Psychiatric treatment-associated stigmatization as viewed through eyes of rural health clinic patients

2017 ◽  
Vol 41 (S1) ◽  
pp. S740-S741
Author(s):  
D. Sendler ◽  
A. Markiewicz
Keyword(s):  
Trend Analysis ◽  
Rural Health ◽  
Rural Community ◽  
Psychiatric Treatment ◽  
Mental Disease ◽  
Psychiatric Patients ◽  
Qualitative Interviews ◽  
Health Clinic ◽  
Competing Interest ◽  
To Receive

IntroductionHaving a mental disease is frequently a stigmatizing experience for patients. We know little about urban inhabitants who travel to rural health clinics to receive mental treatment.ObjectivesRecruit and interview urban-based psychiatric patients who, to avoid stigmatization; travel to rural community clinics with the intention of receiving treatment.MethodsStudy included participants (n = 32) who exchanged treatment in government subsidized city clinics for rural community centers. Qualitative interviews lasting thirty minutes were recorded and transcribed for content analysis. MAXQDA, version 12, was used to annotate transcripts with topic specific nodes, followed by cluster theme and trend analysis.ResultsTrend analysis yielded three areas of concern for subsidized urban psychiatry: cost/insurance, lack of staff professionalism, and family-driven ostracism. Seven respondents cited cost as the main factor, influencing the choice of rural-based care over city clinic. Patients with stable income, but without insurance (n = 14), felt unwelcome in city clinics as their ability to pay was frequently questioned by supporting staff. Lack of trained social workers caused additional distress, as participants could not receive access to additional resources. Only four patients said that their psychiatrists acknowledged poor clinic environment and encouraged remaining in treatment. For 18 respondents, family demanded that they receive treatment in rural clinic so that no one finds out about their mental disease.ConclusionIn large urban clinics, stigma in psychiatry comes in many flavors, especially projected by unprofessional clinic staff and ashamed family. Lack of support forces patients to travel to rural premises to receive unbiased, stress-free care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Psychiatric Services in Saskatchewan under Medicare*

1970 ◽  
Vol 15 (1) ◽  
pp. 63-72 ◽  
Author(s):  
Wilfred A. Cassell ◽  
Colin M. Smith ◽  
Maggie Grandy Rankin
Keyword(s):  
Private Practice ◽  
Urban Areas ◽  
Psychiatric Care ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Treatment Session ◽  
Psychiatric Services ◽  
Treatment Services ◽  
Hospital Visits ◽  
To Receive

This study has examined the nature and extent of services provided to psychiatric patients under ‘Medicare’. An analysis of the records of 864,128 residents of Saskatchewan revealed that in 1965, 13,950 males and 27,009 females received a psychiatric diagnosis from physicians in private practice. Psychoneurotic conditions were frequent. General practitioners provided the majority of treatment services for this group. Physicians practising in urban areas were found to complete more psychiatric treatment than their rural counterparts. Female patients were found to receive relatively more psychiatric care than males. The latter obtained more consultations, hospital visits and somatic investigations. Lastly, the rate of service was infrequent, averaging less than one treatment session per patient.

Chronic Somatic and Psychiatric Co-morbidities are Associated with Psychiatric Treatment Success; A Nested Cross-sectional Study

2017 ◽  
Vol 41 (S1) ◽  
pp. S135-S135
Author(s):  
I. Filipcic ◽  
I. Simunovic Filipcic ◽  
M. Rojnic Kuzman ◽  
G. Vladimir ◽  
P. Svrdlin ◽  
...  
Keyword(s):  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Treatment Success ◽  
Cross Sectional Study ◽  
Interdisciplinary Treatment ◽  
Cross Sectional ◽  
Psychiatric Comorbidities ◽  
Causal Pathways ◽  
Somatic Comorbidities ◽  
Competing Interest

IntroductionA rich body of literature dealt with somatic comorbidities of psychiatric illnesses. However, relatively few explored the association of somatic and psychiatric comorbidities with psychiatric treatment success.ObjectiveObjective of this analysis was to explore chronic somatic and psychiatric comorbidities association with the average number of psychiatric re-hospitalisations annually.MethodsThis cross-sectional analysis was done on the baseline data of prospective cohort study “Somatic comorbidities in psychiatric patients” started during 2016 at Psychiatric hospital Sveti Ivan, Zagreb, Croatia. We included 798 patients. Outcome was the average number of psychiatric re-hospitalisations annually since the diagnosis. Predictors were number of chronic somatic and psychiatric comorbidities. Covariates that we controlled were sex, age, BMI, marital status, number of household members, education, work status, duration of primary psychiatric illness, CGI–severity at diagnosis, treatment with antidepressants and antipsychotics.ResultsInteraction of somatic and psychiatric comorbidities was the strongest predictor of the average number of psychiatric re-hospitalisations annually (P < 0.001). Mean number of re-hospitalisations annually adjusted for all covariates, was increasing from 0.60 in patients with no chronic comorbidities, up to 1.10 in patients with ≥ 2 somatic and ≥ 2 psychiatric comorbidities.ConclusionSomatic and psychiatric comorbidities are independently associated with the psychiatric treatment success. Further studies should look at possible causal pathways between them, and interdisciplinary treatment of psychiatric patients is urgently needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychosis Induced by Interferon-α–A Limitation of Treatment

2017 ◽  
Vol 41 (S1) ◽  
pp. S236-S236
Author(s):  
M. Marinho ◽  
M. Mota-Oliveira ◽  
J. Marques ◽  
M. Bragança
Keyword(s):  
Psychiatric Treatment ◽  
Early Recognition ◽  
Psychiatric Patients ◽  
Psychotic Symptoms ◽  
Interferon Α ◽  
Adequate Treatment ◽  
Increased Risk ◽  
Competing Interest ◽  
The Brain ◽  
Pituitary Adrenal Axis

IntroductionPsychosis is an uncommon but serious complication of treatment with interferon-α, a cytokine frequently used to treat several infectious and malignant diseases.ObjectivesTo provide an overview of interferon-α-induced psychosis.MethodsLiterature review based on PubMed/MEDLINE, using the keywords “interferon-α” and “psychosis”.ResultsPsychotic symptoms usually emerge between 6 to 46 weeks and on average 3 months after the start of interferon-α treatment, occurring most frequently in the form of persecutory, guilt or grandeur delusions and auditory hallucinations. Often they are accompanied by mood symptoms, anxiety, attention disturbances and insomnia. Many factors are known to increase the risk of psychiatric effects as a whole associated with interferon-α. Pathogenesis of interferon-induced psychosis remains unclear, however several theories have been discussed, namely the overlap influence of biological vulnerability and the cytokine's action on the brain. Dopaminergic, opioid, serotoninergic and glutaminergic pathways as well as hypothalamic-pituitary-adrenal axis hypersensitivity are some of the hypotheses raised about the underlying cause of that susceptibility. Psychosis management usually includes stopping interferon-α and introducing antipsychotics with minimal antidopaminergic effects and at the lowest possible dose, due to the increased risk of extrapyramidal reactions in these patients.ConclusionThe decision to use interferon-based treatments in psychiatric patients should be highly individualized. Early recognition and adequate treatment of interferon-induced psychosis might prevent subsequent emergence of serious debilitating symptoms. Thus, it is very important that medical and psychiatric treatment teams work closely together and are familiar with this important subject.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A tribute to Johann Gottlieb Burckhardt-Heussler (1836–1907), the pioneer of psychosurgery

2016 ◽  
Vol 33 (S1) ◽  
pp. S553-S553 ◽  
Author(s):  
M. Arts ◽  
P. Michielsen ◽  
S. Petrykiv ◽  
L. de Jonge
Keyword(s):  
Significant Contribution ◽  
Psychiatric Patients ◽  
Brain Regions ◽  
Medical Community ◽  
Psychiatric Illnesses ◽  
Scientific Papers ◽  
Show Evidence ◽  
Competing Interest ◽  
Chronic Psychiatric Patients ◽  
Deep Brain

IntroductionJohann Gottlieb Burckhardt-Heussler was a Swiss psychiatrist, who pioneered controversial psychosurgical procedures. Burckhardt-Heussler extirpated various brain regions from six chronic psychiatric patients under his care. By removing cortical tissue he aimed to relieve the patients of symptoms, including agitation, rather than effect a cure.ObjectivesTo present the scientific papers of Johann Gottlieb Burckhardt-Heussler on psychosurgery.AimsTo review available literature and to show evidence that Burckhardt-Heussler made a significant contribution to the development of psychosurgery.MethodsA biography and private papers are presented and discussed, followed by a literature review.ResultsThe theoretical basis of Burckhardt-Heussler's psychosurgical procedure was influenced by the zeitgeist and based on his belief that psychiatric illnesses were the result of specific brain lesions. His findings were ignored by scientists to make them disappear into the mists of time, while the details of his experiments became murky. Decades later, it was the American neurologist Walter Freeman II, performing prefrontal lobotomies since 1936, who found it inconceivable that the medical community had forgotten Burckhardt-Heussler and who conceded that he was familiar with, and probably even influenced by, Burckhardt's work.ConclusionIt is partly thanks to Burckhardt-Heussler's pioneering work that modern psychosurgery has gradually evolved from irreversible ablation to reversible stimulation techniques, including deep brain stimulation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Utilization of Emergency Departments for Psychiatric Treatment

1978 ◽  
Vol 23 (3) ◽  
pp. 143-148 ◽  
Author(s):  
G.D. Watson
Keyword(s):  
Emergency Department ◽  
Emergency Services ◽  
Suicide Attempts ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Relevant Literature ◽  
Emergency Department Utilization ◽  
Annual Number ◽  
Personal Distress ◽  
Clinical Records

A survey of four Edmonton hospital emergency department records for a one month period was carried out to determine the frequency of utilization by patients suffering from psychiatric disorders. Male attenders outnumbered females and the majority of patients fell into the 21 — 50 year age range. Alcohol-related illness was almost three times more frequent in males than females, whereas females were more frequently categorized as suffering “personal distress” or presented as suicide attempts. Overall, seventy-three percent of the patients were discharged; of those admitted, females outnumbered males. The changing pattern of emergency department utilization was compared by examining data from one hospital for the years 1972, 1974 and 1976. During this four-year period the annual number of visits by psychiatric patients increased by almost eighty percent, largely due to dramatic increases in alcohol related problems in males and those described as “personal distress” in females. The establishment of intoxication recovery centres in 1973 paralleled a drop in the proportion of patients admitted to inpatient wards for alcohol-related, street drugs and overdose problems. The results of the present survey are compared to those reported in the relevant literature, and the methodological problems encountered in carrying out a retrospective study of emergency services from clinical records are described.

Comorbid depression and ulcerative colitis – is there a connection?

2017 ◽  
Vol 41 (S1) ◽  
pp. S534-S534
Author(s):  
A. Melada ◽  
I. Krišto-Mađura ◽  
A. Vidović
Keyword(s):  
Ulcerative Colitis ◽  
Psychiatric Treatment ◽  
Psychiatric Symptoms ◽  
Specific Treatment ◽  
Unknown Etiology ◽  
Suicidal Thoughts ◽  
Symptoms Of Depression ◽  
Bidirectional Communication ◽  
History Of ◽  
Competing Interest

Ulcerative colitis (UC) is a subset disorder of inflammatory bowel disease (IBD) with chronic course and symptoms such as fatigue, gastrointestinal pain, fever, etc. IBD is associated with psychological manifestations including depression and anxiety. There is an increased number of studies trying to link these comorbidities. The gut-brain axis is regulated by intestinal microbiota and this bidirectional communication including immune, neural, endocrine and metabolic mechanisms may bring us closer to the answer. The following case concerns a 56-year-old patient with history of major depressive disorder who was in continuous psychiatric care and treated with antidepressants. Several years after the beginning of psychiatric treatment, he was hospitalized for diagnostic examination due to subfebrility of unknown etiology, but with no final somatic diagnosis. After two years he was referred to our department and at administration the patient showed symptoms of depression, anxiety, lack of motivation and suicidal thoughts and tendencies. Subfebrility was still present at that time. His psychopharmacotherapy was revised and there was a slight improvement in mood and behaviour. During outpatient follow-ups the symptoms of depression were still prominent and remission was not achieved even with modulation of antidepressant pharmacotherapy. The following year the patient was diagnosed with UC and started specific treatment after he presented with diarrhea in addition to subfebrility. Subsequently his mood improved, suicidal thoughts were diminished and ultimately remission was achieved. This case suggests that only after UC was being treated the psychiatric symptoms also withdrew which implicates that inflammatory mediators were involved in pathogenesis of depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Comparison of Self-reported to Observational Agitation Scales

2017 ◽  
Vol 41 (S1) ◽  
pp. S151-S151
Author(s):  
L. Zun ◽  
L. Downey
Keyword(s):  
Psychiatric Patients ◽  
Likert Scale ◽  
The Self ◽  
Assessment Tools ◽  
Self Assessment ◽  
Convenience Sample ◽  
Ed Visits ◽  
Competing Interest ◽  
A Prospective Study ◽  
Age Range

BackgroundIncreasingly, psychiatric patients are presenting to the emergency department (ED) with agitation. ED staff rarely, if ever, use scale to assess agitation or use any self-assessment tools to determine a patient's level of agitation.ObjectivesTo evaluate the relationship between a patient's self-reported level of agitation and other validated agitation assessment tools.MethodsThis is a prospective study using a convenience sample of patients presenting to the ED with a psychiatric complaint. This study was conducted in an urban, inner-city trauma level 1 center with 55,000 ED visits a year. After obtaining consent, a research fellow administered observational tools, PANSS-EC and ACES and BAM and Likert scale self assessment tools on arrival to the ED. SPSS version 24 was used. The study was IRB approved.ResultsA total of 139 patients were enrolled. The most common ED diagnoses were depression, schizophrenia, or bipolar. Majority of patients were African-American (59%), falling in the 25–44 year old age range (56%) 52% male. Self-reported agitation was rated as moderate to high in 72.4% of these patients on the Likert scale and 76.3% on the BAM. There was a significant correlation between the self-reported score versus the BAM (F = 11.2, P = 0.00). However, the self-reported scores were significantly different from the scores assessed by observational tools (P < 0.05).ConclusionsED providers should assess a patient's self-reported level of agitation because a patient could be feeling markedly agitated without expressing outward signs detected by observational tools.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Social stigma in severe mental illness in Tunisia: Clinical and socio-demographic correlates

2017 ◽  
Vol 41 (S1) ◽  
pp. S577-S577 ◽  
Author(s):  
U. Ouali ◽  
R. Jomli ◽  
R. Nefzi ◽  
H. Ouertani ◽  
F. Nacef
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Cultural Context ◽  
Social Inclusion ◽  
Psychiatric Patients ◽  
Social Stigma ◽  
Cross Sectional Study ◽  
Local Context ◽  
Cross Sectional ◽  
Competing Interest

IntroductionMental patients generally internalize some of the negative conceptions about how most people view them: they might be considered incompetent or untrustworthy or believe that people would not want to hire, or marry someone with mental illness. A lot of research on stigma has been conducted in western countries; however, little is still known on the situation in Arab-Muslim societies.ObjectivesTo evaluate social stigma as viewed by patients suffering from severe mental illness (SMI)MethodsThis is a cross-sectional study on clinically stabilized patients with schizophrenia and Bipolar Disorder (BD) according to DSM IV, who were interviewed in our out-patients clinic with the help of a semi-structured questionnaire, containing 8 opinions on the social inclusion and stigmatization of psychiatric patients, with special reference to the local cultural context (e.g.: “It is better to hide mental illness in order to preserve the reputation of my family”)ResultsWe included 104 patients, 51% with schizophrenia and 49% with BD. Mean age was 38.4 years (18–74 years); 59.6% were males. Overall social stigma scores were high. Social stigma in patients was correlated with gender, age, place of residence and diagnosis. Patients with BD showed significantly less social stigma than patients with schizophrenia.ConclusionOur results show the need for a better understanding of this phenomenon in patients with SMI, but also within Tunisian society, in order to elaborate anti stigma strategies adapted to the local context.Disclosure of interestThe authors have not supplied their declaration of competing interest.

UTILIZATION OF A PEDIATRICIAN IN A MENTAL HEALTH CLINIC

PEDIATRICS ◽  
1970 ◽  
Vol 46 (5) ◽  
pp. 807-809
Author(s):  
William E. Stone
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Health Center ◽  
Psychiatric Treatment ◽  
Mental Health Center ◽  
Mental Health Program ◽  
Health Clinic ◽  
Select Group ◽  
Accurate Picture ◽  
Community Mental Health Program

The field of psychiatry, and certainly the subspecialty of child psychiatry, is currently involved in an identity crisis which has particular relevance to the relationship between the pediatrician and the psychiatrist in the delivery of mental health services to children. This crisis is related to the move from patient-oriented psychiatric treatment to the newer methods of community mental health. A good community mental health program is founded on the knowledge and skills learned from careful work with individual patients, but the techniques and goals of treatment require modification. While individual psychotherapy is still an essential part of patient care, it is frequently impractical in the light of the demands and needs of our current culture. In the community mental health center which I am serving, we are currently involved in a major reassessment of our techniques in order to meet the needs of the community rather than the demands of a small group. Ours is a relatively affluent community, generally considered to be sophisticated, well-educated, and knowledgeable about psychiatry. An easy pitfall in developing a mental health center would be to assume that this is an accurate picture of the entire community and base the whole program on the model of private psychiatric care. However, the city has its pockets of poverty and has large numbers of people who would not respond to insight therapy if it were available to them. Psychiatrists have been, until very recently, poorly trained for work in the community. Their work has been principally in mental hospitals and in outpatient clinics that offered treatment to a very select group of patients.

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