Sample Of Psychiatric Patients Research Articles

Variation in the Levels of Aluminum and Manganese in Scalp Hair Samples of the Patients Having Different Psychiatric Disorders with Related to Healthy Subjects.

There is very limited information available on the role of trace elements in psychiatric disorders (PSD). Immense pieces of evidence support the idea that exposure to trace and toxic metals, such as aluminum (Al) and manganese (Mn), may be factors or cofactors in the etiopathogenesis of a variety of psychiatric disorders. The aim of our study was to assess the Al and Mn in scalp hair samples of 102 patients having different types of psychiatric disorder PSD diseases together with 120 referent subjects of male patients in the age group of 45-60years. The understudy elements in scalp hair samples were assessed by the flame atomic absorption spectrophotometry after microwave-assisted acid digestion method .The validity of methodology was checked by the certified human hair reference material (NCS ZC81002). The recovery of studied elements was found in the range of 98.1-99.2% of certified reference material. The results of this study showed that the mean values of Al and Mn were significantly higher in scalp hair samples of all types of PSD as compared to referents subjects. The resulted data indicated a significant increase in the contents of Mn and Al in scalp hair samples of psychiatric patients than that of its control counterpart, which may provide prognostic tool for the diagnosis of the mental disorders. However, further work is suggested to examine the exact correlation between trace elements level and the degree of disorder.

A bifactorial solution to the Psychopathy Checklist: Screening Version in a sample of civil psychiatric patients.

There is considerable debate about the underlying factor structure of the Psychopathy Checklist: Screening Version (PCL: SV). An established view is that it reflects a unitary construct underpinned by two correlated factors. More recent research has, however, undermined this conceptualisation. Our aim was to compare 10 competing models of the PCL: SV in a sample of civil psychiatric patients. Ten distinct factor models were specified and tested using conventional confirmatory factor analytic techniques, along with confirmatory bifactor modelling. A bifactor model, including two general factors (interpersonal-affective and antisocial-lifestyle), and four subordinate factors (interpersonal, affective, antisocial and lifestyle) provided the best fit to the data. The reliability of the conceptualisation was supported through the use of composite reliability, and the differential relationships exhibited between the general factors and measures of personality, impulsivity and mental health. Our findings provide further weight to taking the two general psychopathy factors into account when interpreting the PCL: SV for clinical purposes. Copyright © 2015 John Wiley & Sons, Ltd.

The Nursing Diagnosis Disturbed Thought Processes in Psychiatric Patients: Prevalence and Associated Characteristics.

To analyze the frequency of the nursing diagnosis disturbed thought processes (DTP) (00130) in a sample of psychiatric and psychogeriatric patients in medium- and long-term units and to describe those factors associated with its presence. A secondary analysis of the data obtained in a multicentric and cross-sectional study developed in Spain was undertaken. The total sample was 624 patients, from which 39.4% (n = 246) had the nursing diagnosis DTP. A statistically significant relationship between the presence of DTP and different variables was found. The nursing diagnosis DTP is very frequent among psychiatric and psychogeriatric institutionalized patients. Patients with DTP may require a more complex nursing attention as its presence is associated with specific care needs.

A Latent Class Analysis of Psychopathic Traits in Civil Psychiatric Patients: The Role of Criminal Behaviour, Violence, and Gender

AbstractThis study aimed to determine whether distinct subgroups of psychopathic traits exist in a sample of civil psychiatric patients, using data from the MacArthur Violence Risk Assessment Project (n = 810), by means of latent class analysis. Multinomial logistic regression was used to interpret the nature of the latent classes, or groups, by estimating the associations with criminal behaviour, violence, and gender. The best fitting latent class model was a 4‐class solution: a ‘high psychopathy class’ (class 1; 26.4%), an ‘intermediate psychopathy class’ (class 2; 16.0%), a ‘low affective‐interpersonal and high antisocial‐lifestyle psychopathy class’ (class 3; 31.3%), and a ‘normative class’ (class 4; 26.3%). Each of the latent classes was predicted by differing external variables. Psychopathy is not a dichotomous entity, rather it falls along a skewed continuum that is best explained by four homogenous groups that are differentially related to gender, and criminal and violent behaviour.

Depersonalization: Physiological or pathological in adolescents?

BackgorundThis study analyzed the presence of DP symptoms in a sample of both psychiatric patients and normal subjects, addressing the issue of DP symptoms in adolescence. MethodsA total of 267 subjects (149 patients and 118 healthy controls) aged between 14 and 65years, were assessed by means of CDS, the SCID-I and the K-SADS. The sample was then divided into two subsamples with a cut-off age of 21years. ResultsAs expected CDS score was significantly higher in the patient group compared to the healthy control group. As for the age issue, among patients no statistical difference was found comparing subjects over and under 21years, whereas in the sample of healthy controls, subjects under 21years reported CDS scores significantly higher. ConclusionsWhile in adults DP symptoms are frequently associated with mental disorders, in adolescents they could be considered as a quasi-physiological phenomenon.

Validation of the Impulsive/Premeditated Aggression Scale in Mexican psychiatric patients

Introduction: Aggression has been linked to several psychiatric disorders. None of the available instruments validated in Mexico is able to classify aggression as impulsive or premeditated. The Impulsive/Premeditated Aggression Scale (IPAS) is a self-report instrument designed to characterize aggressiveness as predominately impulsive or premeditated. Objective: The aim of the study was to determine the validity and reliability of the IPAS in a sample of Mexican psychiatric patients. Method: A total of 163 patients diagnosed with affective, anxiety or psychotic disorder were included. A principal-component factor analysis was performed to obtain construct validity of the IPAS impulsive and premeditated aggression subscales; convergent validity as well as internal consistency of subscales were also determined. Results: The rotated matrix accounted for 33.4% of the variance. Significant values were obtained for convergent validity and reliability of the IPAS subscales. Conclusion: The IPAS is an adequate instrument, which might be used to differentiate the type of aggressive behavior in Mexican psychiatric patients.

Poly-traumatization and harmful behaviors in a sample of emergency department Psychiatric Intake Response Center youth

The purpose of this study is to examine risk factors for poly-traumatization, and the impact of poly-traumatization on harmful behaviors (suicidal, self-harm, and violent), among a group of pediatric patients presenting at an emergency department's psychiatric intake response center. We employed a retrospective medical chart review in a children's hospital for a 2-year span (N=260). The study employed 2 statistical analyses. The first analysis used multinomial logistic regression to model the odds of harmful behaviors comparing increasing numbers of co-occurring traumatization types. The second analysis employed latent class modeling techniques in three ways to (a) define different poly-traumatization populations, (b) examine the relationship between predictors and class assignment, and (c) examine the relationship between class assignment and harmful behavioral outcomes. About 62% of the sample presented with at least 1 traumatization type and about 50% one harmful behavior type. Compared to those with 1, 2, or 3 traumatization types, patients with 4 or more traumatization types have higher odds of harmful behaviors. The latent class analysis revealed 2 populations: High serious victimization and minimal traumatization. History of family mental health issues was the only significant predictor of class membership. Class membership was associated with all of the harmful behavioral outcome categories. These findings support consideration of poly-traumatization as a risk factor for the high occurrence of harmful behaviors in this sample of pediatric psychiatric patients and that history of family mental health issues may contribute to the high co-occurrence of poly-traumatization.

Dyslexia Prevalence in Forensic Psychiatric Patients: Dependence on Criteria and Background Factors

Research on dyslexia in forensic psychiatric patients is limited, and therefore one aim of this study was to assess the prevalence of dyslexia in a sample of forensic psychiatric patients by using different criteria. Another aim was to investigate how phonological-processing skills in these patients might be related to disadvantageous background factors and poor reading habits. Forensic psychiatric patients performed reading, writing and intelligence tests, as well as a battery of phonological processing tasks. They were also interviewed about reading habits and literacy conditions in their childhood homes. Data regarding the patients’ dyslexia diagnoses and backgrounds were collected from forensic psychiatric investigations and patient records. The results showed that 11–53% of the patients met the discrepancy criteria for dyslexia, whereas 50% fulfilled the phonological core deficit criterion. Neither disadvantageous background factors nor reading habits were related to phonological-processing skills.

Relation entre mécanismes de défense et alliance thérapeutique

The therapeutic alliance can be defined as a collaborative relationship between the patient and the practitioner. It represents an essential component of the psychotherapeutic process (Ambresin et al., 2007; Cungi, 2006; Martin et al., 2000). Some authors suggest that a good alliance can have a favorable impact on the therapeutic success (Barber et al., 2000; Hubble, Duncan, & Miller 1999; Horvath & Luborsky, 1993; Horvath & Symonds, 1991). This alliance can be influenced by psychological and behavioral factors (Cungi, 2006) Thus, some defense mechanisms could prevent change or, on the contrary could facilitate adaptation (Ambresin et al., 2007) and have an impact on the therapeutic success (Muris & Merckelbach, 1996). However, the relationship between therapeutic alliance and defense mechanisms represents an insufficiently explored field (Ambresin et al., 2007; Cungi, 2006). The aim of the present study was to examine the relationship between therapeutic alliance and twenty defense mechanisms in a sample of French psychiatric patients, by differentiating results in men and women. We also examined the positive and the negative therapeutic alliance. Sixty patients aged from 18 to 58 (M=41.50; SD=11.03) completed the French versions of the Defense Style Questionnaire-40 (DSQ-40) and the Helping Alliance questionnaire-II (HAq-II). Therapeutic alliance was significantly associated with each defense style: mature (0.62), neurotic (0.45) P<0.01and immature (0.27) p<0.05. The mature defense style was a significant predictor of therapeutic alliance (R(2) adj=36,F=12.39, β=0.65,P<0.01) and of positive therapeutic alliance (R(2) adj=36, F=12.34, β=0.62, P<0.001).Among women, positive therapeutic alliance was significantly associated with all mature defenses, three neurotic defenses (reaction formation, pseudo-altruism, idealization) and four immature defenses (splitting, denial, somatization, passive aggression). Among men, three mature defenses were associated (anticipation, humor, sublimation), four neurotic (reaction formation, pseudo-altruism, idealization and undoing) and two immature (somatization and denial). The negative therapeutic alliance, in our total sample, was associated with two immature defenses (denial and dissociation). Among men, displacement was the only defense associated with negative alliance, among women no defenses was significant. These results highlight the relationship between therapeutic alliance and some defense mechanisms, like some authors have suggested (Ambresin et al., 2007; Bond & Perry, 2004; Bond, 2004). Moreover, some defenses appeared to be more associated with a positive or a negative therapeutic alliance, and could depend on the patient gender. The present study confirms the importance of taking into account the gender in the study of defense mechanisms, and to increase our knowledge about the relationship between therapeutic alliance and defense mechanisms.

Comparing criterion- and trait-based personality disorder diagnoses in DSM-5.

In the recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the official personality disorder (PD) classification system remains unchanged. However, DSM-5 also includes an alternative hybrid categorical-dimensional PD system in Section III to spur additional research. One defining feature of the alternative system is the incorporation of a trait model with PD-specific trait configurations, but relatively little work has evaluated how these traits map onto official PD diagnoses or their implications for diagnosis rates. To that end, we compared official PD criteria to Section III PD traits in a sample of current or recent psychiatric patients. We (a) evaluated the extent to which PD traits predicted traditional PD criterion counts, and (b) computed trait-based diagnosis rates and compared them to those reported in several published outpatient and epidemiological samples. Overall, PD traits generally predicted PD criterion counts, but with less than ideal specificity. In addition, we identified differences in diagnosis rates across approaches. These results provide some support for the Section III approach, but they also identify important areas in need of refinement and future study before the field could reasonably switch to a hybrid PD classification approach like that in Section III.

Peer victimization predicts psychological symptoms beyond the effects of child maltreatment

Experiences of peer victimization have been repeatedly associated with psychological symptoms and disorders. However, as peer victimization is correlated with child maltreatment occurring within the family, it remains unclear whether the pathological effect of peer victimization is an artifact that can be attributed to previous aversive events. To separate the effects of peer victimization from child maltreatment, we studied both event types as well as psychological symptoms in a mixed clinical sample of ambulant and psychiatric patients (N=168), a self-selected community sample recruited through the internet (N=995), and a student sample (N=272). Hierarchical regression analyses showed that, after controlling for child maltreatment, peer victimization accounted for an incremental proportion of the variance of different symptom dimensions in each sample. These results indicate that peer victimization is an independent predictor of psychopathology.

The MMPI-2 in chronic psychiatric illness.

While previous studies on the MMPI-2 in patients with schizophrenia and depression have used mixed samples of both early stage and chronic psychiatric patients. Here, it is investigated whether chronicity itself might have a differential effect on the MMPI-2 profiles of these patients and whether demoralization 'associated with long-term illness' affects the scales of the MMPI-2. Thirty long-term patients with schizophrenia, 30 long-term patients with depression, and 30 healthy participants completed the MMPI-2. Groups were compared on Clinical Scales and on the Restructured Clinical (RC) Scales. Patients with schizophrenia differed from patients with depression on 14 MMPI-2 scales and from healthy controls on 10 scales, generally showing mean UT-scores < 65, indicating a subjective experience of (near) normal functioning. Patients with depression differed from healthy controls on 17 scales mostly with UT-scores > 65, indicating impaired functioning. Demoralization was higher in patients with depression than in patients with schizophrenia and both psychiatric groups differed from the healthy control group. It is concluded that long-term patients with depression show impaired functioning and high demoralization, while long-term patients with schizophrenia surprisingly show near normal functioning and less demoralization.

Predicting psychosis in a general adolescent psychiatric sample

IntroductionCurrent psychosis risk criteria have often been studied on a pre-selected population at specialized clinics. We investigated whether the Structured Interview for Prodromal Syndromes (SIPS) is a useful tool for psychosis risk screening among adolescents in general psychiatric care. Methods161 adolescents aged 15–18 with first admission to adolescent psychiatric services in Helsinki were interviewed with the SIPS to ascertain Clinical High-Risk (CHR) state. The participants were followed via the national hospital discharge register, patient files, and follow-up interviews. DSM-IV Axis I diagnoses were made at baseline and 12months. Register follow-up spanned 2.8–8.9years, and hospital care for a primary psychotic disorder and any psychiatric disorder were used as outcomes. ResultsCHR criteria were met by 54 (33.5%) of the adolescents. Three conversions of psychosis as defined by SIPS emerged during follow-up, two of whom belonged to the CHR group. The positive predictive value of the CHR status was weak (1.9%) but its negative predictive value was 98.0%. Using the DSM-IV definition of psychosis, there were five conversions, three of which were in the CHR group. In regression analyses, hospital admissions for primary psychotic disorder were predicted by positive symptom intensity in the baseline SIPS. In addition, CHR status and SIPS positive and general symptoms predicted hospitalization for psychiatric disorder. DiscussionPsychosis incidence was low in our unselected sample of adolescent psychiatric patients. CHR status failed to predict SIPS or DSM-IV psychoses significantly at 12months. However, in a longer follow-up, CHR did predict psychiatric hospitalization.

Perfectionism, Stress, Daily Hassles, Hopelessness, and Suicide Potential in Depressed Psychiatric Adolescents

The current study examined dimensions of perfectionism, stress, hopelessness, and suicidality in a sample of adolescent psychiatric patients diagnosed with depression. This study evaluated the unique contribution of perfectionism in predicting suicidality after considering other predictors (i.e., hopelessness, depression) and it also examined the diathesis-stress model of perfectionism and suicide. A sample of 55 adolescents (41 females, mean age = 15.53, 25.5 % ethnic/racial minorities) who were psychiatric patients completed measures including the Child-Adolescent Perfectionism Scale, subjective and objective indices of life stress, daily hassles, depression, hopelessness, suicide ideation, prior attempts and suicide potential. In addition, other informants (i.e., adolescents’ parents) completed a diagnostic interview and an interview assessing major stressful experiences. Socially prescribed perfectionism (i.e., the perception that others require perfection of oneself) predicted concurrent levels of suicide potential and this association with suicide potential held even after controlling for the variances accounted for by depression and hopelessness. Hierarchical regression analyses provided partial support for the diathesis-stress model, that is, socially prescribed perfectionism interacted with daily hassles to predict concurrent suicide potential even after controlling for depression, hopelessness, and prior suicide attempt. Together, these findings suggest that socially prescribed perfectionism acts as a vulnerability factor that is predictive of suicide potential or risk among clinically depressed adolescents.

The Factor Structure of the Brief Psychiatric Rating Scale (Expanded Version) in a Sample of Forensic Psychiatric Patients

Severe behavioral problems, aggression, unlawful behavior, and uncooperativeness make the forensic psychiatric population both hard to treat and study. To fine-tune treatment and evaluate results, valid measurement is vital. The Brief Psychiatric Rating Scale-Extended (BPRS-E) is a widely used scale for assessing psychiatric symptoms, with a stable factor structure over various patient groups. For the first time, its usefulness for forensic psychiatric patients was studied by means of an exploratory factor analysis on 302 patients in a penitentiary psychiatric center. A five-factor solution fitted the data best and showed large overlap with previous research done in both in- and outpatient populations with schizophrenia and mixed diagnoses. Around 45% of the patients did not fully comply. Items relying most on self-report caused the most non-adherence, possibly because of difficulty with verbalizing distress. These items loaded on the factors psychosis and affect. The BPRS-E is a suitable instrument for forensic use. Future research and clinical practice should focus on alignment with forensic patients to improve measurement, understanding, and eventually therapeutic interventions.

Characteristics and motivations of absconders from forensic mental health services: a case-control study

BackgroundAbsconding from hospital is a significant health and security issue within psychiatric facilities that can have considerable adverse effects on patients, their family members and care providers, as well as the wider community. Several studies have documented correlates associated with absconding events among general psychiatric samples; however, few studies have examined this phenomenon within samples of forensic patients where the perception of threat to public safety in the event of an unauthorized absence from hospital is often higher.MethodsWe investigate the frequency, timing, and determinants of absconding events among a sample of forensic psychiatric patients over a 24-month period, and compare patients who abscond to a control group matched along several sociodemographic and clinical dimensions. We explore, in a qualitative manner, patients’ motives for absconding.ResultsFifty-seven patients were responsible for 102 incidents of absconding during the two year study window. Forensic patients who absconded from hospital were more likely to have a history of absconding attempts, a diagnosed substance use disorder, as well as score higher on a structured professional violence risk assessment measure. Only one of the absconding events identified included an incident of minor violence, and very few included the commission of other illegal behaviors (with the exception of substance use). The most common reported motive for absconding was a sense of boredom or frustration.ConclusionsUsing an inclusive definition of absconding, we found that absconding events were generally of brief duration, and that no member of the public was harmed by patients who absconded. Findings surrounding the motivations of absconders suggest that improvements in therapeutic communication between patients and clinical teams could help to reduce the occurrence of absconding events.

RDoCs redux

RDoCs redux

Telephone Versus Internet Administration of Self-Report Measures of Social Anxiety, Depressive Symptoms, and Insomnia: Psychometric Evaluation of a Method to Reduce the Impact of Missing Data

BackgroundInternet-administered self-report measures of social anxiety, depressive symptoms, and sleep difficulties are widely used in clinical trials and in clinical routine care, but data loss is a common problem that could render skewed estimates of symptom levels and treatment effects. One way of reducing the negative impact of missing data could be to use telephone administration of self-report measures as a means to complete the data missing from the online data collection.ObjectiveThe aim of the study was to compare the convergence of telephone and Internet administration of self-report measures of social anxiety, depressive symptoms, and sleep difficulties.MethodsThe Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR), Montgomery-Åsberg Depression Rating Scale-Self-Rated (MADRS-S), and the Insomnia Severity Index (ISI) were administered over the telephone and via the Internet to a clinical sample (N=82) of psychiatric patients at a clinic specializing in Internet-delivered treatment. Shortened versions of the LSAS-SR and the ISI were used when administered via telephone.ResultsAs predicted, the results showed that the estimates produced by the two administration formats were highly correlated (r=.82-.91; P<.001) and internal consistencies were high in both administration formats (telephone: Cronbach alpha=.76-.86 and Internet: Cronbach alpha=.79-.93). The correlation coefficients were similar across questionnaires and the shorter versions of the questionnaires used in the telephone administration of the LSAS-SR and ISI performed in general equally well compared to when the full scale was used, as was the case with the MADRS-S.ConclusionsTelephone administration of self-report questionnaires is a valid method that can be used to reduce data loss in routine psychiatric practice as well as in clinical trials, thereby contributing to more accurate symptom estimates.

Risk factors for medication non-adherence among psychiatric patients with substance misuse histories

Medication non-adherence among psychiatric patients is known to be associated with poorer treatment outcomes. The study examined a comprehensive set of modifiable risk factors for non-adherence in a theoretical framework among a diverse, high risk sample of psychiatric patients with substance misuse histories (N=299). Medication side effects and excessive alcohol use were related to lower medication adherence and higher motivation for mental health treatment and recovery support were related to greater adherence. The results suggest that a multifaceted model for intervention to increase psychiatric medication adherence should be developed and tested.

Exploring the Hierarchical Structure of the MMPI–2–RF Personality Psychopathology Five in Psychiatric Patient and University Student Samples

In this study our goal was to examine the hierarchical structure of personality pathology as conceptualized by Harkness and McNulty's (1994) Personality Psychopathology Five (PSY–5) model, as recently operationalized by the MMPI–2–RF (Ben-Porath & Tellegen, 2011) PSY–5r scales. We used Goldberg's (2006) “bass-ackwards” method to obtain factor structure using PSY–5r item data, successively extracting from 1 to 5 factors in a sample of psychiatric patients (n = 1,000) and a sample of university undergraduate students (n = 1,331). Participants from these samples had completed either the MMPI–2 or the MMPI–2–RF. The results were mostly consistent across the 2 samples, with some differences at the 3-factor level. In the patient sample a factor structure representing 3 broad psychopathology domains (internalizing, externalizing, and psychoticism) emerged; in the student sample the 3-factor level represented what is more commonly observed in “normal-range” personality models (negative emotionality, introversion, and disconstraint). At the 5-factor level the basic structure was similar across the 2 samples and represented well the PSY–5r domains.