Young Adult Psychiatric Outpatients Research Articles

Changes in patterns of alcohol consumption in young psychiatric outpatients: two comparable samples assessed with 10 years apart

Aims Over the past 20 years, a trend towards non-drinking and less use of alcohol has been reported among young adults. This study aimed to investigate if a similar trend in alcohol consumption can be seen among young adult psychiatric outpatients. Methods This was a cross-sectional study based on two comparable samples of young adult (18–25 years) psychiatric outpatients recruited approximately 10 years apart in 2002–2003 (N = 197) and 2012–2016 (N = 380). The Swedish version of the Alcohol Use Disorders Identification Test (AUDIT) was used to assess alcohol consumption. Psychiatric diagnoses were based on diagnostic interviews. Differences between the two samples in alcohol consumption and a number of alcohol-use disorder diagnoses were analysed. Cramer’s V was chosen as the effect size measure. Results Mean AUDIT scores and prevalence of diagnosed alcohol-use disorder in the two samples did not differ significantly. The number of non-drinkers was larger among patients in the mid-2010s (15.8% vs. 8.1%; χ2 = 6.76, p < 0.01, Φ = 0.11), but when non-drinkers were excluded, the alcohol consumption was higher among females in the later sample. Conclusion The mean level of alcohol consumption seems not to have changed to the same extent among young psychiatric patients as in the general population. However, some young psychiatric patients have followed the trend of non-drinking, while others consume more alcohol. Further studies on both non-drinking and high alcohol consumption in psychiatric patients are needed to understand their mechanisms.

A cross-sectional study of gastrointestinal symptoms, depressive symptoms and trait anxiety in young adults

Background>Patients with functional gastrointestinal disorders have a high psychiatric co-morbidity. This study aimed to investigate and characterise gastrointestinal symptoms in relation to depressive symptoms and trait anxiety in a well-defined population of young adult psychiatric outpatients and healthy controls.MethodsGastrointestinal symptoms were assessed with the Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome (GSRS-IBS). Depressive symptoms were assessed with the Montgomery-Åsberg Depression Rating Scale- Self assessment (MADRS-S). Trait anxiety was estimated with three of the Swedish universities of Personality (SSP) scales: Somatic trait anxiety, Psychic trait anxiety and Stress susceptibility. Self-ratings were collected from 491 young adult psychiatric outpatients and 85 healthy controls. Gastrointestinal symptom severity was compared between patients with and without current psychotropic medication and controls. Associations between gastrointestinal symptoms, depressive symptoms and trait anxiety were assessed using Spearman’s coefficients and generalized linear models adjusting for possible confounders (sex, body mass index, bulimia nervosa).ResultsPatients, with and without current psychotropic medication, reported significantly more gastrointestinal symptoms than controls. In the generalized linear models, total MADRS-S score (p < 0.001), Somatic trait anxiety (p < 0.001), Psychic trait anxiety (p = 0.002) and Stress susceptibility (p = 0.002) were independent predictors of the total GSRS-IBS score. Further exploratory analysis using unsupervised learning revealed a diverse spectrum of symptoms that clustered into six groups.ConclusionGastrointestinal symptoms are both highly prevalent and diverse in young adult psychiatric outpatients, regardless of current psychotropic medication. Depressive symptom severity and degree of trait anxiety are independently related to the total gastrointestinal symptom burden.

Beliefs and attitudes of psychiatric outpatients toward mental disorders and antidepressants

Introduction: The present study aims to investigate a group of young adult psychiatric outpatients’ knowledge of and attitude toward mental disorder and antidepressants, and determine the relevant factors affecting them.Methods: The study included 81 patients attending the psychiatric outpatient clinic, diagnosed with adjustment disorders, depression and/or anxiety disorder based on DSM-5 criteria, and met the research requirements. The data were collected through an information form for sociodemographic and clinical characteristics, a form to evaluate the knowledge of and attitudes toward the use of antidepressants, and based on the Beliefs Toward Mental Illness Scale (BMI). Severity of depression and anxiety was evaluated with Beck’s Depression Inventory and Beck’s Anxiety Inventory. Results: Regarding age groups, individuals in the 26-32 age group had higher overall scores. The patients with major depression were found to have higher BMI scores. The linear regression analysis revealed that age, education, depression severity and attitudes toward antidepressants were the factors associated with the overall BMI scoresConclusions: This study suggests that some sociodemographic variables, i.e. (age and educational statue), severity of depression and attitudes toward antidepressants are likely influence the beliefs toward mental disorders. Keywords: Mental disorders, beliefs, attitudes, antidepressants

Substance use among youth psychiatric outpatients

IntroductionPortuguese young adults (15–34 years old) were more frequent engaged in substance abuse (1.2%) than the general population, according to the Portuguese substance use annual report (2014). Alcohol was the most frequent substance use on youth adults. Cannabis was the most frequent illicit substance used (23.9% of users were considered dependent), with higher prevalence than previously reported. LSD (0.4%) use was also higher among young adults than in previous studies. Cocaine (0.4%), heroine/opiates (0.4%), ecstasy (0.3%), and hallucinogenic mushrooms (1.1%) had their consumption lowered among young adults.Objectives/aimsTo characterize a population of young adult psychiatric outpatients, regarding substance use and associated risk.MethodsSocio-demographic characterization of our young adult unit outpatient users between 1st January 2015–31st July 2016. Substance use was assessed with the Portuguese version of Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).ResultsA total of 255 outpatients were observed during the timeframe; 58 outpatients were assessed with ASSIST: 44 females (75.9%) and 14 males (24.1%), aged between 16–33 years old (average: 20.95; median: 19.50). For tobacco, 3.5% had high risk, 37.9% moderate risk and 58.6% low risk; 22.4% had moderate risk of alcohol, 13.8% moderate risk of cannabis, and 20.7% moderate risk of tranquilizers. For others substances (cocaine, stimulants, inhalants, hallucinogens, and opiates) the risk was low.ConclusionsIn our sample, alcohol and cannabis use had the highest risk, as reported in the National Annual Report; however, we observed a moderate risk for tranquilizers use. In future care planning, youth mental health should address tobacco and alcohol abstinence, and preventive measures regarding anxiolytics should be undertaken, such as banning sale without medical prescription.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Socio-demographic and clinic characterization in youth psychiatric outpatients: An observational study

IntroductionMost mental disorders begin during adolescence and early adulthood (18–24-years-old), highlighting the importance of understanding the onset and progression of mental disorders among youths. Although progress has been made, namely by creating youth mental health transition services, gaps continue to exist. Locally, our recently constituted young adults unit aimed to minimize discontinuities in care.Objectives/aimsTo characterize a population of young adult psychiatric outpatients, regarding socio-demographic and clinic variables.MethodsSocio-demographic and clinic characterization of young adult psychiatric outpatients observed during 1st January 2015–30th July 2016.ResultsTwo hundred and fifty-five outpatients were observed: 64.3% females and 35.7% males, average age 20.56-years-old (median 20). Most lived in urban areas (59.4%), with their parents (27.8%), were students (80.4%), attending secondary school (36.1%). A total of, 27.5% were referenced by an emergency department, and adjustment disorders (ICD-10 F43.2) were the most frequent diagnosis (21.6%). Regarding suicidal behaviours and self-harm, 9.8% did self-cutting. A vast majority did not have previous psychiatric hospitalizations–only 5.9% outpatients had at least one. In total, 39.8% were medicated with antidepressants (1/3 of which in association with other drugs), and about 38.8% received cognitive-behavioural interventions. About 2/3 of patients (66.3%) remained in care and only about 1/6 (15.7%) were discharged.ConclusionsOur typical youth psychiatric outpatient was of female gender, student, living with its parents. Adjustment disorders were the most frequent diagnosis, and antidepressants were the main psychopharmacologic option, often combined with other psychotropic drugs. In the future, psychotherapy interventions should be more widely available, namely group psychotherapy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Depressive and anxiety symptoms in youth mental health outpatients: An observational study

IntroductionThere is an increased risk to develop mental disorder during adolescence and early adulthood. Given this vulnerability, and in order to facilitate the transition from child and adolescent to adult mental health services, specific services for this age group have been developed in the last years, focusing on accessibility and early referral of young mental patients. Our Psychiatry Department (Coimbra Hospital and University Centre, Portugal) created a specific unit for young adults in order to provide better care, in accordance with the specificities of this subpopulation. The team consists of psychiatrists, psychiatry residents, nurses and a clinical psychologist. Referred patients are under 20 years old, presenting clinically relevant psychopathology or behavior disturbances.Objectives/aimsWe aimed to characterize help-seeking outpatients regarding socio-demographic variables and its relation to depressive and anxiety symptoms.MethodsSocio-demographic characterization was undertaken with young adult psychiatric outpatients observed during eleven months (1st January to 30th November 2015). Multivariate analyses were performed to identify a relationship among socio-demographic and psychopathology variables (assessed with the Portuguese version of Brief Symptom Inventory–53 itens).Results/conclusionsOne hundred and sixty-two outpatients were observed: 97 females (59,9%) and 65 males (40,1%), ages between 17 and 31 years old (average: 19,9; median: 20). We found a positive correlation between depressive and anxiety symptoms and the education level. A negative correlation was found between depressive and anxiety symptoms and male gender and presence of mental illness in the family.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Depression in young adult psychiatric outpatients: delimiting early onset

The aim of this study was to examine differences in childhood, adolescent and adult onset of depression. Young psychiatric outpatients (n = 156) diagnosed with a lifetime depressive episode were divided into three groups according to age of onset of their first depressive episode: childhood (≤12 years, n = 21), adolescent (13-17 years, n = 58) and early adult onset (18-25 years, n = 77). Participants were assessed by diagnostic interviews and by questionnaires measuring previous life events and childhood developmental delays. Clinical characteristics and various risk factors were compared between groups. This clinical sample was dominated by women, with onset of their first depressive episode occurring during adolescence. Childhood onset was related to an increased number of depressive episodes, higher prevalence of personality disorders, more current social problems and more reported development delays during childhood regarding literacy learning, social skills and memory. They also reported more separation anxiety symptoms and neglect during childhood and more experiences of teenage pregnancies and abortions. Childhood onset of depression is associated with more severe symptoms, more psychosocial risk factors and childhood developmental delays. Because all onset groups shared many features, the results are inconclusive if there are distinct subgroups according to age of onset.

Axis V – Global Assessment of Functioning Scale (GAF), further evaluation of the self-report version

Objective The study aimed to examine agreement between patients' and professional staff members' ratings on the Global Assessment of Functioning scale (GAF). Methods A total of 191 young adult psychiatric outpatients were included in a naturalistic, longitudinal study. Axis I and axis II disorders were assessed by means of the Structured Clinical Interview for DSM-IV. Before and after treatment, patients and trained staff members did a GAF rating. Agreement between GAF ratings was analyzed using the intra-class correlation coefficient (ICC). Results The overall intra-class correlation coefficients before and after treatment were 0.65 and 0.86, respectively. Agreement in different axis I diagnostic groups varied, but was generally lower before treatment as compared to after treatment (0.50–0.66 and 0.78–0.90, respectively). Excessive psychiatric co-morbidity was associated with the lowest inter-rater reliability. Agreement, with respect to change in GAF scores during treatment, was good to excellent in all groups. Conclusion Overall, agreement between patients' and professionals' ratings on the GAF scale was good before and excellent after treatment. The results support the usefulness of the self-report GAF instrument for measuring outcome in psychiatric care. However, more research is needed about the difficulties in rating severely disordered patients.

Cross Validation of the 2-8/8-2 MMPI Code Type for Young Adult Psychiatric Outpatients

Young adults attending a college student mental health center and obtaining 2 and 8 as their highest scale elevations (and not scale 7 as the third elevation) on the MMPI were compared to other patients at the center on 175 descriptors obtained from intake interviews. Those items which discriminated (chi2, p less than .05) 2-8/8-2 patients from others in the sample are presented in relationship to the descriptors obtained for this code type by other investigators. The statements generated by the Marks and Seeman interpretive system for adults were then reanalyzed by the Chi Square method to demonstrate the differential effect of statistical method upon code type interpretation. Although previously established correlates of 2-8/8-2 profiles were partially validated, a number of different descriptors emerge for males and females in this population. Questions are raised and discussed concerning methodologies for generating interpretive statements for various clinical populations.