Is consultation at the psychiatric outpatient clinic a useful service for patients and their doctors?

The aim of this retrospective study was to examine the views of patients and general practitioners on consultation after referral to a psychiatric outpatient clinic. Consultation was defined as less than five sessions. One hundred and sixty patients who had consultations at a mean of 42 months before were invited to the study. Ninety-one took part, and they filled in a questionnaire on their views and Symptom Checklist 90-R. Thirty-eight (79%) of 48 GPs gave their opinions on a questionnaire of 128 (80%) written feedbacks from the 160 consultations. The patient and the GP questionnaires showed good psychometric properties. Fifty-one (56%) patients considered the help received at the psychiatric outpatient clinic as good or very good. In 73 (57%) of the cases, the GPs found the consultations helpful. At follow-up, the patients had a significantly reduced mental symptom load. Going to work and living with a spouse were characteristics of patients satisfied with the consultation. Administrative variables did not influence satisfaction. A clear focus and emphasis on patient information as to the nature and treatment opportunities of the mental disorders seems to be a cheap and relevant way of improving patients' satisfaction with consultations. The patients were least satisfied with consultation given by psychiatric nurses. In conclusion, there is need for improvement, but consultations should continue as an important part of the psychiatric service for primary care.     

The influence of coercive measures on patients’ stances towards psychiatric institutions

Objective: To examine the impact of coercive interventions (CI) on patients’ evaluations of psychiatric hospitals as adversaries versus allies.

Methods: Self-constructed interviews were conducted relating to quantitative and subjective aspects of coercion and the attitude towards psychiatry of 79 patients with psychotic and bipolar disorders. The Coercion Experience Scale (CES) and the Admission Experience Survey (AES) were used to establish the subjective impact of CI. Instruments measuring psychopathological symptoms and the Global Assessment of Functioning (GAF) were applied alongside the Schedule for the Assessment of Illness (SAI) and the Beck Cognitive Insight Scale (BCIS). Using a logistic regression approach, considered influencing factors such as number, type and patients’ subjective experiences of CI, cognitive and clinical insight, psychopathological symptoms and patients' global perceptions of their hospitalisation were analysed for their predictive value of patients’ attitudes towards psychiatry.

Results: Binary logistic regression revealed that the subjective experience of CI and the perception of fairness and effectiveness during the treatment process predict patients’ attitudes towards psychiatry to a greater extent than symptom-related measures or the quantity of CI. Patients presenting a higher degree of self-reflectiveness perceive psychiatric institutions more likely as allies.

Conclusions: The manner in which coercion is subjectively experienced has direct influence on patients’ perceptions of psychiatry.     

Frequency,type and factors associated with the use of complementary and alternative medicine in patients with Parkinson’s disease at a neurological outpatient clinic

BackgroundComplementary and alternative medicine (CAM) is described as a set of healthcare and medical practices not currently part of conventional western medicine. In this study, we aimed to investigate the frequency, type and factors associated with the use of CAM in Parkinson’s disease (PD) patients at a neurological outpatient clinic.MethodAll PD patients at the outpatient clinic (N = 421) received a postal questionnaire covering ten types of CAM plus an open alternative labelled ‘other type’, their possible effect, and socio-demographic, health and disease-related factors.Results325/403 (81%) eligible patients responded comprising 172 men and 153 women, median age 74 years for both genders. CAM use was reported by (M/F) 51/59 patients (30/39%); 31/33 patients (18/22%) taking CAM drugs and 48/57 (28/37%) using CAM methods with acupuncture having the highest frequency. Significant differences between CAM users and non-users were found with regard to educational level, perceived health and levodopa load. More females than males used CAM, but the difference was not significant. The majority of CAM users perceived ‘No improvement‘ or ‘Some improvement’. Twenty percent of users reported that they had spent the equivalent of 50 € on CAM during the last 6 months.ConclusionCAM use is rather common among PD outpatients, with one in three having experience of CAM practices. Badly-perceived health and higher education were factors significantly associated with CAM utilization. A trend for more female CAM users was also seen.     

The Quimperlé mood clinic, boosting the health and quality of life of bipolar patients

The Quimperlé mood clinic constitutes a new "gateway" in terms of care based on a spirit of collaboration. Several workshops, all related to each other, are offered. Neuropsychological assessment contribute to the patient care. Multi-disciplinary work is essential to enable the unit to operate.     

Impact of psychiatric symptoms and sleep disorders on the quality of life of patients with Parkinson’s disease

The objective of this study is to assess how the non-motor symptoms of Parkinson’s disease (PD), such as depression, cognitive deterioration, neuropsychiatric and sleep disorders, affect the quality of life, and to compare them with the motor symptoms in order to determine their real impact. A cross-sectional study was designed including 99 patients (mean age 68.5 ± 9.9 years, duration of disease 8.7 ± 6.2 years). Demographic data, onset of PD, years on treatment with levodopa (LD), class of dopaminergic drug prescribed, and dosages were obtained. The following scales were used: quality of life (PDQ-39), Unified Parkinson’s Disease Rating Scale (UPDRS I–IV), Parkinson Disease Sleep Scale (PDSS) and daytime sleepiness (Epworth), Mini-Mental State Examination, depression (HAM-D), and the neuropsychiatric inventory (NPI-10). The PDQ-39 summary index (PDQ-39 SI) was 24.7 ± 13.2. A linear regression model including all variables showed that four independent variables accounted for 67.2% of the variance in the PDQ-39 SI (F = 33,277; p < 0.001): NPI, PDSS, UPDRS IV, and UPDRS I. When sub-items of the NPI, PDSS and UPDRS IV scales are analyzed, significant correlations (p < 0.001) are found between the PDQ-39 SI and depression, agitation, apathy, anxiety, hallucinations, delusions, incontinence of urine, morning painful posturing, restlessness in bed, morning fatigue, duration of off periods, unpredictable and predictable off periods, early morning dystonia, and sudden off periods. Neuropsychiatric symptoms, especially depression, nighttime sleep disorders such as urinary incontinence, nighttime restlessness, morning fatigue and somnolence, off-period dystonia and motor fluctuations are the variables that most affect the quality of life of patients with PD.     

Involuntary psychiatric admission: The referring general practitioners’ assessment of patients’ dangerousness and need for psychiatric hospital treatment

Abstract

Background: In Norway, GPs may decide to refer patients to involuntary psychiatric treatment. Internationally, there has been a discussion regarding criteria for involuntary admission. In Norway and in other countries where the treatment criterion is still used, some have suggested its removal. Aims: To examine which legal criteria GPs used to refer patients to involuntary admission, whether they had thought about using a different criterion, and on which information they based their decision. Methods: A total of 74 doctors who had referred patients to involuntary admission at one major Norwegian psychiatric hospital participated in semi-structured interviews. Results: In total, 38% (28) had applied the danger criterion only and 23% (17) had applied the treatment criterion only; 32% (24) had applied both criteria, while 7% (5) did not answer this question; 74% (55) said that they could not have chosen a different criterion; 45% (33) had based their decision on events/behaviour prior to and during the consultation, 43% (32) on events prior to the consultation only, and 8% (6) on information obtained during the consultation only; 4% (3) did not answer this question. None had used tools to aid in the assessment of danger. Clinical implications: The danger criterion was frequently used by the referring GPs. It is unclear how a removal of the treatment criterion from Norwegian legislation might impact clinical practice. Conclusions: While the danger criterion was applied by a majority, the treatment criterion was also chosen by many and was of importance to the doctors’ reasoning regarding referrals to involuntary admission. Most thought they could not have chosen a different criterion.     

The influence of state mental health perceptions and spending on an individual’s use of mental health services

Purpose

To explore the possible contextual effects of state-level mental health perceptions and public spending for mental health treatment on an individual’s use of mental health services, independent of the individual’s own perceptions.

Methods

Cross-sectional data from the 2007 Behavioral Risk Factor Surveillance System were used. A total of 216,514 participants from 35 states and the District of Columbia were included in the study. Logistic regression and multilevel modeling were used to estimate the effects of individual-level characteristics and three state-level factors—per capita spending on community mental health services, aggregated perceptions of the effectiveness of mental health treatment and the stigma of mental illness—on the individual’s current use of mental health services.

Results

Adjusting for the individual’s perceptions and characteristics, state-level perception of treatment effectiveness was positively associated with the use of mental health services [odds ratio (OR) for 5 % increase in the percentage perceiving effectiveness = 1.08; 95 % confidence interval (CI): 1.01, 1.16]. This association was strongest for individuals who experienced 1–4 days of mental distress in the past 30 days (OR = 1.17; 95 % CI 1.06, 1.29). State-level public spending on community mental health services was also positively associated with an individual’s use of mental health services (OR for a $40 increase in spending = 1.09; 95 % CI 1.01, 1.17); however, state-level perceptions of mental-illness stigma was not.

Conclusions

Our findings suggest there may be contextual effects of state-level perceptions of treatment effectiveness and state spending on community mental health services on the use of mental health services.     

The influence of methylphenidate on the power spectrum of ADHD children – an MEG study

Background

The present study was dedicated to investigate the influence of Methylphenidate (MPH) on cortical processing of children who were diagnosed with different subtypes of Attention Deficit Hyperactivity Disorder (ADHD). As all of the previous studies investigating power differences in different frequency bands have been using EEG, mostly with a relatively small number of electrodes our aim was to obtain new aspects using high density magnetoencephalography (MEG).

Methods

35 children (6 female, 29 male) participated in this study. Mean age was 11.7 years (± 1.92 years). 17 children were diagnosed of having an Attention-Deficit/Hyperactivity Disorder of the combined type (ADHDcom, DSM IV code 314.01); the other 18 were diagnosed for ADHD of the predominantly inattentive type (ADHDin, DSM IV code 314.0). We measured the MEG during a 5 minute resting period with a 148-channel magnetometer system (MAGNES? 2500 WH, 4D Neuroimaging, San Diego, USA). Power values were averaged for 5 bands: Delta (D, 1.5–3.5 Hz), Theta (T, 3.5–7.5 Hz), Alpha (A, 7.5–12.5 Hz), Beta (B, 12.5–25 Hz) and Global (GL, 1.5–25 Hz).). Additionally, attention was measured behaviourally using the D2 test of attention with and without medication.

Results

The global power of the frequency band from 1.5 to 25 Hz increased with MPH. Relative Theta was found to be higher in the left hemisphere after administration of MPH than before. A positive correlation was found between D2 test improvement and MPH-induced power changes in the Theta band over the left frontal region. A linear regression was computed and confirmed that the larger the improvement in D2 test performance, the larger the increase in Theta after MPH application.

Conclusion

Main effects induced by medication were found in frontal regions. Theta band activity increased over the left hemisphere after MPH application. This finding contradicts EEG results of several groups who found lower levels of Theta power after MPH application. As relative Theta correlates with D2 test improvement we conclude that MEG provide complementary and therefore important new insights to ADHD.     

Perception of patients’ unpredictability and beliefs on the causes and consequences of schizophrenia

Abstract.Background: The belief that mental disorders involve a high risk of unpredictable behaviours is a factor which influences negatively the social acceptance of the mentally ill. In this paper, we compare the beliefs about the causes and psychosocial consequences of schizophrenia expressed by 536 respondents who had the firm conviction that patients with schizophrenia are unpredictable and by 457 respondents who firmly believed that they are not.Methods: The survey was conducted in 30 Italian geographic areas, randomly selected taking into account their location and population density. The data were collected by the Questionnaire about Opinions on Mental Illness (QO).Results: Respondents who believed that patients with schizophrenia are unpredictable reported more frequently factors such as use of alcohol and drugs and frequenting bad company as being involved in the development of the disorder. In addition, this group showed more restrictive opinions about patients civil and affective rights. Low education was found to be significantly associated with perception of unpredictability in schizophrenia.Conclusions: These results suggest the need to: a) inform the general public on the main clinical characteristics of schizophrenia and on the risk of unpredictable behaviours in the acute phases of this mental disorder; b) carry out sensitisation campaigns against discrimination toward people with schizophrenia emphasising successful experiences of social integration.     

The influence of acetylcholine,dopamine, and GABA on the functioning of the corticostriatal neuronal network in Alzheimer’s and Parkinson’s diseases: A hypothetical mechanism

A proposed model of the functioning of the basal ganglia complements the existing opinions about the complex interaction between cholinergic and dopaminergic systems. A hypothesis is proposed that one of the means of interaction between these systems is the operation of a negative feedback loop. In this loop, a conditioned stimulus evokes the excitation of dopaminergic neurons and GABAergic cells with long axons in the dopaminergic nuclei, which leads to an increase in the influence on dopamine D2 receptors on striatal cholinergic interneurons; an increase in their inhibition can lead to a pause in their responses. In turn, during this pause reduced action on presynaptic nicotinic receptors at axon terminals of dopaminergic neurons results in a decrease in dopamine release. In addition, dopaminergic neurons are under the inhibitory action of GABAergic striatonigral cells in the striosomes of the dorsal striatum and clusters in the ventral striatum. During the pause, stimulation of M2/M4 receptors located on these striatonigral cells weakens, which should promote potentiation of their excitation, subsequent enhancement of the inhibition of dopaminergic cells, and a decrease in the dopamine concentration in the striatum. In addition, a decrease in the stimulation of M1 receptors on striatopallidal cells and M2 receptors on striatonigral cells of the matrix during the pause should promote synergistic disinhibition through the direct and indirect pathways via the basal ganglia of certain groups of thalamic neurons and enhancement of the excitation of neocortical neurons connected with them. This interaction between cholinergic and dopaminergic systems contributes to the normal functioning of the various parallel cortico–basal ganglia–thalamocortical loops, which play a determining role in movement choice, sensory perception, learning, and intentional behavior. The proposed model implies that cholinergic and dopaminergic denervation of different structures, as well as changes in the density and affinity of receptors that are sensitive to acetylcholine, dopamine, and NMDA, which are typical for Alzheimer’s and Parkinson’s diseases, should lead to abnormal functioning of these loops. This may underlie various cognitive and motor disorders.     

The influence of stigma on young people’s help-seeking intentions and beliefs about the helpfulness of various sources of help

Purpose  

In this study, we examined whether young people’s help-seeking intentions and beliefs about the helpfulness of various sources of help are influenced by their own, and their parents’ stigmatising attitudes towards young people with mental disorders.     

The influence of socio-economic conditions on the prevalence of depressive symptoms and its covariates in an elderly population with slight income differences: the Bambuí Health and Aging Study (BHAS)

BACKGROUND: The influence of socio-economic conditions on covariates of depression has received little attention. AIMS: Examine whether prevalence and covariates of depressive symptoms are affected by socio-economic circumstances. METHODS: Participants were 1,499 (86%) residents in Bambuí city, Brazil, aged ->- 60 years. Depressive symptoms were assessed by the GHQ-12 questionnaire and exploratory variables included demographic characteristics, life events, social support, health conditions and health service use. The analysis was stratified by family income (< US$240.00 [lowest tertile] vs. ->- US$240.00). RESULTS: The prevalence of depressive symptoms was higher in those with lower income (43.9%) in comparison with the better off (27.7%). Dissatisfaction with relationships, worse self-rated health and insomnia were independently associated with depressive symptoms in both income groups (OR from 2.00 to 4.74; p < 0.05). Depressive symptoms were associated with number of chronic diseases, functional disability and hospitalizations among the poorer (OR from 1.73 to 2.37; p < 0.05), while old age (OR 2.08) and female gender (OR 2.03) were associated with depressive symptoms among the better off. CONCLUSION: This study provides evidence that the prevalence of depressive symptoms and their covariates are influenced by socio-economic conditions in a population with slight income differences.     

Influence of bilateral Stn-stimulation on psychiatric symptoms and psychosocial functioning in patients with Parkinson’s disease

Summary. Deep brain stimulation of the subthalamic nucleus is an effective treatment for advanced Parkinson’s disease. There is some evidence that subthalamic stimulation not only affects motor function, but also mood, behaviour and cognition. In the present study we investigated the effects of subthalamic stimulation on psychiatric symptoms and psychosocial functioning in a consecutive series of patients with Parkinson’s disease. 33 patients were assessed three times prior to surgery and at three, nine weeks as well as three, six and twelve months after surgery. We found significant improvements in depression, anxiety, psychological symptoms and distress after surgery. In most cases the amelioration followed surgery and was stable in the course of time. Individual analysis indicated deterioration in three patients despite motor improvement. The results suggest that stimulation of the subthalamic nucleus has a positive influence on psychiatric symptoms, psychosocial functioning and distress. We observed a decline in a minority of patients.     

The influence of visual and auditory information on the perception of speech and non‐speech oral movements in patients with left hemisphere lesions

Patients with lesions of the left hemisphere often suffer from oral‐facial apraxia, apraxia of speech, and aphasia. In these patients, visual features often play a critical role in speech and language therapy, when pictured lip shapes or the therapist's visible mouth movements are used to facilitate speech production and articulation. This demands audiovisual processing both in speech and language treatment and in the diagnosis of oral‐facial apraxia. The purpose of this study was to investigate differences in audiovisual perception of speech as compared to non‐speech oral gestures. Bimodal and unimodal speech and non‐speech items were used and additionally discordant stimuli constructed, which were presented for imitation. This study examined a group of healthy volunteers and a group of patients with lesions of the left hemisphere. Patients made substantially more errors than controls, but the factors influencing imitation accuracy were more or less the same in both groups. Error analyses in both groups suggested different types of representations for speech as compared to the non‐speech domain, with speech having a stronger weight on the auditory modality and non‐speech processing on the visual modality. Additionally, this study was able to show that the McGurk effect is not limited to speech.     

Comparative analysis of EEG and CT findings in the material of neurosurgery division and neurosurgery outpatient clinic at provincial hospital in Włocławek

Eighty inpatients undergoing neurosurgical treatment selected at random were analysed on the basis of diagnostic examinations EEG and CT. Thirty patients (37.5%) were isolated from the material who had one or more EEG and CT examinations. The material comprised patients with past craniocerebral trauma. Routine EEG records were compared with CT findings. The correlation was analysed between CT and EEG results. In most cases a close correlation was found between the localization of CT and EEG changes. In a lower number of cases divergence was found between the hemispheres or brain areas indicated by these methods. A comparability was noted of clinical examination results, CT and EEG in the assessment of late consequences of trauma, and their comparability in early period after trauma.