Using telephone prompts to improve initial attendance at a community mental health center

Contacting patients by telephone before their appointment has been shown to increase clinic attendance in various settings. However, no such studies have been conducted in New Zealand, which has a unique mix of publicly funded secondary care and largely privately funded primary care. A controlled prospective study of telephone prompting was carried out in a New Zealand publicly funded community mental health center. One group of 190 patients was phoned the day before their initial appointment, and their attendance rate was compared with that of 496 patients not phoned. Ninety-six percent of the patients who were successfully contacted kept their appointment, compared with 76 percent of those not contacted.     

Chronic psychiatric patients without psychiatric care: a pilot study

  Background: The study is based on the hypothesis that in any catchment area there are patients with chronic mental illness who are unknown to a comprehensive psychiatric/psychosocial care system. Method: A standardized questionnaire was sent to all general practitioners in a circumscribed catchment area in southwestern Germany in an attempt to identify such a group, to ascertain what the practitioners considered to be the needs of these patients, and to find out why the patients were not receiving specialized psychiatric care. Results: Of 97 general practitioners contacted, 62 returned the questionnaire. Within a study period of 3 months, 89 patients were identified as having a significant psychiatric disorder, of whom 53% were older than 60 years and 15% were schizophrenic. General practitioners most frequently said that provision of specialized psychiatric care was the most pressing need of these patients, followed by a need for psychosocial services. They also said that the major reason patients did not participate in the mental health system was patient refusal of such services. Conclusions: Having identified the existence of a group of chronic psychiatric patients who are not receiving specialized psychiatric care, further in-depth field studies to pursue some of the issues raised in this pilot study will be necessary to determine whether further efforts to reach psychiatric patients without defined psychiatric care would be worthwhile. These issues include estimates of the prevalence of such patients in a defined population, patients' more specific reasons for refusal of psychiatric care, and the quality of psychiatric care they receive from general practitioners in comparison with patients who receive more conventional psychiatric care. Accepted: 12 May 2000     

Predicting assaultiveness in psychiatric inpatients: a pilot study

A sample of 87 psychiatric inpatients known to have been assaultive while in the hospital was contrasted with a matched group of nonviolent patients to identify the personal risk factors that distinguished the two groups. Data were collected using a personal history interview, a neurological examination, and an electroencephalogram. The four risk factors identified--neurological abnormality, history of violent crime, history of violent suicide attempts, and deviant family environment in childhood--were used to develop a statistical model predicting which subjects in a sample of newly admitted patients would become assaultive during the first three months after admission. The predicted classification of patients was found to be significantly related to subsequent assaultive behavior.     

Auricular acupuncture in prison psychiatric units: a pilot study

OBJECTIVE: The study explores whether auricular acupuncture can be a viable treatment form for inmates in prison psychiatric units. METHOD: Inmates in a prison psychiatric unit and in a support unit for violent behavior were offered group treatment with auricular acupuncture three times a week over a period of 9 months. Another prison psychiatric unit served as a control group. RESULTS: Twenty-two inmates received treatment, and 11 inmates received treatment for over 8 weeks. Cortisol levels were higher for inmates in the support unit than for the other two groups. Inmates treated at least 25 times were prescribed fewer psycholeptic drugs than controls. Perceived autonomy increased for treated inmates in the psychiatric unit. Inmates treated for over 8 weeks experienced improved inner harmony and calm and better clarity over future plans. CONCLUSION: Acupuncture is a non-verbal form of treatment appropriate for prison psychiatric units. The treatment facilitates contact and complements other psycho-social treatment forms.     

Which veterans go to VA psychiatric hospitals for care: a pilot study

In a study to determine whether certain factors could predict whether veterans seek psychiatric care at a Veterans Administration psychiatric hospital or at other public hospitals, data were collected on 644 visits by veterans to one VA psychiatric hospital and two non-VA public hospitals. Race, alcoholism, number of presenting problems, kind of prior psychiatric hospitalizations, and whether the disability was service-connected were significant factors in distinguishing veterans seeking psychiatric care at the different hospitals. Age, marital status, income, and transiency were not important factors. Minority status and alcoholism appeared to be independent of each other in predicting greater use of the VA hospital.     

Community leader education to increase epilepsy attendance at clinics in Epworth, Zimbabwe

OBJECTIVE: To determine whether educating community leaders about epilepsy would lead to an increase in epilepsy cases being diagnosed and treated at primary health centers. METHODS: This was a single-arm cohort study performed in Epworth, a periurban township outside Harare, Zimbabwe. The subjects were Epworth community leaders (Local Board members, teachers, nurses, police officers, traditional healers, prophets). Educational workshops were given on epilepsy, its cause, and its management, and the number of new epilepsy cases on local primary health clinic registers 6 months after the workshops was measured. RESULTS: Six new cases were recorded, all among patients previously diagnosed with epilepsy. This was a significant increase (p = 0.02) compared with the null hypothesis. CONCLUSION: Although there was a significant increase in new cases, these did not represent newly diagnosed patients. Significant prejudice within the community may still prevent identified patients with epilepsy from seeking treatment. Alternative methods must be sought to increase the awareness of epilepsy within low-income communities and to reach "hidden" people with epilepsy.     

Using aripiprazole to resolve antipsychotic-induced symptomatic hyperprolactinemia: a pilot study

OBJECTIVE: To assess the effectiveness of substituting aripiprazole for other antipsychotic drugs taken by stable schizophrenic patients suffering from antipsychotic agent-induced symptomatic hyperprolactinemia. METHODS: Seven female schizophrenic patients with symptomatic hyperprolactinemia (167.6+/-58.0 microg/L) were recruited to take part in an 8-week open label trial of aripiprazole (10-20 mg/day) as a replacement for amisulpride or risperidone. Efficacy was assessed via PANSS and CGI-I scores. Serum prolactin levels were measured at baseline, week 4, and week 8. Data were collected from November, 2004 to May, 2005. RESULTS: At the end of weeks 4, serum prolactin levels were normalized (8.8+/-5.5 microg/L) and hyperprolactinemic symptoms were resolved in all patients. However, aripiprazole treatment was discontinued within 6 weeks for 2 of the 7 subjects due to aggravated auditory hallucinations. CONCLUSION: Results from this admittedly small-scale open-label study indicate that switching to aripiprazole may be useful for resolving antipsychotic-induced hyperprolactinemia and associated symptoms.     

Attitude towards psychiatric patients: a pilot study in a northern Italian town

The stigmatisation of the psychiatric patient is still a strong barrier to the integration process of these subjects in our society. Therefore, it is necessary to identify what types of prejudices exist and the types of variables with which they are linked, in order to plan strategies to reduce them. In this exploratory study we administered a semi-structured interview to 303 subjects in order to examine the relationships between social attitudes towards mental disorders and some social demographic variables, the information about mental disorders and the previous 'contacts' with psychiatric patients. The data analysis shows that there is a relationship between knowledge of psychiatric patients and a more positive attitude towards them (i.e., less fear, more integration and work opportunities). This study is to be considered preliminary as far as people's attitudes towards psychiatric patients are concerned. This result encourages the planning and implementation of sensitisation and information programs concerning mental disorders, in the sense that increasing the knowledge of mental disorders could lead to significant achievements in the important fight against the stigma surrounding psychiatric patients.     

Hemodialysis in schizophrenia: psychiatric aspects of treatment failure in a pilot study

In order to examine the reported curative effects of hemodialysis in patients with chronic schizophrenia a pilot study approved by the Committee of Ethics at the University of Lund was initiated in September 1977. 13 patients, 10 men and 3 women, 21--44 years old, were treated. All but one were diagnosed as chronic schizophrenia. The duration of illness was 4--20 years. All the patients functioned defectively psychosocially, and conventional therapy had failed. Our goal was to give at least one dialysis treatment a week during 13 weeks. 10 patients completed the treatment series. The patients were scored according to the Brief Psychiatric Rating Scale and the Rockland and Pollin scale before, during and after the treatment. Conventional therapy was given throughout. Analysis of hemofiltrates for endorphins did not reveal any abnormal levels. 1 patient reported a distinct and hitherto lasting improvement. Marginal and temporary improvements were noted in 3 patients. Therefore placebo effects or spontaneous remission seemed probable. The ratings showed no significant changes in any patient during the treatment period. All patients including those who showed improvement remained seriously incapacitated by their psychiatric illness. Different psychiatric aspects of our failure to reproduce the American findings including cultural discrepancies in diagnostic criteria are discussed.     

The pilot study of a telephone disease management program for depression

Most depressed patients are seen and treated exclusively by primary care clinicians. However, primary care patients with depression are often not adequately treated. The aims of this pilot study were to measure the impact of a telephone disease management program on patient outcome and clinician adherence to practice guidelines, measure the relationship of clinician adherence to patient outcome, and explore the measurement of patient adherence to clinician recommendations and its impact on patient outcomes. Thirty-five primary care practices in the University of Pennsylvania Health System were randomized to telephone disease management (TDM) or "usual care" (UC). All patients received a baseline and a 16-week follow-up clinical evaluation performed over the telephone. Those from TDM practices also received follow-up contact at least every 3 weeks, with formal evaluations at weeks 6 and 12. These interval contacts were designed to facilitate patient and clinician adherence to a treatment algorithm based on the Agency for Health Research and Quality (AHRQ) practice guidelines. Depressive symptoms evaluated with the Community Epidemiologic Survey of Depression (CES-D) scale as well as guideline adherence were the primary outcome measures. Sixty-one patients were enrolled in this pilot project. The overall effect for CES-D scores over time was significant, (P <.001), indicating that those participating in the trial (both TDM and UC groups) showed significant improvement. The interaction between intervention condition and time was also significant (P <.05), indicating that TDM patients improved significantly more over time than did UC patients. A greater proportion of TDM patients had CES-D scores <16 by Week 16 (66.7 versus 33.3%; chi(2), P <.05). The improvement in depression outcome for the TDM group was related to its impact on improving clinician adherence to depression treatment algorithms. The TDM pilot did not show a statistically significant effect on improving patient adherence to clinician recommendations, however. This preliminary data suggests that TDM for depression improves both clinician guideline adherence and patient outcomes in the acute phase of depression. The effect on patient outcome is at least partially explained by the effect of TDM on clinician adherence to depression treatment algorithms.     

Primary care patients in psychiatric clinical trials: a pilot study using videoconferencing

Background  

While primary care physicians play a pivotal role in the treatment of depression, collaboration between primary care and psychiatry in clinical research has been limited. Primary care settings provide unique opportunities to improve the methodology of psychiatric clinical trials, by providing more generalizable and less treatment-resistant patients. We examined the feasibility of identifying, recruiting, screening and assessing primary care patients for psychiatric clinical trials using high-quality videoconferencing in a mock clinical trial.     

Perceived vulnerability to AIDS among rural Black South African children: a pilot study

The aim of the study was to examine Black primary school age children's perception of vulnerability to AIDS in rural South Africa. Data were collected from 100 children chosen by two-stage cluster sampling in a rural community in the central region of the Northern Province, in the age range between 6–11 years: ages 6–8, 45 (23 boys and 22 girls) and ages 9–11, 55 (24 boys and 31 girls). Results indicate that a minority of children (30%) overall felt that anyone can get AIDS and that they themselves (17%) can get AIDS. When asked to identify who gets AIDS, most children believed that people with specific group membership such as sick people, homosexuals or strangers get AIDS, and especially older children associated behaviours or actions such as multiple partners or unsafe sex with getting AIDS. When the children were asked why they could get AIDS most, especially older, children excluded themselves as vulnerable to contracting AIDS due to avoiding risky behaviour and group membership. However, some, especially younger, children included themselves as vulnerable to contracting AIDS. Fear of possibly having AIDS was equally prevalent across the different age groups but it was more prevalent in girls than boys, especially in the older age group, yet few children in the younger age group thought they had AIDS. Almost a third (30%) worried about getting AIDS and even more (40%) thought they will get AIDS. There were important age- and gender-related differences regarding vulnerability and fears about AIDS, which have relevant implications for AIDS education addressing developmentally appropriate concerns.     

Misophonia and comorbid psychiatric symptoms: a preliminary study of clinical findings

Abstract

Objective: Misophonia is a neurophysiological disorder, phenotypically characterized by heightened autonomic nervous system arousal which is accompanied by a high magnitude of emotional reactivity to repetitive and pattern-based auditory stimuli. This study identifies the prevalence of psychiatric symptoms in misophonia sufferers, the association between severity of misophonia and psychiatric symptoms, and the association between misophonia severity and gender.

Methods: Fifty-two misophonia sufferers, 30 females (mean age?=?40.93 ± 15.29) and 22 males (mean age?=?51.18 ± 15.91) were recruited in our study and they were diagnosed according the criteria proposed by Schröder et al. The participants were evaluated by the A-MISO-S for the severity of misophonia and the MINI to assess the presence of psychiatric symptoms.

Results: The most common comorbid symptoms reported by the misophonia patients were respectively PTSD (N?=?8, 15.38%), OCD (N?=?6, 11.53%), MDD (N?=?5, 9.61%), and anorexia (N?=?5, 9.61%). Misophonia severity was associated with the symptoms of MDD, OCD, and PTSD as well as anorexia. There was an indication of a significant difference between men and women in the severity of misophonic symptoms.

Conclusion: Our findings highlight the importance of recognizing psychiatric comorbidity among misophonia sufferers. The presence of these varying psychiatric disorders’ features in individuals with misophonia suggests that while misophonia has unique clinical characteristics with an underlying neurophysiological mechanism, may be associated with psychiatric symptoms. Therefore, when assessing individuals with misophonia symptoms, it is important to screen for psychiatric symptoms. This will assist researchers and clinicians to better understand the nature of the symptoms and how they may be interacting and ultimately allocating the most effective therapeutic strategies.     

Non-compliance in community psychiatry: Failed appointments in the referral system to psychiatric outpatient treatment

Knowledge about the drop-out pattern of psychiatric patients in the referral phase for outpatient treatment is limited. The aim of the present study was to investigate the importance of selected psychiatric, demographic and administrative parameters in this matter. In a newly opened community psychiatric unit with an open referral system, available relevant data concerning the referred patients were gathered over a 6-month period. Of the 137 patients included in the study, 32% did not show up for their first appointment. On making further attempts to contact the patients, the drop-out frequency dropped to 16%, demonstrating that it is worthwhile offering new appointments to the patients who do not show up. There was no demonstrable relation between the time the patients had waited for the first appointment with a psychiatrist and the drop-out frequency. For patients who had been referred with a diagnosis of psychosis (F 20-29, WHO criteria), or addiction, or had been previously admitted to psychiatric hospital, there was a significant increase in the drop-out rate.