Broaching sexual health topics during a doctor-patient encounter in ambulatory psychiatric care

 WSTĘP: Trudności w sferze seksualnej są częstym problemem pacjentów psychiatrycznych. Zarówno psychopatologia niektórych zaburzeń i chorób psychicznych, jak i efekty niepożądane wielu leków stosowanych w psychiatrii mogą negatywnie wpływać na sferę seksualną pacjenta. Celem niniejszego badania było określenie, w jakim stopniu lekarze psychiatrzy podejmują z pacjentami rozmowę na temat sfery seksualnej oraz jakie są oczekiwania pacjentów w tym zakresie.MATERIAŁ I METODY: 615 ambulatoryjnych pacjentów psychiatrycznych oceniło swoją postawę do lekarza prowadzącego, umiejętność psychiatry do taktownego wprowadzenia tematów związanych ze sferą seksualną oraz swoje oczekiwania w zakresie takiej rozmowy. Badanie zostało przeprowadzone w 10 spośród 30 losowo wybranych poradni zdrowia psychicznego w północno-wschodniej Polsce.WYNIKI: Pacjenci ujawniali pozytywną postawę do leczących ich psychiatrów. Ponad połowa ankietowanych ujawniła, że psychiatra nie omawia z nimi sfery seksualnej. Jedna czwarta badanych chciałaby rozmawiać podczas wizyty u psychiatry o swoim życiu seksualnym, jedna czarta nie była pewna, czy chce ten temat podejmować. Gotowość pacjentów do podejmowania w rozmowie tematów seksualnych była istotnie związana z wprowadzaniem przez lekarza tego tematu do rozmowy.WNIOSKI: Psychiatra jako osoba dominująca w diadzie lekarz−pacjent ma wpływ na kształtowanie relacji z pacjentem i wprowadzanie do rozmowy tematów związanych ze sferą seksualną. Taktowne poruszanie przez psychiatrę tematów dotyczących funkcjonowania seksualnego pacjenta zwiększa jego gotowość do rozmowy na ten temat. Introduction: Difficulties in sexual functioning are a frequent problem for psychiatric patients. Both the psychopathology of some psychiatric diseases as well as the side effects of medication used in psychiatry may adversely affect the patient’s sexual functioning. The aim of this study was to investigate to what extent psychiatrists raise sexual matters with patients during their encounters in psychiatric ambulatory care and what the patients’ expectations in this area are.Material and methods: 615 psychiatric outpatients responded to the anonymous questionnaire regarding their attitudes towards their psychiatrists, their evaluation of the doctors’ ability to tactfully address sexual matters during the encounter and their expectations from such an interaction. The study was conducted in 10 out of 30 randomly chosen public mental health clinics in north-eastern Poland.Results: In general, patients expressed a positive attitude towards their therapists. Over half of the study group revealed that the psychiatrist did not discuss with them their sexual health concerns. A quarter of the patients surveyed would have liked to talk about their sex life during their encounter with the psychiatrist whereas a quarter were not certain if they wanted to address the subject. The patient’s readiness to discuss sexual health issues was significantly correlated with the initiation of this topic by the doctor.Conclusions: The psychiatrist as the dominant person in the doctor–patient dyad has a considerable influence on the shape of the patient’s relationship with the therapist and the initiation of sexual health topics during the doctor-patient encounter. The tactful introduction of the topic of the patient’s sexual functioning by the psychiatrist increases the patient’s willingness to discuss their sexual health concerns

How do patients perceive ambulatory psychiatric care and what are their needs?

Introduction and objective The quality of a doctor-patient relationship plays a vital role in all fields of medicine. In the case of psychiatry, this role is special as it provides the foundation for the whole therapeutic process. The aim of this study was to investigate the patient’s perspective on psychiatric visits: patient’s attitudes towards the psychiatrist, patient’s view of the patient-psychiatrist relationship, and the patient’s needs and expectations from this relationship. Material and Methods 615 psychiatric outpatients responded to the anonymous questionnaires connected with their attitudes towards the psychiatrist, evaluation of the doctor, and expectations from psychiatric care. The study was conducted in 10 out of 30 public centres for psychiatric care in north-eastern Poland. Results Generally, the patients liked and positively evaluated their psychiatrists. Patient’s liking for the doctor was connected with the feeling that the doctor also liked the patient, as well as with perceiving the doctor as competent and willing to meet the patient. The longer the treatment with a particular psychiatrist and the rarer need to consult the doctor, the more positive attitude and evaluation of the doctor patients had. According to the patients, the most significant expectations were associated with both conversation with the doctor and receiving emotional support. Conclusions The key phase for forming the patient-psychiatrist relationship was the first stage of cooperation in which patients created their attitudes towards the doctor without modifying them at further stages. Thus, further studies on learning and developing the ability to establish the relationship with the patient, inspiring the patient’s trust and making psychiatric appointments comfortable from the first meeting, will be highly valuabl

Choline Compounds of the Frontal Lobe and Temporal Glutamatergic System in Bipolar and Schizophrenia Proton Magnetic Resonance Spectroscopy Study

Purpose. Modern neuroimaging techniques allow investigating brain structures and substances involved in the pathophysiology of mental disorders, trying to find new markers of these disorders. To better understanding of the pathophysiology and differential diagnosis of schizophrenia and bipolar disorder, this study was conducted to assess the neurochemical alterations in the frontal and temporal lobes in hospitalized patients with schizophrenia and bipolar disorder. Methods. Twenty-one subjects with schizophrenia (paranoid and differentiated types), 16 subjects with bipolar I disorder (manic, depressive, and mixed episode), and 20 healthy subjects were studied. Magnetic resonance (MR) imaging and proton resonance magnetic spectroscopy (1H MRS) were performed on a 1.5 T scanner. Voxels of 8 cm3 were positioned in the left frontal and left temporal lobes. Results. Glx/H2O (GABA, glutamine, and glutamate/nonsuppressed water signal) ratios were significantly increased in the left temporal lobe in schizophrenia, but not in bipolar disorder, compared with controls. Cho/H2O (choline/nonsuppressed water signal) ratios in the left frontal lobe had a tendency to increase in bipolar disorder and schizophrenia, relative to controls. A lower temporal lobe NAA/H2O ratio in mixed than in manic and depressive episode of bipolar patients was also found. No other significant differences were found among three studied groups as regards NAA, Cr, and mI ratios. Conclusions. Our results partially confirm the role of a glutamatergic system in schizophrenia, however, only in a temporal lobe. We also point to the importance of the choline-containing compounds (marker of cellular density) in the frontal lobe of patients suffering from bipolar disorder and schizophrenia. We also found the deleterious effect of mixed bipolar episode on the integrity and functioning of the temporal lobe. Glutamatergic left temporal spectroscopic changes may potentially help in differential diagnosis of schizophrenia from bipolar disorder

Immune suppression of IgG response against dairy proteins in major depression

Abstract Background Interactions between the digestive system, brain functions and immunoglobulin G (IgG) mediated immunity against food antigens became recently a topic of growing interest in psychiatry research. Psychological stress can activate hypothalamic-pituitary-adrenal axis (HPA) with subsequent hypercortisolemia. It can also influence intestinal permeability and dynamics of IgG response. Major depression can by accompanied either by activation of inflammatory response or by immune suppression (e.g. decreased antibody production) where hypercortisolemia is a significant immune modulator. The aim of our study was to assess IgG immune response against 44 food products in depressed patients and controls along with markers of psychological stress, inflammation, psychometric and dietary parameters. Methods Serum IgG concentrations against 44 food antigens, plasma cortisol, TNF-α, IL-6, IL-1b concentrations were measured and psychometric parameters were evaluated using Hamilton Depression Rating (HAM-D 17), Perceived Stress (PSS-10), and Symptom Checklist (SCL-90) scales in 34 depressed patients and 29 controls. Dietary parameters such as frequency of exposure to food antigens, appetite and weight change were assessed. Results There was a significantly lower IgG concentration against dairy in depressed patients compared to controls (post hoc p < 0.05) when there was a high exposure (consumption) to dairy. Our research revealed a significant interaction of IgG concentration against dairy proteins and exposure to dairy between groups (F (2.63) = 3.92, p = 0.025, η2 = 0.12). There was no significant difference in mean IgG concentration against food antigens between patients and controls. We found increased concentration of cortisol in depressed patients (t (1.61) = 2.37, p = 0.02) compared to controls. Patients with melancholic depression had significantly higher (M rank  = 21.27) concentration of cortisol (U = 41, p = 0.006), when compared with the non-melancholic group of patients (M rank  = 12.16). Cortisol concentration significantly positively correlated with HAM-D 17 (r = 0.442, p = 0.009) and with phobias in SCL-90 scale in patients’ group (r = 0.531, p = 0.001). There was decreased concentration of TNF-α (t = 4.256, p < 0.001) in depressed patients compared to controls. IgG concentration of 38.63% food products positively correlated with TNF-α concentration in depressed patients compared to 9.09% of those in healthy controls. Conclusions We observed an immune suppression of IgG response to dairy proteins in depressed patients. Hypercortisolemia with involvement of decreased concentration of TNF-α might play a significant role in suppression of IgG response in depressed patients