Sample Of Psychiatric Patients Research Articles

Cost of treatment as a barrier to access and continuity of healthcare for patients with mental ill-health in Lagos, Nigeria

In Nigeria, there are several barriers to access to effective mental healthcare, e.g. cost, distance to the mental health facility, social stigma, cultural beliefs, attitudes and taboos. This study aimed at i) determining the cost of treatment of a random sample of psychiatric patients and to compare the sample with a matched group of patients from the internal medical department clinics; ii) assessing the impact of cost on access to care and maintenance treatment for the study group in the context of their exclusion from the Lagos State free health services and the National Health Insurance Scheme. Medical records of 100 patients currently attending the outpatients’ clinic of the Department of Psychiatry of the Lagos State University Teaching Hospital (Ikeja, Nigeria) were randomly selected and audited. A similar exercise was also conducted for patients attending the medical outpatients’ clinic in the same hospital. The monthly costs of prescribed medications were computed and compared. The monthly cost of treatment of patients from the Department of Psychiatry compared to patients with physical ailments from the medical outpatients’ clinic was found to be significant vis à vis the average income of average Nigerians. Contrary to expectations, the mean cost of drug treatment borne by medical outpatients was much higher (N=2549.07 vs N=1904.5) (P<0.05) than that of patients attending the psychiatric outpatients’ clinic. However, the expensive cost for the psychiatric patients far exceeded the expensive costs for the medical patients. The findings from this study showed that the average monthly cost of treatment of patients attending the psychiatric clinic was lower than patients from the medical outpatients’ clinic. However, the most expensive cost for psychiatric patients far exceeded the most expensive cost for medical patients. This study also revealed that there is no free health program covering psychiatric treatment anywhere in Nigeria and mental health drugs are funded from personal and family expenses. It is thereby suggested that policy makers should change policy regarding the coverage of Nigerians with mental illness. In doing so, the major barrier to assess and the treatment gap can be reduced.

The Impact Message Inventory–Circumplex (IMI–C): A Replication Study of Its Circumplex Structure in a Dutch Sample

The 56-items Impact Message Inventory–Circumplex (IMI–C) has been developed to describe the interpersonal styles of target persons in terms of the 2-dimensional interpersonal circle, divided in 8 subscales (octants). The IMI–C is based on the assumption that a target person's interpersonal styles can validly be measured by assessing the internal (cognitive and emotional) reactions of the IMI–C respondent (e.g., therapists), interacting with the target person (e.g., psychotherapy patients). This replication study tested the circumplexity of a computer-delivered Dutch IMI–C. The computer-delivered Dutch IMI–C approached circumplexity in a large clinical sample (N = 812) of psychotherapy and psychiatric patients, after removing 3 items from the Submissive octant scale. These 3 items clearly disturbed the IMI–C circumplex structure. It is concluded that, even with the inevitable problem of nested data, circumplexity was approached sufficiently to justify the interpretation of the IMI–C at the octant level, provided that the 3 troublesome Submissive items are removed from the calculations of octant scores. Our replication test of the Dutch IMI–C circumplexity might be an impetus for researchers in the United States to invest in the further validation of the original American version.

Suicide and Other Causes of Death in the Psychiatric Patients of a Mental Health Service over a 5-year Period

Aims: 1) To compare mortality rate and causes of death between psychiatric patients of a Mental Health Department (MHD) and local population of Modena. 2) To appraise the impact of selected demographic and clinical variables on suicide. Study Design: Retrospective analysis. Place and Duration of Study: MHD of Modena between March 2009 and September 2009. Research Article International Neuropsychiatric Disease Journal, 1(1): 46-63, 2013 47 Methodology: Our psychiatric sample was composed by all psychiatric patients followed by the MHD of Modena, who died from 1-1-2004 to 31-12-2008 (n=168). We compared the standardized mortality rate and causes of death of our sample to those of the local population (n=250,000), who died during the same period of time, according to data provided by the registry of the Clinical Epidemiology Service of Modena. From computerized registration system and medical records of MHD and death certificates, we collected: demographic data, psychiatric diagnosis, death causes, time elapsed from the first consultation in MHD to death, time elapsed from the last discharge from psychiatric ward or from the last consultation in MHD to death. Our sample of psychiatric patients was further divided into two groups: the first one was composed of those who committed suicide (n=25) and the second one those that died from other causes (n=143), and all variables of each group were statistically compared to highlight the demographic and clinical features of the two groups. Results: Neoplastic and cardiovascular diseases were the two most frequent causes of death in both psychiatric and local populations and suicide represented the third leading cause of death in the psychiatric sample. Psychiatric patients who committed suicide were statistically significantly younger in comparison to others and killed themselves after 12 days (median) from the last psychiatric consultation or hospital discharge. Conclusion: Our patients presented the same high vulnerability to organic disorders and their fatal consequences as local population with higher risk of suicide which remains a fatal outcome of psychiatric diseases.

1721 – Expressed emotion in a mixed sample of psychiatric, oncological and obese patients

Introduction Expressed Emotion (EE) reflects the “emotional temperature” of a family. High EE and low EE families can be identified. The degree of family EE correlates with patients’ outcome, being a high family EE predictive of a greater likelihood of relapse, an increased need for care and inpatient treatment. Objectives Firstly, to evaluate EE, life events and anxiety in a mixed sample of psychiatric, oncological and obese patients recruited from the Psychiatry, Oncology and Nutrition Wards of the “Maggiore della Carita” General Hospital, Novara (Italy). Secondly, to compare these parameters among the three subgroups of patients. Furthermore, we also recruited a cohabiting relative for each patient and compared the relative's EE and EE as perceived by patients. Methods 112 patients attending the Psychiatry (n=34), Nutrition (n=56) and Oncology (n=21) Wards were involved. Patients were assessed by means of the following scales: Level of Expressed Emotion (LEE) scale, Paykel Life Events scale, State Trait Anxiety Inventory 1 and 2. Results Data collection is ongoing. Anyway, preliminary results suggest that psychiatric patients are more likely to have a longstanding diagnosis, to have received inpatient care but they are less likely to suffer from comorbid organic disorders. Consistently with current literature, obese patients get higher scores than the other subgroups of patients at EE. Conclusions Clinical implications are discussed, focusing on the need to carefully address the issue of high EE families in order to reduce the need for inpatient treatment, increase compliance and improve patients’ and relatives’ quality of life.

Internalized stigma of mental illness in Sweden and Iran—A comparative study

Objectives: Stigma and discrimination because of mental illness is still prevalent even in high-income countries where a lot of emphasis has been given to anti-stigma activities and measures to reduce the marginalization of these persons. One aspect of the stigma issue is the self-stigmatization that persons suffering from mental illness are experiencing. In this study two different societies have been compared as regards internalized stigma of mental illness. Methods: A widely used questionnaire was used by the Internalized Stigma of Mental Illness scale (ISMI). One sample of psychiatric patients from Sweden (N = 163) and from Iran (N = 138) is compared. Results: The Swedish sample generally reports lower levels of experienced stigma except for items covering selfblame and feelings of alienation. Conclusions: There are reasons to consider the aspect of self-stigmatization when working with mentally ill persons even in high income countries with well developed mental health services.

Empirical evidence for Freud's theory of primary process mentation in acute psychosis.

Freud (1895/1966; 1900/1953; 1915/1957) has proposed that primary process functioning is typical for acute psychosis. A nonverbal method, the 'Geocat' (Brakel, Kleinsorge, Snodgrass, & Shevrin, 2000), measures primary processes operationalized as attributional categorization, which considers exemplars as similar if particular features match, even if these components are arranged in a quite different configuration. With the use of GeoCat we explored primary process mentation in 127 psychiatric patients. Results show that (1) there are substantially higher levels of attributional choices in our sample of psychiatric patients, independently of diagnosis, than in a non-patient population; (2) psychotic patients tend to have more attributional choices than non-psychotic patient; patients with acute psychotic symptoms show more attributional re-sponses than patients without acute psychotic symptoms; (3) this increase of attributional choices with the psychotic condition is independent of self-rated anxiety or medication intake. We propose that, instead, this increase of attributional levels in the acutely psychotic patients reflects a predominance of primary processing which is specifically tied to the acutely psychotic condition, as proposed by Freud. © 2012 American Psychological Association.

Development and preliminary validation of the Level of Care Index (LOCI) from the Personality Assessment Inventory (PAI) in a psychiatric sample.

Research over the last decade has been promising in terms of the incremental utility of psychometric tools in predicting important clinical outcomes, such as mental health service utilization and inpatient psychiatric hospitalization. The purpose of this study was to develop and validate a new Level of Care Index (LOCI) from the Personality Assessment Inventory (PAI). Logistic regression was initially used in a development sample (n = 253) of psychiatric patients to identify unique PAI indicators associated with inpatient (n = 75) as opposed to outpatient (n = 178) status. Five PAI variables were ultimately retained (Suicidal Ideation, Antisocial Personality-Stimulus Seeking, Paranoia-Persecution, Negative Impression Management, and Depression-Affective) and were then aggregated into a single LOCI and independently evaluated in a second validation sample (n = 252). Results indicated the LOCI effectively differentiated inpatients from outpatients after controlling for demographic variables and was significantly associated with both internalizing and externalizing risk factors for psychiatric admission (range of ds = 0.46 for history of arrests to 0.88 for history of suicidal ideation). The LOCI was additionally found to be meaningfully associated with measures of normal personality, performance-based tests of psychological functioning, and measures of neurocognitive (executive) functioning. The clinical implications of these findings and potential utility of the LOCI are discussed.

1211 – Self-report and hetero-evaluation of insight and medication adherence in severe mental illness - correlation and clinical interest

Introduction Insight and treatment adherence in serious mental illness, namely psychotic disorders, are well recognized as strong predictors of prognosis; several psychometric instruments have been developed for their evaluation. Objectives and aims To analyze the relation between self and hetero-evaluated insight and treatment attitudes in a clinical sample of psychiatric patients, besides assessing it's clinical correlates and relevance. Methods 60 patients with serious mental illness (schizophrenia and bipolar disorder with psychotic features) were assessed using the Portuguese versions of the ‘Insight Scale' (IS), ‘Medication Adherence Rating Scale’ (MARS) and ‘Insight and Treatment Attitudes Questionnaire’ (ITAQ). General psychopathology and functioning scales were also applied, such as the BPRS, BDI-II and FAST. Relevant sociodemographic and clinical variables were also obtained. Statistical analysis was conducted using SPSS version 19. Results Self-reported insight using the IS was not correlated with the insight subscale of the ITAQ, a hetero-evaluation instrument. Similarly, we found no correlation regarding attitudes to treatment when comparing self-report (MARS) and hetero- evaluation (treatment attitudes subscale of the ITAQ). Nonetheless, patients with a history of medication non-compliance and worse clinical outcomes had significantly lower (p Discussion and conclusions Insight and treatment attitudes assessments can be valuable in clinical practice, contributing to decisions in both in- and outpatient settings involving treatment planning and level of monitoring. Clinician-rated instruments are probably more reliable, with clearer prognostic relevance.

Prevalence and correlates of suicidal ideation and attempts in patients with bipolar mood disorder- a retrospective study

BACKGROUND: Suicide which is a highly individualized act is a common endpoint for many patients with severe psychiatric illness especially bipolar affective disorder. OBJECTIVE: To investigate the prevalence of and risk factors for suicidal ideation and attempts among representative samples of psychiatric patients with bipolar affective disorders. METHODS: The study design was a retrospective one. Charts were screened over a time period from June 2012- December 2012. The charts which were diagnosed as bipolar affective disorder were included in the analysis. The patients were diagnosed using DSM IV TR criteria. The charts were analyzed for the sociodemographic data, age at onset, past, personal and family history, symptamatology, presenting symptoms, treatment details. RESULTS: T he total number of charts which met the inclusion and exclusion criteria were 50 in number. About 34(68%) were males and 16(32%) were females, 35(70%) were married. Most of the sample 64 %( 34) were from 20-40 age group and 84% were educated, almost all the subjects came from the middle and lower socio economic strata. Study found that 5(10%) patients had attempted suicide and 14(28%) had suicidal ideation; all attempters also reported ideation. On comparing the people who attempted suicide with those who had suicidal ideation there was a significant difference (p

New and Improved? A Comparison of the Original and Revised Versions of the Structured Interview of Reported Symptoms

The current study evaluated the accuracy of the Structured Interview of Reported Symptoms, Second Edition (SIRS-2) in a criterion-group study using a sample of forensic psychiatric patients and a community simulation sample, comparing it to the original SIRS and to results published in the SIRS-2 manual. The SIRS-2 yielded an impressive specificity rate (94.3%) that exceeded that obtained using the original SIRS scoring method (92.0%) and approached that observed in the SIRS-2 normative data (97.5%). However, changes in scoring resulted in markedly lower sensitivity rates of the SIRS-2 (36.8% among forensic patients and 66.7% among simulators) compared with the SIRS (47.4% and 75.0%, respectively). The removal of the Total Score from the SIRS-2 further hindered identification of feigning. Analyses also evaluated the additive value of the new RS-Total and MT Index scales in the SIRS-2. Implications of these results for forensic psychologists are discussed.

Differentiating normal and disordered personality using the General Assessment of Personality Disorder (GAPD)

Criteria to differentiate personality disorder from extremes of normal personality variations are important given growing interest in dimensional classification because an extreme level of a personality dimension does not necessarily indicate disorder. The DSM-5 proposed classification of personality disorder offers a definition of general personality disorder based on chronic interpersonal and self/identity pathology. The ability of this approach to differentiate personality disorder from other mental disorders was evaluated using a self-report questionnaire, the General Assessment of Personality Disorder (GAPD). This measure was administered to a sample of psychiatric patients (N = 149) from different clinical sub-sites. Patients were divided into personality disordered and non-personality disordered groups on the basis of the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). The results showed a hit rate of 82% correct identified patients and a good accuracy of the predicted model. There was a substantial agreement between SCID-II interview and GAPD personality disorder diagnoses. The GAPD appears to predict personality disorder in general, which provides support of the DSM-5 general diagnostic criteria of personality disorder.

Memorie traumatiche precoci e disturbo post traumatico da stress. Uno studio sperimentale

[ Early traumatic memories and Post Traumatic Stress Disorder (PTSD). An experimental study] INTRODUCTION. This paper has analyzed the Post-Traumatic Stress Disorder (PTSD) in order to address clinical and psychopathogenetic aspects of the disorder. An extensive literature supports the presence of a strong link between childhood trauma and dissociative symptoms, indicating this link as the primary or predominant source of PTSD. In addiction, several studies have shown that – exposed to the same traumatic conditions – not all people develop a Post Traumatic Stress Disorder, a problem not addressed by clinical research. METHODS. The study aimed at verifying the existence of a correlation between childhood traumatic memories (sexual, psychological, and emotional abuse, exposure to family violence), and the further development of this anxiety disorder. Moreover, the research wanted to obtain a psychopathology profile of PTSD. Subjects were required to fill the Minnesota Multiphasic Personality Inventory (MMPI), including the PTSD-Keane scale, and some MMPI special scales. RESULTS. This research has verified a statistical relationship (logistic regression) between traumatic childhood events and the development of the Post Traumatic Stress Disorder. In addition, the results obtained from the sample of psychiatric patients indicate a strong disorganization of the personality of patients with PTSD symptomatology. DISCUSSION. The data show that childhood trauma organize a basic vulnerability which increases 10 times the risk to develop this pathology after a traumatic experience.

Hospital pharmacists providing drug information to psychiatric inpatients: still a long way ahead

Study objectiveThe aim of this study is to gain knowledge on the opinion of psychiatric patients about the provision of drug information so that the psychiatric hospital pharmacist can consider...

External Validity of the Personality Assessment Inventory (PAI) in a Clinical Sample

This study contributes to the ongoing construct validation of the Personality Assessment Inventory (PAI; Morey, 1991, 2007) by identifying nontest life-event correlates of the PAI full scales and subscales in a sample of psychiatric patients. The life-event data used in this study included education, marital status, and employment, as well as a history of suicide attempts, psychiatric hospitalizations, trauma, medical problems, hallucinations, paranoid ideation, drug abuse, alcohol abuse, and arrest. Correlations were calculated to explore the convergent and discriminant validity of the PAI scales relative to the life-event data. The results showed that the majority of the PAI scales (11 of 13) had meaningful correlations with at least 1 life-event variable. The PAI BOR scale had the greatest number of correlations and was associated with 8 life-event variables. In contrast, the PAI ANX and MAN scales had no correlations above a predetermined threshold (r ≥.21). These findings add to the growing body of empirical correlates of the PAI and generally provide support for the construct validity of the PAI scales.

Predicting future suicide attempts among depressed suicide ideators: A 10-year longitudinal study

Suicidal ideation and attempts are a major public health problem. Research has identified many risk factors for suicidality; however, most fail to identify which suicide ideators are at greatest risk of progressing to a suicide attempt. Thus, the present study identified predictors of future suicide attempts in a sample of psychiatric patients reporting suicidal ideation. The sample comprised 49 individuals who met full DSM-IV criteria for major depressive disorder and/or dysthymic disorder and reported suicidal ideation at baseline. Participants were followed for 10 years. Demographic, psychological, personality, and psychosocial risk factors were assessed using validated questionnaires and structured interviews. Phi coefficients and point-biserial correlations were used to identify prospective predictors of attempts, and logistic regressions were used to identify which variables predicted future attempts over and above past suicide attempts. Six significant predictors of future suicide attempts were identified – cluster A personality disorder, cluster B personality disorder, lifetime substance abuse, baseline anxiety disorder, poor maternal relationship, and poor social adjustment. Finally, exploratory logistic regressions were used to examine the unique contribution of each significant predictor controlling for the others. Comorbid cluster B personality disorder emerged as the only robust, unique predictor of future suicide attempts among depressed suicide ideators. Future research should continue to identify variables that predict transition from suicidal thoughts to suicide attempts, as such work will enhance clinical assessment of suicide risk as well as theoretical models of suicide.

Complex posttraumatic stress disorder in patients with borderline personality disorder and somatoform disorders.

Disorders of Extreme Stress Not Otherwise Specified (DESNOS), also known as Complex posttraumatic stress disorder, was assessed in a sample (N = 472) of adult psychiatric patients with confirmed diagnoses of Borderline Personality Disorder (BPD), Somatoform Disorders (SoD), comorbid BPD + SoD, or Affective or Anxiety Disorders (Psychiatric Controls, PC). BPD + SoD patients had the most extensive childhood trauma histories and were most likely (38%) to meet DESNOS criteria, followed by BPD (26%), PC (17%), and SoD (10%), The BPD + SoD and BPD-only groups reported significantly higher levels of DESNOS symptoms than the SoD or PC groups, and did not differ from each other except for greater severity of DESNOS somatic symptoms by the BPD + SoD group. DESNOS warrants further investigation with psychiatrically impaired adults as a potential independent syndrome or as a marker identifying a subgroups of affectively or both affectively and somatically dysregulated patients diagnosed with BPD who have childhood trauma histories. (PsycINFO Database Record (c) 2012 APA, all rights reserved) Complex Posttraumatic Stress Disorder in Patients With Borderline Personality Disorder and Somatoform Disorders (PDF Download Available). Available from: http://www.researchgate.net/publication/232491929_Complex_Posttraumatic_Stress_Disorder_in_Patients_With_Borderline_Personality_Disorder_and_Somatoform_Disorders [accessed Oct 29, 2015].

Is there adequate empirical justification for radically revising the personality disorders section for DSM-5?

The DSM-5 Personality and Personality Disorders (PDs) Work Group has recommended a reformulation of the PD section. In the present review I examined the empirical support for the Work Group's criticisms of the DSM-IV approach that were central to the justification for radically changing the diagnostic criteria. The Work Group indicated that comorbidity among the DSM-IV PDs is excessive, and to reduce comorbidity they recommended deleting five PDs. The studies they cited demonstrating high levels of comorbidity were of samples of psychiatric patients. A review of the epidemiological literature shows that comorbidity rates are much lower than in patient samples, and this challenges the proposition that high comorbidity is due to the diagnostic criteria. Moreover, the empirical support for the exclusion of some disorders over others is lacking. The Work Group noted that the diagnostic stability of the PDs is modest. However, modest levels of diagnostic stability may be largely attributable to methodological factors such test-retest unreliability, state effects, regression to the mean, and measurement error due to repeated assessments, rather than a reflection of inadequacies of the diagnostic system. Thus, modest stability is likely to be found in any approach toward diagnosing PDs. The present review therefore suggests that several of the core problems linked to the DSM-IV approach toward diagnosing PDs are more likely due to methodological factors than inadequacies of the criteria themselves. The Work Group's recommendation to delete five PDs is inconsistent with the explicit guidelines established for making revisions for DSM-5 which specify that for a disorder to be deleted there should be a thorough review of that disorder's clinical utility and validity.

The Perceived Stress Scale: Evaluating Configural, Metric and Scalar Invariance across Mental Health Status and Gender

The Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, Journal of Health and Social Behavior, 24: 385–396, 1983) and its derivatives are among the most commonly used self-report measures of subjective global stress. Several factorial models of the PSS have been proposed; however, which of these structures reliably measures individuals with mental illness remains unclear. Moreover, despite the detection of gender differences in perceived stress, factorial invariance between genders has not yet been tested with the PSS. Confirmatory factor analysis evaluating six prevailing factorial models of the PSS among a large sample of psychiatric patients and a matched community sample supported a two-factor model. Multiple group analysis established configural, metric and scalar invariance of this model across gender, but only configural invariance across samples differing by mental health status. Implications are that gender differences can be cautiously interpreted as true mean differences rather than artifacts of measurement bias; however, mean perceived stress factor scores should not be compared directly across psychiatric and non-psychiatric samples.

The Depressive Psychopathology Scale: presentation and initial validation in a sample of Peruvian psychiatric patients.

Presentation and validation of the Depressive Psychopathology Scale (DPS), a new, Spanish-language psychometric inventory, in a sample of Peruvian psychiatric patients. From 1999 to 2001, the DPS, Zung Self-rating Depression Scale (ZSDS), and Major Depressive Disorder (MDD) module of the Structured Clinical Interview for DSM-IV Disorders (SCID) were administered to 226 nonpsychotic outpatients referred to the National Institute of Mental Health in Lima, Peru, for their initial clinical evaluation. In the evaluation, attending psychiatrists 1) corroborated the general diagnosis and presence or absence of MDD and 2) rated depression severity based on clinical opinion and on Clinical Global Im-pression-Severity scale criteria. Mean time to complete the DPS was 7.22 minutes (standard deviation, 3.99). Cronbach's alpha value was 0.86. For diagnosis of MDD, based on the SCID, area under receiver operating characteristic curve (AUROC) was 0.872 and the selected cutoff score (26/27) had 81.32% sensitivity and 80% specificity; based on the attending psychiatrists' evaluation, AUROC was 0.832 and the selected cutoff score (25/26) had 77.67% sensitivity and 72.32% specificity. The DPS was significantly correlated with the ZSDS (rho = 0.8, P < 0.001). Some DPS items ("depression worse in the morning," "appetite disturbances," "mood reactivity," and "hypersomnia") showed low loadings on the five factors extracted through principal component analysis and/or did not significantly correlate with depression parameters. The DPS can predict MDD and has convergent validity, as shown by its correlation with the ZSDS. However, additional psychometric studies are recommended to simplify and improve it.

Effects of sex and age on serum concentrations of antidepressants under naturalistic conditions

Summary Introduction: TDM data of psychotropic medication are often obtained from samples of highly selected individuals, in contrast to a typical sample of psychiatric patients. Therefore studies under naturalistic conditions are important to clarify the full clinical relevance of TDM. Methods: We retrospectively evaluated TDM-analyses of antidepressants from 2008 to 2010 in an unselected sample of patients in a standard clinical setting. We examined the influence of sex and age on dose-corrected serum concentrations. Results: Considering only one determination per patient 790 TDM-analyses of amitriptyline (AMI+NOR), 182 of citalopram (CIT), 160 of clomipramine (CLO+N-CLO), 320 of doxepine (DOX+N-DOX), 408 of escitalopram (ESC), 213 of fluoxetine (FLU+N-FLU), 95 of maprotiline (MAP), 945 of mirtazapine (MIR), 88 of sertraline (SER) and 794 of venlafaxine (VEN+ODV) were left. Women had significantly higher dose-corrected serum levels of AMI+NOR, CIT, DOX+N-DOX, MIR and VEN+ODV and patients older than 60 years had significantly higher dose-corrected serum levels of AMI+NOR, CIT, DOX+N-DOX, MIR, SER and VEN+ODV. Females > 60 years had a remarkably higher dose-corrected serum concentration of AMI+NOR, CIT, DOX+N-DOX, MIR and VEN+ODV in contrast to males ≤ 60 years. Discussion: Our results suggest that TDM is recommendable in naturalistic settings, as variables like sex and age have a significant influence on the serum levels of different antidepressant drugs.