Psychiatric Specialist Research Articles

Socio-Demographic Correlates and Patterns of Use Among Patients Visiting Addiction Services of Almadinah Specialized Psychiatric Hospital in Saudi Arabia

Background: Substance use disorders are on the increase worldwide with negative consequences on individuals, their family and the community. Our objective is to study the socio-demographic and patterns of use in those requesting addiction treatment in Addiction treatment services of Almadinah Specialist Psychiatrist Hospital (ASPH). Methods: A descriptive chart review study of 622 patients requesting treatment between the first January 2019 and 31 December 2012. Information was taken from patients’ records and if necessary, completed by a direct interview with the patient. Data collected were analysed using Statistical Package for the Social Sciences (SPSS) version 22.0. Results: The majority were male (96.6%) with a mean age of 32.1 ± 9.2 years. More than half had less than a bachelor’s degree, while 23.5% were highly educated. The majority of patients were single (70.7%), 53.1% reported difficulty keeping a job, 17.8% a high income, 90% a negative family history of substance abuse and 94.7% a negative family history of psychiatric illness. The most frequent substances used, in descendant order, were captagon (69.8%), cannabis (63%) and alcohol (30.7%). The mean age of initiation was around 21 years for the three main substances. The prevalence of co-occurring disorders was at 14%. Two thirds of patients were from the outpatient department (67.7%) and 32.2% from the emergency department (ED). Around a third of our sample visited the emergency room at least once during the month prior to their evaluation and overall, 32.3% needed hospital admission. Conclusions: The fact that 90% of our sample reported a negative history of substance abuse with about 4 out of 5 having an early age of initiation to substance use emphasizes the urgent need for psychoeducational preventive efforts on substance abuse and dependence targeting our youths and their families, in multiple areas particularly in school and neighbourhoods.

Psychiatric pathology model at the department of adolescent health at Vietnam National Children's hospital in the period 2020-2021

This restrospective study is to determine the rate of psychiatric pathologies of adolescents who come for examination and treatment at the Department of Adolescent Health - National Children's Hospital from January 2020 to April 2021. We use the ICD-10 International Classification of Diseases for diagnosis. The mental illnesses accounted for 27.9% of the adolescents who came for examination and treatment. Among psychiatric pathologies, three groups with the highest rates are behavioural and emotional disorders with onset usually occurring in childhood and adolescence (chapter F9) with 45.9%, neurotic, stress-related and somatoform disorders (chapter F4) (29.4%) and mood [affective] disorders (chapter F3) (8.1%). Among the psychiatric pathologies, mood disorder; anxiety and behaviour disorder are the highest prevalent. We recommend to provide training to human resources in psychiatric specialties to effectively treat these conditions.

Current diagnostic pathways for Alzheimer's Disease ‐ A comparison of six countries

AbstractBackgroundDiagnostic pathways from cognitive impairment (CI) to Alzheimer’s disease (AD) are complex and vary geographically. This study aimed to quantify and compare the current diagnostic pathways in six countries.MethodsA real‐world, cross‐sectional survey of 1,694 health care professionals (HCPs) was conducted in six countries (US, China, UK, France, Germany and Spain) from October to November 2021. HCPs provided data for 6,744 patients including patient demographics, presenting symptoms, and diagnostic tests and procedures. Descriptive analyses were conducted for all patients and further stratified by countries and HCP types (primary care physicians (PCP) versus specialists (geriatricians, neurologists and psychiatrists)).ResultsMost common presenting symptoms included problems with memory (89.9%), physical/behavioral (87.1%), executive functioning (72.2%) and language (71.4%). 42.1% of patients were presenting to HCPs the first time for their symptoms.96.0% of patients with data on diagnostic tests by country and specialty (n=6,525), underwent clinical and 95.5% cognitive tests, including tests at scheduled follow‐up visits. Mini‐Mental State Examination (MMSE) was the most frequently used cognitive test (n=5,141). About half the patients (n=3,329) received blood‐tests, mainly to rule out other causes of CI (n=2,687) (Table 1).Diagnostic test use varied by country and specialty. In China, cognitive tests, especially MMSE, were more commonly used by specialists (81.9%) than PCPs (41.6%). In the UK blood tests were more commonly used by PCPs (62.5%) than specialists (46.2%).ConclusionDiagnostic pathways varied largely by country and specialty. This study is relevant to populate diagnostic pathways, fill data gaps and advance patient care in AD by supporting future evidence generation, especially when new treatment options arrive.

The incidence of depressive episodes is different before, during, and after pregnancy: A population-based study

BackgroundDepressive episodes during pregnancy are widely investigated but it is still unknown whether pregnancy is a high-risk period compared to the pre-pregnancy period. Therefore, we aimed to investigate the incidence and recurrence of depressive episodes before, during, and after pregnancy. MethodsIn the current population-based registry study, we calculated monthly incidence and recurrence of psychiatric inpatient admissions and outpatient psychiatric contact for depressive episodes. We identified a population consisting of all first childbirths in Denmark from 1999 through 2015 (N = 392,287). ResultsIncidence of inpatient admission during pregnancy was lower than before pregnancy. After childbirth, a significant increase in first-time and recurrent psychiatric inpatient admissions was observed, especially in the first months. In contrast, outpatient psychiatric treatment incidence and recurrence were increased both during pregnancy as well as in the postpartum period, as compared to pre-pregnancy. LimitationsAnalyses were performed on depressive episodes representing the severe end of the spectrum, questioning generalizability to milder forms of depression treated outside psychiatric specialist treatment facilities. ConclusionWe found a different pattern of severe episodes of depression compared to moderate episodes before, during, and after pregnancy. In light of our findings and those of others, we suggest distinguishing between timing of onset in the classification of depression in the perinatal period: Depression with pregnancy onset OR with postpartum onset (instead of the current DSM classifier “with perinatal onset”), as well as severity of depression, which is important for both clinical and future research endeavors.

Telepsychiatry for people with intellectual disabilities and mental health difficulties during Covid-19 pandemic: survey of self-reported experience and acceptability to patients, carers and psychiatrists in the UK

Aim: This project sought to ascertain views and experiences of people with intellectual disabilities, their carers’, and specialist intellectual disability psychiatrists as to use of telepsychiatry consultations. Background: During the Covid-19 pandemic specialist psychiatrists in intellectual disability services in the United Kingdom (UK) have explored and adopted use of telepsychiatry for psychiatric consultations. Method: An easy-read co-designed questionnaire was sent to potential respondents N = 590 potential respondents (N = 280 patients, N = 280 carers), and a separate questionnaire was sent electronically to N = 30 specialist intellectual disability psychiatrists. Findings: Responses were received from N = 192 respondents (N = 68 (24%) patients, N = 98 (35%) carers, and N = 26 (90%)) psychiatrists. Advantages of telepsychiatry cited were flexibility, and it being less disruptive to patients’ routines, offering convenient practice and saving travel time and cost. Disadvantages reported included loss of rapport and relationship with patients, and an inability to conduct an effective mental state examination. Conclusion: This survey has produced equivocal evidence as to acceptability of telepsychiatry for all people with intellectual disabilities, carers and psychiatrists cannot be assumed. Some patients may need significant support to enable them to engage with such an approach.

Bioethical-medical aspects of the phenomenon of sports doping

Doping is a global problem at world sporting events of a legal nature, medical and ethical. International sports forums have tried to stop the spread of this scourge, to no avail. Educational programs, tests and medical treatment are expected to reduce substance abuse. New, more powerful and undetectable anti-doping techniques and substances are being abused by professional athletes, and drugs are being distributed through various sophisticated networks. Professional athletes are often role models for adolescents, young people and adults and their behaviours are imitated, including drug abuse. The reanalysis of doping in international sports will be oriented towards better information of the psychiatric specialists and towards an urgent intervention in the treatment of the addiction of substances in sports.

Psychological Problems Related to Infertility.

Infertility is a problem of great significance among millions of couples.In our society,to have a child means living a fulfilled life. Thus, couples who cannot do so feel barren and incomplete. Therefore, infertility is more than just a medical problem. It affects all aspects of life, the most important being mental health. For many years, a person's mental health has been overlooked, but in the past few years, it has gained importance that mental health is as significant as physical health, which has also been stated in the WHO definition of health.This article discusses the mental toll that infertility takes on a person's life. A person may experience a myriad of psychological problems, of which stress for extended periods is one. Furthermore, it may cause feelings of guilt, emptiness,anxiety, and depression. The article mainly focuses on the need for counseling for couples dealing with infertility and under treatment because of the long waiting periods accompanying it. Although both men and women can contribute to infertility in India, women are exclusively held responsible, leading to more significant stress while undergoing treatment.The paper also provides an overview of infertility, the factors responsible, and the treatments currently available. Various studies have shown that delivering psychological support through psychiatric clinical specialists may accentuate the results ofIVF (In-vitro fertilization) and ART (Assisted Reproductive Technology). This review sheds light on the effects of infertility on quality of life and how it can be prevented or reduced through psychotherapy.

Sistem Pakar Untuk Diagnosa Retardasi Mental Anak dengan Metode Bayes Berbasis Web

In children's mental retardation, sometimes the child's parents cannot directly consult with a psychiatric specialist because of the limited time in carrying out activities in the hospital and the high cost. Advances in expert systems can overcome this problem, namely by designing a web-based computer system that is integrated with databases and programming languages ​​such as PHP-MySQL so that it can help patients with mental retardation to diagnose the disorder. The purpose of this research is to build a web-based expert system for diagnosing mental disorders. The application of the expert system in this decision making uses the Bayes method, in probability theory and statistics, the Bayes theorem is a theorem with two different interpretations. In Bayes' interpretation, this theorem states how far the degree of subjective belief must change rationally when there are new clues. to get a diagnosis. The result of the implementation of the system is that the system provides choices in the form of symptoms that must be answered by the patient's parents based on the symptoms experienced by the patient and the results of the process the system will provide information on the mental retardation he experienced in order to get a solution with the handler

Editorial introductions.

Editorial introductions.

A rare case of 48, XXYY syndrome in Taiwan

A rare case of 48, XXYY syndrome in Taiwan

Thomas Bewley: put addiction medicine on an equal footing with other psychiatric specialties

Thomas Bewley: put addiction medicine on an equal footing with other psychiatric specialties

Recent findings on subjective well-being and physical, psychiatric, and social comorbidities in individuals with schizophrenia: A literature review.

Care for people with schizophrenia is shifting the locus from long-stay mental hospitals to nonspecialized community-based settings. Knowledge on the care is not a sole property of psychiatric specialists. Community healthcare workers who do not specialize in psychiatry are recommended to learn more about schizophrenia. This review aimed to summarize recent findings on subjective well-being and physical, psychiatric, and social comorbidities in individuals with schizophrenia. A literature review was conducted. We retrieved findings from existing systematic reviews and meta-analyses as our preferred method. When data were not available, we referred to other types of studies. As per our review, individuals with schizophrenia demonstrated poor subjective well-being, happiness, and life satisfaction despite individual differences. Pharmacotherapy caused weight gain and constipation, whereas race and hospitalization might affect weight reduction. Individuals with schizophrenia demonstrated poor oral health, a high prevalence of noncommunicable diseases, and unique eating behaviors. Depression, sleep disorders, smoking, and alcohol and drug consumption were frequently found in the individuals. Research findings regarding problematic internet and smartphone use and stress perception were limited. Low health literacy and neglect of preventable behaviors were frequently seen in individuals with schizophrenia. They tended to be less educated, poor, unemployed, unmarried/unattached, and had poor social cognition, resulting in little social support and a small social network. Retrieving recent data, we confirmed that individuals with schizophrenia had poor subjective well-being and suffer from various physical, psychiatric, and social comorbidities.

Do "Real World" Childhood Mental Health Services Reduce Risk for Adult Psychiatric Disorders?

This study tested the "intervention as prevention" hypothesis: that treatment of childhood psychopathology in the community might reduce risk for adult psychopathology. Analyses were based on a prospective, population-based study of 1,420 children followed up to 8 times during childhood (ages 9-16 years; 6,674 observations) about psychiatric status and specialty mental health services use. Participants were followed up 4 times in adulthood (ages 19, 21, 25, and 30 years; 4,556 observations of 1,336 participants) to assess adult psychopathology. Participants with a childhood psychiatric disorder who used childhood specialty mental health services were at similar risk for adult emotional (odds ratio [OR]= 0.7; 95% CI= 0.3-1.4, p= .29) disorders and at higher risk for adult substance disorders (OR= 2.1; 95% CI= 1.1-4.2, p= .03) as compared those with a childhood disorder who did not use services. The risk for substance disorders was driven by children with behavioral disorders (OR= 3.6; 95% CI= 1.6-8.1, p= .002). Sensitivity analyses suggest that an unmeasured confounder would have to have an E value of 3.26 or risk ratio of 1.92 to alter this finding. Higher "dose" of services use (defined at 6+ visits) was not associated with improved outcomes. Community services use may reduce psychopathology within childhood, but they do not necessarily prevent adult psychiatric problems. These findings are consistent with the notion of mental health problems as chronic conditions that often begin in childhood but that may recur in different forms across the lifespan even when treated.

Children with neuro-developmental disorders at Center for Child and Adolescent Mental Health in Cambodia.

ABSTRACTThe Center for Child and Adolescent Mental Health (CCAMH) is one of the centers that have psychiatric specialists for children in Cambodia. This study aims to understand the characteristics of children with neuro-developmental disorders, especially autism spectrum disorder (ASD), at CCAMH. This study included 440 cases that were randomly chosen from 2,147 new patients at CCAMH in 2018–2019 and were aged 0–12 years. Socio-demographic factors, parent’s information, obstetrical factors, and clinical data were collected from patients’ records. A logistic regression analysis and Pearson’s chi-square test were used to compare the characteristics between children who were finally diagnosed with ASD and the others (non-ASD). Of the 440 patients, most were male (75.2%), 0–4 years old (57.7%), and diagnosed with ASD (50.0%). Common symptoms were delay of speech, playing alone, and hyperactivity. ASD was significantly more prevalent in male patients compared to females and in the 0–4 years age group compared to the 5–12 years age group. Parents who lived in Phnom Penh and had high education were more likely to visit the CCAMH with their children who were diagnosed with ASD. Regarding treatment, approximately half of all 440 patients had family counselling and psychosocial education. ASD patients had more speech therapy, special education and structured teaching, and networking and coordination therapy compared to non-ASD patients. To provide education and therapy to children with ASD and their parents from the early stage, information about the center and ASD should be widely distributed to all parents in Cambodia.

Melatonin use among children, adolescents, and young adults: a Danish nationwide drug utilization study.

We aimed to provide a detailed description of the use of melatonin in Danish children, adolescents, and young adults during 2012-2019. We identified melatonin users 0-24years of age (n = 43,652; median age 16years) via the Danish nationwide health registers. Melatonin is a prescription drug in Denmark. The incidence of melatonin use increased from 2.4 to 3.9/1000 person-years during 2012 to 2019. Among 6,557 incident users in 2019, 53% filled only a single prescription within the first 6months. Long-term use was most common among the younger age groups, with 17% of 5-9-year-olds and 14% of 10-13-year-olds being in continued treatment (no treatment breaks) 12months after their first melatonin prescription. Disregarding treatment breaks, 3 in 10 were using melatonin 12months after their first melatonin prescription and this proportion was also highest among 5-9-year-olds (63%) and 10-13-year-olds (51%). Psychopathology was common among melatonin users with 75% registered with either a psychiatric disorder diagnosis (54%), a filled prescription for another psychotropic (58%), or a contact to a private practice psychiatrist (15%) within ± 12months of treatment initiation. General practitioners authorized melatonin prescriptions to almost half of all new users (48%), while psychiatric specialists authorized 37% of first prescriptions. In conclusion, the incidence of melatonin use increased in Denmark from 2012 to 2019. A substantial proportion of users had concurrent psychopathology most likely explaining their use of melatonin. Long-term melatonin use was more common among the youngest age groups, which should be a focus of interest due to limited safety data.

Junior Doctor Mentors: Enhancing Medical Student Psychiatry Training

AimsIncreased clinical contact during undergraduate psychiatry placements has been shown to both increase the likelihood of students considering a career in psychiatry and reduce mental-health related stigma. It can be challenging to provide medical students with a valuable clinical experience, a problem which has been further exacerbated by the coronavirus pandemic. We aimed to develop a junior doctor mentoring scheme to increase clinical exposure and teaching for students.MethodsWithin NHS Lanarkshire, groups of 4–6 University of Glasgow medical students are accommodated for their five-week clinical psychiatry blocks, during which they have a varied structured timetable, providing an overview of different psychiatric specialties. As such, students meet a wide range of clinicians, which can unfortunately mean there is little continuity in their training throughout the block.We developed a mentoring scheme to help address this issue. Enthusiastic trainee doctors – including foundation year two doctors, GP trainees and psychiatry core trainees – were invited to participate. Medical students are paired with a mentor for the duration of their block, during which they meet informally on a weekly basis. Mentors provide students with ward shadowing opportunities and bedside teaching, as well as completing work-place based assessments (WPBAs), discussing case reports and providing an additional perspective for end-of-block reports.ResultsThe mentoring scheme has been running successfully for every five-week student placement since October 2020. Student feedback has been collected via an anonymous electronic questionnaire. Students were asked what they enjoyed the most about their placement, with students frequently highlighting the support from their mentor.Examples from free-text comments included, “having an assigned mentor was really useful as someone to touch base with and go through clinical cases” and, “having a mentor was invaluable – it is crucial to have a friendly face on the wards and a contact to complete WPBAs”.Informal feedback from mentors has also been positive with trainees enjoying the opportunity to develop their teaching skills and support student training. Mentors also highlighted the role's benefit for their portfolios and specialty applications.ConclusionThis simple and cost-free intervention has had resoundingly positive feedback from medical students and trainees. Medical students enjoy having consistent informal teaching, support and feedback. Our mentoring scheme will continue for all medical students in NHS Lanarkshire and we would encourage other areas to consider a similar project. By increasing clinical exposure we hope to further reduce mental health stigma amongst students and inspire the psychiatrists of tomorrow.

Burnout among early career psychiatrists in Russia – results of a cross-sectional study

IntroductionDespite the long history of burnout studies, the problem of burnout among psychiatric specialists in Russia is insufficiently studied. The risk of burnout is the highest among psychiatrists in the first 10 years of their career.ObjectivesTo assess the prevalence and severity of burnout in early career psychiatrists (ECPs) in Russia.MethodsAn anonymous online survey of ECPs in Russia was conducted in July-August 2019 with a screening for burnout using the Maslach Burnout Inventory (MBI). The final sample consisted of 165 people (61.2% women; mean age 31.05±3.88). 95.2% of respondents lived in urban areas.ResultsA high level of burnout according to at least one of the MBI scales was revealed in 71.5% of ECPs: in 79 (78.2%) women and 39 (60.9%) men (χ2(1)=5.74; p=0.017). Mean values of the MBI Emotional Exhaustion scale corresponded to 23.33±8.97 and 17.97±8.49 (U=1999.5; p=0.003), the MBI Depersonalization scale – 10.46±4.81 and 9.16±4.22 (U=2598.5; p=0.083), and the MBI Personal Accomplishment scale – 33.02±5.98 and 35.32±5.75 (U=2409.5; p=0.026) for women and men, respectively. The following risk factors for professional burnout were identified: female sex (OR=3.54 [95% CI: 1.96; 6.39], p<0.001), overlapping of several working positions (OR=2.44 [95% CI: 1.36; 4.37], p=0.003), difficulties in work due to changes in documentation requirements introduced since the start of career (OR=2.32 [95% CI: 1.31; 4.11], p=0.004).ConclusionsA high frequency of burnout among ECPs in Russia was revealed which suggests the urgent need for studies assessing the ways to prevent burnout in psychiatrists in Russia.DisclosureNo significant relationships.

Prescribing of Psychiatric Drugs in Pregnancy: A Review of Current Practice in a Community Mental Healthcare Setting

AimsPrescribing of psychotropic medications in pregnancy is still considered a ‘grey area’ in clinical practice. National Institute for Health and Care Excellence (NICE) in the UK suggests that the decisions should be person-specific, considering the risks to both the mother and unborn child, and the patient is supported to make an informed decision. It is important to explore the use of psychotropic medications during pregnancy, or lack of it, and its subsequent impact on maternal mental health. It was intended to review the decisions expectant mothers are making regarding taking psychiatric medications during pregnancy, and the associated clinical outcomes. Their mental capacity for taking decisions was also checked.MethodsA retrospective audit of case notes of patients (n = 16) known to community psychiatric team (CMHT) and specialist perinatal mental health (PNS) services in Wolverhampton, who notified their pregnancy between December 2020 and December 2021. Demographic and clinical data were collected from the electronic records.ResultsThe sample had a mean age of 28.8 ± 6.3 years (range: 19 to 39 years), and 68.8% of them were Caucasian. A wide range of psychiatric diagnoses were present, most (62.5%) had comorbid diagnoses; and 25% had substance use, most commonly cannabis. Mean duration of gestation at the review following notification of pregnancy was 14.5 ± 7.7 (range: 6 to 29) weeks. It was observed that 25% were not taking psychiatric medications prior to pregnancy, 43.8% stopped taking their medication prior to the psychiatric review, most stopping abruptly, and 31.2% had continued their medication. The medications included aripiprazole, olanzapine, quetiapine, venlafaxine, sertraline and promethazine. Following the review, only 18.8% continued their medications. Of the 13 (81.3%) patients who were not taking medications, 9 (69.2%) had adverse mental health outcomes, with 2 (15.4%) patients requiring inpatient care. However, later 8 (61.5%) started taking medications whilst under the care of PNS. All of them had mental capacity to decide regarding their psychiatric treatment at the review.ConclusionMost psychiatric patients avoided taking psychotropic medications initially during pregnancy, however, a considerable proportion restarted their medications following review with the perinatal psychiatry team. The majority of patients who did not take medications had negative mental health consequences. It is important to develop an evidence base about the use of psychiatric medications in pregnancy and the associated short and long-term outcomes that may help the quality of information shared with patients.

Containing Chaos: A Self-Reflection of a Final Year Medical Student’s Elective in a High Security Psychiatric Hospital

IntroductionThroughout training, medical students are often only exposed to a limited selection of psychiatric specialities, predominantly general adult inpatient settings. This medical student had the opportunity to undergo a placement at a high security forensic hospital. With only three such hospitals in England, this is an environment that few students and even qualified doctors have been able to experience. In this presentation, the author will explore their prior expectations, key skills gained, and surprising realisations that made the elective highly valuable.ObjectivesTo reflect on the skills learned and revelations made during the elective period and share these as a presentation.MethodsThe author completed a 6-week placement at Ashworth High Security Psychiatric Hospital. He then reflected on his experiences.ResultsThis placement allowed the development of a range of skills and personal discoveries. The skills included enhanced personal safety awareness, improved use of varied communication styles, and de-escalation and management techniques with higher risk patients. The main finding was the fine line between Ashworth’s patients and mainstream society, and how easily these two entities can overlap. Carl Jung spoke of a ‘shadow’ that must be integrated, and the humanity within each patient made this philosophical concept a sobering reality.ConclusionsHigh security placements are valuable educational opportunities and teach important skills, not often found in the current medical school curriculum. These placements offer the transferable communication and interpersonal skills essential in any budding psychiatrist, and also provide a vital environment for self-reflection and personal growth.DisclosureNo significant relationships.

Patients’ online access to psychiatric records: Providers’ experiences

IntroductionPatients attending psychiatric specialist health services in Northern Norway have since 2015 had the opportunity to access their medical records online. Prior to implementation, there were some concerns in the professional field that patient accessible electronic health records might introduce some challenges.Objectives In this study, we asked psychiatric providers in outpatient psychiatric care about the impact of patients’ online access to documentation practices and whether they felt the access impacted the provider-patient relationship. We also examined whether the providers sought to deny patients’ access to any information.Methods16 qualitative in-depth interviews were performed with mental health providers working in the specialist services in North Norway. Participants had different professional backgrounds, and included doctors, nurses, psychologists and others. The interviews were audio recorded and transcribed verbatim. The data were qualitatively analyzed by means of the framework method.ResultsThe providers varied in their encouragement of patients’ online access, but few expressed concerns. There had been little specific training on how to optimize the writing of notes to accomodate patients’ online acces, but several pointed out that there had been an increased focus on the importance of adapting the notes to promote understanding. Increased transparency was in general seen positively, but the service might not fit all patient categories. Very few patients were denied access. In most cases, the service could improve the patients’ understanding of the treatment and the provider-patient relationship.ConclusionsWhile some voiced caveats, patients’ online access was in general seen as beneficial to the treatment and the provider-patient relationship.DisclosureNo significant relationships.