Psychiatry Outpatient Department Research Articles

Validity and reliability of the Japanese version of the Substance Use Stigma Mechanism Scale.

Stigma against people who have alcohol and drug problems severely affects their health and well-being. An instrument based on stigma theory assessing individual-level stigma is essential for a comprehensive understanding of their stigma. We evaluated the validity and reliability of the Japanese version of the Substance Use Stigma Mechanism Scale (SU-SMS-J) among a population who had alcohol or drug use problems. Adults with experience in substance use disorders from psychiatry outpatient departments and rehabilitation facilities participated in the self-administered questionnaire survey. Confirmatory factor analysis was conducted to test the structural validity of the 5-factor model proposed in other language versions, and factor loadings and correlation between the subscales were confirmed. The correlations between the SU-SMS-J and psychometric properties related to substance use (e.g., severity of substance use, motivation to change) were investigated to assess concurrent validity. Internal consistency was assessed using Cronbach's alpha coefficients. Data from 126 participants were analyzed. The 5-factor model was acceptable with good or reasonable model fit indices. The correlations between subscales were weak to moderate, and this result suggested the SU-SMS-J assessed different but related components of stigma: enacted, anticipated, and internalized stigma from different stigma sources (family and healthcare workers). The SU-SMS-J and subscales showed moderate concurrent validity. Internal consistency was mostly sufficient, with Cronbach's alpha coefficients of 0.86 for all items and 0.66-0.93 for subscales. The SU-SMS-J is valid and reliable for use among populations with substance use problems in various settings in Japan.

Correlates of Sexual Dysfunction in Male Patients with Alcohol Dependence Syndrome: A Cross-Sectional Study

Introduction: Sexual dysfunction and alcohol dependence syndrome are complex issues that significantly impact the overall well-being and quality of life of affected individuals. Sexual dysfunction, encompassing various issues such as erectile dysfunction, reduced libido, and orgasmic disorders, is a prevalent concern affecting a substantial proportion of the male population worldwide. Aim: To estimate prevalence of sexual dysfunction in patients admitted for Alcohol dependence and to identify various Clinical and Socio demographic correlates for sexual dysfunction in this population. Materials and Methods: The study involved fifty-eight male participants who had sought deaddiction treatment at the Psychiatry Outpatient Department of Tertiary Care Centre, Maduranthakam for alcohol dependence syndrome, diagnosed according to the ICD‑10. Information on sociodemographic, alcohol-related, and sexual dysfunction-related variables was gathered. Sexual dysfunction was assessed for the past year, ignoring temporary and situational complaints. The relationship between sexual dysfunction and various study variables was explored using relevant statistical tools. Results: Out of the total sample size evaluated using SAD-Q score, 71% are moderately dependent and 29 % are severely dependent. Sexual Dysfunction was present for 64% of patients in the study. For the 58 patients in the study, the most common sexual dysfunction reported was an absence of sexual desire in 19 patients, followed by erectile dysfunction which was present in 18 patients. The ability to reach orgasm was difficult for 6 patients. Satisfaction from orgasm was absent for 4 patients. Conclusion: This research seeks to advance our understanding of sexual dysfunction in male patients with alcohol dependence syndrome by unravelling the intricate web of factors influencing their sexual health.

Study of Life Events and Quality of Life in Patients of Major Depressive Disorder

Abstract Background: Depression is one of the most common mental illnesses found across all ages, genders and socioeconomic status. It has significant health, psychosocial, and economic impact. It is worse than many chronic medical diseases and has a negative effect on quality of life which persists even after remission. Objectives: The aim of this research was to study the relationship of major depressive disorder with quality of life and stressful life events in adults. Materials and Methods: This was a cross-sectional study wherein purposive sampling method was employed. Patients from psychiatry outpatient department who fulfilled the criteria for major depressive disorder and belonging to the age range of 18–75 years were shortlisted and requested to participate in the study. After taking informed consent, data on quality of life, enjoyment and satisfaction, stressful life events and severity of depression were gathered using questionnaires and a semi structured interview. Results: Severity of depression was found to be negatively correlated with quality of life, enjoyment and satisfaction P = 0.001 level of significance. There were no significant correlations between severity of depression and stressful life events. Pearson’s Chi-square indicated that the severity of depression has a significant association with highest educational qualification, occupation, marital status, and socioeconomic status. Conclusion: Measuring and keeping track of quality of life through self-report levels is important in improving depressive disorders and should be integral part of management. Other steps comprise of starting early treatment, ensuring treatment adherence, reducing severity, and reducing relapse. Psychosocial interventions should also be taken into consideration.

Assessment of Stigma among Caregivers of Armed Forces Professionals Suffering from Mental Illness

Abstract Background: Having a person with mental illness in the family invariably leads to stigmatic experiences to the family members. Perceived stigma in caregivers leads to social isolation, psychological distress, and suboptimal functioning. Additionally, perceived stigma among such caregivers is one of the barriers that prevent them from taking appropriate care of their dependents with mental illness. There has been little research in this field in the Indian armed forces population. Objective: The objective of this study was to assess the perceived stigma among caregivers of armed forces personnel suffering from mental illnesses. Methods: The calculated sample size was 139 but in our study period of time (December 1, 2019–February 28, 2020) we received the enough number of patients and we continued our study with 150 study subjects which is enough more than the 139. Hence, the total number of 150 caregivers visiting the psychiatry outpatient department of a tertiary care military hospital in North India along with their mentally ill dependents were included in the study after obtaining valid informed consent. The subjects were interviewed, their sociodemographic data were collected, and stigma scores were assessed on a 15-item Explanatory Model Interview Catalogue (EMIC) Stigma Scale. Results: Total stigma score ranged from 20 to 40 with a median of 31. Caregivers with lower level of education, lower income, rural residency, elder age, and diagnosis of psychosis/substance abuse in dependent were found to have higher scores of perceived stigma. Conclusions: Caregivers of patients with mental illnesses experience significant stigma which needs to be addressed so that they can provide optimum care to their mentally ill dependents. Limitation: As EMIC does not provide any standard cutoff for low or high stigma or to categorize persons as having stigma or not, it was difficult to compare results with other studies that used different tools to assess stigma.

Study of Clinical Correlates and Symptomatology with Level of Functioning in Patients with Schizophrenia

Abstract Background: The burden of schizophrenia is largely due to deficits it causes in functioning. However, the variables influencing and predicting real-life functioning have not been systematically investigated in such patients. Aims: The aims of this study were to study the sociodemographic data, illness-related variables, and level of functioning in patients with schizophrenia and to assess the relationship between clinical correlates, symptomatology, and level of functioning. Materials and Methods: This was a cross-sectional study conducted in the psychiatry outpatient department of a teaching hospital. Sociodemographic and illness-related data were collected using a semi-structured pro forma. Schizophrenia was diagnosed as per the International Classification of Diseases-10 criteria, and severity of symptoms was rated using Positive and Negative Syndrome Scale (PANSS). Functional outcomes were rated using the Social and Occupational Functioning Assessment Scale (SOFAS) and Specific Level of Functioning (SLOF) scale. The data were compiled, tabulated, and analyzed. Results: A total of 170 patients suffering from schizophrenia with a mean age of 38.22 years were recruited for the study. On the SOFAS, 56.5% of patients scored more than 60, indicating good functionality. It was found that age at onset had a positive correlation, whereas duration of illness, duration of untreated psychosis (DUP), positive family history of psychosis, and PANSS scores had a negative correlation with SOFAS and SLOF subdomain scores. Conclusion: In patients with schizophrenia, male gender, unemployment, positive family history of psychosis, lower age at onset, longer duration of illness, longer DUP, and greater symptom severity (positive and negative) are associated with poor functioning.

Autistic features in patients with intellectual disability attending the psychiatry outpatient department of a tertiary healthcare center

Background: Meta-syndromic groups with cognitive and relational impairment include both autism spectrum disorder (ASD) and intellectual disability (ID). When it comes to individuals with intellectual difficulties, autistic traits are often unexplored unless they reach the level of the syndrome. The presence of both autism and ID increases disability percentage. Aim: To study the presence of autistic symptoms in individuals with ID. Materials and Methods: This was a cross-sectional, observational study in which after informed consent from caretakers of patients with ID, clinical history and sociodemographic details were recorded. Further Indian Scale for Assessment of Autism (ISAA) was administered for evaluation of autistic features. Statistical analysis of the data was done using the Chi-square test and Spearman’s correlation. Results: Out of 150 subjects with ID, 18% (n = 27) were diagnosed with comorbid ASD. A statistically significant (P value = <0.001) association was found between the severity of ID (intelligence quotient, [IQ]) and the severity of autism in patients. Various domains of autism like social relation and reciprocity, speech, language, communication, emotional responsiveness, etc., showed a statistically significant correlation with IQ. Conclusion: This study finding also highlights that lower IQ scores, i.e., severe ID have higher incidence and severity of autistic features. Improving assessment both clinically and on objective testing can help in planning rehabilitation for these patients.

An observational study on prescription pattern of drugs and psychiatric disorders occurring in elderly patients in a tertiary care hospital

Abstract Background: Elderly age group is the most vulnerable age group for various health-related issues. Psychiatric disorders and their management are quite important, especially in this vulnerable population. With increased availability of newer drugs, rational prescription of drugs is essential. Objectives: The objectives of this study were as follows: (1) To assess the prescription pattern of antipsychotic drugs and other psychiatric drugs prescribed to elderly psychiatry patients, (2) to determine the psychiatric illness occurring among the elderly psychiatric patients, and (3) to estimate the polypharmacy and cost burden of drugs prescribed. Materials and Methods: It was an observational study conducted over a period of 6 months in “Government Hospital for Mental Care.” The prescriptions were collected from the outpatient medical records and were thoroughly analyzed to assess antipsychotics and other psychiatric drugs being prescribed and the disorders frequently came across in the elderly patients who visited the psychiatry outpatient department. Results: Two hundred and fifty prescriptions were analyzed during the study. Male patients outnumbered female patients. The majority of the patients were of age group 50–60 years. Schizophrenia was the most common disorder encountered in the study population followed by psychosis and bipolar. Among the drugs, trihexyphenidyl followed by quetiapine, olanzapine, risperidone, and so on were the most common drugs prescribed. Conclusion: In the current study the prescribing pattern of drugs is as per the norms with rational usage of more efficacious drugs. Polypharmacy is limited. Periodic drug utilization studies help to solve the issues related to polypharmacy and improve the quality of treatment given to the patients.

Sexual dysfunction and marital adjustment in married men with alcohol dependence syndrome

Background: Only a few studies have systematically assessed sexual dysfunction and marital adjustment in married men with alcohol dependence in India. Aim: To assess the prevalence and pattern of sexual dysfunction and marital adjustment in a clinical sample of married men with alcohol dependence. The association of sexual dysfunction and marital adjustment with the severity of alcohol dependence was also explored. Materials and Methods: This cross-sectional study included 100 consecutive married men attending psychiatry outpatient department (OPD) with a diagnosis of alcohol dependence syndrome (ADS). A pre-designed study proformawas used for collecting relevant socio-demographic and clinical details of the study participants. Sexual dysfunction, marital adjustment, and alcohol dependence were assessed using the following validated tools: the Arizona Sexual Experiences Scale (ASEX), the Marital Adjustment Questionnaire (MAQ), and the Severity of Alcohol Dependence Questionnaire (SADQ), respectively. Results: Of 100 patients, about 15% had clinical sexual dysfunction based on ASEX. The most commonly reported sexual dysfunction was difficulty with erection (24.0%), followed by problems in desire (18.0%), sexual arousal (12.0%), ability to reach orgasm (12.0%), and satisfaction with orgasm (9.0%). Sexual dysfunction (ASEX score) showed significant positive correlation (rs = 0.345; P < 0.001) with alcohol dependence severity (SADQ score). Also, the severity of alcohol dependence was negatively correlated (rs = -0.240; P = 0.016) with the overall level of marital adjustment (MAQ score) with spouse. Conclusion: Sexual dysfunction is common in married men with ADS, with both sexual dysfunction intensity and marital adjustment difficulties being positively associated with the severity of alcohol dependence.

Psychiatric Co-morbidity with Obsessive Compulsive Disorder

Background: Obsessive-compulsive disorder is a chronic psychiatric disorder. It is associated with substantial psychiatric comorbidity. Major Depressive disorder & mixed anxiety and depressive disorder are the most common psychiatric co-morbidities.Objective: To evaluate the psychiatric co-morbidity with obsessive-compulsive disorder.Materials and Methods: It was a descriptive and cross-sectional clinical study. It was conducted in the Outpatient Department of Psychiatry, Khwaja Yunus Ali Medical College, Sirajganj from January 2021 to December 2022. Total 100 patients were taken. All the selected patients were interviewed in detail by using ICD-10. Analysis was done according to the Statistical Package for Social Science (SPSS) for windows version 25.Results: This study shows obsessive compulsive disorder is more common in young to middle age (21 to 40 years) and mean age of onset of illness was 28.31±10.21 years. Maximum (57%) were female and 43% were male. Depressive disorder, mixed anxiety and depressive disorder were most common psychiatric comorbidity (63% and 22%) in patient with OCD followed by panic disorder in 7% patients, social phobia in 5% patients, generalized anxiety disorder in 5% patients, substance abuse in 5% patients, schizophrenia in 5% patients, bipolar affective disorder in 2% patients and tic disorder in 1% patients.Conclusion: This study demonstrates a high prevalence of psychiatric comorbidities in individuals diagnosed with OCD. The most prevalent co-occurring disorders are depressive disorder & mixed anxiety and depressive disorder. KYAMC Journal Volume: 14, No: 04, January 2024: 206-209.

Comparative Study of Outcome in Cessation Therapy of Smoked Form of Tobacco and Factors Affecting It Using Tablet Bupropion or Nicotine Replacement Therapy

Background: Tobacco use is one of the major causes of preventable deaths and diseases in India. Standard treatment used in tobacco use disorder can be broadly categorized as nicotine replacement therapy (NRT) and nonnicotine pharmacotherapy. Aims: The aim of this study was to compare the outcome of tobacco cessation in subjects using the smoked form of tobacco, using tablet bupropion or NRT, and to assess various factors influencing the outcome. Settings and Design: Twelve-week follow-up study was conducted in patients of tobacco use disorder attending the outpatient department of psychiatry in a tertiary care teaching institute for a duration of 12 months, after permission from the institutional ethical committee. Materials and Methods: Hundred subjects were taken as per the inclusion criteria. After obtaining the general sociodemographic data, the severity of tobacco dependence was assessed by Fagerstrom Scale at baseline, 2 weeks, 4 weeks, 8 weeks, and 12 weeks after assigning intervention (tablet bupropion or NRT) of their choice. Statistical Analysis Used: SPSS software is used for statistical analysis. Pearson correlation, analysis of variance, and multiple regression analysis were done and P < 0.05 was considered to be significant. Results and Conclusion: NRT works better in all groups of patients having mild, moderate, or severe tobacco dependence, whereas bupropion works better in groups of patients having moderate-to-severe tobacco dependence.

Effect of Gender on Reaction Time in Patients Having a Psychiatric Disorder

Background: Reaction time is a measure of how fast an organism can react to a certain stimulus. As such, it is a measure of an individual’s performance and the function of sensory-motor connection. While there are studies evaluating the differences in reaction time with gender and psychiatric illness as independent variables, data are lacking when considering them together. Aims: The aim of the study is to study the gender differences in reaction time in patients suffering from psychiatric illness. Settings and Design: The study involves an observational, longitudinal comparative study in the psychiatric outpatient department (OPD) of a tertiary care facility. Materials and Methods: After institutional ethics approval, 100 patients on psychotropic medications attending psychiatry OPD were included in the study along with at least 100 relatives who were not on psychotropic medications, serving as control. Required data were collected using semi-structured pro forma. The reaction time of patients and the control group was assessed using an application on the mobile phone available online as – the “Human Benchmark test.” Data obtained were entered in the MS Excel sheet and analyzed using the computerized software and a P ≤ 0.05 was considered statistically significant. Results: In the group of patients, the males showed delayed reaction time as compared to females, while in the control group, males performed better than the female population in reaction time tests. The highest reaction time was found to be in the substance use disorder group of patients at all points of testing, followed by that of patients with schizophrenia. Conclusions: Gender did not significantly affect the reaction time in both patient and control groups.

Sleep Disturbances In Patients With Alcohol Dependence Attending Psychiatry Outpatient Department At A Tertiary Care Hospital: A Cross‐Sectional Study

Sleep Disturbances In Patients With Alcohol Dependence Attending Psychiatry Outpatient Department At A Tertiary Care Hospital: A Cross‐Sectional Study

Drug Utilization Evaluation of Antidepressant Prescribing Practice in a Psychiatric Outpatient Hospital: A Prospective Cross-Sectional Study

Background: One of the main causes of morbidity is psychiatric disorders, which are becoming a burden to public health. The therapeutic choices are influenced by several factors, including treatment paradigms, safety, and costs that determine outcomes. Aim: We carried out the drug utilization evaluation (DUE) of antidepressants in patients visiting the psychiatry outpatient department. Study Design: An observational, prospective, and cross-sectional study. Place and Duration of Study: Department of Psychiatry, Jaya Krishna Hospital, Hanamkonda, TS, between September 2021 to April 2022. Methodology: We included patients who visited the psychiatric outpatient hospital, were clinically diagnosed, and received any antidepressants for the long term. The relevant data collected from the information resources was systematically analyzed for DUE. Results: Among 417 patients, the majority were in the age group of 31-40 (33.3%) years, and the most affected were female (57.3%), married (73.4%), and housewives (29.5%). Depression (37.6%) was the most commonly diagnosed psychiatric disorder. Of these prescriptions, 5.3% were monotherapy, the remaining was polytherapy (94.7%), and the majority of them had three drugs (36.2%). The average number of drugs per encounter was 3.4, drugs prescribed by generic names were 41.4%, injectable drugs prescribed were 2.6%, and drugs listed in the National List of Essential Medicines were 61.3%. Of all, 88.7% of prescriptions had at least one antidepressant, predominantly SSRIs, and fluoxetine (23.0%) was the most commonly prescribed. Benzodiazepines (59.7%) were the most frequently prescribed concomitant drug class and clonazepam (50.6%) was the most widely prescribed. Suicidal thoughts (5.8%) were the most commonly observed ADR. Conclusion: The study observed a pattern of polytherapy, mainly antidepressants from the SSRIs, notably fluoxetine mostly prescribed, and suicidal thoughts were the frequent ADR. Drug use surveillance studies, rationalizing therapeutic choices, and proper patient counseling would improve therapeutic outcomes by minimizing side effects and ADRs.

A Study on Spectrum of Clinical Variables on the Patients Attending Psychiatry Outpatient Department in a Tertiary Care Hospital

Objectives The objective of the study is to determine the spectrum of clinical variables of the patients attending psychiatry OPD in a tertiary care hospital and to determine the association of those variables with various sociodemographic factors.The study was conducted in the psychiatric Out-patient Department(OPD) of a tertiary care hospital Barak Valley region in the Northeastern part of India. Material and Methods Retrospective observational study where we assessed 1827 consecutive patients asking for psychiatric services, attending psychiatry OPD of Silchar Medical College & Hospital in the one-year period. Out of a total of 1827 cases, 1200 cases were enrolled for the study, meeting the study criteria. Data regarding sociodemographic profile, duration of illness, and provisional diagnosis were also collected, and self-design proforma was used. For socioeconomic class Modified Kuppuswamy Scale is used. The patients were diagnosed and classified on the basis of ICD-10 Criteria by consultant psychiatrists. The patient’s complete profile and data were presented in tables with the use of Microsoft excel. The data obtained was entered and analyzed by using SPSS Version 21. Any case attending psychiatry opd with psychiatric problems and who were provided psychiatric services. Results Out of a total of 1200 patients, most patients were in the age group of 21–40 years, followed by 41– 60 years. The mean age is 34.5. Majority of them were male (59.4%) belonged to Hindu religion (56.08%),were married (44.41%),and educated upto primary school level (26.75%), living in nuclear family (64%), belonged to lower class socioeconomic status (33.5%). It was seen that the majority of the patients (31.25%) belonged to the ICD-10 category of F20-F29, and Schizophrenia (F20) was the most common diagnosis (21.75%). The majority of patients in diagnostic categories of F10-F19, F20-F29, F30-F39, F40-F48, G43, and G44, were in age group 21–40 years, while among MR and G40 were of age < 20 years. Looking at the individual diagnostic category, we found that the majority of the cases belonging to the categories of F10-F19 (19.49%), F20-F29 (35.20%), F30-F39 (14.02%), G40 (3.16%), G44 (14%), and others (2.24%) were males. while majority of cases having the diagnosis of F40-F48 (30.8%), MR (13.96%) and G43 (5.54%) were females. Conclusion This study has reflected the pattern of clinical variables of the patients attending the tertiary care center. It has helped us to understand the nature and extent of psychiatric disease burden in the community with an aim to facilitate designing and planning for providing better mental health care to the community as a whole.

Phenomenology of Depressive Disorders with and without Psychotic Features: A Comparative Study

ABSTRACT Background: Depressive disorders can present with psychotic features, which warrants a different diagnosis and a different phenomenological study. Aim: To study the phenomenology of depressive disorders with and without psychotic features. Methodology: One hundred and forty-eight patients presenting to psychiatry outpatient department of a tertiary care center were screened using Mini International Neuropsychiatric Interview questionnaire to select patients for our study. Sociodemographic data and some clinical variables of these patients were collected. These patients were further assessed for depression severity and psychotic symptoms by using Montgomery and Asberg Depression Rating Scale (MADRS) and Modified Psychotic Symptoms Ratings Scale (PSYRATS), respectively. Results: Mean MADRS score for patients with depression without psychotic features was 38.38 and for patients with depression with psychotic features was 44.51. Result was found to be significant. Suicidality was found to be on a higher side in patients of depression with psychotic features. Conclusion: Main finding related to our study was that depression severity was found to be more in patients of depression with psychotic features. There are certain phenomenological differences which warrant a separate diagnosis of depression with psychotic features. These include the increased intensity of suicidality, visible sadness, inner stress, difficulty in concentration, lassitude, altered ability to feel, and thoughts of suicide present in patients of depression with psychotic features.

Determinants of remote measurement-based care uptake in a safety net outpatient psychiatry department as part of learning health system transition.

Behavioral measurement-based care (MBC) can improve patient outcomes and has also been advanced as a critical learning health system (LHS) tool for identifying and mitigating potential disparities in mental health treatment. However, little is known about the uptake of remote behavioral MBC in safety net settings, or possible disparities occurring in remote MBC implementation. This study uses electronic health record data to study variation in completion rates at the clinic and patient level of a remote MBC symptom measure tool during the first 6 months of implementation at three adult outpatient psychiatry clinics in a safety net health system. Provider-reported barriers to MBC adoption were also measured using repeated surveys at one of the three sites. Out of 1219 patients who were sent an MBC measure request, uptake of completing at least one measure varied by clinic: General Adult Clinic, 38% (n = 262 of 696); Substance Use Clinic, 28% (n = 73 of 265); and Transitions Clinic, 17% (n = 44 of 258). Compared with White patients, Black and Portuguese or Brazilian patients had lower uptake. Older patients also had lower uptake. Spanish language of care was associated with much lower uptake at the patient level. Significant patient-level disparities in uptake persisted after adjusting for the clinic, mental health diagnoses, and number of measure requests sent. Providers cited time within visits and bandwidth in their workflow as the greatest consistent barriers to discussing MBC results with patients. There are significant disparities in MBC uptake at the patient and clinic level. From an LHS data infrastructure perspective, safety net health systems may need to address the need for possible ways to adapt MBC to better fit their populations and clinical needs, or identify targeted implementation strategies to close data gaps for the identified disparity populations.

Attention deficit hyperactivity disorder in adults : prevalence and association with addictive disorders

Introduction Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder witch assumed to be a disorder of childhoood but recently has been shown to persist into adulthood. As in children, core features of adult ADHD include inattention, impulsivity, and/or hyperactivity.Despite growing interest in adult ADHD, little is known about its prevalence or correlates.ObjectivesWe aimed to estimate the prevalence of ADHD in adult outpatient psychiatric care at the university hospital of Gabes (southern Tunisia) and to explore its association with addictive disorders.MethodsWe conducted a cross-sectional, descriptive, and analytical observation study,in the outpatient psychiatry department of the Gabes university hospital, during the period ranging from 1/1/2023 to 30/06/2023. We used an anonymous pre-established information sheet exploring the socio-demographic, clinical, therapeutic data of the patients, lifestyle habits and substance use, the DSM-5 to classify diagnoses, CGI-S to rate the severity of overall mental illness, Fagerström test to assess the nicotine dependence, Adult ADHD Self-Report Scale (ASRS) in its validated Arabic version to screen ADHD and the Diagnostic Interview for ADHD in Adults (DIVA) to confirm the ADHD diagnosis. Data entry and analysis were performed using Statistical Package for Social Sciences (SPSS) version 21.0.Results The response rate in our study was around 64.5%, 205 patients were included.The mean age of the patients was 48years ±14.9, the male/female ratio was 1.The estimated prevalence of adult ADHD according to the DIVA was 5.9% (male/female ratio=1/2). At the uni-variate study, significant associations were found between ADHD and the age category (p=0), the marital status (OR=0.14; CI [0.03- 0.55], p=0.003), theFagestrom score (p=0.01), cannabis consumption (OR=19; CI [1.8-201], p=0.018), psychotropic drugs consumption (OR=39; CI[3-196], p=0.02), self-harm behavior (OR=6.9, CI[1.9-26], p=0.01), excessive use of internet and screens (OR=38, CI[7-179],p=0). At the multivariate study, two determining factors were found: cannabis consumption(OR=8 [1- 58]; p=0.031), and the excessive use of internet and screens (OR=25 [4-144]; p=0).Conclusions Regarding our findings and the important prevalence of the adult ADHD,more efforts are needed to increase the detection and treatment of this disorder, in order to set up an early intervention before major impairments and complications become irreversible.Disclosure of InterestNone Declared

Predictors of admission to an assertive outreach service for psychosis in Lebanon

IntroductionSchizophrenia is a chronic, debilitating mental illness that contributes significantly to the global burden of disease. Assertive outreach treatment for patients with schizophrenia and psychotic disorders has been implemented to improve treatment adherence and outcomes.The suitability of this model of care outside the western context has not been fully established. The Psychosis Recovery Outreach Program (PROP),staffed by a multidisciplinary team that applies principles of early intervention and assertive outreach, was initiated in February 2016 at a leading psychiatric facility in Lebanon.ObjectivesThe aim of this study is to identify and analyze clinical and demographic variables associated with patient enrollment in PROP, out of a typical clinical population attending a psychiatric outpatient department.MethodsThis retrospective study included patients above 18 y.o. at time of first point of care with a primary diagnosis of psychosis according to the International Classi-fication of Diseases 10 (ICD-10), and who presented to the outpatient psychiatry department at the American University of Beirut Medical Center (AUBMC) and were following up in PROP. We collected twelve-month data and used logistic regression models to identify predictor variables for enrollment in the service compared to those receiving standard treatment.ResultsIn total, 45 patients participated in the study. Patients were mostly males (77.8%), younger than 39 years (80%), of college or higher education (68.2%), and diagnosed with schizophrenia (46.7%) or schizoaffective disorder (48.9%). About one-quarter (22.7%) had a comorbid cannabis use disorder. A majority received more than one oral antipsychotic (75.6%) while half (51.1%) were maintained on a long-acting injectable (LAI) antipsychotic.The following variables were significant predictors of enrollment in PROP: having a comorbid cannabis use disorder (OR 2.83 [1.25 – 6.37]), being prescribed a LAI antipsychotic (OR 9.99 [4.93-20.24]) or more than one oral antipsychotic (OR 4.57 [2.22-9.39]), visiting the emergency department more than once (OR 8.7 [2.64-28.68]), and admission to the psychiatry unit (OR 13.91[3.17-60.94]). In addition, those following up in PROP were younger and less likely to be in the oldest age group (over 54 years) [OR 0.11 (0.01-0.93)], less likely to be females (OR0.39 [0.18-0.81]), and less likely to be diagnosed with “other psychotic disorder” as com-pared to schizophrenia (OR 0.14 [0.03 – 0.62]).ConclusionsPROP was the first community treatment program to use the principles of assertive outreachin Lebanon. Our findings highlight that the assertive out-reach model of care is applicable to its target population in the context of psychiatric care in Lebanon, namely young individuals with psychosis, higher comorbidities and a severe course of illness.Disclosure of InterestNone Declared

Patient Characteristics and Adherence to Antidepressant Medication Treatment at PsychiatricOutpatient Department of Mardan Medical Complex, Pakistan

Background: Adherence to antidepressant treatment is an important factor in the treatment and effective management of depressed patients. Characteristics of patients can help in determining compliance to treatment protocols. In order to find link between compliance and demographic characteristics of patients, insight can be obtained through exploration of these variables.Objectives: To determine the association between patient characteristics and antidepressant medication adherence. To identify characteristics of patients that may improve or worsen compliance to antidepressant medication. Material and Methods: This study was a descriptive, cross-sectional study aiming to find the link between personal characteristics and adherence to anti-depressant medications. The study was conducted at Psychiatry outpatient department of a tertiary care hospital, Mardan Medical Complex, Mardan Pakistan, from 05th September 2018 to 08th February 2021. Data was collected from 660 patients who presented with depressive symptoms to Psychiatry OPD. The main objective was to identify characteristics of patients leading to poor compliance to antidepressant medication. Results: Total study population was 660. Majority of the study population 82.9 % (n-549) were female. Uneducated were, 56.6 % (375), 81.1 % (n-537) were unemployed, and 65.9 % (n-436) were married. Follow up interviews were conducted in 316 (47.7 %) patients at 3rd week, 186 (28.1 %) patients at 6th week, 130 (19.6 %) patients at 9th week, 96 (14.5 %) patients at 12th week, and 31 (4.7 %) patients at 6 months. There was no significant difference found on the basis of patient characteristics and adherence. However, compliance was better among patients who had longer duration of illness. Conclusion: Medication adherence is a common problem among depressed patients and leads to impaired daily life functioning. Our study could not found any significant difference regarding patient characteristics among compliant and non compliant patients. Educating patients regarding the use of antidepressant medication treatment should be added to routine practice. Keywords: Anti depressants, Depression, Non-adherence, Poor compliance.

Relationship Between Insomnia and Continued Outpatient Treatment in Psychiatric Patients.

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