Prospective study of psychiatric illness as a predictor of weight loss and health related quality of life one year after bariatric surgery

ObjectiveDespite a lack of evidence, there is an assumption that patients with more complex psychiatric histories (CPH) prior to bariatric surgery have poor post-surgical weight loss and worsening psychiatric symptoms following surgery. Consequently, those with CPH are excluded from bariatric surgery in many bariatric clinics. This study examines whether psychiatric illness affects post-surgical weight loss and HRQOL, focusing on patients with CPH.MethodThis prospective cohort study investigated 341 patients from a tertiary care centre bariatric surgery program who had surgery between September 2010 and October 2013. Patients were divided into CPH, other psychiatric disorder (OPD), or no psychiatric disorder (NPD) groups based on lifetime psychiatric diagnoses. Groups were compared one year post-surgery in regards to percent total weight loss (%TWL), mental and physical health related quality of life (HRQOL) using a Kruskal–Wallist test. Linear regression analysis was used to determine if mental illness group, gender, age, pre-op BMI, education, employment and relationship status predict change in %TWL and HRQOL.ResultsThere was no significant difference in %TWL or physical HRQOL across groups. The CPH group experienced a decrease in mental HRQOL (p = 0.0003). Mental illness severity predicted mental HRQOL (p = 0.002) but not physical HRQOL or %TWL.ConclusionThose with controlled CPH can achieve comparable weight loss compared to those with OPD or NPD. However, CPH may predict post-surgical decline in mental HRQOL. These findings demonstrate a need to reevaluate exclusion criteria to ensure equitable access to care, while continuing to monitor for psychiatric illness following surgery.     

Psychological distress among patients attending a general medical outpatient clinic in Pakistan

It is not known whether the pattern of psychiatric disorders in medical outpatients in Pakistan is similar to that observed in the West. Consecutive medical outpatients completed the Self-Report Questionnaire (SRQ) to detect probable psychiatric disorder. The usual cut-off score of 8/9 was used. One-thousand and sixty-nine patients completed the SRQ (84% response rate) at four half-day clinics. Sixteen percent of men and 58% of women presented with medically unexplained symptoms. In men, 80% of patients with medically unexplained symptoms had an SRQ score of 9 or above (probable depressive disorder) compared to 40% of those with symptoms caused by recognized physical illness (P<.0005). In women, the respective proportions were 55.4% and 49.6% (P=.34). Depressive disorder is probably very common in medical outpatients in Pakistan, especially in men with medically unexplained symptoms. Systematic attempts to initiate antidepressant treatment in this setting should be attempted.     

Psychiatric aspects in Parkinsonism treated with L-dopa

Psychiatric aspects of patients with Parkinsonism treated with L-dopa are described. These include acute psychosis in patients with or without previous psychiatric illness and worsening or improvement of pre-existing psychiatric conditions. Therapeutic management is discussed The relevance of these studies to the understanding of the psychiatric aspects of Parkinsonism in general is discussed.     

Long-term psychological outcome for non-treatment-seeking earthquake survivors in Turkey

This study examined the incidence of posttraumatic stress disorder (PTSD) and depression in 586 earthquake survivors living in prefabricated housing sites a mean of 20 months after the 1999 earthquake in Turkey. The estimated rates of PTSD and major depression were 39% and 18%, respectively. More severe PTSD symptoms related to greater fear during the earthquake, female gender, older age, participation in rescue work, having been trapped under rubble, and personal history of psychiatric illness. More severe depression symptoms related to older age, loss of close ones, single marital status, past psychiatric illness, previous trauma experience, female gender, and family history of psychiatric illness. These findings suggest that catastrophic earthquakes have long-term psychological consequences, particularly for survivors with high levels of trauma exposure. These findings lend further support to the need for long-term mental health care policies for earthquake survivors. Outreach service delivery programs are needed to access non-treatment-seeking survivors with chronic PTSD.     

Psychiatric Symptoms Endorsed by Somatization Disorder Patients in a Psychiatric Clinic

Patients with somatization disorder (SD) endorse high rates of psychiatric symptoms. However, prior studies have not addressed whether these endorsed symptoms reflect underlying psychiatric illness or whether they represent symptom overendorsement mirroring somatic complaints in patients with SD. Thirty-two female outpatients with SD and 101 with other psychiatric disorders completed a checklist of current and lifetime psychiatric symptoms. These findings were analyzed with respect to the diagnoses given by their treating psychiatrists. Patients with SD displayed significantly more current and lifetime psychiatric symptoms than did patients without either SD or cluster B personality disorder. Patients with SD endorsed a large number of psychotic, manic, depressive, and anxiety symptoms; however, they endorsed few alcohol use disorder symptoms. Psychotic and manic symptoms endorsed by patients with SD did not reflect their clinical diagnoses: only two patients with SD carried an additional clinician diagnosis of either schizophrenia or bipolar disorder, despite high rates of endorsed symptoms by the group. Patients with cluster B personality disorders but without SD showed a symptom profile similar to that of patients with SD. Psychiatric outpatients with SD endorse many more psychiatric symptoms than do other psychiatric patients. Patients with SD in the psychiatric treatment setting may mimic other psychiatric illnesses; therefore, SD should be considered in the differential diagnosis for a wide variety of psychiatric illness, including psychotic and mood disorders     

Stability and course of neuropsychological deficits in schizophrenia

BACKGROUND: Neuropsychological deficits in schizophrenia appear to predate clinical symptoms of the disease and become more pronounced at illness onset, but controversy exists about whether and when further neuropsychological progression may occur. OBJECTIVE: To identify and characterize any subset of patients who evidenced progressive neuropsychological impairment, we compared the longitudinal stability of neuropsychological functioning in schizophrenic outpatients and normal comparison subjects. METHODS: One hundred forty-two schizophrenic outpatients and 206 normal comparison subjects were given annually scheduled comprehensive neuropsychological evaluations during an average of 3 years (range, 6 months to 10 years). Clinically and demographically defined subgroups were compared, and test-retest norms were used to identify individual patients who showed unusual worsening over time. RESULTS: The schizophrenic group was neuropsychologically more impaired than the normal comparison subjects but showed comparable test-retest reliability and comparable neuropsychological stability over both short (mean, 1.6 years) and long (mean, 5 years) follow-up periods. No significant differences in neuropsychological change were found between schizophrenic subgroups defined by current age, age at onset of illness, baseline level of neuropsychological impairment, improvement or worsening of clinical symptoms, and occurrence of incident tardive dyskinesia. Norms for change also failed to show neuropsychological progression in individuals with schizophrenia. CONCLUSIONS: Neuropsychological impairment in ambulatory persons with schizophrenia appears to remain stable, regardless of baseline characteristics and changes in clinical state. Our results may not be generalizable to the minority of institutionalized poor-outcome patients.     

Patient satisfaction with outpatient psychiatric treatment: the role of diagnosis, pharmacotherapy, and perceived therapeutic change.

OBJECTIVE: To investigate the influence of diagnosis, type of treatment, and perceived therapeutic change on patient satisfaction following psychiatric treatment for nonpsychotic, nonsubstance-related disorders. METHOD: We mailed questionnaires, including Larsen's Client Satisfaction Questionnaire and Grawe's Bern Inventory of Treatment Goals, to outpatients who had undergone 8 or more therapy sessions 1 year following treatment. RESULTS: Patients with somatoform, eating, and personality disorders were less satisfied than patients with affective, anxiety, and adjustment disorders. Symptom reduction and changes in the interpersonal domain were important outcomes associated with patient satisfaction. Although pharmacotherapy itself was not related to patient satisfaction, patients who perceived improvements in pharmacotherapy as one of the most important treatment outcomes were less satisfied than others. Preliminary evidence shows that coping with specific problems and symptoms is associated with satisfaction among male patients, whereas changes in the interpersonal domain seem to produce satisfaction among female patients. CONCLUSION: Patient-reported change and diagnostic category appear to play a relevant role in generating patient satisfaction. Further research is needed to clarify the interactions between sex, perceived outcome, and satisfaction.     

Primary psychiatric illness in a neurological out-patient department in North-East England

A retrospective study of 2716 patients attending a neurological out-patient clinic in the north east of England, from May 1970 to May 1974 showed an incidence of 13·2% of primary psychiatric illness. Forty-eight per cent were male and 52% female.The patients were categorised into three diagnostic groups: neurotic and personality disorders, schizophrenia and affective disorders. Eight-two per cent of psychiatric disorders were placed in the first category, 1% had schizophrenia and 17% had affective disorders. The commonest presenting symptoms and mode of referral are discussed.     

Impact of the early phase of the COVID-19 pandemic on the use of mental health services in South Korea: a nationwide,health insurance data-based study

Purpose

The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected the utilization of mental health services. Existing evidence investigating this issue at the nationwide level is lacking, and it is uncertain whether the effects of the COVID-19 pandemic on the use of psychiatric services differs based on psychiatric diagnosis.

Methods

Data from the claims database between October 2015 and August 2020 was obtained from the Health Insurance Review and Assessment agency in South Korea. Based on the main diagnostic codes, psychiatric patients were identified and categorized into diagnostic groups (anxiety disorders, bipolar and related disorders, depressive disorders, and schizophrenia spectrum disorders). We calculated the number of psychiatric inpatients and outpatients and the medication adherence of patients for each month. We compared the actual and predicted values of outcomes during the COVID-19 pandemic and performed interrupted time-series analyses to test the statistical significance of the impact of the pandemic.

Results

During the COVID-19 pandemic, the number of inpatients and admissions to psychiatric hospitals decreased for bipolar and related disorders and depressive disorders. In addition, the number of patients admitted to psychiatric hospitals for schizophrenia spectrum disorders decreased. The number of psychiatric outpatients showed no significant change in all diagnostic groups. Increased medication adherence was observed for depressive, schizophrenia spectrum, and bipolar and related disorders.

Conclusions

In the early phase of the COVID-19 pandemic, there was a trend of a decreasing number of psychiatric inpatients and increasing medication adherence; however, the number of psychiatric outpatients remained unaltered.

     

Global health disparities in vulnerable populations of psychiatric patients during the COVID-19 pandemic

The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population. In this narrative review, we examine the impact of the pandemic on significant global health disparities affecting vulnerable populations of psychiatric patients: People of diverse ethnic background and color, children with disabilities, sexual and gender minorities, pregnant women, mature adults, and those patients living in urban and rural communities. The identified disparities cause worsened mental health outcomes placing psychiatric patients at higher risk for depression, anxiety and posttraumatic stress disorder symptoms. Those psychiatric patients who are ethnic minorities display barriers to care, including collective trauma and structural racism. Sexual and gender minorities with mental illness face discrimination and limited access to treatment. Pregnant women with psychiatric diagnoses show higher exposure to domestic violence. Children with disabilities face a higher risk of worsening behavior. Mature adults with psychiatric problems show depression due to social isolation. Psychiatric patients who live in urban communities face pollutants and overcrowding compared to those living in rural communities, which face limited access to telehealth services. We suggest that social programs that decrease discrimination, enhance communal resilience, and help overcome systemic barriers of care should be developed to decrease global health disparities in vulnerable population.     

Outcome of psychiatric treatment: what is relevant for our patients?

This study investigated relevant outcome domains in the patient's perspective following psychiatric outpatient treatment for non-psychotic, non-substance-related disorders. Questionnaires, including the Client Satisfaction Questionnaire (CSQ) and the Bern Inventory of Treatment Goals (BIT-C) applied as a broad typology of outcome domains, were mailed 1 year after treatment to outpatients who had undergone eight or more therapy sessions. Patients reported a wide range of relevant outcomes, including changes with respect to the interpersonal domain, their self-concept, and existential issues. Changes in depressive and anxiety symptoms were rated as particularly important; the reports of both symptomatic and more integral changes were related to treatment characteristics, patient's diagnostic category, and patient's employment status. Patient satisfaction was particularly related to reported changes in the interpersonal domain. This exploratory study provides evidence that traditional outcome measures that include mood, anxiety, and fear symptoms continue to assess the most important areas for change in patients' views. However, they might miss relevant therapeutic achievements in some of our patients, particularly in those suffering from adjustment and personality disorders. The use of measures that include dimensions such as personal growth, purpose of life, and positive relations with others may record important changes in these patients.     

Primary psychiatric illness in a neurological out-patient department in North East England. An assessment of symptomatology.

A total of 2,716 patients attended a neurological out-patient clinic in North East England between May 1970 and May 1974. The symptomatology of 358 patients with primary psychiatric illness has been analyzed in a retrospective study. There were 172 symptom wordings and these were grouped in 18 headings. The most common symptoms were headache, dizziness and pain in the body. The presenting symptoms were analyzed with reference to age, sex, pattern of referral, diagnostic category and method of disposal. Aspects of non-organic disease in a neurological clinic are discussed.     

Panic disorder in the medically ill

The authors describe five patients with concurrent panic disorder and medical illness. Panic disorder either caused worsening of the medical illness or was associated with continued physiologic symptoms that mimicked the symptoms of the medical illness after the illness had improved. In both cases, panic disorder was associated with high rates of medical utilization, increased patient suffering, and often costly medical tests. Accurate diagnosis and treatment decreased physiologic and psychiatric symptoms as well as medical utilization.     

Premenstrual symptoms and premenstrual exacerbation in patients with psychiatric disorders

The aim of the present study was to examine the frequencies of premenstrual syndrome (PMS) and premenstrual exacerbation (PME) of a number of psychiatric disorders in Chinese subjects. Premenstrual syndrome was assessed using a symptom checklist based on International Classification of Diseases (10th revision; ICD-10) criteria. Premenstrual exacerbation was defined as premenstrual worsening of pre-existing generalized anxiety disorder (GAD), major depressive disorder or dysthymic disorder (depressive disorders, DD), panic disorder (PD), or schizophrenia (SCH). Fifty outpatients were randomly sampled for each diagnostic group. Diagnosis was performed by psychiatrists using the structured Mini-International Neuropsychiatric Interview (MINI), and the frequencies of PMS and PME were compared for the different diagnostic groups. The PMS symptoms were reported by 78%, 80%, 68%, and 52% of GAD, DD, PD, and SCH patients, respectively, with 52%, 52%, 36%, and 20% fulfilling the definition of PME. No significant statistical relationships between diagnostic entities and family history of PMS, years of education, or age were demonstrated, but number of PMS symptoms was associated with severity of PME. No significant relationships were demonstrated between PME and marital status, parity, years of education, age, or family history of PMS. The results showed that high PME rates were noted for a sample of Chinese women with mental disorders, especially those with depressive and anxiety disorders.     

Hospitalized psychiatric patients view the World Trade Center disaster

There is conflicting literature describing how psychiatric patients, particularly those with schizophrenia, respond to overwhelming environmental disasters, with some reports describing marked improvement in their symptoms. This view is contrary to the notion that those individuals who are most vulnerable (i.e. people with serious psychiatric illness) are at high risk for further increase in psychiatric symptoms subsequent to stressful events. Since the terrorist attack of September 11, 2001, was such a catastrophic event, the following project was undertaken to examine its consequences on a population of hospitalized and thus severely ill psychiatric patients. Medical records for 156 New York City psychiatric inpatients were examined to evaluate their psychiatric condition during the time prior to and subsequent to the September 11, 2001, terrorist attacks on the World Trade Center in New York City. We failed to find any difference between the patients who had the opportunity to directly view the disaster through windows and those who did not. However, significantly more patients with a schizophrenia spectrum diagnosis showed evidence of worsening in their symptoms than those with affective disorder or other diagnoses in response to the events of September 11.     

Clinical applications of DSM-III in consultation-liaison psychiatry

The authors examine the clinical application of DSM-III from the perspective of the consultation-liaison psychiatrist. They discuss contributions of DSM-III that have refined psychiatric diagnosis in medical-surgical settings, including the multiaxial system, a broader approach to the organic mental disorders, introduction of the category of psychological factors affecting physical condition, and an improved classification of disorders that present with physical symptoms. However, some areas of continuing ambiguity remain, such as how much discretion a clinician has to discount somatic symptoms related to physical illness in the diagnosis of depression, the implications of exempting bereavement from diagnostic status, and uncertainty about what constitutes evidence of an etiological relationship.     

Traumatic stress responses in treatment-seeking earthquake survivors in Turkey

This study examined the incidence of posttraumatic stress disorder (PTSD) and depression in 1,027 earthquake survivors who were consecutively referred to a community center at a mean of 14 months after the August 1999 earthquake in Turkey. Seventy-seven percent of referrals were women. The estimated rates of PTSD and major depression were 63% and 42%, respectively. More severe PTSD symptoms related to greater fear during the earthquake, female gender, lower education, loss of friends, shorter time since the earthquake, and material loss. More severe depression symptoms related to female gender, longer time since the earthquake, lower educational level, loss of a family member, and past psychiatric illness. In conclusion, long-term public mental health policies are needed for postearthquake psychological problems. These policies need to take into account the risk factors for traumatic stress and the gender differences in referral patterns. The differential stressor-response relationship may have important implications for treatment.     

Rate of psychiatric illness 1 year after traumatic brain injury

OBJECTIVE: Neurobehavioral symptoms are not uncommon after a traumatic brain injury. However, psychiatric syndromes per se have rarely been studied in patients with such an injury. The purpose of this study was to evaluate the type and extent of psychiatric syndromes in patients with traumatic brain injury. METHOD: One hundred ninety-six hospitalized adults were studied 1 year after a traumatic brain injury with the use of a two-stage psychiatric diagnostic procedure. Psychiatric diagnoses were made according to ICD-10 criteria on the basis of data from the Schedules for Clinical Assessment in Neuropsychiatry interview. RESULTS: Of 164 patients interviewed, 30 (18.3%) had an ICD-10 diagnosis of a psychiatric illness. Among the 120 patients who were 18-64 years old, 21.7% had a psychiatric illness, compared with 16.4% in a study of the general population. A depressive illness was present in 13.9% of the traumatic brain injury patients, compared with 2.1% of the general population, and panic disorder was present in 9.0%, compared with 0.8% of the general population. CONCLUSIONS: In comparison with the general population, a higher proportion of adult patients had developed psychiatric illnesses 1 year after a traumatic brain injury; the rates of depressive episode and panic disorder were significantly higher in the study group. A history of psychiatric illness, an unfavorable global outcome according to the Glasgow Outcome Scale, a lower score on the Mini-Mental State examination, and fewer years of formal education seemed to be important risk factors in the development of a psychiatric illness. Compensation claims, however, were not associated with the rate of psychiatric illness.     

Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry

This study aimed to assess and compare the immediate stress and psychological impact experienced by people with and without psychiatric illnesses during the peak of 2019 coronavirus disease (COVID-19) epidemic with strict lockdown measures. Seventy-six psychiatric patients and 109 healthy control subjects were recruited from Chongqing, China and completed a survey on demographic data, physical symptoms during the past 14 days and a range of psychiatric symptoms using the Impact of Event Scale-Revised (IES-R), Depression, Anxiety and Stress Scale (DASS-21) and Insomnia Severity Index (ISI). IES-R measures PTSD symptoms in survivorship after an event. DASS-21 is based on tripartite model of psychopathology that comprise a general distress construct with distinct characteristics. The mean IES-R, DASS-21 anxiety, depression and stress subscale and ISI scores were higher in psychiatric patients than healthy controls (p < 0.001). Serious worries about their physical health, anger and impulsivity and intense suicidal ideation were significantly higher in psychiatric patients than healthy controls (p < 0.05). More than one-third of psychiatric patients might fulfil the diagnostic criteria post-traumatic stress disorder (PTSD). More than one-quarter of psychiatric patients suffered from moderately severe to severe insomnia. Respondents who reported no change, poor or worse physical health status and had a psychiatric illness were significantly more likely to have higher mean IES-R, DASS depression, anxiety and stress subscale scores and ISI scores (p < 0.05). This study confirms the severity of negative psychological impact on psychiatric patients during the COVID-19 epidemic with strict lockdown measures. Understanding the psychological impact on psychiatric patients during the COVID-19 pandemic has the potential to provide insight into how to develop a new immunopsychiatry service. Further research is required to compare pro-inflammatory cytokines between psychiatric patients and healthy controls during the pandemic.