What do patients want from their psychiatrist? A cross- sectional questionnaire based exploratory study from Karachi

<p>Abstract</p> <p>Background</p> <p>The aspects of consultation that are important for psychiatric patients have always remained a less acknowledged area. The aim of this study was to identify these aspects.</p> <p>Methods</p> <p>A Cross-sectional, questionnaire based study was carried out in a psychiatry outpatient clinic of two tertiary care hospitals in a developing country. The patients were asked to fill out the questionnaire containing a total of 11 close-ended questions plus 1 open-ended question. They graded them as not important, important, very important or do not know. Non-psychotic patients aged 18 and above, visiting the clinic were recruited into the study before they went in for their first consultation.</p> <p>Results</p> <p>The response rate of patients was 84%. More than 90% wanted the doctor to tell them the cause of their illness, talk to them about their condition, provide symptomatic relief, let them know that how long their illness would last and make the final decision about their treatment plan. Less than 20% wanted to be part of a support network. A significant 82% wanted talking therapy as part of their treatment plan.</p> <p>Conclusion</p> <p>The three issues, most important for patients were: the doctor should listen to them, make the final decision about treatment and provide symptomatic relief. Only 20% wanted to be a part of patients' support group.</p

Evaluation of the efficacy and safety of olanzapine as an adjunctive treatment for anorexia nervosa in adolescent females: a randomized, double-blind, placebo-controlled trial

<p>Abstract</p> <p>Background</p> <p>Anorexia Nervosa (AN) is a serious, debilitating condition that causes significant physical, emotional, and functional impairment. The condition is characterized by destructive weight loss behaviours and a refusal to maintain body weight at or above a minimally normal weight for age and height. AN often develops in adolescence and is a predominantly female disorder. Treatment for AN typically involves medical, nutritional and psychological interventions. Pharmacotherapy is also often used; however, the literature on the effectiveness of these drugs in a pediatric population is very limited. Olanzapine, which is an 'atypical' antipsychotic, is becoming more widespread in the treatment of AN. Olanzapine is hypothesized to facilitate weight gain, while decreasing levels of agitation and decreasing resistance to treatment in young women with AN. This randomized, double-blind placebo-controlled trial seeks to examine the effectiveness and safety of olanzapine in female youth with AN.</p> <p>Methods/Design</p> <p>Adolescent females between the ages of 12 and 17 diagnosed with AN (either restricting or binge/purge type) or Eating Disorder Not Otherwise Specified with a Body Mass Index of less than or equal to 17.5, will be offered inclusion in the study. Patients will be randomly assigned to receive either olanzapine or placebo. Patients assigned to receive olanzapine will start at a low dose of 1.25 mg/day for three days, followed by 2.5 mg/day for four days, 5 mg/day for one week, then 7.5 mg/day (the target dose chosen) for 10 weeks. After 10 weeks at 7.5 mg the medication will be tapered and discontinued over a period of two weeks. The effectiveness of olanzapine versus placebo will be determined by investigating the change from baseline on measures of eating attitudes and behaviors, depression and anxiety, and change in Body Mass Index at week 12, and after a follow-up period at week 40. It is anticipated that 67 participants will be recruited over two years to complete enrollment.</p> <p>Discussion</p> <p>Randomized controlled trials designed to measure the safety and effectiveness of olanzapine in comparison to placebo are desperately needed, particularly in the adolescent population.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN23032339</p

Sexual dysfunction during treatment with serotonergic and noradrenergic antidepressants: Clinical description and the role of the 5-HTTLPR

Objectives. Sexual dysfunction (SD) is a frequently reported side-effect of antidepressant treatment, particularly of selective serotonin reuptake inhibitors (SSRIs). In the multicentre clinical and pharmacogenetic GENDEP study (Genome-based Therapeutic Drugs for Depression), the effect of the serotonin transporter gene promoter polymorphism 5-HTTLPR on sexual function was investigated during treatment with escitalopram (SSRI) and nortriptyline (tricyclic antidepressant). Methods. A total of 494 subjects with an episode of DSM-IV major depression were randomly assigned to treatment with escitalopram or nortriptyline. Over 12 weeks, depressive symptoms and SD were measured weekly with the Montgomery-Asberg Depression Rating Scale, the Antidepressant Side-Effect Checklist, the UKU Side Effect Rating Scale, and the Sexual Functioning Questionnaire. Results. The incidence of reported SD after 12 weeks of treatment was relatively low, and did not differ significantly between antidepressants (14.9% escitalopram, 19.7% nortriptyline). There was no significant interaction between the 5-HTTLPR and antidepressant on SD. Improvement in depressive symptoms and younger age were both associated with lower SD. The effect of age on SD may have been moderated by the 5-HTTLPR. Conclusions. In GENDEP, rates of reported SD during treatment were lower than those described in previous reports. There was no apparent effect of the 5-HTTLPR on the observed decline in SD. © 2011 Informa Healthcare.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Psychiatrischer Versorgungsbedarf in betreuten Wohneinrichtungen

Subject: Providing care and support for individuals with severe mental illness in sheltered and supported housing facilities is frequently characterized by difficult courses, particularly if it concerns residents with “heavy user” profiles. These individuals oftentimes change their residence and are extensively hospitalized on acute psychiatric wards. To date, little is known about the needs of providers of sheltered and supported housing concerning cooperation with psychiatric hospitals and support by psychiatric services. Methods: An explorative survey was conducted among the sheltered and supported housing facilities in the canton of Zurich. A short questionnaire was distributed among all 140 institutions in written form. The responses were analyzed thematically with respect to four predefined categories. Results: Fifty-six institutions providing 1,600 places (about 50 % of the capacity in the canton of Zurich) responded. Experiences and problems with the focus group of residents as well as causes for problematic courses are described. A sound working routine with the psychiatric hospitals was considered as a precondition for the provision of high quality housing support. The needs concerned regular and flexible cooperation with psychiatric hospitals as well as open communication in particular at discharge from the clinic and intake at the housing facility. Conclusions: Concentration of competencies and knowledge within psychiatric hospitals about sheltered housing institutions and their needs could improve service provision and may result in higher certitude of housing facilities. Thereby, their ability to manage patients with severe mental illness could be improved and extensive hospitalization of individuals from this group could be reduced. Fragestellung: Die Betreuung von Personen mit schweren psychischen Erkrankungen und Charakteristika der sog. Heavy users in Wohneinrichtungen ist häufig mit Problemen verbunden. Dies kann zu wiederholten Wechseln der Wohnform sowie monatelangen Aufenthalten auf psychiatrischen Akutstationen führen. Zum psychiatrischen Versorgungsbedarf der betreuten Wohneinrichtungen und zur Zusammenarbeit mit den Kliniken ist bislang wenig bekannt. Methode: Explorative schriftliche Befragung der betreuten und begleiteten Wohneinrichtungen im Kanton Zürich zur deren Perspektive auf die Thematik anhand eines kurzen Fragenkatalogs. Thematische narrative Auswertung zu vier vorab definierten Kategorien. Resultate: 56 der 140 angeschriebenen Einrichtungen haben sich an der Befragung beteiligt. Diese Einrichtungen bieten zusammen rund 1600 Wohnplätze (50 % der gesamten Kapazität im Kanton Zürich) an. Erfahrungen mit der Betreuung der fokussierten Klientel sowie Ursachen für problematische Verläufe werden beschrieben. Voraussetzung für eine tragfähige Betreuung dieser schwierig zu betreuenden Personen ist eine gute und routinierte Zusammenarbeit mit den psychiatrischen Kliniken. Eine intensive und flexible Zusammenarbeit sowie eine transparente Kommunikation mit den psychiatrischen Kliniken, insbesondere in der Zeit unmittelbar nach Klinikentlassung und in Krisensituationen eines Bewohners sind zentrale Anliegen der betreuten Wohneinrichtungen. Schlussfolgerungen: Die Bündelung von Wissen und Kompetenzen innerhalb der Klinik über die Rahmenbedingungen der Wohneinrichtungen und deren psychiatrischen Versorgungsbedarf könnte die Versorgung an der Schnittstelle verbessern, für mehr Sicherheit für die Wohneinrichtungen sorgen und damit deren Tragfähigkeit erhöhen. Häufige und lange Aufenthalte in der Klinik könnten damit weiter reduziert werden