied individuals born 1966-1978 (from the Swedish Total Population Register) with newly diagnosed ADHD between the ages of 30-45years and individuals without ADHD matched on birthdate, birth county, and sex. Healthcare utilization and expenditure for psychiatric and somatic disorders were obtained over four years (two years pre- and post-initial ADHD diagnosis). Middle-aged adults with newly diagnosed ADHD showed higher levels of healthcare utilization and costs (outpatient, inpatient, medications) for psychiatric and somatic comorbidities relative to adults without ADHD, both before and after the initial diagnosis. Females showed greater average group differences across the study period for medication prescriptions than males. Total incremental annual costs per capita were €2478.76 in adults with ADHD relative to those without, and costs were mainly driven by inpatient care. Psychiatric outpatient visits were statistically significantly higher the year before the ADHD diagnosis compared with two years before and after the diagnosis. This study demonstrates the substantial burden of psychiatric and somatic comorbidities in middle-aged adults newly diagnosed with ADHD. Psychiatric outpatient visits peaked in the year leading up to the ADHD diagnosis. Findings further suggested that females with ADHD may seek more treatment for comorbidities than males, which may reflect a general female tendency.

The use of ‘my side telling’ during history taking in psychiatric consultations

Using the method of conversation analysis, this article examines an interactional practice through which psychiatric practitioners exhibit knowledge about their patients’ problems, symptoms, or experiences in psychiatric outpatient consultations. This practice is referred to as ‘my side telling’. The data were from audio recordings of 55 psychiatric outpatient visits to four psychiatrists in China. In the data, the psychiatrists employ ‘my side telling’ within larger sequences of talk where psychiatrists solicit their patients to elaborate on their problems or experiences, treating prior answers of the patients as unsatisfactory. Based on empirical study of the data, it is argued that ‘my side telling’ in psychiatry is not merely used to elicit information. Rather, through facing patients with facts or evidence which the psychiatrists got from other sources, it acquires a confrontative function and may be employed as a tool to test the patients’ sense of reality and willingness to talk about their experiences. Thus, it is shown to work towards assessing patients for possible psychiatric conditions and forming diagnostic hypotheses. I further argue that ‘my side telling’ allows the psychiatrists to achieve a balance between respecting the patients’ rights to report their own experiences and influencing the directions in which the information is reported.

Muutos psykiatristen avohoitokäyntien toteutuksessa ja johtajien kokemukset etäasiointia estävistä ja edistävistä tekijöistä COVID-19 aikakaudella

Psykiatrisia avohoidon palveluita on digitalisoitu aktiivisesti jo ennen koronavirusepidemiaa, mutta varsinkin epidemian käynnistymisen jälkeen etäasioinnin merkitys on kasvanut. Tämän poikkileikkaustutkimuksen tavoitteena oli selvittää, kuinka koronaepidemia on vaikuttanut psykiatristen avohoitokäyntien toteutusmuotoon ja kuvailla psykiatristen erikoissairaanhoidon palveluiden johtajien kokemuksia etäasioimisesta. Tutkimuksen tuloksia voidaan hyödyntää psykiatristen avohoitopalveluiden arvioinnissa sekä kehittämisessä sekä jatkotutkimuksessa.&#x0D; Kyselyaineisto kerättiin osana COVID-19 tilannekuvaseurantaa sähköisellä kyselylomakkeella koronaepidemian käynnistymisen jälkeen toukokuussa 2020. Kyselyssä oli sekä strukturoituja että avoimia kysymyksiä. Kyselyyn vastasi 39 aikuispsykiatrian, nuorisopsykiatrian ja lasten psykiatrian toimialojen esimiestä ja johtajaa 19 eri sairaanhoitopiiristä. Kvantitatiiviset kysymykset avohoitokäyntien toteutusmuotojen määrästä raportoitiin prosenttiosuuksina ja avointen kysymysten vastaukset analysointiin induktiivisella sisällönanalyysillä.&#x0D; Tulosten perusteella etäasioinnin suhteellinen osuus kaikista asiointitavoista kasvoi voimakkaasti koronaepidemian käynnistymisen jälkeen. Psykiatrisista avohoitokäynneistä toteutettiin puhelimitse tai etäyhteydellä tammikuussa 9% ja toukokuussa 48% (39 prosenttiyksikön kasvu). Etäasiointia haastoivat välineiden riittämättömyys ja toimimattomat ohjelmat, asiakkaiden puuttuvat laitteet, yhteydet ja tilat, etäasioinnin soveltumattomuus kaikkeen toimintaan, ammattihenkilöiden ja asiakkaiden negatiivinen asennoituminen, riittämätön osaaminen etäasioinnin käyttöön ja organisatoriset ongelmat. Etäasiointia edistivät asiakkaiden ja ammattihenkilöiden myönteinen asenne ja ilmapiiri, koronaepidemian aiheuttama tarve etäasioinnille, etäasioinnin soveltuvuus ja tuttuus psykiatrisissa avohoitopalveluissa, asiakkaiden aikaisempi tuntemus, pitkät välimatkat, toimivat etäverkostot ja ajansäästö, toimiva tekniikka, ohjelmistot ja välineet sekä riittävä tuki.&#x0D; Etäasiointi on mahdollistanut epidemiatilanteessa psykiatristen avohoitopalveluiden tarjoamisen niille asiakkaille, joille etäasiointi soveltuu ja jotka kykenevät etäasiointiin. Etäasioinnin merkitys koronaepidemian aikana on ollut tärkeä, mutta etäasioinnin lisäksi on tärkeää innovoida ratkaisuja, kuinka psykiatrisia avohoitopalveluita voitaisiin toteuttaa niille asiakkaille, joille etäasiointi ei syystä tai toisesta sovellu.

The Impact of COVID-19 Pandemic in Psychiatric Outpatient Visits in Abu Dhabi – A Retrospective Study

Introduction: Coronavirus pandemics has affected mental health services around the globe. A marked reduction in psychiatric admission and emergency visits were reported recently. With regards to outpatient services, there was an adoption of tele-psychiatry in mental health facilities in many countries. Objectives: To examine the impact of COVID-19 pandemics on the psychiatric outpatient visits in the largest Psychiatric Hospital in Abu Dhabi, UAE, during the month of April 2020. Methodology: A descriptive retrospective study of medical records of all patients attended the general adult psychiatry clinic in the month of April 2020. Results: 1,050 patients were included in the analysis. The sample consists of 55.9% males. The mean age was 40.7 years. The predominant ethnicity was Arab (88.3%). The most prevalent diagnosis was depressive disorder 32.7%. Only 1.6 % patients attended the clinic as new appointments. Tele-assessment was conducted in 64% (N=672) visits. 9.3 % reported to be in relapse during April. Patient with schizophrenia showed the lowest relapse rate 5.7%. Only 8.5% had taken PCR COVID test, with two patients tested positive. Conclusion: The great shift to tele-assessments and the service of medications home delivery were the main reason for maintaining the service in the psychiatric outpatient settings.

From the Front Line: Trainees’ Perspective on Providing Care During COVID-19 Pandemic

From the Front Line: Trainees’ Perspective on Providing Care During COVID-19 Pandemic

Critical Predictors for the Early Detection of Conversion From Unipolar Major Depressive Disorder to Bipolar Disorder: Nationwide Population-Based Retrospective Cohort Study.

BackgroundUnipolar major depressive disorder (MDD) and bipolar disorder are two major mood disorders. The two disorders have different treatment strategies and prognoses. However, bipolar disorder may begin with depression and could be diagnosed as MDD in the initial stage, which may later contribute to treatment failure. Previous studies indicated that a high proportion of patients diagnosed with MDD will develop bipolar disorder over time. This kind of hidden bipolar disorder may contribute to the treatment resistance observed in patients with MDD.ObjectiveIn this population-based study, our aim was to investigate the rate and risk factors of a diagnostic change from unipolar MDD to bipolar disorder during a 10-year follow-up. Furthermore, a risk stratification model was developed for MDD-to-bipolar disorder conversion.MethodsWe conducted a retrospective cohort study involving patients who were newly diagnosed with MDD between January 1, 2000, and December 31, 2004, by using the Taiwan National Health Insurance Research Database. All patients with depression were observed until (1) diagnosis of bipolar disorder by a psychiatrist, (2) death, or (3) December 31, 2013. All patients with depression were divided into the following two groups, according to whether bipolar disorder was diagnosed during the follow-up period: converted group and nonconverted group. Six groups of variables within the first 6 months of enrollment, including personal characteristics, physical comorbidities, psychiatric comorbidities, health care usage behaviors, disorder severity, and psychotropic use, were extracted and were included in a classification and regression tree (CART) analysis to generate a risk stratification model for MDD-to-bipolar disorder conversion.ResultsOur study enrolled 2820 patients with MDD. During the follow-up period, 536 patients were diagnosed with bipolar disorder (conversion rate=19.0%). The CART method identified five variables (kinds of antipsychotics used within the first 6 months of enrollment, kinds of antidepressants used within the first 6 months of enrollment, total psychiatric outpatient visits, kinds of benzodiazepines used within one visit, and use of mood stabilizers) as significant predictors of the risk of bipolar disorder conversion. This risk CART was able to stratify patients into high-, medium-, and low-risk groups with regard to bipolar disorder conversion. In the high-risk group, 61.5%-100% of patients with depression eventually developed bipolar disorder. On the other hand, in the low-risk group, only 6.4%-14.3% of patients with depression developed bipolar disorder.ConclusionsThe CART method identified five variables as significant predictors of bipolar disorder conversion. In a simple two- to four-step process, these variables permit the identification of patients with low, intermediate, or high risk of bipolar disorder conversion. The developed model can be applied to routine clinical practice for the early diagnosis of bipolar disorder.

Medically Treated Self-Injury Among Children and Adolescents: Repeated Attempts and Service Use Over 1 Year.

Clinical, demographic, and service use patterns of youths ages 6-18 years who had a medically treated self-injury were examined to understand factors associated with recurrence of such an injury in the subsequent year. This retrospective cohort analysis used data from 31,147 youths who were medically treated for self-injury. Data were from IBM/Watson MarketScan commercial claims and encounters databases (2007-2016). The index self-injury was defined as the first event with an ICD code related to self-injury or suicidal ideation combined with a wound code. Cox proportional hazards regression was used to determine the hazard ratios and 95% confidence intervals (CIs) describing associations with subsequent medically treated self-injury for youths who were hospitalized in psychiatric facilities in the seven days before or after the index self-injury versus those who were not. Approximately 2% of the 31,147 youths had another medically treated self-injury in the year following the index self-injury. The hospitalized group had higher service use in the years prior to and following their self-injury, but the mean number of outpatient psychiatric visits before the index self-injury did not differ significantly between groups. Hazard ratios for clinical, demographic, and service use variables indicated that those who were hospitalized in psychiatric facilities for the index event were twice as likely (95% CI=1.7-2.7) as those who were not to have another medically treated self-injury in the year after the index event. In this retrospective, observational study, psychiatric hospitalization after self-injury was strongly associated with recurrence of self-injury in the subsequent year.