Psychiatric Outpatients Research Articles

Behavioral physical activity counselling to promote an active healthy lifestyle among adolescent psychiatric outpatients. The TRANSPAC-study

Introduction
 Mental health disorders are one of the main reasons for disability in adolescents worldwide (Dahl et al., 2018). Sleep disturbances are an important contributor to a vicious cycle of increased vulnerability during this developmental period. Interventions that improve sleep are suggested to improve psychosocial outcomes. One such intervention may be physical activity (PA), with a beneficial effect on both sleep and mental health. Yet, PA levels are declining during adolescent years, with even higher inactivity levels for individuals with psychiatric disorders. Guidance on how to address PA counselling (PAC) among psychiatric adolescents in routine clinical practice has the potential to improve clinical and psychosocial outcomes.
 Methods
 During this ongoing randomized waitlist controlled trial, 18 adolescent psychiatric outpatients have been recruited from local clinics and private practices. Those who met inclusion criteria were aged 12 to 18 years, suffered from sleep problems, and had at least one additional mental health diagnosis. Exclusion criteria included organic sleep and brain disorders and changes in medication. At baseline, participants completed questionnaires related to sleep and psychopathology. For the next seven days, participants wore an Actigraph to track PA and sleep patterns. Participants were serially randomized into two groups after baseline: PAC or Treatment as usual (TAU). At 3-month follow-up, all tests were repeated. Additionally, a semi structured interview was conducted with intervention participants. To assess intervention effects, mixed model ANOVAs were conducted for PA, psychopathology, and composite sleep health.
 The 6-session intervention builds on previous standardized and theory-based PAC programs (Gerber et al., 2019).
 Results
 By 2023, follow-up data were available from 12 participants (Mage 15.33 yrs; 75% females). Preliminary data show a significant trend for increased PA on school days, and composite sleep health (p = .07). Yet, compliance of Actigraph wear time was low. No changes were observed for psychopathology. The post-intervention interview revealed positive experiences.
 Discussion/Conclusion
 The preliminary data show the feasibility of the intervention. It is likely that improvements in PA and sleep patterns must first stabilize before they can have a meaningful impact on psychopathology. However, more data is needed to confirm the results. The interviews revealed that the content and mode of delivery were generally accepted. Considering the many other obligations adolescents face in their everyday lives, including homework and psychotherapy, the combination of online and face-to-face sessions was well received. Because of the low compliance rate of Actigraph wear time, alternative devices should be considered for this population.
 References
 Dahl, R. E., Allen, N. B., Wilbrecht, L., & Suleiman, A. B. (2018). Importance of investing in adolescence from a developmental science perspective. Nature, 554(7693), 441–450. https://doi.org/10.1038/nature25770
 Gerber, M., Beck, J., Brand, S., Cody, R., Donath, L., Eckert, A., Faude, O., Fischer, X., Hatzinger, M., Holsboer-Trachsler, E., Imboden, C., Lang, U., Mans, S., Mikoteit, T., Oswald, A., Pühse, U., Rey, S., Schreiner, A. K., Schweinfurth, N., … Zahner, L. (2019). The impact of lifestyle physical activity counselling in IN-PATients with major depressive disorders on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers: Study protocol for a randomized controlled trial. Trials, 20(1), 1–21. https://doi.org/10.1186/s13063-019-3468-3

Problematic use of Internet in a sample of psychiatric outpatients: preliminary observations from the "real world".

This study aims to explore the prevalence, characteristics, and psychopathology related to Problematic Use of Internet (PUI), including Internet Addiction (IA), within a sample of psychiatric outpatients. 143 psychiatric stable outpatients (18-65, mean age: 49; F=84) were included in this study, regardless of their categorical diagnosis. Socio-demographic, clinical, psychopathological, and Internet use-related data (PIU-Scale, Internet Addiction Test, devices, use, activities) were collected across the sample. The prevalence of PUI ranged between 1% (IAT) and 25% (PIU-S), with a homogeneous distribution of PUI symptoms' severity among the four main psychopathological areas (depressive, bipolar, anxiety, and psychotic disorders). PUI was correlated with age and was higher in students as in the general population. Significant associations were found between PUI symptoms and both personality and eating disorders; PUI was also positively correlated with the presence of other addictions (e.g., alcohol and/or substances). A greater proportion of patients with PUI presented other forms of behavioural addiction compared to non-symptomatic patients. Social media and online shopping, as well as video-streaming, resulted to be the main forms of PUI among patients with problematic use of the Internet. More studies are required among students diagnosed with eating and personality disorders. The association between PUI and other addictive disorders would support the hypothesis of their common shared pathophysiology. Healthcare providers and educators should be made aware of such risks. More studies are needed to confirm such preliminary findings.

Perceived Social Support among Psychiatric Outpatients: A Cross-Sectional Study in Indonesia

Perceived Social Support among Psychiatric Outpatients: A Cross-Sectional Study in Indonesia

Internalized Stigma and Adherence to Treatment Among Outpatients with Mental Illness

Background: Treatment adherence, the key to therapy success and patients' quality of life, can be influenced by many factors in psychiatric patients, including self-stigma, alongside insight, illness duration, social support, health beliefs, personality, substance abuse, side effects, and life circumstances. Objectives: This study aims to identify factors, particularly self-stigma, affecting treatment adherence in stable psychiatric outpatients. Methods: A sample of 200 adult mental health patients in Arak, Iran, diagnosed with schizophrenia, bipolar disorder, major depressive disorder, or anxiety disorders, participated in this study. Self-stigma was assessed using the Internalized Stigma of Mental Illness (ISMI) scale, and treatment adherence was measured using the Drug Attitude Inventory (DAI-10). Data were analyzed using descriptive statistics, correlation, regression, and chi-square tests. Results: Among the 200 participants (73 men and 127 women, with an average age of 35.1 years), the average stigma score was 62.8. The mean DAI-10 score was 4.8, with 172 showing positive medication attitudes. Younger, smoking, and alcohol-consuming patients showed lower treatment adherence. Higher self-stigma correlated with lower adherence, but there were no significant associations with gender, marital status, diagnosis, or diagnosis duration. Conclusions: This study highlights the importance of addressing self-stigma as a barrier to treatment adherence in individuals with mental illnesses. Strategies to reduce self-stigma may improve treatment outcomes, especially among younger patients and those with substance use disorders. Further research is warranted to develop effective interventions for enhancing medication adherence in stable psychiatric outpatients.

Influence of mental health service provision on the perceived quality of life among psychiatric outpatients: associations and mediating factors.

ObjectiveTo investigate the relationship between perceived mental health service provision and quality of life (QoL) as perceived by patients in psychiatric outpatient care.MethodsA total of 373 adult patients registered at 15 psychiatric outpatient clinics in three regions in central and southern Sweden were included in the study. Survey data were collected using a questionnaire on mental health service provision, symptom severity, recovery, clinical diagnosis, sociodemographics (serving as independent variables) and QoL (serving as the dependent variable). Three aspects of mental health service provision were used: patients’ perceived quality of care, perceived staff-patient interaction, and patient reported psychiatric treatments. Structural equation modelling was used to model the relationship among the variables.ResultsVariables in mental health service provision showed few direct associations with patients’ perceived QoL. Instead, the associations of mental health service provision on QoL were mainly mediated through symptom severity and recovery. These relationships were retained after adjusting for sociodemographic variables and clinical diagnoses. The final model achieved excellent goodness of fit (χ2 = 49.502, p = 0.230, RMSEA = 0.020, CFI = 0.997 and a SRMR = 0.024).ConclusionThis study shows that mental health service provision is associated with patients’ perceived QoL; however, this association is mostly indirect and mediated by reduced symptom severity and increased recovery. This finding can help inform the design of future interventions to enhance service provision to improve patients’ QoL.

The temporal association between religious/spiritual struggles and anxiety symptoms: A longitudinal study of psychiatric outpatients

BackgroundAnxiety disorders like Generalized Anxiety Disorder (GAD) often cooccur with religious/spiritual (R/S) struggles, but the temporal association between anxiety symptoms and R/S struggles has not been studied in many clinical samples. The current longitudinal study examines this association in a sample at high risk for elevated anxiety and R/S struggles—adult psychiatric outpatients. MethodsAfter their initial psychiatrist evaluation at a U.S. group practice, 163 outpatients completed measures of R/S struggles, anxiety symptoms, depressive symptoms, and religiousness. The analytic sample (N = 120; 77.9% T1 retention) completed these measures 6-months and 12-months later (T2 and T3). ResultsPatients exhibited high baseline rates of anxiety symptoms (72.5% met likely criteria for GAD) and R/S struggles (59.2% reported high levels of at least one R/S struggle subtype), yet they demonstrated small-to-moderate decreases in anxiety, depression, and R/S struggles over time. Controlling for sociodemographics and baseline struggles, anxiety, and depression, there was a bidirectional association between T2/T3 overall R/S struggles and T3/T2 anxiety symptoms. T2 moral and ultimate-meaning struggles were related to higher T3 anxiety symptoms, and T2 anxiety symptoms were related to higher T3 demonic struggles. LimitationsResults may have been impacted by attrition, selection bias, maturation, and statistical regression. Findings need replication in larger, more diverse samples and in other countries, treatment settings, and clinical populations. ConclusionsAdult psychiatric outpatients are at high risk for R/S struggles, and these struggles are important to assess and address in their mental health treatment. Moral, ultimate-meaning, and demonic struggles may be most anxiety-relevant.

Need to Take Heart? Talk to Your Psychiatrist for 20 Minutes.

A powerful correlation exists between the equilibrium of the sympathetic and parasympathetic nervous systems and heart rate variability (HRV). Thus, HRV is useful as a physiological index of both physical and emotional health; autonomic nervous system dysregulation, with a sympathetic predominance and a low HRV, has been associated with a variety of physical (cardiovascular, neurological) and psychiatric disorders. We used a validated algorithm of measuring the HRV (noninvasive, 2-minute approach) in new psychiatric outpatients in first author's private practice. The subjects had an initial measurement, followed by a 20-minute consultation with minimal supportive psychotherapy, followed by an exit measurement. The initial study spanned the "COVID months"; to control for this variable, an identical study was performed in 2023. There was a highly significant decrease in the sympathetic predominance in the test groups; no such trend was found in the control groups. A short psychiatry consultation may be sufficient to decrease patients' sympathetic hyperactivity and improve their well-being.

How do professionals and non-professionals respond to non-suicidal self-injury? Lived experiences of psychiatric outpatients in Singapore

BackgroundFor young people who engage in non-suicidal self-injury (NSSI), receiving negative responses to their NSSI can pose a barrier to future help-seeking. This qualitative study aimed to explore helpful and unhelpful ways in which professionals and non-professionals respond to NSSI, from the perspectives of individuals with lived experiences of NSSI.MethodsSemi-structured interviews were conducted with 20 outpatients (6 males, 14 females) aged 17 to 29 years from a tertiary psychiatric hospital in Singapore, who had reported engaging in NSSI behavior in an earlier study. The interviews were audio recorded and transcribed verbatim. Thematic analysis was used to identify themes and subthemes in the data.ResultsProfessionals’ responses were organized into three main themes: ‘prescribing solutions without understanding needs’, ‘disapproval or judgment’, and ‘helpful responses’. Non-professionals’ responses were organized into four main themes: ‘emotionally charged responses’, ‘avoidance and inaction’, ‘poor understanding of reasons for NSSI’, and ‘providing tangible support and acknowledging NSSI’. Participants also described how unhelpful responses negatively impacted their willingness to seek help.ConclusionsOur findings provide a better understanding of responses to NSSI that are considered helpful and unhelpful, and can be used to improve existing guidelines on responding to NSSI.

The Work and Social Adjustment Scale (WSAS): An investigation of reliability, validity, and associations with clinical characteristics in psychiatric outpatients.

This study, the first to assess the reliability and validity of the Work and Social Assessment Scale (WSAS) in Norwegian routine mental health care, examines differences in functional impairment based on sick leave status, psychiatric diagnosis, and sex. Including 3573 individuals from community mental health services (n1 = 1157) and a psychiatric outpatient clinic (n2 = 2416), exploratory factor analysis (EFA) on subsample 1 and confirmatory factor analysis (CFA) on subsample 2 were utilized to replicate the identified factor structure. EFA supported a one-factor model, replicated by the CFA, with high internal consistency (α = .82, ω = .81). Patients on sick leave reported greater impairments in all aspects of functioning, except for relationships, with the largest effect size observed in the reported ability to work (d = .39). Psychiatric outpatients with major depressive disorder were associated with difficulties in home management, private leisure activities, and forming close relationships. Patients with attention-deficit/hyperactivity disorder reported less impairment than those with other disorders. Patients with personality disorders reported more relationship difficulties than those with PTSD, ADHD, and anxiety. No differences were found in the perceived ability to work between diagnoses. Women had a higher impairment in private leisure activities, whereas men reported more impairment in relationships. The demonstrated reliability and validity suggest that WSAS is a valuable assessment tool in Norwegian routine mental health care. Variations in functional impairment across sick leave status, sex, and psychiatric diagnoses highlight the importance of integrating routine assessments of functional impairment into mental health care practices. Future research should combine WSAS with register data to allow for a broader understanding of treatment effectiveness, emphasizing improvements in functional outcomes alongside symptom alleviation.

Prevalence of Childhood Sexual Abuse Among Tunisian Psychiatric Outpatients and its Associated Factors

Objectives In this study, we aim to estimate the prevalence of childhood sexual abuse (CSA) in psychiatric outpatients in Tunisia and to identify the associated factors. Methods This cross-sectional study was conducted on 133 patients (80 men and 53 women; mean age: 45.02`11.8 years) referred to the psychiatry clinic of the University Hospital of Gabes in Southern Tunisia. Data was collected using the childhood trauma questionnaire - short form, and the suicide behaviors questionnaire-revised. Descriptive statistics and inferential statistics including a correlation test were used for data analysis. The significance level was set at 0.05. Results The overall prevalence of CSA was 9.8%. Participants with a history of CSA had a significantly younger age at the onset of psychiatric symptoms and longer duration of hospitalization. The results of multivariate analysis showed that CSA increased the risk of having psychiatric comorbidities by 5.9 (AOR=5.9, 95% CI, 1.3%, 28.8%) and the risk of suicidal ideation by 5.1 (AOR=5.1, 95% CI, 1.03%, 26.9%). Conclusion The history of CSA has a negative impact on psychiatric patients in adulthood. This association is multifactorial, and there is a need for further longitudinal studies in this regard.

Significant contribution of chronotype to emotional well-being in chronic psychiatric outpatients in Greece

Circadian rhythms are pivotal for human functioning, and their disruption holds significant implications for well-being. One common source for circadian disruptions is circadian misalignment that can be related to chronotypes. Chronotypes refer to an individual's preferred timing for sleep and wakefulness. Individuals with late chronotypes are at a disadvantage in the morning-oriented modern world and are demonstrated to have negative consequences in many aspects of life. In the context of psychiatric disorders, chronotypes are related to prevalence of disorders and to treatment effects but less attention is given to the relationship between chronotype and well-being in chronic psychiatric patients. The current study aims to elucidate the extent to which individual chronotypes contribute to emotional well-being within a cohort of individuals with chronic psychiatric disorder in outpatient clinic.Participants (n = 100) were recruited from the outpatient clinic of the 3rd Department of Psychiatry, AHEPA University Hospital, Thessaloniki, Greece, and the AX Mental Health Outpatient Clinic in Heraklion, Crete, Greece. Most participants were diagnosed within the F2 cluster, Psychotic disorders (n = 38), or F3 cluster, Mood (affective) disorders (n = 48). The Morningness-Eveningness Questionnaire (MEQ) was employed to assess chronotype. The STAI-Y1, CES-D, QoL Uniscale and RASS Questionnaires were used to assess aspects of emotional well-being. A single measure of emotional well-being was generated using Z-score transformation. Student's t-test, ANOVAs and Pearson's correlations were used to identify parameters contributing to emotional well-being, followed by a comprehensive regression model.Results show a significant contribution to emotional well-being by “psychiatric diagnosis” with schizophrenia/schizoaffective patients showing better emotional well-being compared with the “other” group, “receiving treatment” with patients receiving treatment showing higher score than ones who do not receive treatment, and “morningness/eveningness preference” where morningness was associated with higher score of emotional well-being. No other demographic or health-related parameters were significantly associated with emotional well-being score.These findings clearly indicate the critical importance of chronotypes to the emotional well-being of chronic psychiatric patients. Additional thought and research should explore possible chronotherapy interventions that will address this issue in patients.

A study of sleep problems and its associated factors among patients presenting in psychiatry OPD at tertiary-level hospital in Nepal

Background: Sleep disturbances amongst those with psychiatric disorders are quite common and may occur as a primary disorder or in association with any psychiatric disorders. The aim of this study is to find out the prevalence of sleep disorders and its associated factors in psychiatric outpatients. Material & Methods: This cross- sectional study was conducted among the patients presenting in the psychiatric opd, from 1st Feb 2022 to 30th July, 2022 in tertiary level hospital in Nepal. Total 217 samples were included and purposive sampling technique was applied for sample collection. After written informed consent from participants socio-demographic data were collected. Athens Insomnia scale (ASI) and Screening symptoms of sleep disorder(s) were the tools applied to the participants to find out types of sleep disorders. Results: In our study, sleep disorders were found in 66.8% of the patients presenting to psychiatric opd. Insomnia was the most common finding accounting for 59.4 % of the participants. Narcolepsy was found in 2.3% whereas parasomnia was found in 5.1 %; periodic limb movement disorder/Restless leg syndrome (PLMD/RLS) in 5.1%; disturbed circadian rhythm was found in 3.7% and Sleep Related Breathing Disorder was found in 5.1% of the participants. Patients diagnosed with mood disorder (80.4%) and primary headache disorders (82.9%) had more sleep problems compared to other diagnosis. Conclusion: This study was the first in Nepal to assess the prevalence of sleep disorders in psychiatric outpatients. Our study emphasis importance of careful evaluation of sleep problems for proper management of the psychiatric patients.

Predicting Acute Changes in Suicidal Ideation and Planning: A Longitudinal Study of Symptom Mediators and the Role of the Menstrual Cycle in Female Psychiatric Outpatients With Suicidality.

Cross-sectional and preliminary longitudinal findings suggest that cyclical ovarian hormone fluctuations influence acute suicide risk. The authors provide the first analyses in females with suicidality to investigate which daily symptoms covary with suicidal ideation and planning thoughts, the role of the menstrual cycle in daily symptom variation, how daily fluctuations in symptoms mediate the menstrual cycle-suicidality relationship, and how these associations vary across individuals. Naturally cycling psychiatric outpatients (N=119) with past-month suicidal ideation provided daily ratings of psychiatric symptoms (depression, hopelessness, anxiety, feeling overwhelmed, agitation, anhedonia, worthlessness, rejection sensitivity, anger, perceived burdensomeness, and interpersonal conflict), suicidal ideation, and suicidal planning across at least one menstrual cycle. Symptom ratings were decomposed into trait (person-centered mean) and state (daily person-centered mean deviation) components. Five cycle phases were identified in relation to menses onset and ovulation (surge in urine luteinizing hormone level). Hypotheses were tested in multilevel structural equation models. Nearly all psychiatric symptoms covaried with fluctuations in daily suicidal ideation, and a limited set of symptoms (depression, hopelessness, rejection sensitivity, and perceived burdensomeness) predicted within-person increases in suicidal planning. Many patients demonstrated perimenstrual worsening of psychiatric symptoms, suicidal ideation, and suicidal planning. Depressive symptoms (depression, hopelessness, perceived burdensomeness, and anhedonia) were the most robust statistical mediators predicting perimenstrual exacerbation of suicidality. Research on the menstrual cycle and suicide has been limited historically by small, cross-sectional samples. This study provides the first evidence that measuring day-to-day correlates of suicidality in a large transdiagnostic sample of females with suicidal ideation can contribute to understanding the pathways by which the menstrual cycle influences acute suicide risk.

Sleep quality of adult psychiatric outpatients at Chris Hani Baragwanath Academic Hospital.

Sleep disorders are increasingly prevalent among the general population and individuals with mental disorders. However, little research has focused on the sleep quality of psychiatric patients beyond depression, despite its relevance in diagnostic criteria. This study aimed to assess overall sleep quality in psychiatric outpatients and to assess for an association with socio-demographic variables. This study took place at the adult psychiatric outpatient department of Chris Hani Baragwanath Academic Hospital. A cross-sectional study design was employed to evaluate overall sleep quality using the self-administered Pittsburgh Sleep Quality Index (PSQI), a validated tool. The PSQI yields a global score ranging from 0 to 21, with scores of 5 or greater indicating poor sleep quality. Eligibility was determined through structured clinical interviews and data obtained from participant records. Poor sleep quality was found in 50% of participants. Sleep quality did not differ significantly based on sex or age. Subscale analysis revealed reduced sleep duration and efficiency, nocturnal disturbances and daytime dysfunction. Additionally, 38% of participants required pharmacological intervention for sleep issues, despite lacking a diagnosis of primary or comorbid sleep disorders. Half of the psychiatric outpatients experienced poor sleep quality, irrespective of socio-demographic factors, psychiatric diagnosis, symptom remission or medication type. This study highlights the importance of addressing sleep disturbances as comorbid conditions in psychiatric patients. Comprehensive evaluation and management of sleep quality can lead to improved patient outcomes and quality of life.

Factors influencing concentrations of risperidone and 9-hydroxyrisperidone in psychiatric outpatients taking immediate-release formulations of risperidone.

To analyze the factors affecting the concentrations of the active moiety of risperidone (RIS) and its active metabolite 9-hydroxyrisperidone (9-OH-RIS) in psychiatric outpatients taking immediate-release formulations. This is a retrospective study on the therapeutic drug monitoring (TDM) data regarding RIS and 9-OH-RIS in adult psychiatric outpatients. TDM data with simultaneous RIS and 9-OH-RIS monitoring from March 2018 to February 2020 and relevant medical records (including dosage, dosage form, sex, age, diagnosis, combined medication, and comorbid disease) from 399 adult psychiatric outpatients (223 males and 176 females) were included in this study. The daily dose of RIS was 5.56±2.05mg, the concentration of total active moiety was 42.35±25.46ng/mL, and the dose-adjusted plasma concentration (C/D) of active moiety was 7.83±3.87 (ng/ml)/(mg/day). Dose, sex, and age were identified as important factors influencing concentrations of RIS and 9-OH-RIS in adult psychiatric outpatients. Individualized medication adjustments should be made according to the specific conditions of psychiatric outpatients. The findings strongly support the use of TDM to guide dosing decisions in psychiatric outpatients taking RIS.

Positive Orientation and Psychological Distress: An Examination with Psychiatric Outpatients

Introduction: This research was conducted to extend the theoretical construct of positive orientation (PO) to psychiatric outpatients. This research also examined the effect of PO on alleviating stress, anxiety, and depression among psychiatric outpatients. Methods: This cross-sectional survey recruited 301 psychiatric outpatients online. As these respondents have a short attention span, short measures were used to measure PO-related variables (life satisfaction, optimism, self-esteem) and indicators of psychological distress (depression, anxiety, and stress). These outpatients are at the legal age to provide consent for themselves (M = 30.12, SD= 8.11). The majority of them have been identified as male (80.07%). Similarly, the ethnic distribution was unequal, with the majority of these outpatients identified as Malay (85.05%), followed by those who were identified as Chinese (7.31%), Indian (4.32%), and from other ethnic groups (3.32%). Results: Generalized structured component analysis (GSCA) supported that satisfaction with life, optimism, and self-esteem reflect the construct of PO. Furthermore, PO predicted depression, anxiety, and depression negatively. Conclusion: It is possible to replicate the construct of PO with psychiatric outpatients using single item measures for life satisfaction, optimism, and self-esteem. PO is beneficial to psychiatric outpatients as it reduces the severity of depression, anxiety, and stress.

Differences in cognitive and academic performance during the COVID-19 pandemic in child psychiatric outpatients.

This study examined the impact of the COVID-19 pandemic on cognitive and academic functioning in 574 youth presenting for outpatient clinical neuropsychiatric evaluations. We extended the prior literature by (a) determining the extent to which academic difficulties documented in population and community samples also occurred in child psychiatric outpatients; (b) evaluating the impact of the pandemic on neuropsychological functions relevant to academic performance (overall cognition, executive functions, and graphomotor skill); and (c) investigating the moderating impact of attention deficit hyperactivity disorder (ADHD) diagnosis. We compared cross-sectional scores on standardized measures for groups of youth evaluated at three time periods related to the COVID-19 pandemic: (a) prior to onset (PRIOR; N = 198), (b) during Year 1 (Y1; N = 149), and (c) during Year 2 (Y2; N = 227). Relative to overall cognitive ability, math scores were lower in Y1 and Y2 and reading scores were lower in Y2. Additionally, relative to overall cognitive ability, youth showed lower working memory in Y1 and lower processing speed in Y1 and Y2. Graphomotor skill and parent-rated executive functions (EF) did not vary significantly across the three time periods. ADHD status did not moderate psychometric test scores but did moderate parent-rated EF. These data suggest that the COVID-19 pandemic has negatively impacted academic and executive functions in child psychiatry outpatients. More research is needed to understand the long-term implications for development. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychometric Properties of the Persian Version of the Revised Temperament and Character Inventory (TCI-140) in a Psychiatric Outpatient Sample in Iran

Background: Cloninger first proposed the personality theory, considering both normal and abnormal personality traits. Later, different complementary versions of the Temperament and Character Inventory (TCI) found their way into the academic milieu to enhance their psychometric properties and efficiency in both experimental and clinical settings. Objectives: The main objective of the current research was to investigate the principal psychometric properties of the Persian version of the Temperament and Character Inventory (TCI-140). Methods: This research is a cross-sectional study. The data included information on psychiatric outpatients visiting Roozbeh psychiatric hospital in 9 months in 2021. Purposive sampling was performed on volunteers. A total of 471 outpatients filled out the TCI-140, 150 of whom also filled out the Personality Inventory for the DSM-5 (PID-5). Exploratory factor analysis (EFA) was performed using principal component analysis (PCA) by Promax rotation. Results: The internal consistency of all dimensions (Cronbach's alpha: Above 0.70, except for reward dependence) was proved to be satisfactory, but that of some subscales (NS1, NS4, RD4, CO3, and CO5) was quite poor. Test-retest reliability confirmed that for all dimensions, ICC > 0.70, indicating a high reliability. The findings of the PCA revealed that all dimensions were loaded in accordance with the theoretical expectations. At the facet level, all the facets were loaded on their factors except for sentimentality and dependence. According to the correlation findings, the concurrent validity of TCI-140 was acceptable for PID-5. The results showed that HA had relatively high positive correlations with detachment (r = 0.55) and negative affect (r = 0.48). Conclusions: The results confirmed the satisfactory reliability and validity of the Persian version of TCI-140 despite its drawbacks. Hence, it can be employed to examine personality traits.

Attitudes towards deprescribing in geriatric psychiatry: A survey among older psychiatric outpatients.

Understanding the patient perspective is a significant part of the deprescribing process. This study aimed to explore the attitudes of older patients with psychiatric disorders towards deprescribing. A total of 72 of psychiatric outpatients (68% women; median age 76 years) completed the validated Danish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Patients used a median of eight medications (interquartile range 6-12), with 88%, 49% and 24% using antidepressants, antipsychotics and anxiolytics, respectively. Fifty-one percent of patients reported an intrinsic desire to stop one of their medications, while 92% would be willing to stop one on their physician's advice. Seventy-five percent of patients would be worried about missing out on future benefits following deprescribing and 37% had previous bad deprescribing experiences. Use of ≥8 regular medications was associated with more concerns about stopping medication and greater perceived burden of using medication, while use of antipsychotics was not associated with any differences in rPATD factor scores. It is crucial for health care professionals to be aware of patients' specific concerns and past experiences to promote a patient-centred deprescribing approach that takes into account the needs and preferences of older patients with psychiatric disorders.

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.