Prevalence of Hoarding in an Adult Inpatient Population and Its Association With Axis I Diagnoses

Objective

Hoarding behavior is not limited to obsessive-compulsive disorder (OCD) alone. With the objective of highlighting the association between hoarding behavior and common psychiatric disorders, we explored its occurrence in psychiatric inpatients and co-occurrence with Axis I diagnoses.

The Staffing of Inpatient Child and Adolescent Mental Health Services

Background:  There is a need for more accurate information regarding the staffing of Child and Adolescent Psychiatric inpatient units. This is both to facilitate clinical governance and to allow planning and focused further development of these services.
Method:  Postal surveys were sent to all units in England and Wales.
Results:  Seventy-three percent ( n  = 1060) of the 1460 staff employed by the units were nurses; 43% of nurses were unqualified. On average there was one consultant psychiatrist for every 25 patients. Only 12% of nurses working on a 'census' day held a specialist qualification in nursing children. The use of agency and bank staff was higher in independent sector units than in NHS units (37% vs 10% of all nurses who worked a shift on the census day).
Conclusions:  Some child and adolescent inpatient units are not staffed by a multi-disciplinary team. There is evidence of problems of recruitment and retention of nurses.     

Changes in Outpatient Psychiatric Diagnosis in Privately Insured Children and Adolescents from 1995 to 2000

This study examined changes in the diagnostic patterns among children and adolescents treated for mental health problems between the years 1995 and 2000. Using a large database (MarketScan) which compiles claims information from private health insurance plans nationwide, our sample consisted of 100,716 children (under the age of 18) who submitted claims for outpatient mental health services, out of a total of 1,723,681 covered children. Over the five years period, there was a dramatic increase in the proportion of children diagnosed with both Autism and Bipolar disorders. An increase was also observed in Anxiety, ADHD and Depressive disorders. A decrease was observed in diagnostic prevalence of Oppositional, Adjustment and Substance Abuse disorders.     

Stability and Course of Personality Disorders: The Need to Consider Comorbidities and Continuities Between Axis I Psychiatric Disorders and Axis II Personality Disorders

The literature pertaining to the stability and course of personality disorders is briefly reviewed. Available data suggest that PD diagnoses demonstrate only moderate stability and that—although generally associated with a plethora of negative outcomes—they can show improvement over time. This paper highlights the pervasiveness of diagnostic co-occurrence and its implications for continued investigation of the question of PD stability. In addition to examining the stability (and outcome) of PDs, longitudinal studies need to consider continuities between diagnoses. The Collaborative Longitudinal Personality Disorder Study (CLPS) is described briefly vis-a-vis some of these major issues.     

Clinical Correlates of False Positive Assignment in Bipolar Screening Measures Across Psychiatric Diagnoses among Patients without Bipolar Disorder

ObjectiveIn this study, we aimed to determine clinical correlates of false positive assignment (FPA) on commonly used bipolar screening questionnaires. MethodsA retrospective chart review was conducted to a total of 3885 psychiatric outpatients. After excluding patients who have bipolar spectrum illnesses, patients who were assigned as having hypomania on the mood disorder questionnaire (MDQ) or the hypomania checklist-32 (HCL-32) were identified as patients who had FPA. Psychiatric diagnoses and severity of emotional symptoms were compared between patients with and without FPA. ResultsPatients with FPA on the MDQ showed significant associations with presence of major depressive disorder, generalized anxiety disorder, and alcohol-use disorder, while patients with FPA on the HCL-32 showed associations with presence of panic disorder and agoraphobia. FPA on the MDQ was also associated with greater emotional symptoms and lifetime history of suicide attempts. Logistic regression analysis showed that male sex, younger age, presence of alcohol-use disorder, and severity of depression and obsessive-compulsive symptoms were significantly associated with FPA on the MDQ. ConclusionThe FPA for the MDQ was associated with clinical factors linked to trait impulsivity, and the FPA for both the MDQ and the HCL-32 could be related to increased anxiety.     

Diagnostic Stability of Schizophrenia in Psychiatric Emergency Room Patients

Diagnoses obtained from the hospital computer system were compared at two consecutive visits in 286 psychiatric emergency room patients within a 7-month period. Diagnostic agreement of schizophrenia and changes from and to schizophrenia were examined. There was moderate stability for a schizophrenic diagnosis in patients at two consecutive visits (kappa 0.5). schizophrenia was a more stable diagnosis in males (kappa 0.6) than females (0.4). Underdiagnosis of schizophrenia in females may be due to initial diagnostic confusion with affective illnesses. Further studies are needed in other settings to assess if underdiagnosis is associated with undertreatment of schizophrenia in females.     

Co-occurrence of Axis I and Axis II disorders in substance abusers

OBJECTIVE: This study examined the co-occurrence of anxiety/mood and personality disorders (PDs) in substance abusers, the impact of anxiety/ mood disorders on the symptom profiles of PDs, and the impact of anxiety/mood disorders and PDs on pre-treatment status. METHOD: Current anxiety/mood disorders and PDs and pre-treatment status were assessed using semi-structured interviews in 370 treated substance abusers. RESULTS: Anxiety/mood disorders and PDs frequently co-occurred, with the overall pattern of associations being non-specific. The strongest associations were of social phobia with avoidant and schizotypal PD, and of major depression with borderline PD. However, symptom profiles of PDs were not associated with anxiety/mood disorders. Finally, anxiety/mood disorders and PDs were both independently and differentially associated with poor pre-treatment characteristics. CONCLUSION: The findings suggest the clinical importance of obtaining both Axis I and Axis II diagnoses in treated substance abusers, and highlight the distinctiveness of the Axis I and Axis II disorders.     

Creating an innovative youth mental health service in the United Kingdom: The Norfolk Youth Service

Young people attempting to access mental health services in the United Kingdom often find traditional models of care outdated, rigid, inaccessible and unappealing. Policy recommendations, research and service user opinion suggest that reform is needed to reflect the changing needs of young people. There is significant motivation in the United Kingdom to transform mental health services for young people, and this paper aims to describe the rationale, development and implementation of a novel youth mental health service in the United Kingdom, the Norfolk Youth Service. The Norfolk Youth Service model is described as a service model case study. The service rationale, national and local drivers, principles, aims, model, research priorities and future directions are reported. The Norfolk Youth Service is an innovative example of mental health transformation in the United Kingdom, comprising a pragmatic, assertive and “youth‐friendly” service for young people aged 14 to 25 that transcends traditional service boundaries. The service was developed in collaboration with young people and partnership agencies and is based on an engaging and inclusive ethos. The service is a social‐recovery oriented, evidence‐based and aims to satisfy recent policy guidance. The redesign and transformation of youth mental health services in the United Kingdom is long overdue. The Norfolk Youth Service represents an example of reform that aims to meet the developmental and transitional needs of young people at the same time as remaining youth‐oriented.     

The clinical course of children treated in a short-term inpatient programme

Forty-six children admitted to short-term, usually 4–6-week child psychiatric inpatient treatment were evaluated from multiple perspectives on admission, at discharge, and at 5-month, one-year, and 3-year follow-ups. The majority of the patients showed an improvement in functioning over the course of the 3-year follow-up. However, the 3-year stability of parent, teacher and clinical ratings of the child was very high. Furthermore, the majority of children had a high level of symptoms at follow-ups. Conduct problems had the highest stability and predicted the poorest outcome. The results stress the importance of long-term follow-up of children discharged from child psychiatric tertiary sevices. In many of these cases, the problems were persistent chronic problems that require continued monitoring and evaluation over many years. Short-term hospitalization should be seen as a pathway to further assistance rather than a complete form of treatment.     

Bipolar disorder in children and adolescents: obstacles to early diagnosis and future directions

Aim: This article reviews research centred around juvenile bipolar disorder with particular reference to diagnostic difficulties. Putative deficits are scrutinized with respect to trait likelihood and the roles of neuropsychology and neuroimaging in enhancing our understanding of juvenile bipolar disorder are discussed. Methods: Search terms including childhood, adolescent, youth and juvenile combined with the terms ‘bipolar disorder’, mania, depression and hypomania were used to identify relevant studies in MEDLINE and PsychLit. Results: Over recent years research into this relatively new disorder has increased phenomenally. Key issues within the field include diagnostic specificity, the heritability of the disorder, the impact of comorbidity and the implications of neuropsychological and neuroimaging findings. Conclusion: Despite concerning controversies in literature the diagnosis of bipolar disorder in children and adolescents as compared with adults, promising future research directions include better neurological characterization of the disorder through the application of findings from clinical populations, neuropsychological and neuroimaging research.     

The Impact of a Community Mental Health Center on Psychiatric Hospitalizations in Two Athens Areas

This paper explores the impact of a CommunityMental Health Center intervention activities on theinpatient psychiatric morbidity of two areas served bythis center. Athens University established this Center, the first of its kind in the Greater Athensarea. A comparison among the utilization rates ofinpatient psychiatric services by community residentsduring the years 1979, 1985, 1991 and 1995 is made. The results of the 1995 survey show a significantreduction in the number and days of hospitalization anda remarkable cut in compulsory admissions when comparedwith those in 1979. It is concluded that medication monitoring, outreach, domiciliary care forpatients in crisis, and day care are effective androbust principles of mental health services.     

Psychiatric Liaison Referral of Elderly Inpatient in a Medical School Hospital

Abstract: A retrospective study of elderly inpatient referral was carried out at Saga Medical School Hospital in order to assess the effectiveness of consultation-liaison service. A total of 51 patients aged 65 and over were referred to the Psychiatric Department. Their referral rate, clinical characteristic, diagnosis and psychiatric recommendation were reviewed from the records. A comparison of various aspects concerning the referral for the periods before and after the installation of an effective psychiatric consultation-liaison service showed a mild change. The striking finding was that the referral rate increased significantly for male patients under 75 years of age.     

The Effect of Stress Management Group Therapy on Patients on an Adolescent Psychiatric Unit

The effect of stress management group therapy on a broad range of psychiatric symptoms was evaluated on an adolescent psychiatric unit. Adolescent boys and girls from ages 11 to 18 were placed in either an experimental group or a control group. The experimental group received three session of stress management group therapy in addition to the usual treatment on the unit, while the control group received only the usual treatment on the unit. Both groups were evaluated with the Brief Psychiatric Rating Scale (BPRS) before and after the stress management groups. Although both the experimental and the control groups improved their BPRS scores over the time of treatment, the experimental group showed a significantly greater improvement than the control group. The results indicate the stress management group therapy may be effective in reducing a broad range of psychiatric symptoms.