Senior Psychiatrists Research Articles

Motor Disturbances in Autistic Children.;case Control Study

Background Children with autism have developmental motor profile that differ from other healthy children. This is evident since early childhood, sometime noted by parents and neglected by clinicians. These motor deficits are related to other domains of dysfunction in children with autism as social and language skills. Improving motor deficits can help better prognosis for these children. Aim To detect motor deficits in a sample of autistic children and correlate them with the severity of autistic symptoms. Methods We recruited 20 autistic children ranging from 3 to 6 yrs from the Institute of psychiatry outpatient child psychiatry and rehabilitation clinics of Ain-Shams university hospital. We excluded patient with total intelligence less than 75 or having other developmental disorder. We matched them with healthy controls for age and sex and compared both motor development and self help skills using Brigance scale. We confirmed diagnosis of autism in each patient by applying ICD-10 criteria of autism by a senior psychiatrist and by having a Childhood Autism Rating Scale (CARS) score above 30. Relation of autism severity and motor deficits was assessed later by Correlation co-efficient test. Results Compared to controls, autistic children showed statistically significant low Brigance test scores on; gross movement, fine movement and self-help skills subdomains. Motor delay was significantly correlated with the severity of autism. Conclusions Motor deficits were evident in autistic patients and could indicate severity

Interactions of European Early Career Psychiatrists with the Pharmaceutical Industry: Status Quo and Directions for the Future

Interactions between the pharmaceutical industry and physicians have recently received attention for their potential to create conflicts of interest in clinical practice, research and education. As a consequence, several medical and psychiatric associations including the EPA have published guidance papers to encourage best practice. In this context, the European Federation of Psychiatric Trainees (EFPT) performed a cross-sectional survey among European psychiatric trainees in order to ascertain the current level of interactions, as well as beliefs and attitudes towards interactions with the pharmaceutical industry. Responses from 1444 psychiatric trainees from 20 countries were obtained and reveal important differences in the level of interactions across Europe. Assigning a an educational role to the pharmaceutical industry and aid by senior psychiatrists in organizining industry-sponsored events were associated with a higher degree of interactions. Creating alternative, non-industry-sponsored educational opportunities and specific training dedicated to industry interactions may help to reduce the impact of the pharmaceutical industry on psychiatric training in the future.

Comorbidity between attention deficit hyperactivity disorder (ADHD) and bipolar disorder in a specialized mood disorders outpatient clinic

BackgroundComorbidity between ADHD and Bipolar Disorder (BD) is associated with greater severity of BD. The current study aims at investigating, in a specialized mood disorders clinic, the percentage of comorbid ADHD–BD subjects and assessing the impact of ADHD on the severity of BD. MethodsOut of 539 mood disorders subjects, the medical records of 138 BD subjects were scrutinized in terms of their clinical and demographic characteristics, and their scores at the Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist were logged. Those positively scoring at the ASRS-v1.1 underwent clinical assessment by a senior psychiatrist specialized in ADHD. Comorbid ADHD–BD subjects were then compared with BD sufferers without ADHD. ResultsSixty-three (45.65%) of the participants were screened positive at the ASRS-v1.1. 49 were clinically assessed for the presence of ADHD. Only 27 (55%) received a diagnosis of ADHD. Comorbid ADHD–BD subjects were found to be younger at the onset of BD, showed higher numbers of depressive episodes, more anxiety and substance use disorders, more borderline personality traits and greater cyclothymic temperament. Comorbid BD–ADHD subjects reported more childhood emotional abuse. LimitationsSome subjects were unreachable and thus not clinically assessed for ADHD. ConclusionsMore than 20% of BD subjects were suffering from ADHD. The comorbidity of the two disorders was associated with worse outcomes, possibly resulting from stressful early-life events. More than 40% of the subjects who scored positively at the ASRS-v1.1 did not suffer from ADHD, which suggests that this scale should be used with caution in BD subjects.

Dissociative Identity Disorder Among Adolescents: Prevalence in a University Psychiatric Outpatient Unit

The aim of this study was to determine the prevalence of dissociative identity disorder (DID) and other dissociative disorders among adolescent psychiatric outpatients. A total of 116 consecutive outpatients between 11 and 17 years of age who were admitted to the child and adolescent psychiatry clinic of a university hospital for the 1st time were evaluated using the Adolescent Dissociative Experiences Scale, adolescent version of the Child Symptom Inventory-4, Childhood Trauma Questionnaire, and McMaster Family Assessment Device. All patients were invited for an interview with the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) administered by 2 senior psychiatrists in a blind fashion. There was excellent interrater reliability between the 2 clinicians on SCID-D diagnoses and scores. Among 73 participants, 33 (45.2%) had a dissociative disorder: 12 (16.4%) had DID, and 21 (28.8%) had dissociative disorder not otherwise specified. There was no difference in gender distribution, childhood trauma, or family dysfunction scores between the dissociative and nondissociative groups. Childhood emotional abuse and family dysfunction correlated with self-reported dissociation. Of the dissociative adolescents, 93.9% had an additional psychiatric disorder. Among them, only separation anxiety disorder was significantly more prevalent than in controls. Although originally designed for adults, the SCID-D is promising for diagnosing dissociative disorders in adolescents, its modest congruence with self-rated dissociation and lack of relationship between diagnosis and childhood trauma and family dysfunction suggest that the prevalence rates obtained with this instrument originally designed for adults must be replicated. The introduction of diagnostic criteria for adolescent DID in revised versions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, would refine the assessment of dissociative disorders in this age group.

Is sense of coherence helpful in coping with caregiver burden for dementia?

Sense of coherence (SOC) is associated with a reduced risk of various health problems and is thought to be a major factor related to the ability to cope with stress. In the present study, we examined the association between caregiver burden and SOC among caregivers to persons with dementia. Participants included 274 caregivers or family members of community-dwelling elderly dementia patients. To assess the cognitive function of patients, neuropsychological tests (e.g. Mini-Mental State Examination, Clinical Dementia Rating) were conducted by a clinical psychologist who was well trained in interviewing participants; the tests used a semi-structured interview protocol. Senior neurologists and psychiatrists also independently evaluated the dementia status of patients. To assess the SOC and caregiver burden, a social welfare counsellor asked questions from a 13-item version of the SOC scale and the short, eight-item Japanese version of the Zarit Caregiver Burden Interview (ZBI). Among 78 caregivers of elderly subjects with cognitive impairment due to dementia, the ZBI score was significantly associated with SOC (r = -0.38, P = 0.001). Multiple regression analyses revealed that SOC scores (β = -0.42, P < 0.001) and Mini-Mental State Examination scores (β = -0.28, P = 0.009) were significantly associated with ZBI scores (F(2, 76) = 10.51, P < 0.001). SOC was closely associated with personal strain in the ZBI (β = -0.41, P < 0.001; F(3, 75) = 8.53, P < 0.001). Caregivers with a strong SOC may be less prone to experiencing personal strain from their burden. These results suggest that reinforcement of SOC would contribute to reducing the personal strain.

Get Started in Integrated Care by Picking Up the Phone

Get Started in Integrated Care by Picking Up the Phone

The potential consequences of informal interpreting practices for assessment of patients in a South African psychiatric hospital

In South Africa health care practitioners are commonly professionals who speak only one, or at most two, of the languages spoken by their patients. This provides for language provision challenges, since many patients are not proficient in English or Afrikaans and ad hoc and haphazard arrangements are made for interpreting by untrained personnel. As part of a larger study (conducted in 2010) in a public psychiatric hospital, we report here on the potential consequences for diagnostic assessments of 13 psychiatric evaluations mediated by ad hoc interpreters who were employed as health care workers and household aides. The psychiatric evaluations were recorded and transcribed verbatim. The first author checked for accuracy of transcription and translations, and the two members of the author team who are both senior African language academics rechecked transcription and translation. We used the typology developed by Vasquez and Javier (1991) to study interpreter errors (i.e. omissions, additions and substitutions). All errors were independently rated by a senior psychiatrist and a senior clinical psychologist to determine whether the errors were likely to have a bearing on clinical decisions concerning the patient and to rate whether errors deemed clinically significant contributed to making the patient appear more ill psychiatrically, or less ill. Of the 57 errors recorded, 46% were rated as likely to have an impact on the goal of the clinical session. Raters concurred that the clinically significant errors contributed towards potentially making the patient look more psychiatrically ill. Detailed analyses of evaluations demonstrate the complexity of informal interpreter positioning regarding issues of diagnosis and cultural factors in illness. Evaluations conducted where clinicians and interpreters are not trained in language and interpreting issues may create a distorted picture of the patients' mental health conditions.

Morbidity profile of patients attending the centers for mental health service provided jointly by the Government of Nepal and Community mental health service of Community Mental Health and Counseling- Nepal (CMC-Nepal)

Introduction: Community mental health program initially conducted in Lalitpur district by UMN and later in the western region demonstrated the possibility of providing mental health services in the primary health care level if proper mental training is provided to different levels of health workers and the program is well supervised. Community Mental Health and Counseling- Nepal (CMC-Nepal) extended the same model of community mental health program to several other districts of the country after taking permission from the Ministry of Health and Population. The basic objective of the study was to prepare morbidity profile of patients attending the centers for mental health conducted jointly by the government of Nepal and Community Mental Health and Counseling- Nepal (CMC-Nepal). Material and method: Ten days block training in mental health for health assistant (HA) and Auxiliary Health Workers (AHW) was conducted by the CMC-Nepal. Senior psychiatrists, psychologists and psychiatric nurse were the trainers. Materials like mental health manual, audiovisuals, flip charts and case stories were used during training by the facilitators. An especially developed patient record card was used for case record, diagnosis and treatment. The study was carried out in between July 2010 to June 2011. A total of 6676 cases were studied during the study period. Results: Community mental health program identified 4761 total new cases in 12 months (July 2010 to June 2011), out of which 2821 were females (59%) and 1940 were males (41%). Similarly total old cases both females and males were 6676 registered in these centers for treatment. Out of all new cases patients with Anxiety Neurosis emerged as the largest group (50%) followed by Depression (24.88%). Other commonly diagnosed conditions were Epilepsy (7.5%), Psychosis (5.3%) and Conversion disorder (5.7%) and unspecified cases (6.5%). The implications of the results are discussed, in the current context. Conclusion: Mental health services need to be provided at the community so as to prevent cases of prolonged subjection to mental illness and also prevent cases of stigma and discrimination. DOI: http://dx.doi.org/10.3126/jpan.v2i1.8569 J Psychiatrists’ Association of Nepal Vol .2, No.1, 2013 14-19

Addiction: A Kind of Loving

Addiction: A Kind of Loving by Dr David Marjot. Published by Southern Universities Press. London. 2013. Pages 238. No index. Distributed by Gardners books: www.gardners.com. ISBN: 978-0-9570504-2-6, no price given. ![Graphic][1] David Marjot is a senior psychiatrist with long experience in the treatment of alcohol- and drug-related problems. In 2009, he wrote The Diseases of Alcohol , which distilled this experience and his views about alcohol-related problems and their clinical aspects. Some of this is repeated in the present work, but here he advances a theory of addiction which he feels has been almost totally neglected. His hypothesis is that addiction is akin to an enduring love affair, a ‘mistaken attachment’. It is … [1]: /embed/inline-graphic-1.gif

APA Senior Psychiatrists Roll Out Red Carpet to Their Events

APA Senior Psychiatrists Roll Out Red Carpet to Their Events

1188 – Motor disturbances in autistic children: cross sectional, controlled study

Children with autism have developmental motor profile that differ from other healthy children. This is evident since early childhood, sometime noted by parents and neglected by clinicians. These motor deficits are related to other domains of dysfunction in children with autism as social and language skills .Improving motor deficits can help better prognosis for these children. To detect motor deficits in a sample of autistic children and correlate them with the severity of autistic symptoms. We recruited 20 autistic children ranging from 3 to 6 yrs from the Institute of psychiatry outpatient child psychiatry and rehabilitation clinics of Ain-Shams university hospital .We excluded patients having total intelligence less than 75 or having other developmental disorder. We matched them with healthy controls for age and sex and compared both motor development and self help skills using Brigance scale. We confirmed diagnosis of autism in each patient by applying ICD-10 criteria of autism by a senior psychiatrist and by having a Childhood Autism Rating Scale (CARS) score above 30. Relation of autism severity and motor deficits was assessed later by Correlation co-efficient test. Compared to controls, autistic children showed statistically significant low Brigance test scores on; gross movement, fine movement and self-help skills subdomains .Motor delay was significantly correlated with the severity of autism. Motor deficits were evident in autistic patients and could indicate severity

How mental health clinicians want to evaluate the care they give: a Western Australian study

To explore how Western Australian mental health clinicians want to evaluate their care. METHODS; Using a participatory action research framework, 10 senior psychiatrists and 11 clinical nurse specialists working in an inpatient mental health setting participated in individual interviews, focus groups and meetings. All interviews were de-identified during transcription and transcripts and field notes were analysed for common themes. Participants identified what they wanted to measure, how they wanted to measure it and how these changes could be implemented. Clinicians stressed the importance of measuring context (physical, clinical and service) and process as well as outcome, and of evaluating care at an individual and service level with consumer involvement. What is known about the topic? Completion rates of mandatory national outcome measures in mental health in Australia are variable and clinicians have mixed views as to their value. Several barriers have been identified as to their use including clinical, resource and ownership issues. What does this paper add? Some studies have identified areas of good practice and elicited practical suggestions for improvement but few have asked clinicians how they actually want to evaluate the care they provide. This study explored how mental health clinicians wanted to evaluate their care, using a participatory action research framework that encouraged participants to pinpoint problems and issues, account for their social context and develop actions to address them. What are the implications for practitioners? Clinicians were enthusiastic for high quality care and evaluation, but pessimistic about their ability to introduce sustainable change. Establishing and supporting active and responsible leadership at service level may solve this, as may encouraging local standard setting and benchmarking in collaboration with consumers and carers.

Evaluation of a pilot project for mental health screening for children looked after in an inner London borough

PurposeThe purpose of this paper is to evaluate the feasibility of a screening test for looked after children in order to identify undetected psychiatric disorders.Design/methodology/approachChildren aged four to 16 in care in one London Borough for four consecutive months were eligible for screening. Carers, teachers and children aged over 11 were asked to complete the Strengths and Difficulties Questionnaire (SDQ). Where the SDQ suggested that a psychiatric disorder was “possible” or “probable”, participants were then invited to complete the Developmental and Well‐Being Assessment, which was rated by a senior psychiatrist to generate diagnoses if appropriate.FindingsThe paper finds that over one year, 23 children were eligible for screening. A total of 18 underwent the initial stage of screening, and seven were subsequently diagnosed with a formal psychiatric disorder.Originality/valueThis study illustrates the unmet need for mental health interventions among children looked after by the local authority and confirms the feasibility of a simple screening protocol.

Patients' Appraisal of Psychiatric Trainee Interview Skills

The aim of this pilot project was to explore the extent to which judgments made by psychiatrist examiners accord with those of patients in postgraduate clinical examinations, so as to inform further consideration of the role of patients in such assessments. Senior psychiatrist examiners (N=8) and patients (N=30) rated 16 aspects of trainee psychiatrist interviewing style and performance during 30 observed clinical interviews (OCIs) conducted in the format of official examinations. Significant differences were apparent in the judgments of examiners and patients regarding 7 of 16 rated aspects of trainee performance. Differences were evident largely in domains in which patients could be expected to be "expert," reflecting their subjective experience of the interviewer. By contrast, there was little difference in the judgments of patients and examiners on the more technical criteria. These preliminary findings provide some challenge to the assumption that psychiatrists are the best judges of the "technical" skills and knowledge required by the profession. They support previous findings, with simulated patients, of the discrepancy between patient and examiner judgments of the more subjective elements of the examination. Psychiatric patients could contribute to clinical examinations as co-examiners, rather than merely constituting the substrate for the examination.

Experienced stigma and self-stigma in Chinese patients with schizophrenia

ObjectiveTo investigate experienced stigma and self-stigma in patients with schizophrenia in mainland China. MethodsNinety-five patients with schizophrenia, enrolled between January 2011 and March 2011, completed Chinese versions of two self-report questionnaires: the Internalized Stigma of Mental Illness (ISMI) scale and the Modified Consumer Experiences of Stigma Questionnaire (MCESQ). They also completed two other self-report questionnaires: the Social Support Rating Scale (SSRS) and the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. Patients were also assessed by a senior psychiatrist using the Scale for Assessment of Positive Symptoms (SAPS) and the Scale for Assessment of Negative Symptoms (SANS).All analyses were performed using SPSS 17.0 and included descriptive statistics, correlation analysis and multiple linear regression. ResultsOn the ISMI, the percentage of participants who rated themselves above the mid-point of 2.5 (meaning high level of self-stigma) on subscales and overall score was 44.2% (n=42) for alienation, 14.7% (n=14) for stereotype endorsement, 25.3% (n=24) for perceived discrimination, 32.6% (n=31) for social withdrawal and 20.0% (n=19) on the overall score. On the MCESQ, the percentage of participants who rated themselves above the mid-point of 3.0 on subscales and overall score was 24.2% (n=23) for stigma, 1.1% (n=1) for discrimination and 1.1% (n=1) on the overall score. Some socioeconomic variables, but not positive or negative symptoms, were related to the severity of psychiatric stigma. ConclusionsResults document the seriousness of experienced stigma and self-stigma in persons with schizophrenia. Strategies are needed to improve how governments and persons with schizophrenia cope with stigma.

Factors predicting psychiatric co-morbidity in gender-dysphoric adults

Persons with gender identity disorder (GID) often suffer from psychiatric co-morbidity, and it is an important prognostic factor for long-term psychosocial adjustment in GID. However, previous research has not addressed the risk factors of psychiatric co-morbidity. In this study, we tried to clarify the risk factors among individuals with GID in Japan. A total of 326 consecutive GID persons were evaluated independently by two senior psychiatrists at the GID clinic using personal clinical interviews and results of examinations. The prevalence of current psychiatric co-morbidity was 17.8% of the total sample. School refusal was significantly associated with psychiatric co-morbidity. Sexual attraction to neither males nor females among GID persons and sexual attraction to females among male-to-female (MtF) GID persons were also significantly related to psychiatric co-morbidity. This is the first report to demonstrate a close relationship between patterns of sexual orientation and psychiatric co-morbidity among GID persons. We should pay more attention to psychiatric co-morbidity, especially among GID persons with non-homosexual sexual orientations.

Correlation between insight and internalized stigma in patients with schizophrenia.

BackgroundThe relationship between insight and internalized stigma in patients with schizophrenia is important both for theoretical and practical reasons because of its close association with patients' willingness to seek (or accept) care for their mental illness.ObjectiveTo investigate the relationship between insight and internalized stigma in patients with schizophrenia in mainland China.Methods65 inpatients and 27 outpatients with schizophrenia who had a median duration of four years of illness completed Chinese versions of two self-report questionnaires—the Internalized Stigma of Mental Illness (ISMI) scale and the Modified Consumer Experiences of Stigma Questionnaire (MCESQ). The patients were also assessed by senior psychiatrists using the Scale for Assessment of Positive Symptoms (SAPS) and the Scale for Assessment of Negative Symptoms (SANS). Patients were divided into those with and without insight into their illness based on the score of the insight item on the Chinese version of the Brief Psychiatric Rating Scale.Results49 patients were classified as having insight and 43 classified as lacking insight. Compared to patients with insight, those without insight had a significantly shorter duration of illness, were more likely to be inpatients, and (at trend level only) had more prominent positive and negative symptoms. The ‘alienation’ subscale score of the ISMI was significantly higher in patients with insight but none of the remaining six subscales in the two instruments were different between the two groups and only 4 of the 48 separate items in the two scales were significantly different between the groups. Logistic regression analysis found no relationship between lack of insight and the scores of the two self-completion stigma scales or the scores of the two clinician-administered symptom scales.ConclusionThis study among inpatients and outpatients with schizophrenia in China does not support findings of previous studies that report increased experience of stigma among patients who have better insight. The measures of stigma used in the study need further revision and validation for use in China and studies with a wider spectrum of patients that make more detailed assessments of insight and that follow fluctuations in insight and experiences of stigma over time are needed to clarify the complex relationship between these two phenomena in patients with schizophrenia.

The Gravity of Weight: A Clinical Guide to Weight Loss and Maintenance; Nutrition in InstitutionsThe Gravity of Weight: A Clinical Guide to Weight Loss and Maintenance KarasuSylvia R.M.D., and KarasuT. ByramM.D.; Washington, D.C., American Psychiatric Publishing, 2010, 518 pages, $66Nutrition in Institutions CrossMaria and MacDonaldBarbara; Oxford, United Kingdom, Wiley-Blackwell, 2009, 440 pages, $109.99

The Gravity of Weight: A Clinical Guide to Weight Loss and Maintenance; Nutrition in InstitutionsThe Gravity of Weight: A Clinical Guide to Weight Loss and Maintenance KarasuSylvia R.M.D., and KarasuT. ByramM.D.; Washington, D.C., American Psychiatric Publishing, 2010, 518 pages, $66Nutrition in Institutions CrossMaria and MacDonaldBarbara; Oxford, United Kingdom, Wiley-Blackwell, 2009, 440 pages, $109.99

Validation of the Chinese version of the "Mood Disorder Questionnaire" for screening bipolar disorder among patients with a current depressive episode

BackgroundThe Mood Disorder Questionnaire (MDQ) is a well-recognized screening tool for bipolar disorder, but its Chinese version needs further validation. This study aims to measure the accuracy of the Chinese version of the MDQ as a screening instrument for bipolar disorder (BPD) in a group of patients with a current major depressive episode.Methods142 consecutive patients with an initial DSM-IV-TR diagnosis of a major depressive episode were screened for BPD using the Chinese translation of the MDQ and followed up for one year. The final diagnosis, determined by a special committee consisting of three trained senior psychiatrists, was used as a 'gold standard' and ROC was plotted to evaluate the performance of the MDQ. The optimal cut-off was chosen by maximizing the Younden's index.ResultsOf the 142 patients, 122 (85.9%) finished the one year follow-up. On the basis of a semi-structured clinical interview 48.4% (59/122) received a diagnosis of unipolar depression (UPD), 36.9% (45/122) BPDII and 14.8% (18/122) BPDI. At the end of the one year follow-up,9 moved from UPD to BPD, 2 from BPDII to UPD, 1 from BPDII to BPDI, the overall rate of initial misdiagnosis was 16.4%. MDQ showed a good accuracy for BPD: the optimal cut-off was 4, with a sensitivity of 0.72 and a specificity of 0.73. When BPDII and BPDI were calculated independently, the optimal cut-off for BPDII was 4, with a sensitivity of 0.70 and a specificity of 0.73; while the optimal cut-off for BPDI was 5, with a sensitivity of 0.67 and a specificity of 0.86.ConclusionsOur results show that the Chinese version of MDQ is a valid tool for screening BPD in a group of patients with current depressive episode on the Chinese mainland.

Physical health examination in Section 136 suites

[Hampson (2011)][1] placed little emphasis on the initial physical assessment of detained patients. Peer-group feedback for on-call Section 12 doctors involved in these assessments in the West Midlands indicates a significant shift towards the senior psychiatrist in the responsibility for basic