Search Results (74)

Background: The rising rate of referrals to outpatient psychiatry is difficult to manage. To explore intake and pre-assessment strategies to reduce strain related to the high volume of referrals, two intake tools and two caregiver symptom rating tools were trialled in a child and adolescent outpatient mental health clinic in Ontario, Canada. Methods: Intake personnel completed two tools in addition to the routine intake procedure in a feasibility study. Caregivers completed two symptom-rating tools, and feedback on the use of the tools was sought with a survey. Results: There were statistically significant differences between priority groups (i.e., determination as usual with high, medium, or low priority) on both intake tools, but no statistically significant differences between either caregiver rating tool were found. Conclusions: Standardizing the assessment process may facilitate care. Caregiver ratings did not align with triage priorities; however, these ratings may inform clinical assessments. Full article

Background and Objectives: This study aimed to estimate the prevalence of documented borderline personality disorder (BPD) diagnosis and study-defined BPD indicators among adults with depressive disorders in outpatient psychiatric care, and to quantify a subgroup who were indicator-positive but had no documented diagnosis (potential under-recognition). Materials and Methods: This retrospective, cross-sectional study included adult outpatients with depressive disorders receiving pharmacological treatment at Maharaj Nakorn Chiang Mai Hospital. BPD status was classified using (1) a documented BPD diagnosis in the electronic medical record (EMR) and (2) study-defined indicators, comprising a symptom-based indicator (documentation of ≥5 DSM-5 BPD criteria) and a prescribing-based indicator (antidepressant treatment with concurrent use of antipsychotics and/or mood stabilizers). Prevalence and overlap across diagnoses and indicators were summarized using a Venn distribution. Results: Among 1175 patients, 63 (5.4%) had a documented BPD diagnosis. Using EMR indicators, 84 (7.1%) met the symptom-based indicator and 325 (27.7%) met the prescribing-based indicator. In total, 374 (31.8%) had either a documented BPD diagnosis or at least one indicator, while 801 (68.2%) had neither. Overall, 370 (31.5%) met at least one indicator (symptom-based and/or prescribing-based). Among indicator-positive patients, 311 (84.1%) had no documented BPD diagnosis, representing 26.5% (311/1175) of the total cohort. Conclusions: Study-defined EMR indicators flagged a substantial subgroup with potential under-recognition of BPD features in depressive-disorder clinics. These indicators may help prioritize targeted assessment and structured diagnostic evaluation to support access to BPD-informed care and support referral to BPD-informed psychotherapy. Full article

Background/Objectives: Limited data exist on care delivery, engagement, and clinical outcomes among rural populations accessing telehealth mental health services, particularly within integrated psychotherapy-and-psychiatry models. This retrospective observational 12-week cohort study aimed to examine access, engagement, and preliminary clinical outcomes for rural and non-rural patients receiving services through a national outpatient telehealth mental health program. Engagement and clinical outcomes were expected to be comparable among rural and non-rural patients. Methods: Descriptive and inferential analyses were conducted to examine access to care, engagement, and changes in depressive symptoms, anxiety symptoms, and suicidal ideation among rural and non-rural patients receiving telehealth mental health services over a 12-week treatment period. Clinical outcomes were evaluated using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7). The full sample included 8354 rural and 177,864 non-rural patients and was used to assess access and engagement in treatment. A clinical sample (rural n = 2096; non-rural n = 43,067) that included patients who completed 12 weeks of care was further examined to assess symptom improvement outcomes. Results: Rural patients demonstrated greater baseline symptom severity and medical complexity relative to non-rural patients. Mean time to first appointment was 5.2 days among rural patients and 5.5 days among non-rural patients, with comparable engagement across groups and rural patients averaging approximately 1–2 touch points per week in care. Patient satisfaction ratings averaged 4.9 out of 5. Within the clinical sample, rural patients demonstrated clinically meaningful symptom improvement across depression and anxiety outcomes. Mean PHQ-9 scores improved by 7.0 points (95% CI: 6.72–7.28), and mean GAD-7 scores improved by 6.1 points (95% CI: 5.83–6.37). Additionally, 70.5% of rural patients achieved a minimal clinically important difference in PHQ-9 or GAD-7 scores, and 66.7% of patients reporting suicidal ideation at baseline no longer endorsed suicidal ideation at endline. Conclusions: These findings support the feasibility and preliminary effectiveness of large-scale virtual mental health care models for rural populations. Rural patients demonstrated engagement and clinical outcomes comparable to non-rural patients despite greater baseline severity and medical complexity. Full article

Pediatric psychiatric emergency department (ED) visits have increased globally, yet many children do not receive timely outpatient follow-up. Although South Korea provides universal health coverage through its National Health Insurance (NHI), additional financial barriers may impede the continuity of mental health care. This study examined whether supplemental private insurance is associated with improved outpatient mental health follow-up after pediatric psychiatric ED visits within a universal coverage system. A retrospective cohort study was conducted at a tertiary children’s hospital in South Korea including 520 psychiatric ED visits (480 unique patients aged <18 years) from 2016 to 2024. The primary outcome was attendance at an outpatient mental health visit within 30 days of ED discharge. Multivariable logistic regression was used to assess the association between insurance type (NHI-only versus NHI plus supplemental private insurance) and follow-up, adjusting for age, sex, clinical presentation, and prior mental health care. Overall, 53.7% of patients attended a 30-day follow-up visit. Patients with supplemental private insurance had significantly higher follow-up rates than those with NHI alone (58.8% vs. 45.5%, p = 0.019). In adjusted analysis, supplemental private insurance was independently associated with increased follow-up (adjusted odds ratio 1.50, 95% confidence interval 1.10–2.05, p = 0.02). A significant interaction was observed between insurance type and prior mental health care (p_interaction = 0.03): the insurance effect was pronounced among patients without prior outpatient mental health treatment (45.6% vs. 38.8%) but negligible among those with prior treatment (71.9% vs. 72.5%). Prior outpatient mental health treatment (adjusted odds ratio 2.00, 95% confidence interval 1.30–3.10) and suicidal presentation were also significant predictors. Even within a universal health coverage system, supplemental private insurance is associated with better outpatient follow-up after pediatric psychiatric emergencies, particularly among patients new to the mental health system. Reducing financial barriers, expanding community-based mental health services, and strengthening care coordination are essential to ensure equitable continuity of care for all children. Full article

Introduction: Caffeine is the most consumed psychostimulant worldwide. Schizophrenia is an uncommon mental disorder affecting 0.34% of the global population. The aim of the current study was to investigate a possible association between caffeine consumption and symptom profile, dangerous behavior, and cognitive functions in patients with schizophrenia. Methods: This prospective cohort study included consecutive patients diagnosed with schizophrenia who were admitted to the psychiatry ward or visited the psychiatry outpatient clinics at a tertiary University Hospital in Greece for a period of 12 months. All patients underwent an extensive psychiatric and cognitive function assessment using the standardized Greek version of the Positive and Negative Symptom Scale (PANSS), the generalized anxiety disorder scale (GAD-7), and the Addenbrooke cognitive test (ACE-R). Results: In total, 53 patients were included in the present study. Mean age of the participants was 45 ± 11 years. The mean age at onset was 23 ± 7 years, while mean duration of illness from age of onset was 21.58 years. Caffeine serum levels exhibited a positive correlation with the poor attention component of the general psychopathology PANSS subscale, as well as with the attention and orientation component in the ACE-R. Moreover, another positive correlation was observed between the perilous behavior PANSS subscale and caffeine serum levels. Conversely as caffeine serum levels increased, fewer negative symptoms were reported, specifically, the poor rapport and passive/apathetic social withdrawal of the negative PANSS subscale. Conclusions: In summary, this study highlights the significant associations between caffeine serum levels, symptom severity, and cognition among patients with schizophrenia. While the findings provide valuable insights, they should be interpreted with caution due to the study’s several limitations. More larger scale cohort studies are needed in order to elucidate the impact of caffeine consumption in patients with schizophrenia. Full article

In oncology, traditional H&P templates centered on a single chief complaint often fail to address the longitudinal care needs and emotional complexities of cancer patients, leaving learners unprepared for sensitive conversations such as breaking bad news or discussing treatment goals. To address this, we conducted a literature review of specialty-focused H&P tools in child psychiatry and gynecology and, drawing on our experiences as two first-year medical students in an outpatient oncology clinic, developed an oncology H&P template to guide novice clinicians. The guide incorporates structured prompts for rapport-building; detailed oncologic and family cancer history; functional independence assessments; treatment goals; emotional wellbeing; support networks; and responding to emotion. After initial pilot testing by the two developers under supervisor guidance, the template was distributed to five then ten additional students and disseminated via the ASCO online forum and Twitter. Feedback from ten oncologists and oncology trainees highlighted the template’s value in gathering review of systems, past treatment details, functional status, and cancer history. Our findings suggest that this oncology-tailored tool enhances interview flow, promotes comprehensive data collection, and supports empathetic patient engagement. Integration into routine oncology training is planned, with future adaptations for specific oncological subspecialties and potential use in other medical specialties. Full article

Psychiatric illness during childhood and adolescence is a growing concern, placing increased pressure on psychiatric services. Reliance on an evidence-based assessment tool may facilitate the identification and management of symptoms and may facilitate accountability. The purposes for this study were to characterize the psychiatric symptoms of a sample of pediatric patients accessing outpatient psychiatry using the DSM Level 1 Cross-Cutting Measure (CCSM), compare patient and caregiver ratings (CCSM), and explore patients’ acceptability of using the CCSM. The sample consisted of 51 patients (mean age 14 years) and 46 caregivers (mean age 43 years). Patient and caregiver ratings suggested problems with sleep, inattention, depression, irritability/anger, and anxiety. The most common discordance concerned suicide ideation. Most patients (34 of 38) reported that the assessment tool was easy to complete. The CCSM may be a useful, evidence-based, standardized, transdiagnostic assessment tool aligned with the DSM-5 that can be used in a variety of mental health settings to identify symptoms, inform treatment planning, and track progress. Full article

Background: Clinician empathy is associated with family satisfaction and reduced anxiety, but quantitative data from the parents’ perspective in pediatric psychiatry are limited. Objective: To assess parent-perceived physician empathy in pediatric psychiatry consultations and explore its associations with clinical and demographic factors. Methods: Cross-sectional, consecutive sample of parents attending an outpatient pediatric psychiatry clinic (n = 163 parents). A 10-item behavioral empathy scale (range 10–40) was used. Analyses included reliability testing, group comparisons, correlations, OLS regression, and exploratory PCA. Results: The mean total empathy score was 34.5 (SD 4.2); most parents rated physicians as highly empathic (65%). Parents of children with ASD reported lower empathy compared to those with anxiety/depression. Empathy increased modestly with child age and was associated with a calmer state at the end of the visit. PCA suggested exploratory evidence of potential subdimensions, including child-centered communication and listening/facilitation. Conclusions: Parent-perceived empathy in this sample was generally high; however, behaviors that directly involve and facilitate the child (listening, encouraging questions) may need strengthening, particularly for children with ASD. Results should be interpreted in light of the single-center design, the absence of a recorded participation rate, parent-proxy reporting, and the exploratory nature of the PCA. Full article

Background: This article presents an international comparative review of involuntary psychiatric care, Community Treatment Orders (CTOs), and forensic mental health services, with operational implications for Italy. Italy has a community-based model inspired by the “Basaglia Law” (Law No. 180/1978), emphasizing deinstitutionalization and continuity of care. Nevertheless, risk governance gaps persist for high-complexity patients, imposing a disproportionate legal and clinical burden on mental health professionals. This group includes individuals who refuse treatment despite meeting criteria for compulsory admission, patients at elevated risk with substantial management complexity, and offenders with a current or suspected psychiatric disorder. Methods: We conducted a comparative legal and policy review across seven jurisdictions (Italy, England and Wales (UK), France, Germany, Spain, the United States, and Canada) to map frameworks for involuntary treatment, forensic services, CTOs (or equivalents), and community-based risk management. We also extracted procedural safeguards, duration and renewal limits, and interfaces with forensic services. Results: CTOs are available in five of the seven jurisdictions (England and Wales, France, Spain, the United States, and Canada) but are absent in Italy and Germany. We propose a three-pillar framework: (1) enforceable outpatient measures, including CTOs; (2) Forensic Psychiatry Units within Local Health Authorities; and (3) oversight boards with judicial, clinical, and social representatives. These components aim to redistribute responsibility, ensure continuity of care, and provide proportional oversight within a least restrictive, graduated system. Conclusions: When narrowly targeted, time limited, and paired with robust safeguards and service-quality standards, CTOs can support adherence and continuity for patients who repeatedly disengage from care. For Italy, integrating this instrument within the three-pillar framework and under independent oversight could strengthen patient rights and public safety, reduce revolving-door admissions, and improve outcomes. Full article

Psychiatric illness during childhood and adolescence is a serious public health concern. Caregivers are critical for their child’s enactment of psychiatric interventions, though caregiver distress can have serious impacts on caregivers and their child’s outcomes. The purpose of this study was to explore the associations of caregiver distress with child symptom severity, family functioning, and caregiver social support and self-care at the time of their child’s referral to outpatient psychiatry. Caregiver distress was most strongly associated with parent self-care (higher distress for parents associated with less self-care), child symptoms (higher distress associated with higher severity), and parent age (higher distress associated with younger caregivers). These findings shed light on important and evolving characteristics of caregivers, which could be considerations for child and family interventions in outpatient psychiatry, and the importance of a family approach for improving overall health. Full article

Major Depressive Disorder (MDD) is a chronic mental disorder characterized by anhedonia, loss of desire, guilt, suicidal thoughts, and appetite changes. It is reported that individuals with MDD resort to binge eating to escape from negative feelings. In this study, we aimed to determine the relationship between binge eating behavior and the concept of psychological pain associated with emotions such as shame, guilt, and anger in individuals with MDD. We conducted the study in the Psychiatry Outpatient Clinics of Balcalı Hospital, Çukurova University Faculty of Medicine. The sample consisted of 147 individuals with MDD without psychotic symptoms and 128 healthy controls with sociodemographic characteristics similar to the MDD group. We administered a sociodemographic data form, the Hamilton Depression Rating Scale (HDRS), Psychache Scale (PS), Tolerance for Mental Pain Scale-10 (TMPS-10), Barratt Impulsiveness Scale (BIS-11), and Eating Disorder Examination Questionnaire (EDE-Q-13). Eighty-two (55.7%) of the patients with MDD were diagnosed with binge eating disorder (BED). In the group of MDD patients with BED comorbidity, the EDE-Q-13 total, binging subscale, and HDRS scores were significantly higher than those of the other groups (p < 0.05 for each group), with large to very large effect sizes (e.g., EDE-Q-13 binging d = 1.04; HDRS d = 1.91; PS d = 1.22). There was no significant difference between the MDD groups (with and without BED) regarding the BIS and BIS subscales’ subscores, PS, and TMPS scores. For participants with MDD, there was a significant same-directional correlation between EDE-Q-13 binging, HDRS, BIS, and PS scores (p < 0.05 for each), with moderate to strong effect sizes (EDE-Q-13 binging and HDRS: r = 0.398, p < 0.001; binging and PS: r = 0.273, p < 0.001; binging and BIS: r = 0.233, p = 0.005; binging and TMPS-10: r = –0.257, p = 0.002). Additionally, a negative correlation was observed between TMPS and the scores for EDE-Q-13 binging, HDRS, BIS, and PS. A linear regression analysis indicated that depression severity and BMI were the strongest predictors of binge eating behavior (R² = 0.243; f² = 0.32). Based on our results, we concluded that the presence of binge eating behavior in patients with MDD is associated with more severe depressive symptoms, psychological pain, impulsivity, and lower tolerance to psychological pain. The finding that binge eating behavior was most strongly associated with depression severity and body mass index (BMI) supports the notion that binge eating behavior is a maladaptive attitude. Longitudinal studies comparing individuals with different BMIs in different clinical samples are needed to confirm our results. Full article

Background and Objectives: Although psychiatric disorders in early childhood are increasingly recognized, comprehensive clinical data from large samples in this age group remain limited. This study presents one of the largest and longest-term evaluations in Türkiye of children aged 0–72 months referred to child psychiatry. It aims to identify the most common presenting complaints, diagnostic patterns, and key predictors of psychotropic medication initiation in a previously understudied age group. Materials and Methods: This retrospective analysis included 3312 children aged 0–72 months who presented to the outpatient child psychiatry clinic of Trakya University Medical Faculty Hospital in Edirne, Türkiye. Clinical records were reviewed to extract data on presenting complaints, psychiatric diagnoses, psychotropic medication initiation, and demographic details, including age and sex. Results: The most common presenting complaints were “delayed speech development”, “irritability/frustration”, “hyperactivity”, “requests for medical reports”, and “stuttering.” These complaints were more prevalent among children who received psychiatric diagnoses. Psychiatric diagnoses were more common in boys. Boys also presented at older ages and had longer follow-up durations. Psychotropic medications were initiated in 26.9% of the cases. The most frequently reported side effects were loss of appetite and drowsiness. Logistic regression analysis revealed that specific complaints were significantly predictive of initiating medication. These included “inability to speak”, “irritability/frustration”, “hyperactivity”, “lack of eye contact”, “aggression”, “school refusal”, “sleep problems”, and “fears.” Conclusions: This study revealed that some early childhood complaints, such as “inability to speak”, “restlessness”, “hyperactivity”, and “not making eye contact”, are strong predictors of both psychiatric diagnosis and initiation of psychotropic medication. The findings highlight the usefulness of structured assessment protocols in early childhood psychiatric services. The implementation of systematic screening for risk symptoms may facilitate early diagnosis and support more appropriate and timely treatment approaches, especially in resource-limited regions. Full article

Background: The present study aimed to investigate the clinical correlates of treatment response to mood stabilizers in patients with bipolar disorder (BD), with a specific focus on trait-related characteristics such as impulsivity and affective temperaments. Methods: In- and outpatients diagnosed with BD were recruited at the Section of Psychiatry of the General Hospital/University of Perugia. Socio-demographic, clinical, and current psychopathological characteristics were collected. The treatment response was retrospectively assessed using the Alda Scale. Trait characteristics were evaluated through the Barratt Impulsiveness Scale (BIS-11) and the Brief Temperament Evaluation of Memphis, Pisa, and San Diego—Münster version (briefTEMPS-M). Bivariate analyses and a general linear model were employed to analyze the correlates of treatment response to mood stabilizers. Results: Among the investigated variables, trait impulsivity showed a significant negative association with treatment response. A similar effect was observed for depressive temperament, while other affective temperaments were not significantly associated with treatment outcomes. Patients with good treatment responses exhibited higher illness duration and lower severity of BD, higher prevalence of comorbid anxiety disorders, lower diurnal variation in depressive symptoms, and lower functional impairment in autonomy and occupational domains. The main limitations of this study were represented by the small sample size, the retrospective assessment of treatment response, and the inclusion of patients from a single center. Conclusions: The present findings suggest that impulsivity and depressive temperament should be investigated as potential predictors of poor response to mood stabilizers in BD. These trait dimensions, together with other clinical markers, may serve as useful targets for patient stratification and the development of personalized treatment strategies. Full article