Psychiatry Outpatient Setting Research Articles

Proxy consultations for severe mental illnesses: An exploratory cross-sectional study from a tertiary care hospital.

Non-adherence to medication leading to a break in continuity of care poses significant challenges in severe mental illness (SMI), leading to poor outcomes. In India, proxy consultation, wherein caregivers consult on behalf of patients, is a commonly adopted but insufficiently researched area to address these challenges. To explore the extent of proxy consultation in outpatient care of persons with SMI and investigate its sociodemographic and clinical correlates. In a tertiary care psychiatry outpatient setting, we conducted a cross-sectional study involving 374 caregivers of persons with SMI (Schizophrenia, Bipolar and related disorders). Descriptive statistics and univariate logistic regression were performed to examine correlates' relationships with proxy consultation. Proxy consultation prevalence was 43% in the past 1 year. Compared with 18 to 30 years, middle-aged patients aged 31 to 40, 41 to 50 and 51 to 60 years had twofold, threefold and sixfold increased chances of proxy consultation, respectively. Being illiterate had six times higher odds than graduates, three times and two times if they studied till primary and secondary education. Early age of onset was associated with three times higher chances of proxy consultation compared to the onset of illness in adulthood. On the contrary, male gender and upper and middle socioeconomic status decreased the chances of proxy consultation by 40%. Financial difficulties (n = 72, 45%) and patients' unwillingness to visit outpatients (n = 44, 27.5%) were the most commonly cited reasons for proxy consultation. Proxy consultations are relatively common, driven by many social, economic, patient-related, pragmatic and practical factors. In formulating community care policies for persons with SMI, the primary imperative should be to conduct additional research, deepening our understanding of proxy consultations. Additionally, it is essential to be mindful of the diverse issues associated with proxy consultations during the formulation process.

Antidepressant prescription patterns and polypharmacy in outpatient psychiatry: a cross-sectional study.

Background and aim: Prescription patterns of antidepressants have changed over the years with a shift towards newer antidepressants with better tolerability and safety. Polypharmacy is common in psychiatry settings. The study aimed to evaluate the antidepressant drug prescription pattern and polypharmacy in a psychiatry outpatient setting. Investigations: This prospective observational study was conducted in a psychiatric outpatient clinic. The medication use data of eligible patients were collected. In addition, the rationale of antidepressant medication prescription, the defined daily dosage (DDD), the prescribed daily dose (PDD), and the PDD to DDD ratio were assessed. The assessment of prescription polypharmacy was conducted utilizing the framework provided by the National Association of State Mental Health Program Directors. Results: Data from 131 patients was analyzed. Major depressive disorder (32.8%) was the most common disorder for which antidepressants were prescribed. The majority, 91 (69.4%), received monotherapy. Selective serotonin reuptake inhibitors were the most frequently prescribed drugs in 69 (52.7%). Mirtazapine was the most frequently 32(24.4%) prescribed drug. Escitalopram and mirtazapine were the most commonly prescribed combination therapy (4.6%). Antipsychotic medications (37.4%) were the most widely co-prescribed medications, along with antidepressants. The PDD to DDD ratio was less than 1 for mirtazapine and imipramine; they were ≥1 for others. Psychiatric polypharmacy was documented in 87.1% of prescriptions. The total polypharmacy was not significantly (p>0.05) associated with demographic, illness, and treatment-related variables. Conclusion: Selective serotonin reuptake inhibitors were the most commonly prescribed antidepressants, monotherapy, and combination therapy. A substantial amount of patients received concomitant administration of antidepressants or psychotropic drugs, warranting careful monitoring.

Dementia literacy and familiarity with term dementia: An exploratory study from a psychiatry outpatient setting.

Dementia, often misperceived as an inherent facet of aging, is, in fact, a progressive neurodegenerative condition. It carries a significant stigma due to its associated psychological and behavioral manifestations, leading to neglect and abuse within households. Studies reveal an alarming 90% treatment gap for dementia in India, largely due to limited knowledge about symptom recognition and accessing services. Thus, enhancing dementia literacy becomes crucial for early diagnosis and proper management. This study aims to assess dementia literacy and familiarity with the term "dementia" in a North Indian tertiary health-care setting. This cross-sectional study used a case vignette method among patients and their attendants at psychiatry outpatient setting in a tertiary care hospital. A validated Hindi-translated case vignette depicting a dementia patient was employed. The study gathered sociodemographic data, the case vignette, and three related questions. Participants read the vignette and provided answers. The analysis included 200 responses collected in 1 month. Respondents predominantly associated the case's condition with memory issues, mental illness, and psychosocial factors. They suggested social support, a nurturing family environment, communal living, and consulting a doctor for the protagonist. Familiarity with "dementia" was at a mere 24%. Dementia literacy and awareness of "dementia" are notably low in our sample. Urgent efforts are required to enhance dementia awareness to facilitate timely prevention, early detection, and effective management.

Clinical Characteristics of Outpatient Adolescents Undergoing Ongoing Psychotherapy in a Greek Tertiary Hospital from June 2016 to December 2019

Background: Adolescents with mental disorders often have difficulty engaging in ongoing treatment. Dropout from treatment is common. Aim: This paper aims to explore the clinical characteristics of a cohort of adolescents with mental disorders who were stably and actively undergoing psychotherapy over a relatively long period of time (for at least four months). Method: A purposive single-center cross-sectional cohort survey was conducted from June 2016 to December 2019. The sample of the study (N=50) was recruited from the Child and Adolescent Psychiatry outpatient setting of a large tertiary hospital of Thessaloniki, the second largest city in Greece. An intelligence test (Wechsler Intelligence Scale for Children, WISC III) and a self-report measure of depression (Beck Depression Inventory, BDI II) were used. All the participants underwent a rigorous clinical assessment of their mental health status in both initial and ongoing psychotherapy. The initial diagnosis was reconfirmed during the course of therapy. Mental disorders were defined and diagnosed using the ICD-10 (1992) (International Classification of Diseases). Results: The largest percentage of adolescents (44.9%) were found to suffer from mood (affective) disorders, while 20.4% suffered from neurotic disorders. We also found high prevalence of pessimism (32.7%), reduction of energy (28.6%) and difficulty in concentration (32.7%). A total of 22.4% of adolescents reported sleep disorders. A limited interest in sex was noted, which was in contrast with international and Greek data, where interest and experimentation around sex seems to preoccupy a high percentage of adolescents. Furthermore, sleep disorders, either as a symptom of an underlying disease or as an independent clinical condition, seem to preoccupy adolescents, and this may be a motive for them to seek treatment. Conclusion: For the most part, the findings of this study were consistent with the findings of prior studies; however, previous studies did not exclusively include adolescents engaging in ongoing psychotherapy. As we identified some inconsistencies with prior studies related to interest in sex and sleep disorders, further research is recommended for the investigation of possible correlations between these findings and ongoing psychotherapy engagement rates. Note, however, that the findings in this study are not representative of adolescents in Greece due to the fact that the used sample was not representative.

An Audit of Physical Health Monitoring in the Community Psychiatry Outpatient Setting: Can We Improve?

AimsCare in the community psychiatric setting involves regular monitoring of both mental and physical health. Patients with mental illness worldwide have higher rates of morbidity and earlier mortality, often due to physical disease, most commonly of metabolic or cardiovascular origin. The reasons for these findings are numerous, though a significant contributor is the underperformance of lifestyle screening and subsequent underutilisation of interventions. As standard, it is recommended that practitioners of all grades should, at each appropriate opportunity, assess their patient's current physical status and screen for lifestyle factors that increase risk of morbidity. These include: weekly physical activity, weight/BMI, diet, smoking status and alcohol intake. Our aim was to investigate if our Community Team was meeting both trust-set standards and national standards.MethodsA list of all outpatient appointments, including all clinic types, and all grades of staff, was generated from 1/11/21 to 19/11/21 giving a total of 48 appointments. A list of questions were then answered using data taken from notes available on an electronic system. This allowed analysis of the frequency of assessment for each lifestyle factor and frequency of offered interventions, where appropriate. Further analysis across all grades of staff, both outpatient appointment clinics and medication monitoring clinics, and across specific mental health disorders was performed.ResultsEach lifestyle factor should have been checked at each appointment and interventions offered where appropriate. In each assessment an intervention could have been offered following identification of a modifiable factor. No factor was assessed at every opportunity. Only 2 interventions (4%) were offered. Targeted Medication Monitoring Clinics (MMC) did not perform better than Outpatient Follow-up Clinics (OPA), OPA offered more interventions. These findings were consistent across all grades of practitioner and diagnoses.ConclusionAssessment of modifiable risk factors was not performed at each assessment, and where interventions were appropriate, they were rarely offered. This was a universal issue across the team, and in spite of specialised clinics, or high risk disorders, there was substandard physical health management. Therefore, opportunities to modify risk of physical disease, or improve treatment of the underlying psychiatric disorder are being missed. This is troublesome as community psychiatry often has the space, time, and rapport with patients to explore these issues, furthermore, many psychiatric treatments carry the burden of increased risk of morbidity and mortality. Consequently, the onus should be upon us to manage these risks and improve patient health through simple, short interventions and timely signposting and referrals.

Overview of practice of Consultation-Liaison Psychiatry.

Overview of practice of Consultation-Liaison Psychiatry.

Frequency and Predictors of Potential Drug Interactions among Psychiatry Outpatients on Treatment with Antidepressant Medications

Antidepressant medications are prescribed to treat depression and related psychiatric illnesses. In patients with depression, many categories of drugs are prescribed to treat clinical conditions and comorbidities. Hence, it is essential to screen such patients for potential drug interactions. The study aimed to assess the frequency of potential drug interactions (pDDIs) associated with antidepressant medications administered to the outpatients of the psychiatry department. This cross-sectional investigation was conducted in a psychiatry outpatient setting. Patients satisfying inclusion criteria were screened for pDDIs by reviewing the patients’ electronic case records. All the identified pDDIs were further evaluated using Micromedex database 2.0.A total of 131 eligible patients’ case records were reviewed. The frequency of pDDIs between antidepressants and other psychotropic medications, antidepressants and non-psychotropic medications, antidepressants,tobacco, antidepressants, and ethanol was 48.1%,9.2%, 7.6%, and 3.8%, respectively. Use of more than three medications [RR: 1.5; CI: 1.1-2.1], presence of total [RR: 7.9; CI: 1.1-52.5] as well as psychiatric polypharmacy [RR: 4.8; CI: 1.3-17.9] were identified as predisposing factors of pDDIs.The results of the multiple regression indicated that the model was a significant predictor of pDDIs (F[3, 127]= 6.368, p<0.01, R2 = 0.13). In comparison,psychiatric polypharmacy was the only variable contributing significantly to the model (B = -0.423, p<.05). Nearly fifty percent of patients taking antidepressant medications were found to have the potential for developing drug interactions. Review of treatment charts for psychotropic, non-psychotropic, and non-prescription medications, along with different medical conditions that patients suffer from and the social habits of patients,is essential to identify and resolve potential drug interactions in at-risk patients.

Detached co-involvement in interactional care: Transcending temporality and spatiality through mHealth in a social psychiatry out-patient setting

This article explores how the integration of digital technology into healthcare processes of social psychiatry impacts the healthcare professional-patient relation. To this end, it adopts a new materialist perspective, viewing the context of social psychiatry as an assemblage of human and technological components and their relations. We draw on a qualitative study of the introduction of an mHealth platform including shared calendars, messaging, and video calls into the care processes of a social psychiatry out-patient setting in Denmark. The study demonstrates how technology acceptance is facilitated by familiarity and relational trust, how the platform streamlines routine care tasks by providing shared structures, and how the platform allows for a multi-channel approach to interactional care. The analysis reveals an emerging type of care interaction, detached co-involvement, which appears to strengthen the healthcare professional-patient relation and concomitantly increase patient autonomy by facilitating temporally and spatially detached albeit more frequent interactions. The implications of these findings extend beyond the context of social psychiatry. First, they demonstrate that the careful integration of digital technology into care processes has the potential to increase the involvement of and even empower mentally vulnerable patients. Second, they demonstrate how adding such technology can extend an assemblage temporally and spatially and, consequently, allow components to remain attached to it while they attach to and detach from other assemblages.

Establishment of a geriatric clinic in psychiatry outpatient setting of a tertiary care hospital: Impact on care of elderly and training

Although there is a rapid increase in the elderly population in India, there is a lack of geriatric mental health services across the country. In India, although the postgraduation psychiatry program is available across many centers, little attention is paid to the subspecialty of geriatric psychiatry during the postgraduation training. There are very few courses (in the form of doctorate of medicine and fellowship programs) available in the subspecialty of geriatric psychiatry in the country. In this background, this paper focuses on the experience of establishing a geriatric clinic in a postgraduation psychiatry department and the impact of the same on patient care, research, and training in the area of geriatric psychiatry. The patient care data suggest that with the establishment of the geriatric clinic, there is an increase in the number of elderly patients admitted to the inpatient setting and those receiving electroconvulsive therapy. Further, there is an increase in the research in the area of geriatric psychiatry.

Practical applications of brief screening questionnaires for autism spectrum disorder in a psychiatry outpatient setting.

ObjectivesThis study was designed to examine the diagnostic performance of the social and communication disorders checklist (SCDC) and strength and difficulties questionnaire (SDQ) to detect autism spectrum conditions (ASC), along with the social responsiveness scale‐second edition (SRS‐2) as reference, in a psychiatry outpatient setting.MethodsWe translated the SCDC into Japanese since its Japanese version was unavailable. We examined its test‐retest reliability as well as the internal consistency reliability and diagnostic performance of the three questionnaires among 41 Japanese psychiatric outpatients, using the best‐estimate diagnosis of ASC based on the diagnostic interview for social and communication disorders, as a gold standard.ResultsThe test‐retest reliability was high for the SCDC. Although the internal consistency reliability was high for the SCDC and SRS‐2, that was low for the prosocial and peer problem subscales of the SDQ. The performance of the SCDC, SDQ, and SRS‐2 to detect ASC was moderate: the area under the ROC curve of 0.78, 0.78, and 0.84, respectively.ConclusionsAlthough questionnaires to detect ASC, including the three examined, generally have only moderate performance in this setting, these can be successfully applied to high‐risk populations such as psychiatry outpatients, when multi‐level rather than dichotomous likelihood ratios are used.

A Comparative Study of Health Anxiety in Neurology and Psychiatry Settings.

Objectives Prevalence of health anxiety is highly varied based on different settings and samples studied. This study aimed to assess the prevalence of health anxiety among outpatients attending neurology and psychiatry outpatient setting in tertiary care hospital and understand the clinical correlates. Participants and Methods This was a cross-sectional study conducted in the outpatient settings including participants fulfilling study criteria. The assessments included semi-structured proforma for demographic and clinical details, general hypochondriasis subscale of Illness Behavior Questionnaire, and Short Health Anxiety Inventory. Data were collected in Epi-info and data analysis was done using STATA12. Results The health anxiety was reported to be 25% and 19% among psychiatry and neurology outpatients, respectively. Higher education level positively correlated with health anxiety. Skilled workers tend to have higher health anxiety than semiskilled workers. Patients with diagnosis of somatoform disorder and multiple diagnosis scored higher on health anxiety in both the settings. Conclusion Health anxiety appears to be common in psychiatry and neurology settings and needs further evaluation to understand its impact on consultation and health resource usages.

Assessment of incidence, causality, severity, and preventability of suspected adverse drug reactions to antidepressant medications in a psychiatry outpatient setting of a secondary care hospital.

ABSTRACTBackground:Antidepressant medications are primarily used in the management of depression and various anxiety disorders. Antidepressant medications are known to cause adverse drug reactions (ADRs). Reporting ADRs can help in the rational use of medication and better patient drug management.Objective:The aim of this study was to monitor the incidence and nature of ADRs to antidepressant medications in a psychiatric outpatient setting of a secondary care hospital of the UAE.Materials and Methods:It was a cross-sectional study conducted in the psychiatric outpatient setting of a secondary care hospital. Patients attending psychiatry outpatient department and prescribed with antidepressant medications were included. All clinical side effects or ADRs noted by physician and reported by patients were documented and assessed according to causality, severity, and preventability scales.Results:A total of 131 patients were screened for the presence or occurrence of ADRs. During the study duration, an aggregate of 29 patients reported at least one ADR. Incidence of suspected ADR to antidepressant medications was found to be 22.1%. Most commonly documented suspected ADR was found to be weight gain in eight (18.1%) patients followed by somnolence in four (9.1%) patients. Escitalopram was the most common drug implicated with ADR in 13 (29.6%) patients followed by fluoxetine in 6 (13.6%) patients. According to World Health Organization-The Uppsala Monitoring Centre causality assessment, the predominance of the suspected ADRs was of “possible” type in 27 (61%) patients, and “mild” in severity in 40 (91%) patients, and “not preventable” in 37 (84%) patients. A statistically significant association (P = 0.019) was observed only between the presence of drug-interaction and the occurrence of ADR (relative risk: 0.429, confidence interval: 0.211–0.872).Conclusion:Most of the suspected ADRs related to antidepressants were “mild,” “predictable,” and “not preventable” in nature. Continuous monitoring may help in identifying, reducing, and preventing the risk of ADRs.

Screen use habits among children and adolescents with psychiatric disorders: A cross-sectional study from Turkey

In this cross-sectional study, we investigated screen use habits, problematic internet use (PIU), and screen?psychopathology relationship in a clinical sample of children and adolescents. The study included 277 children and adolescents (129 [46.4%] girls) aged between 6?17 years referred to a psychiatry outpatient setting for various reasons. All parents completed the Strengths and Difficulties Questionnaire (SDQ), while adolescents also completed the Internet Addiction Test (IAT). The mean screen time was 3.85 (SD = 2.72) hours per day. Longer screen times were found among children and adolescents with specific psychiatric disorders compared to those with no psychiatric symptoms; especially among those with internalizing disorders (i.e., an anxiety disorder and/or depression), but also with attention deficit/hyperactivity disorder and/or conduct disorder. Longer screen time may be related with more functioning impairments. Based on the IAT, 2.1% of adolescents may have PIU. The findings from this study suggest that children and adolescents with psychiatric symptoms may have prolonged screen times. This needs to be taken into account during diagnostic and therapeutic procedures.

Impact of pharmacist-led collaborative patient education on medication adherence and quality of life of schizophrenia patients in a tertiary care setting

Schizophrenia is a chronic mental-disorder and one of the top 10 causes of disability globally. Nearly 4.3 million people suffer from schizophrenia in India but very few visit a hospital for diagnosis or treatment. Of those patients who receive treatment, medication non-adherence and decreased quality of life (QOL) are the major problems. The objective of study was to assess the impact of pharmacist-led collaborative patient education on medication adherence and QOL in schizophrenia patients in a psychiatry out-patient setting of a tertiary-care setting. Patients were randomized into two groups. Interventional patients received medication review, followed by patient education session using Patient-Information Leaflets (PILs) developed for the study. Control patients received usual-care. Patients data were collected at the beginning of the study and after each follow-up of one-month interval, till 3rd follow-up. Medication adherence and QOL were assessed using Medication Adherence Rating Scale and WHOQOL-BREF questionnaire respectively. Twenty-three patients completed the study, 13 were in the intervention and 10 in the control group. Majority of the study subjects were of age group 18–39years (69.56%) and female (65.21%). Medication adherence mean improvement was 0.7±0.67 and 1.75±0.2 in control and intervention groups respectively. Similarly, mean QOL improvement was 16.12±1.98 and 24.17±0.3 in control and intervention groups respectively. Statistically significant improvement in the mean medication adherence and QOL was observed in the intervention group. Results showed that pharmacist-psychiatrist collaborative care can significantly improve patients’ medication adherence and QOL.

Assessment of Response to Providing Health-related Information in a Community Psychiatry Outpatient Setting

The objective of this study was to assess the subjective responses of patient and staff to the provision of health-related information in an outpatient psychiatric clinic. Simple educational information on healthy eating, exercising, and smoking cessation was provided in the waiting area of a clinic over the course of a year. This information took the form of educational handouts, educational DVDs, and monthly "special events" such as a poster competition for smoking cessation. In addition, patients were given an opportunity to attend free nutritional counseling sessions. Also, when needed, staff assisted patients in making appointments with primary care physicians. At the end of the year, a survey was distributed to patients and staff to assess the perceived benefits of the initiative. The majority of the 79 patients who completed the survey (n=60, 76%) had used the information provided, 95% of whom (n=57) had made some behavioral change, with 13% of the total survey respondents indicating that they had quit smoking. Ninety percent of the surveyed providers (18/20) felt that the initiative had had a positive impact on their patients. These results suggest that simple, low cost health and wellness initiatives in conjunction with an enthusiastic expenditure of a relatively small amount of staff time have the potential to have a positive impact on individuals attending an outpatient psychiatric clinic.

A clinical study of anxiety disorders in children and adolescents from North Indian children and adolescents clinic

Background and objectivesAnxiety disorders are the most common group of psychiatric disorders in children and adolescents. But few studies on specific anxiety disorders in children and adolescents are available in India. Therefore, this study was planned to identify anxiety disorders in children and adolescents in an Indian psychiatry outpatient setting and elicit its phenomenology and co-morbidities. Methods1465 persons were screened using screen for child anxiety related emotional disorders (SCARED) scale. The screen positive patients were assessed and diagnosis of anxiety disorders was established according to DSM-IV-TR. Detailed assessment of the phenomenology of anxiety disorders was done by K-SADS-PL. Results42 (2.86%) patients had different anxiety disorders. Out of which 16 (38.1%) patients had obsessive compulsive disorder, 10 (23.81%) patients with specific phobias, 6 (14.29%) patients with generalized anxiety disorder, 4 (9.52%) patients with social anxiety disorder and 3 (7.14%) patients each with separation anxiety disorder and panic disorder. Co-morbidities were found in 54% of patients with anxiety disorders. Dissociative disorder, specific phobias and social anxiety disorder were the common co-morbidities. Interpretation and conclusionAnxiety disorders are less commonly found in clinic settings (2.86%). No case of posttraumatic stress disorder or acute stress reaction was found in this study.

O-59 - Baseline individual depressive symptoms predict naturalistic outcome in depressive disorders: the leiden routine outcome monitoring study

Introduction Being able to predict a chronic course in depressive disorders is highly relevant for clinicians. Naturalistic studies on clinical predictors at symptom level are scarce. Objectives and aims To investigate the predictive value of individual depressive symptoms measured with the widely used Beck Depression Inventory self-report scale (BDI-II) on naturalistic outcome (remission/response; measured on the observer-rated Montgomery Asberg Depression Rating Scale [MADRS]) in a large cohort of depressive outpatients in a psychiatry outpatient setting. Methods We used a cohort of 1489 adult patients aged 18–65 years with MDD or dysthymic disorder established with the MINI-Plus diagnostic interview. All patients had a Routine Outcome Monitoring (ROM) baseline measurement in 2004–2009, with a maximum of two years of follow-up. We used multivariable Cox regression models to predict remission and response measured on the MADRS, and adjusted for clinical and demographic characteristics that had been identified as correlates of outcome in earlier studies. Results Of the 21 BDI-II items, the symptoms pessimism and loss of energy independently predicted non-remission and non-response. For pessimism, the HRs for remission and response were 0.81 (95% CI: 0.73–0.89, P Conclusions These findings in a naturalistic treatment setting may help clinicians to identify depressive patients at risk for an unfavourable outcome.

An exploratory study of nutraceutical prescription pattern among psychiatric patients in an out-patient setting

Background: Nutraceuticals are increasingly being used in psychiatric practice. However the literature continues to be limited for most of these agents. Prescription of nutraceuticals to psychiatric patients has not been systematically studied in Indian setting. The current study is aimed at assessment of prescription pattern of nutraceuticals in psychiatry out-patient setting in a tertiary care center. Materials and Methods: The study was carried out at the out-patient department of a tertiary care hospital. The sample frame was constituted by all the prescriptions from the out-patient psychiatry department. The information was collected for the socio-demographic variables using a semi-structured proforma. The patients were diagnosed based on the ICD-10 and the diagnoses were grouped as per the 10 categories of ICD-10. The prescriptions were screened for the nutraceuticals. The data were analyzed using SPSS ver 14.0. Results: A total of 174 consecutive prescriptions from the consenting patients were included in the study. Highest proportion of the study subjects (36.8%) belonged to the 'mood disorder' category (F 30-39), followed by 'schizophrenia, schizotypal and delusional disorders' category (F 20-29) (24.1%). Majority of the prescriptions at first visit (75.9%) did not include a nutraceutical. 63.2% of the last prescriptions did not include any nutraceutical. The different diagnostic categories did not differ significantly with regards to prescription of nutraceutical at the first visit. However there was a significant difference between the different diagnostic categories with regards to nutraceutical in the last prescription. Conclusions: Of all the diagnostic categories, prescriptions of individuals diagnosed with 'mood (affective) disorders' and 'neurotic, stress related and somatoform disorders' demonstrated significant increase in prescription of nutraceutical at the last prescription as compared to the first prescription.

Functioning and well-being of patients in a consultation-liaison psychiatry clinic

Outpatient consultation-liaison (C-L) psychiatry clinics are valuable settings for research and teaching endeavors. However, little is known about psychiatric symptoms and health status of persons treated in such settings. In this study, 80 persons seen in an outpatient C-L psychiatry clinic were compared with 100 persons seen in a mood disorder clinic on a variety of self-report instruments. Outpatient C-L clinic patients were found to have significantly poorer health status than mood clinic patients on the following domains as measured by the RAND instrument: general health perception, pain, physical functioning, and role functioning due to physical problems. Both groups had poor role functioning due to emotional problems and poor social functioning. The groups did not differ in depressive symptoms but C-L patients were significantly less anxious. Thus, it appears that patients in an outpatient C-L setting not only have significant medical comorbidity, as expected, but have levels of psychiatric distress comparable to that seen in a traditional psychiatry outpatient setting. These findings indicate that such a clinic is a fertile area for research and training in the diagnosis and treatment of persons with comorbid physical and mental disorders.