Past trauma and present functioning of patients attending a women's psychiatric clinic

A women's psychiatric clinic, incorporated within a university teaching general hospital and staffed entirely by women, was opened in March of 1980. The authors studied a sample of 100 women who came to the clinic and characterized them by demographic variables, psychiatric diagnoses, health problems, chronic illness, death in the family, and traumatic incidents. Death in the family before she was 18 was found to predict a woman's subsequent request for or completion of sterilization. Physical or sexual abuse was significantly related to abortion, and abortion and trauma were significantly correlated.     

Psychological problems among patients attending an infertility clinic

Ten couples presenting at an infertility clinic for the first time, and ten couples already undergoing treatment, all with a complaint of primary infertility, were seen by a clinical psychologist, and interview and questionnaire data gathered. Nine patients complained of significant emotional disturbance; nine showed evidence of impaired social adjustment; five individuals reported sexual dysfunction secondary to their infertility, with a primary sexual dysfunction found in a further couple; and a deterioration in the marital relationship was reported by seven couples. Overall, nine women and four men showed signs of current emotional disturbance, social maladjustment or secondary sexual dysfunction. Psychological problems were not generally reported by the partner in whom the aetiological factor for the infertility was found. The results are thought to confirm previous clinical reports suggesting a high incidence of psychological problems in this population, with implications for their management.     

Patterns of hearing loss and psychiatric morbidity in elderly patients attending a hearing clinic

This study examines the relationship between hearing loss and psychiatric diagnosis in a geriatric population attending a hearing clinic. Major depression was the most frequent psychiatric disorder and was diagnosed in 30% of subjects. A sensorineural type hearing loss was diagnosed in 85% of the depressed subjects. More hearing loss was seen in subjects with onset of depression after age 55 years, in comparison to geriatric patients with depression onset before age 55 years, subjects with other psychiatric disorders and subjects without a psychiatric diagnosis (p <0.001). The audiogram and speech audiometry suggest involvement of auditory nerve and central auditory pathways in late onset depression.     

Characteristics of patients completing referrals from an emergency department to a psychiatric outpatient clinic

Many patients referred from emergency departments for psychiatric outpatient treatment fail to make contact with the facilities to which they have been referred.^1–4 Completion rates in the range of 7.1%–63% have been typically reported.^2,3,5 While diverse explanations such as the method of referral³ and characteristics of facilities¹ have been suggested as determinants of the low completion rate, research has focused largely on demographic characteristics of the patients referred.^3,5,6 For example, patient's sex,^2,5 socioeconomic status,¹ race,⁵ and age^2,3 have been found to relate to the completion of referrals made in the emergency department.While the clinical characteristics of psychiatric emergency department patients have received some attention, studies have focused more on describing these patients^6–9 than on investigating the relationship between their characteristics and successful completion of referrals. Furthermore, studies which have attempted to relate clinical characteristics to completion rates,^2,4,10 along with those focusing on demographic characteristics, have tended to overlook the question of whether patients who failed to complete their referrals to a particular facility actually made contact with some other psychiatric facility.The purposes of the present study are (1) to investigate both the demographic and clinical characteristics of patients who successfully complete referrals from a psychiatric emergency department to a psychiatric outpatient clinic and (2) to determine by means of a thorough follow-up the characteristics of patients who failed to complete the referral but sought treatment elsewhere in the community.     

Olfactory-triggered panic attacks among Cambodian refugees attending a psychiatric clinic

Olfactory panic attacks have not been systematically assessed in a psychiatric population by any previous studies. Among Cambodian refugees attending a psychiatric clinic, the present investigation determines the following: (a) 1-month current prevalence of olfactory-triggered panic attacks, (b) associated psychopathology (Hopkins Symptom Checklist and the Structured Clinical Interview for DSM-IV-diagnosed posttraumatic stress disorder [PTSD]), and (c) frequency in events of olfactory panic of catastrophic cognitions (Panic Attack Cognitions Scale [PACQ]) and flashbacks (Clinician-Administered PTSD flashback scale). Forty-five percent of 100 consecutive psychiatric patients were found to have suffered an olfactory-triggered panic attack in the previous month; having current olfactory panic attacks was highly correlated with psychopathology (e.g., to PTSD diagnosis: and chi(2)=50.0; df=1; p<.001); and during olfactory-triggered panic attacks, catastrophic cognitions and flashbacks were common. Possible mechanisms for generation of high rates of olfactory-triggered panic attacks in this population are discussed (the "traumatic memory/catastrophic cognitions/interoceptive conditioning/escalating arousal" or "TCIE" model of panic generation) as are treatment implications.     

Mortality in patients attending a psychiatric service

This study followed during 10 years 322 Belgian patients aged between 20 and 39 years living in the district of Anderlecht and who had presented themselves for the first time to the psychosocial sector of this district between 1970 and 1973. Fifteen deaths were observed, 10 of which were among the under 30's. The S.M.R. observed (5.27) is similar to the results obtained in other international studies. The survival curves (Kaplan-Meier method) confirm the more considerable excess of mortality during the first years of the follow-up. The decreased sample was matched to a control sample of patients frequenting the centre and compared by the Mac Nemar test. There was very little difference between the two samples. The deceased had however rarely moved house during their follow-up and had accumulated a series of risk factors from the beginning.     

Prevalence of suicidal ideation and other suicide warning signs in veterans attending an urgent care psychiatric clinic

BackgroundSuicide prevention in the clinical setting is focused on evaluating risk in the coming hours to days, yet little is known about which factors increase acute risk.PurposeTo determine the prevalence of factors that may serve as warnings of heightened acute risk.MethodsVeterans attending an urgent care psychiatric clinic (n = 473) completed a survey on suicidal ideation and other acute risk warning signs.ResultsMore than half the sample (52%) reported suicidal ideation during the prior week. Of these, more than one-third (37%) had active ideation which included participants with a current suicide plan (27%) and those who had made preparations to carry out their plan (12%). Other warning signs were also highly prevalent, with the most common being: sleep disturbances (89%), intense anxiety (76%), intense agitation (75%), hopelessness (70%), and desperation (70%). Almost all participants (97%) endorsed at least one warning sign. Participants with depressive syndrome and/or who screened positive for post-traumatic stress disorder endorsed the largest number of warning signs. Those with both depressive syndrome and post-traumatic stress disorder were more likely to endorse intense affective states than those with either disorder alone. All p-values for group comparisons are <.008.ConclusionOur major findings are the strikingly high prevalence of past suicidal ideation, suicide attempts, current suicidal ideation and intense affective states in veterans attending an urgent care psychiatric clinic; and the strong associations between co-occurring post-traumatic stress disorder and depressive syndrome with intense affective states.     

Characteristics of Vietnamese patients attending an anxiety clinic in Australia and perceptions of the wider Vietnamese community about anxiety

This article examined the causes underlying low utilization of mental health services by Vietnamese immigrants in Australia. Study 1 examined cases of Vietnamese patients who had attended an anxiety disorders clinic, while Study 2 surveyed Vietnamese people in the community on their knowledge and attitudes towards common mental problems. Results from Study 1 showed that Vietnamese patients had significantly higher attrition rates, and presented with a larger number of nonanxiety disorders than their Australian-born counterparts. Study 2 results indicated that many Vietnamese people did not differentiate clearly between the terms 'stress', 'anxiety' and 'depression'. Additionally, many participants felt that there was a generally negative cultural attitude towards people suffering from these problems and the mental health system itself. These outcomes suggest the importance of education for ethnic communities regarding available mental health facilities and treatments offered, as well as specific information on mental illness to help remove stigma.     

Enuresis in child psychiatric clinic patients

The clinical profile and the outcome of 386 enuretic children attending a child psychiatric clinic were studied and compared with 2,404 other child psychiatric cases assessed during the same period. The profiles of developmental and family history, psychiatric diagnoses, specific delays in development at assessment, and intelligence resembled each other. The only exceptions were an overrepresentation of delayed developmental milestones in the history and an underrepresentation of neuroses and eating disorders among enuretics.     

Psychosomatic patients in a psychiatric clinic

This study reports lifetime prevalence of certain "psychosomatic disorders" in psychiatric patients in India. The "psychosomatic disorders" studied were peptic ulcer, bronchial asthma, rheumatoid arthritis, ischemic heart disease and irritable bowel syndrome. One percent of psychiatric patients had these psychosomatic illnesses. Ten of the fifteen cases had two psychosomatic illnesses. Patients with psychosomatic disorders were significantly more often older in age (p = 0.003) and from an urban background (p = 0.05) as compared to other psychiatric patients. Depression was the commonest diagnosis, and was significantly (p = 0.01) more often diagnosed in the psychosomatic patients. Psychosis was not diagnosed in patients with psychosomatic disorders. This article emphasizes the need for identifying concomitant psychosomatic problems in psychiatric patients for their appropriate management.     

Panic disorder among Cambodian refugees attending a psychiatric clinic. Prevalence and subtypes

This study surveys Khmer refugees attending two psychiatric clinics to determine both the prevalence of panic disorder as well as panic attack subtypes in those suffering panic disorder. A culturally valid adaptation of the SCID-panic module, the Cambodian Panic Disorder Survey (CPDS), was administered to 89 consecutive Cambodian refugees attending these psychiatric clinics. Utilizing culturally sensitive panic probes, the CPDS provides information regarding both the presence of panic disorder and panic-attack subtypes during the month prior to interview. Of 89 patients surveyed at two psychiatric clinics, 53 (60%) currently suffered panic disorder. Among the 53 patients suffering panic disorder, the most common panic attack subtypes during the previous month were the following: “sore neck” [51% of the 53 panic disorder patients (PDPs)], orthostatic dizziness (49% of PDPs), gastrointestinal distress (26% of PDPs), effort induced (21% of PDPs), olfactory induced (21% of PDPs), and “while-sitting dizziness” (16% of PDPs).     

Panic disorder among Vietnamese refugees attending a psychiatric clinic: prevalence and subtypes

This study surveys Vietnamese refugees attending two psychiatric clinics to determine both the prevalence of panic disorder (PD) as well as panic attack subtypes in those suffering PD. A culturally valid adaptation of the SCID-panic module (the Vietnamese Panic Disorder Survey or VPDS) was administered to 100 Vietnamese refugees attending two psychiatric clinics. Utilizing culturally sensitive panic probes, the VPDS provides information regarding both the presence of PD and panic attack subtypes during the month prior to interview. Of 100 patients surveyed, 50 (50%) currently suffered PD. Among the 50 patients suffering PD, the most common panic attack subtypes during the previous month were the following: “orthostatic dizziness” (74% of the 50 panic disorder patients [PDPs]), headache (50% of PDPs), wind-induced/temperature-shift-induced (24% of PDPs), effort-induced (18% of PDPs), gastro-intestinal (16% of PDPs), micturition-induced (8% of PDPs), out-of-the-blue palpitations (24% of PDPs), and out-of-the-blue shortness of breath (16% of PDPs). Five mechanisms are adduced to account for this high PD prevalence as well as the specific profile of subtypes: 1) a trauma-caused panic attack diathesis; 2) trauma-event cues; 3) ethnic differences in physiology; 4) catastrophic cognitions generated by cultural syndromes; and 5) a modification of Clark’s spiral of panic.     

Prescribing patterns in an outpatient psychiatric clinic

Summary Prescribing patterns were studied in a psychiatric outpatient clinic. Psychiatrists tended to prescribe large quantities of antidepressants or other drugs. In contrast, the daily doses for antidepressants and neuroleptics were often too low. Significant variations were noted between three outpatient clinics in the choices among a various psychotropic drugs from a given therapeutic group.     

Psychological profile of somatizing patients attending the integrative clinic.

OBJECTIVE: A clinic to evaluate and treat referred somatizing patients was established in the medicine clinic of a university medical center. METHOD: Fifty-four patients were evaluated and compared to an age- and sex-matched non-somatizing patient group. RESULTS: Somatizing patients had increased rates of psychiatric and alcohol and substance abuse histories. Somatizing patients scored high on all subscales of the SCL-90 and were most frequently found in the Anxious/Moody Cluster of the MBHI. These patients also endorsed highly beliefs in medical problems as a focus of their lives. CONCLUSIONS: These patients' psychological beliefs set the stage for conflict in the medical setting. The implications of these results are discussed in relation to liaison clinics, early identification, and treatment approaches.     

Demographic and clinical features of patients attending a memory clinic

Basic demographic and clinical features of the first 418 patients assessed at the Maudsley Memory Clinic are reported. Alzheimer's disease was the most frequent diagnosis (57%), followed by a group of patients complaining of memory problems but with no obvious neuropsychiatric diagnosis (24%). The latter were more likely to be younger unmarried self-referred women living alone and with a frequent family history of dementia. The routine use of extensive laboratory investigations in memory clinics is not recommended, considering the meagre number of subjects suffering from reversible conditions identified in our clinic. The Maudsley Memory Clinic has proved to be a popular centre for the assessment and diagnosis of patients with memory complaints and has provided a useful source of subjects for research into memory-associated disorders. The role of memory clinics in the new financial climate in the National Health Service remains to be determined.     

Burnout among relatives of psychiatric patients attending psychoeducational support groups

OBJECTIVE: The effectiveness of family interventions may be improved by concentrating on elements of objective burden that best predict subjective burden. The relationship between subjective burden and objective burden was investigated among caregivers of patients with serious mental illness in the Netherlands who were attending psychoeducational support groups. METHODS: The study used pretest data from an intervention study in which psychoeducational family support groups in the Netherlands were evaluated. A total of 164 participants from 19 psychoeducational groups organized by nine community mental health centers completed the Dutch translation of the Maslach Burnout Inventory and the Involvement Evaluation Questionnaire. Regression analyses were conducted, with elements of subjective burden as dependent variables and elements of objective burden, demographic characteristics, and characteristics of the patient's disorder as predictors. RESULTS: Burden in general and emotional exhaustion were the aspects of subjective burden best predicted by objective burden. In two regression models, objective burden together with the other predictors explained 57 percent and 54 percent of the variance in subjective burden. Two aspects of objective burden-strain on the relationship with the patient and ability to cope with the patient's behavior-were related to almost all the investigated aspects of subjective burden. CONCLUSIONS: Strong evidence was found for the relationship between objective and subjective burden and for the hypothesis that particular elements of objective burden contribute more to subjective burden than others. The findings suggest that psychoeducation should concentrate on helping relatives cope with the strain on the relationship with the patient and on improving their ability to cope with the patient's behavior.