Standardized Psychiatric Assessments Research Articles

Longitudinal study of coping strategies in first-time stroke patients: association with cognitive dysfunction, stroke site and depression

BACKGROUND. Inadequate coping strategies are associated with affective disorders and poor quality of life in stroke survivors. Although coping strategies are determined by several non-modifiable factors they have been shown to change over time.
 AIM. Longitudinal assessment of coping strategies and associated factors in patients with first-ever stroke.
 MATERIAL AND METHODS. This study was a part of prospective observational study of a cohort of patients with first-ever stroke. Patients underwent standard psychiatric, neurological and cognitive assessment and CT. Patients without aphasia, severe fatigue, eye problems fulfilled the coping strategies indicator (Amirkhan J.H., 1990): 87 patients in the first week after stroke, 45 patients in the second week, 20 patients in 3 months, 21 patients in 6 months, 33 patients in 1 year after stroke. Non-parametric statistics were used.
 RESULTS. Different coping strategies were not determined by age, gender and severity of neurological deficit; there were some correlations with educational level, work status, cognitive dysfunction, stroke volume and lesion location. There were differences in the use of coping strategies in the groups with different depression manifestations: in the group with depression manifestations in the early recovery period and later, coping strategies did not differ from the control group in the acute stroke period, but since the manifestation of depression the amount of avoidance strategies increased. In the group with pre-stroke depression, a significant increase in avoidance strategies was observed in the first week after the stroke.
 CONCLUSIONS. The longitudinal study of coping strategies revealed that the use of coping strategies is a dynamic process determined by several modifiable and non-modifiable factors in combination. Coping strategies were not predictors of depression; on the contrary, depression seems to influence the choice of coping strategies.

Primary prevention of depression in head and neck cancer patients: a scoping review.

To conduct a scoping review of the literatureon psychological interventions directed to identify primary prevention strategies for depression among adult head and neck cancer (HNC) patients. Systematic searches were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review including relevant studies within the PubMed, PsycINFO, and EMBASE databases. Two authors independently screened the searches and reviewed the included articles according to the predetermined eligibility criteria based on the PICOS format. Studies included subjects with previous or current diagnosis of depression were excluded. The risk of bias assessment of these trials was conducted following the Cochrane tool for assessing the risk of bias in randomized trials. The search was repeated prior to submission to ensure all current articles meeting criteria were included. The search yielded 875 studies. The title and abstract screen, followed by the review of full texts identified five articles that met inclusion criteria. Four were randomized controlled trials (RCT) and the fifth was a non-randomized but controlled study. Different psychosocial interventions were used, including psycho-educational interventions, psychosocial counseling, and pharmacotherapy. All studies established the diagnosis of depression or screened for the diagnosis using standardized psychiatric assessment tools, either Diagnostic and Statistical Manual of Mental Disorders criteria or validated patient reported outcome measures. The average follow-up periods after intervention was 9.8months. There was a significant decrease in the incidence of depression or depressive symptoms favoring the intervention group in three out of the five studies that were included. Psychological interventions identified thus far studying primary prevention of depression in HNC patients show promising results. However, the paucity of data and heterogeneity of the interventions challenges the ability to compare the prevention modalities and outcomes. Future well-designed RCTs with large sample sizes are recommended to better conclude a result of effectiveness.

The reliability of symptom assessment by telepsychiatry compared with face to face psychiatric interviews

IntroductionWith the start of the COVID-19 pandemic, the various social distancing policies imposed have mandated psychiatrists to consider the option of using telepsychiatry as an alternative to face-to-face interview in Hong Kong. Limitations over sample size, methodology and information technology were found in previous studies and the reliability of symptoms assessment remained a concern. AimTo evaluate the reliability of assessment of psychiatric symptoms by telepsychiatry comparing with face-to-face psychiatric interview. MethodThis study recruited a sample of adult psychiatric patients in psychiatric wards in Queen Mary Hospital. Semi-structural interviews with the use of standardized psychiatric assessment scales were carried out in telepsychiatry and face-to-face interview respectively by two clinicians and the reliability of psychiatric symptoms elicited were assessed. Results90 patients completed the assessments The inter-method reliability in Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Columbia Suicide Severity Rating Scale and Brief Psychiatric Rating Scale showed good agreement when compared with face-to-face interview. ConclusionSymptoms assessment by telepsychiatry is comparable to assessment conducted by face-to-face interview.

Epilepsy-Specific Anxiety: A Potential Clue to the Seizure Onset Zone.

Anticipatory Anxiety of Seizures is Associated With Ictal Emotional Distress and Amygdala Onset Seizures Tarrada A, Aron O, Vignal JP, Ertan D, Maillard L, Hingray C. Epilepsia. 2022;63(5):1130-1140. doi:10.1111/epi.17215.Objective:Anxiety disorders are a frequent psychiatric condition in patients with epilepsy. Anticipatory anxiety of seizures (AAS) is described as a daily persistent fear or excessive worry of having a seizure. AAS seems to be related to “subjective ictal anxiety” reported by patients. The current study aimed to assess the association between objective ictal features and the presence of AAS.Methods:Ninety-one patients with drug-resistant focal epilepsy underwent a standardized psychiatric assessment, specific for epilepsy, and presurgical long-term video-electroencephalography (EEG) or stereo-EEG (SEEG). We compared seizure semiology and epilepsy features of patients with AAS (n = 41) to those of patients without AAS (n = 50). We analyzed emotional and motor behavior ictal signs as well as ictal consciousness. We further assessed amygdala ictal involvement in seizures recorded with SEEG (n = 28).Results:AAS was significantly associated with the presence of ictal emotional distress; negative emotional behavior (P < .01) and negative emotion were explicitly reported to the examiner during recording (P = .015), regardless of the ictal level of consciousness. Among the patients recorded with SEEG, we found a significant involvement of amygdala within the seizure onset zone (P < .01) for patients with AAS.Significance:Higher risk of developing AAS is associated with seizures expressing negative emotional symptoms, independently of ictal consciousness level. Persistent interictal fear of seizures might be viewed as the consequence of a reinforcement of the emotional networks secondary to amygdala involvement in seizures of temporal origin. Physicians should screen for AAS not only to assess the impact of epilepsy on daily life, but also as an interictal biomarker of ictal semiology and emotional network involvement at seizure onset.

Anticipatory anxiety of seizures is associated with ictal emotional distress and amygdala onset seizures

Anxiety disorders are a frequent psychiatric condition in patients with epilepsy. Anticipatory anxiety of seizures (AAS) is described as a daily persistent fear or excessive worry of having a seizure. AAS seems to be related to "subjective ictal anxiety" reported by patients. The current study aimed to assess the association between objective ictal features and the presence of AAS. Ninety-one patients with drug-resistant focal epilepsy underwent a standardized psychiatric assessment, specific for epilepsy, and presurgical long-term video-electroencephalography (EEG) or stereo-EEG (SEEG). We compared seizure semiology and epilepsy features of patients with AAS (n=41) to those of patients without AAS (n=50). We analyzed emotional and motor behavior ictal signs as well as ictal consciousness. We further assessed amygdala ictal involvement in seizures recorded with SEEG (n=28). AAS was significantly associated with the presence of ictal emotional distress; negative emotional behavior (p<.01) and negative emotion were explicitly reported to the examiner during recording (p=.015), regardless of the ictal level of consciousness. Among the patients recorded with SEEG, we found a significant involvement of amygdala within the seizure onset zone (p<.01) for patients with AAS. Higher risk of developing AAS is associated with seizures expressing negative emotional symptoms, independently of ictal consciousness level. Persistent interictal fear of seizures might be viewed as the consequence of a reinforcement of the emotional networks secondary to amygdala involvement in seizures of temporal origin. Physicians should screen for AAS not only to assess the impact of epilepsy on daily life, but also as an interictal biomarker of ictal semiology and emotional network involvement at seizure onset.

Frailty and Depression in Late Life: A High-Risk Comorbidity With Distinctive Clinical Presentation and Poor Antidepressant Response.

To investigate the longitudinal relationship between physical frailty, the clinical representation of accelerated biological aging, and antidepressant medication response in older adults with depressive illness. An 8-week randomized placebo-controlled trial (escitalopram or duloxetine) followed by 10 months of open antidepressant medication treatment (augmentation, switch strategies) was conducted in an outpatient research clinic. 121 adults aged 60 years or older with major depressive disorder (MDD) or persistent depressive disorder and a 24-item Hamilton Rating Scale for Depression (HRSD) ≥16 were enrolled. Primary measures assessed serially over 12 months include response (50% reduction from baseline HRSD score), remission (HRSD score <10), and frailty (non/intermediate frail [0-2 deficits] vs frail [≥3 deficits]); latent class analysis was used to classify longitudinal frailty trajectories. A 2-class model best fit the data, identifying a consistently low frailty risk (63% of the sample) and consistently high frailty risk (37% of the sample) trajectory. Response and remission rates (ps ≤ .002) for adults in the high-risk frailty class were at least 21 percentage points worse than those in the low-risk class over 12 months. Furthermore, subsequent frailty was associated with previous frailty (ps ≤ .01) but not previous response or remission (ps ≥ .10). Antidepressant medication is poorly effective for MDD occurring in the context of frailty in older adults. Furthermore, even when an antidepressant response is achieved, this response does little to improve their frailty. These data suggest that standard psychiatric assessment of depressed older adults should include frailty measures and that novel therapeutic strategies to address comorbid frailty and depression are needed.

The Systemic Assessment Clinic, a Novel Method for Assessing Patients in General\xa0Adult Psychiatry: Presentation and Preliminary Service Evaluation

The traditional model of psychiatric assessment and diagnosis can be criticised as reductive. We developed an innovative model for psychiatric assessment of adult patients referred to our adult mental health team, the Systemic Assessment Clinic, incorporating the principles and techniques of systemic family therapy and dialogical practice into standard psychiatric assessment. We conducted a service evaluation, comparing prospective use of mental health services for patients assessed either in the Systemic Assessment Clinic or in standard assessment. Patients assessed in the Systemic Assessment Clinic had more favourable outcomes than those in standard assessment: they were significantly less likely to need multiple follow-up treatment appointments with a psychiatrist and to be re-referred to mental health services once discharged, indicating reduced healthcare costs. Satisfaction rates for participants attending the systemic assessment clinic were high. Our service evaluation gives preliminary evidence that the Systemic Assessment Clinic could be a potential new model for psychiatric assessment; further evaluation is warranted in a randomised controlled trial.

Incremental Validity Of The Diagnostic Criteria For Psychosomatic Research – Revised (DCPR-R) To Clinical Assessment In Primary Care

Psychosocial problems are highly prevalent among primary care (PC) patients, but they often remain undetected using traditional classification systems. The aim of the present study was to test the incremental validity of the revised version of the Diagnostic Criteria for Psychosomatic Research (DCPR-R), in addition to standard psychiatric assessment based on DSM-5, with regard to the prediction of psychosocial functioning of PC patients. Two-hundred PC patients were consecutively recruited. A comprehensive assessment was performed using two clinical interviews and three self-rating questionnaires (the PsychoSocial Index [PSI], the Short-Form Health Survey [SF-12] and the Illness Attitude Scales [IAS]) for the assessment of psychopathology and psychosocial functioning. Adding the DCPR-R to DSM-5, the amount of explained variance significantly increased by 9% to 16% in the PSI subscales, by 13% in the SF-12 mental component summary, and by 2% to 6% in the IAS scales. The joint use of DCPR-R and DSM-5 thus significantly increased the prediction of psychosocial functioning of primary care patients. These findings further support the use of the DCPR-R in PC settings, particularly in patients who do not satisfy DSM-5 criteria and yet present with high psychological distress, maladaptive illness behavior, impaired psychological well-being and quality of life.

Hidden Obstacles to Treatment in Child and Adolescent Psychiatry: An Introduction to Intergenerational Trauma

The purpose of this article is to illustrate barriers to the treatment of children and adolescents with mental health problems that may not be evident in standard psychiatric assessment. In this case, the presence of intergenerational psychological trauma, which is manifested in parental factors, grandparental factors, and the sociocultural background.

Impact of rural address and distance from clinic on depression outcomes within a primary care medical home practice

BackgroundDepression is the second leading cause of death among young adults and a major cause of disability worldwide. Some studies suggest a disparity between rural and urban outcomes for depression. Collaborative Care Management (CCM) is effective in improving recovery from depression, but its effect within rural and urban populations has not been studied.MethodsA retrospective cohort study of 3870 patients diagnosed with depression in a multi-site primary care practice that provided optional, free CCM was conducted. US Census data classified patients as living in an Urban Area, Urban Cluster, or Rural area and the distance they resided from their primary care clinic was calculated. Baseline demographics, clinical data, and standardized psychiatric assessments were collected. Six month Patient Health Questionnaire (PHQ 9) scores were used to judge remission (PHQ9 < 5) or Persistent Depressive Symptoms (PDS) (PHQ9 ≥ 10) in a multivariate model with interaction terms.ResultsRural patients had improved adjusted odds of remission (AOR = 2.8) and PDS (AOR = 0.36) compared to urban area patients. The natural logarithm transformed distance to primary care clinic was significant for rural patients resulting in a lower odds of remission and increased odds of PDS with increasing distance from clinic. The marginal probability of remission or PDS for rural patients equaled that of urban area patients at a distance of 34 or 40 km respectively. Distance did not have an effect for urban cluster or urban area patients nor did distance interact with CCM.ConclusionResiding in a rural area had a beneficial effect on the recovery from depression. However this effect declined with increasing distance from the primary care clinic perhaps related to greater social isolation or difficulty accessing care. This distance effect was not seen for urban area or urban cluster patients. CCM was universally beneficial and did not interact with distance.

A multi-dimensional approach to the relationship between insight and aggressiveness in schizophrenia: Findings from the FACE-SZ cohort

BackgroundAggressiveness is a stigma frequently associated with schizophrenia. The role of insight as a risk factor of aggressiveness remains contradictory; mainly because single measures of these states mask their complexity and heterogeneity. MethodsThis study was conducted on 666 patients aged 15 and above with a DSM-IV-TR diagnosis of schizophrenia spectrum disorder, drawn from the French national network of schizophrenia expert center database. Collected data comprised socio-demographics and standardized psychiatric assessments. Aggressiveness was evaluated using the Buss-Perry Aggression Questionnaire and insight using the Scale to assess Unawareness of Mental Disorder (SUMD) and Birchwood Insight Scale (BIS). ResultsHostility was the aggressiveness dimension the most strongly associated with SUMD insight dimensions. Patients aware of their illness were nearly twice as likely to show hostility than those seriously unaware (OR = 1.95, 95% CI.: 1.08–3.5), but not when further adjusting for depression. Similarly, those aware of the consequences of their illness and of their symptoms were more hostile. Patients moderately aware of illness consequences had a higher risk of both anger and physical aggressiveness than those unaware (OR = 2.63, 95% CI.: 1.42–4.86, OR = 2.47, 95% CI.: 1.33–4.60, respectively), even when adjusting for depression for anger. ConclusionOur study confirms that a multi-dimensional approach to insight and aggressiveness is essential to understand the types of links between these clinical states. Insight may trigger the expression of an underlying hostile tendency, maybe via depression and self-stigmatisation. This should be taken into account in therapeutic approaches to improve insight.

To what extent does depression influence quality of life of people with pharmacoresistant epilepsy in Argentina?

Depression is the most frequent psychiatric co-morbidity in patients with epilepsy. Lifetime prevalence of depression is reported more frequently in temporal lobe epilepsy and is estimated at 35%. This co-morbidity appears to be related with various mechanisms. The aim of this study was to determine the quality of life (QoL) of patients with pharmacoresistant epilepsy with and without co-morbid depression in an Argentinean population. Patients admitted to the video-EEG monitoring unit during the period 2010-2013 went through a standardized psychiatric assessment using SCID-I (Structured Clinical Interview for Axis I diagnoses of DSM-IV), BDI II (Beck Depression Inventory) GAF (Global assessment of functioning), and Q LES Q-SF (for quality of life). Patients were divided in two groups: with and without depression (according to DSM-IV). Sociodemographic data, BDI II scores, GAF, and quality of life (QoL) were compared between the two groups. Comparisons were made using Student's t-test and Mann-Whitney U test. Frequency distributions were compared by Chi-square test. Spearman correlation coefficients were determined. Seventy-seven patients with pharmacoresistant epilepsy were eligible for this study, 41 patients were included in the group with depression (mean BDI II 15.93), and 36 in the group without depression (mean BDI II 3.36) (p=0.001). The overall QoL was significantly lower in the group with depression compared to the group without depression (p<0.01). The most affected areas were: physical health (p=0.013), mood (p=0.006), course activities (referring to school as well as to hobbies or classes outside of school) (p=0.003), leisure time activities (p=0.011), social activities (p=0.047), general activities (p=0.042), and medication (p=0.022). Severity of depression according to BDI II had a negative correlation with overall QoL (r - 0.339, p<0.01). No correlations were found between seizure frequency, QoL and BDI II. Patients with pharmacoresistant epilepsy and co-morbid depression reported worst QoL. Depression disrupts daily functioning (leisure, social functioning) and is a negative influence for subjective perception of health and medication. Interdisciplinary treatment should be considered (neurology-psychiatry-psychotherapy).

Depression and Survival in Patients With Head and Neck Cancer: A Systematic Review.

The incidence of depression in patients with head and neck cancer (HNC) is estimated to be as high as 40%. Previous studies have demonstrated an effect of depression on rehabilitation and survival in the posttreatment period. To systematically review the relationship between depression and survival in patients with HNC undergoing curative treatment. A search of electronic databases as well as gray literature was undertaken from January 1, 1974, to August 20, 2014, including MEDLINE (via Ovid), EMBASE (via Ovid), CINAHL, EBSCO, PsycINFO (via Ovid), Elsevier Scopus, and Institute for Scientific Information Web of Science Core Collection, using controlled vocabulary and medical subject headings representing HNC, depression, and survival. Articles in these databases were reviewed for inclusion by 2 independent reviewers according to predetermined eligibility criteria and were adjudicated by a third reviewer. The articles were then quantitatively scored using the GRACE (Good Research for Comparative Effectiveness) tool, a validated instrument for assessing the quality of observational studies. Qualitative assessment of each article was then undertaken. A total of 654 references were retrieved across all databases. A review of the abstracts and full texts identified 3 articles, each describing a distinct, single study, including a total of 431 patients, that were eligible for analysis. Scores for the articles as assessed with the GRACE tool ranged from 9 to 11. In each of the 3 studies used in the analysis, the comparison groups were depressed and nondepressed patients as established by a standardized psychiatric assessment tool. Two of the 3 studies demonstrated a statistically significant difference in survival for patients with HNC and depression; however, a sensitivity analysis was not possible due to the incompatible statistical analyses performed in each study. An association between depression and survival in patients with HNC is apparent; however, the strength and etiology of this association is not yet clear. Further directed and multi-institutional study is required to investigate this association and determine appropriate screening and management strategies.

The role of early posttraumatic neuropsychological outcomes in the appearance of latter psychiatric disorders in adults with brain trauma.

Background:The objective was to determine the predictors of posttraumatic psychiatric disorders (PTPD) during the first 6 months following traumatic brain injury (TBI) focusing on neuroimaging, clinical and neuropsychological appraisements during acute and discharge phase of TBI.Materials and Methods:We designed a prospective, longitudinal study in which 150 eligible TBI patients were entered. Postresuscitation brain injury severity and discharged functional outcome were evaluated by standard clinical scales. First neuroimaging was done at a maximum of 24 h after head trauma. Early posttraumatic (PT) neuropsychological outcomes were assessed using Persian neuropsychological tasks at discharge. The standardized psychiatric assessments were carefully implemented 6 months postinjury. A total of 133 patients returned for follow-up assessment at 6 months. They were divided into two groups according to the presence of PTPD.Results:Apparently, aggression was the most prevalent type of PTPD (31.48%). There was no significant difference between groups regarding functional outcome at discharge. Diffuse axonal injury (12.96%) and hemorrhages (40.74%) within the cortex (42.59%) and sub-cortex (33.33) significantly occurred more prevalent in PTPD group than non-PTPD ones. Primary postresuscitation TBI severity, early PT lingual deficit and subcortical lesion on first scan were able to predict PTPD at 6 months follow-up.Conclusion:Almost certainly, the expansive dissociation risk of cortical and subcortical pathways related to linguistic deficits due to severe intracranial lesions over a period of time can augment possibility of subsequent conscious cognitive-emotional processing deficit, which probably contributes to latter PTPD. Hence, early combined therapeutic supplies including neuroprotective pharmacotherapy and neurofeedback for neural function reorganization can dampen the lesion expansion and latter PTPD.

Behavioral Addictions: Helping Patients to Engage in Treatment

Back to table of contents Previous article Next article From the ExpertsFull AccessBehavioral Addictions: Helping Patients to Engage in TreatmentMichael AscherM.D.Michael AscherSearch for more papers by this authorM.D.Published Online:25 Feb 2015https://doi.org/10.1176/appi.pn.2015.3a1While traditionally the term “addiction” was confined to substance use disorders, extreme behaviors are now being recognized as “behavioral addictions” and attracting attention for their relevant social impact. This group includes sex, love, gambling, food, work, Internet use, and compulsive buying. Unlike with other behavioral addictions where research remains in its infancy, research in pathological gambling and substance use disorders suggests a strong neurobiological link based on biochemical, functional, neuroimaging, and genetic studies. A research work group of the DSM reclassified gambling disorder, making it the first (and only) behavioral addiction in DSM. “Internet gaming disorder” is a “condition for further study” and listed in Section 3 of DSM-5. Like substance use disorders, the addiction model can be helpful in understanding behaviors that can hijack the pleasure-reward circuitry in the brain, resulting in compulsive engagement, loss of control, cravings, withdrawal, tolerance, and negative consequences (financial, interpersonal, legal, and so on) for the individual. Additionally, many of our patients may present with subclinical behavior that can be both personally and professionally damaging. Behavioral addictions can have calamitous effects on both the individual and families. Patients who suffer from behavioral addictions can experience myriad emotions including shame, guilt, fear, irritability, sadness, and anxiety. To complicate matters, when patients present for treatment for a behavioral addiction, the only outcome for which they are often initially hoping is a decrease in negative consequences associated with the behavior, and not extinction or modification of the behavior itself. It can be difficult for clinicians to discern and assess when excessive behavioral patterns require psychiatric intervention or whether presenting problems fall within the realm of normative behavior. Moreover, behavioral addictions can present in a wide range of subtle and complex patterns, and individuals are likely to fluctuate between the line of pathology and habit. Tracking and monitoring symptoms over time is critical for establishing patterns of use and documenting ongoing consequences. Unfortunately, inquiring about many of these behaviors is not part of the standard psychiatric assessment, and most individuals do not normally seek treatment for behavioral addictions. The importance of asking the right questions and creating a space of nonjudgment is crucial. Without an investment in building the therapeutic alliance, clinicians can fail to gather all the pieces necessary to understand the full clinical picture of their patients.It can help to build the therapeutic alliance by exploring the concept of ambivalence with our patients. After eliciting the behavior, clinicians should explicitly tell the patient that ambivalence is a normal part of the motivation and change process. While medications can help to alleviate some symptoms associated with behavioral addictions and other co-occurring disorders, psychotherapy (both individual and group) often provides the best outcome. Psychiatrists are therefore in the position to provide psychoeducation to patients about the benefits of establishing a relationship with their therapist to explore more fully the problem and the function of the behavior. Explaining to patients that the behavior does not define them but is a symptom of an unmet need or underlying issue can be helpful in decreasing shame. Maintaining an empathic but hopeful stance that they can live a happier and more meaningful life if they engage in treatment can increase the likelihood that they will gather the intrinsic resolve to address the problem through treatment, which may include medications, therapy, or 12-step facilitations. The importance of maintaining an open, curious, flexible approach is paramount to building the therapeutic alliance and leading to improved treatment outcomes. ■Michael Ascher, M.D., is a clinical associate in psychiatry at the University of Pennsylvania Perelman School of Medicine. He is the coeditor of The Behavioral Addictions, published by American Psychiatric Publishing. APA members can order the book at a discount here. ISSUES NewArchived

MDDScore: confirmation of a blood test to aid in the diagnosis of major depressive disorder.

Previously, a biomarker panel was developed for use as an aid to major depressive disorder (MDD) diagnosis; it consisted of 9 biomarkers associated with the neurotrophic, metabolic, inflammatory, and hypothalamic-pituitary-adrenal axis pathways. This panel and associated algorithm produced good clinical sensitivity and specificity (92% and 81%, respectively) in differentiating MDD patients from individuals without MDD. To further validate the panel, we performed a prospective study using a larger set of new prospectively acquired MDD patients and a similarly collected population of nondepressed subjects. The addition of gender and body mass index (BMI) effects to the algorithm was also evaluated. Blood samples were obtained from MDD patients (n = 68) clinically evaluated at multiple sites in 2011 and 2012 using standard psychiatric assessment tools and structured clinical interviews according to DSM-IV criteria. Blood samples (n = 86) from nondepressed subjects were obtained as controls. MDD and nondepressed samples were randomized into independent training (n = 102) and validation sets (n = 52). Analytes in sera were quantified by immunoassay. Training set biomarker data were used to develop a logistic regression model that included gender and BMI in a manner that allowed for their interaction with the biochemical analytes. For the training set, the sensitivity and specificity of the test (with 95% CI) were 93% (0.80-0.98) and 95% (0.85-0.99), respectively. This method (designated the MDDScore) was then applied to the independent validation set and had a sensitivity and specificity of 96% (0.77-0.98) and 86% (0.66-0.95), respectively. The overall accuracy for the training set was 94%; the validation set accuracy was 91%. Examination of a randomized independent set of samples confirms the ability of the previously established biomarker panel to identify persons with MDD; the accuracy was over 90%. The improved model that adds gender and BMI to the previously established panel of 9 biomarkers is robust and simple; it provides the most rigorously tested, objective diagnostic test for MDD to date.

Sex Education Groups in a Psychiatric Day Hospital: Clinical Observations

Although the prevalence of sexual dysfunction is high among individuals diagnosed with severe and chronic mental illness, the topic of sexuality is often not part of standard psychiatric assessment. Discussions about sexuality could improve patients’ quality of life. This article outlines the development and implementation of a sex education group for patients admitted to a psychiatric day hospital in Montreal, Quebec, Canada, along with clinical observations. The series was well received by patients who felt that attending the group helped normalize their sexual concerns by providing a safe place in which to learn and to talk about sexuality.

A comparison of psychiatric diagnoses among HIV-infected prisoners receiving combination antiretroviral therapy and transitioning to the community.

BackgroundThe criminal justice system (CJS), specifically prisons and jails, is ideally suited for uniform screening of psychiatric (PD) and substance use disorders (SUDs) among people living with HIV/AIDS (PLWHA), who are concentrated in these settings. By accurately diagnosing PDs and SUDs in these controlled settings, treatment can be initiated and contribute to improved continuity of care upon release. In the context of PLWHA, it may also improve combination antiretroviral treatment (cART) adherence, and reduce HIV transmission risk behaviors.MethodsA retrospective data analysis was conducted by creating a cohort of PLWHA transitioning to the community from prison or jail enrolled who were enrolled in a controlled trial of directly administered antiretroviral (DAART). Participants were systematically assessed for PDs and SUDs using the Mini International Neuropsychiatric Interview (MINI), a standardized psychiatric assessment tool, and compared to diagnoses documented within the correctional medical record.ResultsFindings confirm a high prevalence of Axis I PDs (47.4%) and SUDs (67.1%) in PLWHA even after prolonged abstinence from alcohol and drugs. Although prevalence of PDs and SUDs were high in the medical record, there was fair to poor agreement among PDs using the MINI, making evident the potential benefit of more objective and concurrent PD assessments to guide treatment.ConclusionsAdditional PD diagnoses may be detected in PLWHA in CJS using supplementary and objective screening tools. By identifying and treating PDs and SUDs in the CJS, care may be improved and may ultimately contribute to healthier outcomes after community release if patients are effectively transitioned.Electronic supplementary materialThe online version of this article (doi:10.1186/s40352-014-0011-1) contains supplementary material, which is available to authorized users.

La détermination de l’incapacité totale de travail des victimes d’infractions pénales : intérêt de l’évaluation psychiatrique standardisée

BackgroundProfessionals in forensic field are not always able to determine personal inability for victims of criminal offences. Psychological impact assessment is one of the main reasons. However, this specific evaluation is essential for a full, fair and overall forensic assessment. ObjectivesThis study aimed at showing whether formalized practice of psychiatric assessment could change the duration of personal inability for victims of criminal offences. MethodAfter a first forensic assessment, fifteen victims who had psychological impact of criminal offences were recruited for a psychiatric assessment (classic psychiatric interview and standardized psychometric scales). The duration of personal inability-related post-traumatic stress, determined by the psychiatrist, was compared to the duration of the first personal inability, determined at the first forensic assessment. The relationship between psychometric scores and personal inability's duration were measured. ResultsAn increase by seven days of personal inability was observed between the standardized psychiatric assessment and the initially set by the forensic examiner. A change in category of the offence was shown for quarter of victims of the study (personal inability>8 days). A positive correlation between psychometric scores and duration of personal inability was found. ConclusionThis exploratory research showed a benefit effect of standardized psychiatric assessment focused on psychological impact among victims of criminal offenses. Difficulties in personal inability determination are also described, along with organizational aspects of this specific assessment, notably in common and complex situations such as chronic violence.

Anorexia nervosa: differences and similarities between adolescents with and without a history of obesity

The aim of this study was to evaluate clinical differences and similarities between anorexia nervosa (AN) patients with and without a history of obesity. We evaluated 108 patients (10–18 years old) with the restricting or purging subtype of AN, treated at a public referral facility in Brazil. To evaluate clinical characteristics, we used a standardized psychiatric interview, the Development and Well-Being Assessment, the Children's Global Assessment Scale, the Eating Disorder Examination Questionnaire (EDE-Q), and body mass index (BMI)-for-age percentile. The mean age was 14.8±2.5 years, and 95 (88.0%) of the patients were female. Of the 108 patients evaluated, 78 (72.2%) had restrictive AN and 23 (21.3%) had a history of obesity. Patients with and without a history of obesity were similar in terms of age at onset, time from symptom onset to treatment, duration of treatment, impact of the disease on global functioning, and comorbidities. At treatment initiation, those with a history of obesity were at a higher BMI-for-age percentile and scored higher on the Weight Concern subscale of the EDE-Q. We conclude that severe cases of AN can occur in patients with and without a history of obesity with no differences in terms of the baseline characteristics and the duration of treatment. The significantly higher BMI-for-age percentiles amongst patients with a history of obesity (at treatment initiation) suggests that the urge for treatment shouldn't be based on BMI percentile only.