Psychiatry Clinic Research Articles

Hearing Loss in Older People With Schizophrenia: Audiologic Characteristics and Association With Psychosocial Functioning

The severity and impact of hearing deficits among adults with schizophrenia spectrum disorders may become increasingly relevant with advancing age. This study evaluated hearing ability and associated psychosocial functioning among older adults aged 50-70. Cross-sectional analysis. Four outpatient psychiatry clinics in New York City. Individuals aged 50-70 years with diagnoses of schizophrenia or schizoaffective disorder. Unaided pure tone air conduction audiometry conducted using a portable audiometry system determined the pure tone average (PTA) hearing threshold across four frequencies: 500, 1k, 2k, and 4k Hz. Better ear PTA defined the hearing threshold. Audiometry data retrieved from the U.S. National Health and Nutrition Examination Survey aided interpretation of sample hearing loss rates. Standard measures evaluated psychiatric symptoms, perceived impact of hearing impairment, loneliness, and quality of life. Among audiometry completers (N = 40), 35% (n = 14) demonstrated subclinical hearing loss (16-25 dB) and 35% (n = 14) had mild or worse hearing loss (≥26 dB). Rates were higher than expected based on age-based population data. Those who perceived hearing handicap rated it moderate (12.2%) or severe (7.3%); those who perceived tinnitus rated the impact as mild to moderate (12.2%) or catastrophic (2.4%). Neither psychiatric symptoms nor interviewer-rated quality of life was associated with hearing ability. Greater loneliness was significantly correlated with worse audiologic performance (r = 0.475, p <0.01) and greater perceived hearing handicap (r = 0.480, p <0.01). Identifying the need for hearing loss treatment among aging adults with schizophrenia spectrum disorders is important given the potential implications for social functioning, cognitive, and mental health.

87 Suitability of the I-InTERACT-North Parenting Program for families with autistic children

Objective:I-InTERACT-North is a stepped-care telepsychological parenting intervention designed to promote positive parenting skills and improve child behaviour. Initially developed for children with traumatic brain injury, our pilot study has shown efficacy in increasing positive parenting skills and reducing problem behaviours for children with early brain injury (e.g., stroke, encephalopathy). Recently, the program has expanded to include children with neurodevelopmental disorders, including Autism Spectrum Disorder. Although positive parenting programs (e.g., Parent-Child Interaction Therapy) can be effective for autistic children, it is unknown whether the goals most important to these families can be addressed with IInTERACT-North program. An examination of suitability and preliminary efficacy was conducted.Participants and Methods:Parent participants of autistic children between 3 and 9 years (n= 20) were recruited from the neonatal, neurology, psychiatry, or cardiology clinics at The Hospital for Sick Children and the Province of Ontario Neurodevelopmental Disorders (POND) Network. Top problems, as reported by parents at baseline, were analyzed qualitatively through a cross-case analysis procedure in order to identify common themes and facilitate generalizations surrounding concerning behaviours. Parent-reported intensity of their children’s top problem behaviours on a scale from 1 (“not a problem”) to 8 (“huge problem”) were quantified. To explore preliminary program efficacy, t-tests were used to compare pre- and post-intervention problems and intensity on the Eyberg Child Behavior Inventory (ECBI) (n=16).Results:A total of 56 top problem data units were examined, with convergent thematic coding on 53 of 56 (94.6% inter-coder reliability). Four prevalent, high-agreement themes were retained: emotion dysregulation (19; 33.9%), non-compliance (12; 21.4%), sibling conflict (7; 12.5%), and inattention and hyperactivity (7; 12.5%). Average problem intensity for these themes ranged from 5.85 to 6.53 (where 8 is greatest impairment) with emotion dysregulation having the highest intensity (6.53) compared to the others. Scores on the ECBI were lower post-intervention (Intensity scale: M= 59.06, SD= 8.1; Problem scale: M= 60.69, SD= 11.5) compared to pre-intervention (Intensity scale: M= 61.19, SD= 10.4; Problem scale: M= 64.31, SD= 11.7), but small sample size precluded detecting statistical significance (p’s = .16 and .07, respectively).Conclusions:Thematic analysis of top problems identified by parents of autistic children suggested that concerns were transdiagnostic in nature, and represent common treatment targets of the I-InTERACTNorth program. Though challenging behaviours related to restricted interests or repetitive behaviours may exist in our sample, parental behavioural goals appeared to align with the types of concerns traditionally raised by participants of the program, supporting a transdiagnostic approach. Preliminary data point to positive treatment outcomes in these families.

Reshaping the diagnostic borders: Historical analysis of the diagnostic changes following the introduction of the schizophrenia concept

BackgroundAlthough the concept of schizophrenia is still widely presented as having replaced that of dementia praecox, studies have shown that the former was broader than the latter, resulting in a more complex diagnostic redistribution. However, this is poorly documented by quantitative approaches. AimsWe sought to test the hypothesis that the use of the concept of schizophrenia had caused a diagnostic redistribution and to quantify it. MethodA retrospective study, based on admission register archives of the Strasbourg University Clinic of Psychiatry was conducted. The frequency of diagnoses given to patients were examined at two key time periods: one before (TP1) and one after (TP2) the introduction of the schizophrenia concept (established between 1926 and 1928). Eight main diagnoses related to schizophrenia were considered. ResultsPatients diagnosed with schizophrenia at TP2 mainly received the diagnoses of dementia praecox but also depression, hebephrenia, manic depressive illness, hysteria, paraphrenia, catatonia and mania at TP1. Dementia praecox and hebephrenia were the most relayed by schizophrenia. Bayesian sensitivity analyses confirmed the robustness of our data against distinct scenarios challenging our hypothesis. ConclusionsOur results confirm the broadening of the concept of schizophrenia compared to that of dementia praecox but also qualify the different concepts supposed to have been impacted. They provide unique quantitative data that define the contours of the diagnostic redistribution thus provoked. They also give relevant input in the current context where the need to rethink the DSM/ICD concept of schizophrenia is still debated.

Investigating the effects and side effects of two antipsychotic drugs in the treatment of children and adolescents with Tourette syndrome: a semi-experimental research.

Due to the high prevalence of Tourette's disorder among children and adolescents and its negative consequences, an appropriate and effective medical treatment with minimal complications is necessary. Therefore, this study was conducted to compare the effects of Aripiprazole and Risperidone on Tourette's disorders in children and adolescents. The statistical population of this semi-experimental study was children and adolescents aged seven to eighteen years old. They were diagnosed with Tourette's disorder based on the DSM-V criteria by the clinical interview of a child and adolescent psychiatrist in the child Psychiatry clinic of Ibn-e-Sina's Psychiatric Hospital (Mashhad-Iran) in 2018. A total of forty participants were selected by the convenience sampling method, and they were randomly divided into two groups treated with medicines, Risperidone or Aripiprazole, for two months. Then, the demographic information questionnaire was completed. The Y-GTSS Scale was completed. The clinical Effect Rating Scale (CGI-Tics Scale) was completed. Calculation of body mass index and medical side effects complications were completed. The evaluation was carried out at the beginning and on the second, fourth, and eighth weeks, and the results were compared. The data were analyzed using SPSS software. 14, descriptive statistics, Chi-square, and variance analysis. The two groups were homogeneous in terms of demographic variables and body mass index. Despite the positive effect of both medicines, no significant difference was observed among the general scores of such disorders, the overall score of severity, Tourette's recovery, and BMI of these two groups at the intervals and the end of treatments. (p <0.05). Due to the low number of complications reported, statistical comparisons of the medical side effects were not made. According to the results, the two medicines, Aripiprazole and Risperidone, effectively improved the symptoms of Tourette's disorder and its overall severity. However, there were no significant statistical differences between them. Furthermore, in terms of the medical side effects, the statistical comparison between the two medicines was impossible due to the small number of complications.

(047) K-POP is Popular: A Novel Collaborative Care Approach in the Kidney Palliative Care Outpatient Psychiatry Clinic

(047) K-POP is Popular: A Novel Collaborative Care Approach in the Kidney Palliative Care Outpatient Psychiatry Clinic

Analysis of the Stress of Health Workers of Psychiatry Clinic and Dermatovenerology Clinic

Abstract Stress at a workplace represents stress caused by the job of a person, which occurs when the demands of the workplace are not in accordance with the needs of health workers. Two basic types of pathological stress at workplace are: burnout syndrome at work and technostress. The set goals were to assess the level of stress among health workers employed by the Psychiatric Clinic and the Dermatovenerology Clinic, and compare the results obtained, and identify a group of health workers exposed to the highest level of stress within the studied healthcare institutions. A total of 93 respondents were included in the study, of which 43 were from the Dermatovenerology Clinic and 50 from the Psychiatric Clinic. In the process of collecting data from respondents, the questionnaire used is modified version of “The Workplace Stress Scale”. The most important is to note that there is no correlation between night-shift work and stress level, as well as gender, or level of education, even though many studies in the world indicate a connection between these factors - which is marked as an increased risk of stress. Starting from the goals of the work, it is concluded that employees at the Dermatovenerology Clinic are more exposed to stress than employees in the Psychiatric Clinic. The level of education, gender, age, shift work does not affect the level of stress. The factor that most affects the level of stress is personal income and a short deadline for executing the given actions.

A pilot study of low-intensity focused ultrasound for treatment-resistant generalized anxiety disorder

ObjectiveThis study intended to evaluate a possible therapeutic effect among patients with treatment-refractory generalized anxiety disorder (trGAD) by using transcranial focused ultrasound (tfUS) to modulate amygdalar activity. MethodsTwenty-five participants with severe trGAD as outlined in the DSM-V were recruited from Los Angeles neurology and psychiatry clinics. All participants completed eight weekly 10-min tfUS sessions targeting the right amygdala. Functional and structural neuroimaging were used to navigate individual targets. Outcome measures including the Hamilton Anxiety Inventory (HAM-A, primary outcome) and Beck Anxiety Inventory (BAI) were collected at baseline and protocol completion. Upon study completion, participants were asked to report perceived change in clinical status using the Patient Global Impression – Improvement (PGI-I) scale. Data was collected from May 2020 through January 2023. ResultsAll participants were able to tolerate treatment without notable side effects. No adverse events were reported. A Wilcoxon Signed-Rank Test was conducted to compare pre- and post-tfUS measures of anxiety. tfUS resulted in a significant decrease in anxiety as measured by the HAM-A (W = −3.69, p < 0.001, pre-post-Δ = −12.64 ± 12.51) and the BAI (W = −3.94, p < 0.001, pre-post-Δ = −12.88 ± 10.42). Sixteen (16) of twenty-five (25) total participants indicated clinically significant benefit on PGI-I scores at completion. ConclusionThis study provides preliminary evidence supporting the safety and efficacy of tfUS as a clinical intervention. These results warrant further investigation of tfUS as a therapeutic intervention for anxiety and other psychiatric and neurological disorders. ClinicalTrials.gov identifierNCT04250441.

Improving patient-centered care for HIV and mental illness: exploring hospital and community integration through education

ABSTRACT Current models of care delivery are failing patients with complexity, like those living with HIV, mental illness and other psychosocial challenges. These patients often require resource-intensive personalized care across hospital and community settings, but available supports can be fragmented and challenging to access and navigate. To improve this, the authors created a program to enhance integrated, trauma-informed care through an innovative educational role for a HIV community caseworker embedded in an academic HIV Psychiatry clinic, called the Mental Health Clinical Fellowship. Through qualitative interviews with 21 participants (patients, physicians, clinicians and Mental Health Clinical Fellows) from October 2020–March 2023, the authors explore how implementation of this program affects patient experiences and satisfaction with care. Patients described their care experiences as less stigmatizing, more accessible, holistic and coordinated. They often attributed this to the integration between fellow and psychiatrist, and specifically the accessible stance of community organizations embedded within a hospital, which helped build trust. Interchangeable and integrated support by caseworker and psychiatrist improved patient engagement in psychiatric management and patient satisfaction with their care. Cross-context and cross-disciplinary care provision that includes providers from community and hospital working directly together to deliver care can improve care for patients with significant complexity.

Comparing patient reported and medical record data of adverse drug reactions to anti-seizure drugs.

Anti-seizure drugs (ASDs) can potentially cause serious adverse drug reactions (ADRs). Patient self-reporting can increase the rate of ADR detection, but studies examining patient self-reporting of ADRs caused by ASDs are lacking. To determine the characteristics of ADRs reported by patients receiving ASDs, assess laboratory data and medical record confirmation of patient-reported ADRs, and explore factors associated with laboratory data and medical record confirmation. A self-reporting questionnaire was distributed to patients prescribed ASDs at outpatient clinics. Patients assessed the causality of suspected ADRs using Causality Assessment Tool. Naranjo's algorithm was used by researchers for causality assessment. Medical records were used to gather information on ADR symptoms, ASD medication, and abnormal laboratory data. From 478 distributed questionnaires, 93.1% completed the questionnaire and 67.4% of respondents reported at least one ADR. The most common ADRs were drowsiness (50.7%), dizziness (9.7%), and ataxia (4.3%). For causality, suspected ADRs were classified as possible in 52.3% of cases and probable in 46.3% of cases by patients, and possible in 64.7% of cases and probable in 25.7% of cases by researchers. Only 12.7% of patients had laboratory data and/or medical record confirmation of suspected ADRs. The psychiatry clinic was less likely to confirm suspected ADRs compared to the epilepsy clinic (OR = 0.412, p = 0.022). Confirmation of patient-reported ADRs with either laboratory data or medical records was uncommon. Recording patient-reported ADRs in patients' medical history and monitoring laboratory tests related to patient-reported symptoms should be promoted to increase the safety of ASD treatment.

Court-ordered inpatient psychiatric care in Switzerland: determinants of length of stay and treatment outcome.

IntroductionIn several European countries, offenders with decreased or abolished responsibility and high risk of recidivism due to long-lasting mental disorders are compulsory admitted for court-ordered treatments (COT) that take place in high and medium-security hospitals. As a rule, length of stay in these structures is very long implying major restrictions for the inmate and high societal cost. Despite intensive research, the predictors of length of stay and treatment outcome in long stay forensic services is still matter of debate.MethodsWe report here a detailed analysis of the demographic, psychiatric and offense predictors of length of stay and discharge locations of 204 mentally disordered offenders convicted to COT in a new medium-security forensic psychiatry clinic in Geneva, Switzerland. Kaplan-Meier survival estimates were performed to determine time to release. Length of stay was predicted by Cox regressions, and discharge locations were predicted by multinomial logistic regressions.ResultsThe typical inpatient was a 35-age single male re-offender, submitted to COT after a conviction for physical violence (78.9%) or property violation (64.2%), with drug trafficking (52.9%), in relation to psychotic (67.2%), antisocial or borderline personality disorder (35.8%) with comorbid substance use disorders (60.3%). Sex offenses were found in 24.5% of cases and were associated with Cluster B personality disorders. The median length of stay was of 2.5 years and was independent of demographic variables, severity of crime recidivism and psychiatric diagnosis. Longer COT at admission, and type of offense (in particular drug traffic and sexual violence) predicted longer stays. At discharge, 32.8% of cases were transferred to sheltered educational housing, 23.1% to open low-security wards, while 30.6% returned to regular prisons and 9.7% to their country of origin.DiscussionYounger age and conviction for property violation rather than physical violence increased the chances to be discharged to sheltered educational housing. Longer COT at admission, personality disorders, and conviction for sexual offense increased the risk to return to prison. These data suggest that sex offenses determine not only longer stays under COT but also drastically decreases the chance of freedom for inmates with Cluster B personality disorders.

3.63 A Survey of Bullying Experiences in a Child and Adolescent Psychiatry Clinic Population

3.63 A Survey of Bullying Experiences in a Child and Adolescent Psychiatry Clinic Population

Swedish multimodal cohort of patients with anxiety or depression treated with internet-delivered psychotherapy (MULTI-PSYCH)

PurposeDepression and anxiety afflict millions worldwide causing considerable disability. MULTI-PSYCH is a longitudinal cohort of genotyped and phenotyped individuals with depression or anxiety disorders who have undergone highly structured internet-based...

5.73 Factors and Implementations to Decrease No-Show Rates for Follow-Up Appointments at the Child Psychiatry Clinic

5.73 Factors and Implementations to Decrease No-Show Rates for Follow-Up Appointments at the Child Psychiatry Clinic

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

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

The roles of Klotho and FGF-23 in bipolar manic episode.

Bipolar disorder (manic episode) is an essential psychiatric disorder with unknown etiology, in which inflammation is considered to play a role. Klotho and FGF-23 are known to be associated with inflammation. Therefore, this study aimed to determine the link between Klotho and FGF-23 levels and bipolar disorder. In this study, 42 men with BD and 41 healthy controls were enrolled, followed up, and/or treated at the High-Security Forensic Psychiatry Clinic. Sociodemographic data form, Young Mania Rating Scale, and Hamilton Depression Rating Scale were applied to all participants. Klotho and FGF-23 levels were significantly increased in patients with BD manic episodes. There was no correlation between Klotho and FGF-23 levels and clinical parameters. For Klotho and FGF-23, cutoff values of 69 and 1,646 yielded 67.4% sensitivity and 72.1% specificity and 81.4% sensitivity and 51.2% specificity, respectively. Klotho and FGF-23 may play critical roles in the etiopathology of manic episodes and are potential candidate biomarkers for bipolar disorder. This relationship might contribute to the etiopathogenesis of the disease and determine its treatment. Anti-Klotho and anti-FGF-23 administration may be a future treatment for controlling the course of the disease.

Fentanyl and the Opioid Epidemic: Practical Guidance for Child and Adolescent Psychiatry Clinicians

Fentanyl and the Opioid Epidemic: Practical Guidance for Child and Adolescent Psychiatry Clinicians

Three-Year Prognosis of Late-Life Depression in an Outpatient Geriatric Psychiatry Clinic: Medical Comorbidities Worsen Outcomes.

Depression is one of the most important reasons for psychiatric referrals in elderly patients. Geriatric depression can be chronic and is associated with an increased risk of dementia. We aimed to determine the prognosis of major depression patients and associated risk factors regarding persistence of depression. Patients who were admitted to the tertiary geriatric psychiatric outpatient unit of Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul between January and December 2018 and were diagnosed with major depression according to DSM-5 diagnostic criteria were included in the study. A structured telephone interview was conducted with between February-April 2022. For detailed clinical evaluation, Turkish version of Structured Clinical Interview for DSM-5-Disorders/Clinician Version (SCID-5/CV-TR), Telephone Cognitive Screen (T-cogS-TR), Geriatric Depression Scale (GDS), Clinical Dementia Rating Scale (CDR), Lawton-Brody Instrumental Activities of Daily Living Scale (IADL) and Beck Anxiety Inventory (BAI) were used. Of the 123 patients interviewed, 40.9% were diagnosed with major depression and 14.6% with minor depression. 43.4% showed significant anxiety and depression symptoms. Dementia developed in 14.6% of the patients. Only 29.5% of the patients recovered completely. Hypertension, orthopedic disease or arthritis, cancer, and absence of prior work experience were found to be predictors of current depression diagnosis. Geriatric depression has an unfavorable prognosis despite continued antidepressant treatment and may even serve as a prodrome for future dementia. Timely management of co-morbid medical conditions such as hypertension can potentially improve the prognosis of geriatric depression.

Effect of Childhood Trauma on Substance Users’ Attitudes of Coping with Stress

Objective: This study seeks to examine the effects of childhood traumas on substance users’ attitudes of coping with stress.&#x0D; Method: This descriptive study seeking relationship was conducted with 133 individuals diagnosed with substance use and receiving treatment in the alcohol and substance treatment centre and closed psychiatry clinics of a mental health hospital located in Turkey.&#x0D; Results: The mean age of first substance use of the participants included in the study was 17.8 ± 4.7. The participants got the highest score from the emotional neglect subscale of the Childhood Trauma Questionnaire (12.83 ± 3.46). Individuals in the study got the highest score from the religious coping subscale of the Coping Orientation to Problems Experienced Inventory (13.39 ± 2.71). Childhood traumatic experiences were found to be effective in the development of coping attitudes including denial, behavioural disengagement, use of emotional social support, substance use, and acceptance. &#x0D; Conclusion: Childhood traumatic experiences of substance users have an effect on their dysfunctional coping attitudes. It is recommended that psychiatric nurses include primary, secondary, and tertiary protective approaches towards childhood traumas in their work on combating addiction.

The Relationship Between Anxiety Symptoms, Anxiety Sensitivity, and Emotional Schemas in Patients Admitted to Psychiatry Outpatient Clinic

Introduction. Anxiety disorders are among the most common mental disorders being an important cause of disability as they impair the functionality of affected individuals.&#x0D; Our study aimed to evaluate the effects of anxiety sensitivity, which is one of the cognitive structures involved in the etiology and perpetuation of psychopathologies, and emotional schemas, which evaluate how people handle their emotions, on anxiety symptoms.&#x0D; Methods. One hundred participants who were admitted to the outpatient psychiatry clinic, agreed to participate in the study, and met the inclusion criteria were included in the study. The Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-I), Leahy Emotional Schema Scale Turkish Version (LESS-T), and Anxiety Sensitivity Index (ASI-3) were administered to the participants.&#x0D; Results. A correlation analysis revealed a significant relationship between the BAI score and BDI-I score, ASI-3 total score, and LESS-T Uncontrollability, Weakness, Comprehensibility, Acceptance of Emotions, Rumination, Denial of Emotions, Validation subscale scores (p &lt; 0.05). A logistic regression analysis that examined the risk factors predicting anxiety symptoms in individuals found that increasing BDI-I and ASI-3 total scores had an increasing effect on the development of anxiety, and an increase in the LESS-T Denial of Emotions subscore had a decreasing effect.&#x0D; Conclusions. Determining anxiety sensitivity and emotional schemas in patients with anxiety symptoms may be a guide in identifying and treating the risk factors for the development of anxiety disorders.

Effect of Atypical Antipsychotic Usage at Therapeutic Doses on Daytime Sleepiness

The aim of this study is to determine the effect of using atypical antipsychotic drug usage at therapeutic doses on daytime sleepiness. One hundred twenty volunteers who met the inclusion-exclusion criteria were divided into two equal groups. Group 1: patient group (60 patients volunteers used atypical antipsychotic in therapeutic doses and hospitalized in the psychiatry clinic of Tekirdağ Namık Kemal University Hospital and Group 2: control group (60 control volunteers). Socio-demographic and Clinical Information Form consist of 14 questions was administration all volunteers. Also, Epworth Sleepiness Scale which is a survey that determines the degree of sleepiness in eight different situations during the day was administered to all volunteers. Atypical antipsychotic drug usage at therapeutic doses significantly increased patients’ daytime sleepiness compared to the control group. Among the atypical antipsychotic drugs usage in therapeutic dose, the drug that caused the most daytime sleepiness was clozapine. Also, using of atypical antipsychotic drugs in therapeutic doses markedly decreased patients’ life quality compared to the control group. Atypical antipsychotic drug usage at therapeutic doses could cause daytime sleepiness and reduce patients’ quality of life.