Depression and literacy are important factors for missed appointments

Multiple variables are related to missed clinic appointments. However, the prevalence of missed appointments is still high suggesting other factors may play a role. The purpose of this study was to investigate the relationship between missed appointments and multiple variables simultaneously across a health care system, including patient demographics, psychiatric symptoms, cognitive functioning and literacy status. Chart reviews were conducted on 147 consecutive patients who were seen by a primary care psychologist over a six month period and completed measures to determine levels of depression, anxiety, sleep, cognitive functioning and health literacy. Demographic information and rates of missed appointments were also collected from charts. The average rate of missed appointments was 15.38%. In univariate analyses, factors related to higher rates of missed appointments included younger age (p = .03), lower income (p = .05), probable depression (p = .05), sleep difficulty (p = .05) and limited reading ability (p = .003). There were trends for a higher rate of missed appointments for patients identifying as black (p = .06), government insurance (p = .06) and limited math ability (p = .06). In a multivariate model, probable depression (p = .02) and limited reading ability (p = .003) were the only independent predictors. Depression and literacy status may be the most important factors associated with missed appointments. Implications are discussed including regular screening for depression and literacy status as well as interventions that can be utilized to help improve the rate of missed appointments.     

Impact of Appointment Waiting Time on Attendance Rates at a Clinical Cancer Genetics Service

The increase in demand for clinical cancer genetics services has impacted the ability to provide services timeously. Given limited resources, this often results in extended appointment waiting times. Over the last 3 years, the Cancer Genetics Service at the National Cancer Centre Singapore has continued to experience a steady increase in demand for its service. Nevertheless, significant no-show rates have been reported. This study sought to determine whether an association exists between appointment waiting times and attendance rates. Data was gathered for all participants meeting inclusion criteria. Attendance rates and appointment waiting times were calculated. The relationship between mean waiting times for those who did and did not attend their scheduled appointments was evaluated using Welch’s t test and linear regression model. The results showed a significant difference in mean appointment waiting times between patients who did and did not attend (32.66 versus 43.50 days respectively; p?<?0.0001). Furthermore, patients who waited for longer than 37 days were significantly less likely to attend. No-show rates increased as the waiting time increased, at a rate of 19.60% per 20 days and 21.40% per 30 days. In conclusion, appointment waiting time is a significant predictor for patient attendance. Strategies to ensure patients receive an appointment within the necessary timeframe at the desired setting are important to ensure that individuals at increased cancer risk attend their appointments in order to manage their cancer risks effectively.     

AN APPOINTMENT-KEEPING IMPROVEMENT PACKAGE FOR OUTPATIENT PEDIATRICS: SYSTEMATIC REPLICATION AND COMPONENT ANALYSIS

Child health-care appointments that are not kept are an important pediatric problem. Previous research has shown that reducing effort (with a parking pass) and reminding patients (with mailed and telephone reminders) significantly improved appointment keeping for first-time and patient-scheduled appointments. This study, using a posttest-only group design, evaluated the effects of various combinations of that intervention applied to clinic-scheduled follow-up appointments. All combinations of the intervention significantly increased cancellations, but none increased appointments kept or decreased appointments not kept significantly. Log linear analyses showed that the lag time between scheduling and the appointment significantly influenced appointment keeping. The results suggest that if clinics want to increase cancellations, a mailed reminder and effort reduction are sufficient. To increase appointment keeping, other interventions, such as reduced lag time, may be necessary.     

Risk factors for psychological morbidity in women attending a one-stop diagnostic clinic with suspected breast disease

Abstract

The present study was designed to identify risk factors for psychological morbidity in women attending a one-stop diagnostic clinic with suspected breast disease. A cohort of 158 women were recruited and were asked to complete scales measuring psychological morbidity and psychosocial factors in the period immediately before their appointment and to repeat the assessments of psychological morbidity on the day of the appointment. Relevant clinical and demographic data were also collated. Within the cohort 1.4% of respondents received a diagnosis of malignant disease. Psychological morbidity, both prior to and during the diagnostic appointment was strongly predicted by psychosocial factors (i.e., acceptance-resignation coping, personal self esteem and discrepancies in social support), accounting for 54% and 63% of the variance at pre-appointment and appointment day phases respectively. Other measured variables were found not to be correlated with and/or to account for a significant proportion of the variance in the measures of morbidity. These results suggest that these psychosocial variables should be targeted in interventions designed to reduce psychological morbidity in this patient group.     

The jumping to conclusions bias associated with symptoms in schizophrenia: which factors influence this bias?

ABSTRACT

Jumping-to-conclusions (JTC) bias has been found to be associated with delusions. However, there is limited data about which other factors are related to JCT bias. The aim of the current study was to investigate the effects of psychotic, cognitive, impulsivity and anxiety symptoms on JTC bias. We compared individuals with paranoid schizophrenia, non-paranoid schizophrenia, generalized anxiety disorder and healthy individuals in terms of JTC bias. Beads task (90:10 and 60:40 versions), Tower of London task, BPRS, SAPS, SANS and BIS-11 were applied. Our results show that the factors related with JTC bias were different on each version of the Beads task. Education levels, anxiety and negative symptoms of individuals with schizophrenia were found to affect JTC bias on 90:10 version of task, whereas positive symptoms and impulsivity levels were related to JTC bias on 60:40 version. These results are important as they contribute to our understanding of this relationship.     

Factors influencing failure to show for a family evaluation

Abstract

An important issue in clinical practice concerns clients' failure to keep their initial evaluation appointments, which has been termed defection (Shapiro and Budman, 1973). Research findings and clinical impressions suggest that client defection can be related to three sets of factors: actuarial variables, client psychological and motivational variables, and client-clinician interaction prior to the initial appointment (Rubinstein and Lorr, 1956; Garfield, 1971). Among the actuarial variables, the following have been suggested as being related to clients' defection: referral source, distance client must travel for the appointment, client socioeconomic status (SES), and waiting time (Brill and Storow, 1960; Raynes and Warren, 1971; Lorion, 1973).     

Expressed emotion and Milan systemic intervention: a pilot study on families of people with a diagnosis of schizophrenia

This article presents the results of a pilot study carried out on families of people with a diagnosis of schizophrenia (high‐frequency users of psychiatric services) using a standardized version of systemic family intervention based on the Milan Approach (‘Circular Interview’). We used expressed emotion (EE) to compare and assess two homogeneous samples of families, a treatment group (n = 10) and a control group (n = 8). We found that families participating in circular interviews showed a reduction in criticism, while 30% of their members with a diagnosis of schizophrenia relapsed. Families not receiving treatment showed no changes in EE levels, while 62.5% of their members with a diagnosis of schizophrenia relapsed. Although the difference in relapse rates is not statistically significant, these results justify further studies on the use of nondirective systemic intervention with families of people with a diagnosis of schizophrenia.     

The impact of waiting-list times on client attendance for relationship counselling

The impact of waiting-list times on subsequent attendance for appointments has received extensive attention within the area of health, but hitherto has received relatively little interest from counselling services. Given the current pressure on all welfare agencies for accountability and efficient use of resources, counselling organisations need to consider resource usage and barriers to efficiency. A study was therefore made of one aspect of this issue: the impact of short v. long time-delays between initial referral and first appointment for relationship counselling. It was found that clients offered appointments within two weeks of referral were significandy more likely to attend for first appointment than were clients whose appointment came between 4 and 12 weeks post-referral. The implications of these results for organisational policy are discussed.     

Assessment of shared decision-making in community mental health care: Validation of the CollaboRATE

Background/ObjectiveCollaboRATE is a 3-item self-report measure of the patient experience of shared decision-making (SDM) process. The objective of this study is to assess the psychometric properties of CollaboRATE in community mental health care.MethodA cross-sectional study was conducted at a Community Mental Health Center of the Canary Islands Health Service. Two hundred and fifty consecutive psychiatric outpatients were invited to participate. Of those, 191 accepted (76.40% of response rate) and completed the CollaboRATE, the Control Preferences Scale (CPS), and a form with sociodemographic and clinical variables.ResultsExploratory factor analysis ratified the unidimensionality of the measure. High internal consistency was found (α Cronbach = .95, Guttman's λ = .93, and ω = .95). Strong positive correlations (p < .0001) were found between the CollaboRATE and the CPS. Only 39.80% of respondents gave the best possible score on CollaboRATE.ConclusionsThis study provides evidence for the reliability and validity of the Spanish version of the CollaboRATE as a measure of SDM. The measure is quick to complete and feasible for use in outpatient mental health care. At present, a significative number of psychiatric outpatients are not involved in SDM. The use of this measure in psychiatric routine care can be a key tool in assessing and implementing SDM.     

How semantic content of stimuli works on episodic memory processes in negative schizophrenia: Evidence from picture recognition

IntroductionEven though episodic memory is impaired in schizophrenia, semantic processing strategies can improve patients’ performance. However, it is less clear if negative schizophrenia patients can benefit from semantic strategies, and if both familiarity and recollection processes can be enhanced in patients with schizophrenia.ObjectiveThe aim of this study was to investigate the possibility for negative schizophrenia patients to enhance their familiarity and/or recollection processes in the presence of concrete images.MethodA recognition memory task using concrete versus abstract images as stimuli was designed to assess the performance of schizophrenia patients for single item recognition and the recollection of spatial context, allowing us to calculate the estimates of familiarity and recollection processes. Thirty-six patients with schizophrenia and 18 healthy individuals participated to the study. Schizophrenia patients were divided into two groups according to their scores on the negative scale of the Positive and Negative Syndrome Scale for Schizophrenia (PANSS).ResultsResults showed that, while healthy participants enhanced their recollection estimates in the presence of concrete images, both schizophrenia groups could enhance their familiarity estimates.ConclusionSemantic strategies are helpful to promote successful familiarity process in schizophrenia patients, independently from clinical dimension of negativity. However, recollection process seems not to respond to such strategies.     

The validation of a religiosity measure for individuals with schizophrenia

Measures of religiosity validated for psychotic patients do not exist. This study sought to examine the psychometric properties of a modified version of the Religious Life Inventory (RLI) in this population. It was anticipated that religiosity would be affected by psychotic symptoms. The religiosity of patients with schizophrenia was assessed while symptoms were more evident and again after treatment, to evaluate changes in religiosity. Four factors were found which characterized the religiosity of people with schizophrenia. These factors were found to have good construct validity. Patient's responses indicated a reduced need for religion when re-assessed once symptom scores were reduced.     

Conversion to non-remunerated plasmapheresis donation: Effects of labeling and donation environment

IntroductionPlasmapheresis donors’ recruitment strategies should focus on asking whole-blood donors (WBDs) to convert to plasmapheresis.ObjectiveThis study measured the effect of labeling on the conversion of WBDs to plasmapheresis donation and examined the relationship between the type of blood drive and conversion to plasmapheresis.MethodsTwo blood drives destined towards students were held either on a university campus (mobile blood drive), or in a blood center. At the end of each whole-blood donation, the nurse performed a labeling, reactivated a few minutes later by a second individual asking the donor if he would agree to donate plasma. If so, an appointment for plasma donation was made or a promise was collected. The number of commitments to plasmapheresis (promise/appointment) and the number of achievements of these commitments measured the effect of labeling.ResultsFew significant differences between social or functional labeling were found compared to a “no labeling” condition in terms of commitments and concretizations. The in-center blood drive achieved three times more engagements than the mobile blood drive (p < .001). Appointments had better chances to turn into a plasma donation than promises (p < .001).ConclusionLabeling as it was tested seemed ineffective in conversion from whole blood donation to plasmapheresis, but further studies should be carried out to replicate these results. When only collected during in-center blood drives, blood collection agencies should try to develop in-center whole blood donations and promotional approaches towards plasma donation. When approaching potential plasmapheresis donors, appointments should be preferred to promises. Further research is needed to examine the causes of these results.     

Self-consciousness impairments in schizophrenia with and without first rank symptoms using the moving rubber hand illusion

IntroductionThe moving rubber hand illusion allows the evaluation both the sense of body ownership and agency using visuo-motor stimulations.MethodsWe used the moving rubber hand illusion in anatomic congruence with explicit measures to compare active asynchronous and passive synchronous movements in patients diagnosed with schizophrenia with first rank symptoms (FRS) (n = 31) versus without FRS (n = 25).ResultsPatients with FRS are characterized by a lack of agency in active asynchronous condition. The two groups had no sense of ownership in synchronous passive condition. Using a multivariate regression model, we found an association between agency and body ownership measures in the active asynchronous condition in two groups (OR: 1.825, p < 0.001). In the passive condition, this association was only present in the group with first rank symptoms (OR: 2.04, p < 0.001).ConclusionTemporal proximity and sensorimotor information are essential in the understanding of self-consciousness disorders in schizophrenia.     

Context-processing deficits in schizophrenia: diagnostic specificity, 4-week course,and relationships to clinical symptoms

Previous research on schizophrenia suggests that context-processing disturbances are one of the core cognitive deficits present in schizophia. However, it is not clear whether such deficits are specific to schizophrenia as compared with other psychotic disorders. To address this question, the authors administered a version of the AX Continuous Performance Test designed to assess context processing in a sample of healthy controls, patients with schizophrenia, and patients with other psychotic disorders. Participants were tested at index (when medication naive and experiencing their first contact with psychiatric services) and 4 weeks later, following medication treatment. At index, patients with schizophrenia and the psychotic comparison group demonstrated similar impairments in context processing. However, context-processing deficits improved in the psychotic comparison group at 4 weeks but did not improve in patients with schizophrenia.     

Missed first appointments: Prevalence and associated factors in first-time attendees at an outpatient psychiatric clinic in Nigeria

In Nigeria, outpatient care forms the bulk of the psychiatric service. While there are no published data, empirical observations indicate that default may be high and exerting a huge toll on the cost of care. The aims were to determine the first-appointment default rate among newly seen outpatients in a psychiatric clinic and to identify factors associated with it. The study was a survey of all newly seen patients from 1 January 2006 to 31 January 2006, and who were given a follow-up appointment. A total of 223 new patients were seen. Of these, 151 (67.7%) turned up for their appointment, 61 (27.4%) defaulted, and 11 (4.9%) were referred. Defaulters were more likely to be Christians, younger in age, and in employment. On using correlation statistics, respondents’ religion and occupational status demonstrated a linear relationship and a significant association with follow-up attendance/non-attendance. The rate of non-attendance at first follow-up is of clinical concern, and the possible contribution of religion to this may be enormous. Clinicians and health policy makers need to be sensitive to this. The introduction of community psychiatric services and collaboration between orthodox and traditional/religious practitioners may help reduce default rates.     

Psychometric properties of the French version of Brief Sensation Seeking Scale (B-SSS)

IntroductionA French version of the Briefing-Sensation Seeking Scale (B-SSS) (Hoyle et al., 2002) was developed according to a process of double reverse translation.ObjectiveTwo studies were then led to validate the psychometrics properties (validity and the reliability) of this French version of the B-SSS.MethodsIn the first study, 97 participants (14–24 years old) answered the original version (in English) and the translated version (in French). In the second study, 124 participants (14–24 years) answered the French version at two times measurement. Psychometrics analyses brings together reliability indices (Cronbach's alpha and temporal stability) and concurrent validity indices.ResultsFor both studies, Cronbach alphas were used to assess internal consistency, while intraclass coefficients (ICC) demonstrated temporal stability. In the second study, Pearson correlations between the French version and the ImpSS supported concurrent validity. Reliability is acceptable in the first study (α = .601 in, 674; ICC = .550–.895) and satisfactory in the second study (α = .734–.755; ICC = .650–.948). Pearson's correlation of the French version of the B-SSS and the ImpSS varies between .658 and .754.ConclusionPsychometrics properties of the French version of the B-SSS show that this scale can be used to measure sensation seeking with teenagers and for young adults.     

Does the German version of the Exercise Dependence Scale measure exercise dependence?

ObjectiveTo examine the concordance of a questionnaire-based categorization as ‘at-risk for exercise dependence’ and an interview-based diagnosis of exercise dependence.DesignOne hundred thirty four subjects answered the German version of the Exercise Dependence Scale-21 (EDS-G). They were also assessed with a structured clinical interview for exercise dependence.MethodThe congruence between the questionnaire-based categorizations of ‘at-risk for exercise dependence’ and the diagnosis of exercise dependence based on the interview was examined using κ-coefficients.ResultThe agreement between questionnaire-based and interview-based diagnoses was fair to moderate with more false positive categorization based on the EDS-G.ConclusionAssuming that a structured clinical interview allows a more accurate diagnostic categorization, the EDS-G might overestimate the prevalence of exercise dependence.     

The sociocultural conceptualisations of schizophrenia and patterns of help seeking in south-east Nigeria

Socioculturally influenced interpretations of mental illness play decisive roles on the time and choice of treatment. These often result in significant delays before patients present at the psychiatric services, with consequent worsening of the prognosis. The aim was to assess the association between sociocultural factors, choice of treatment and treatment delay among patients with schizophrenia. A cross-sectional study of 360 patients with schizophrenia, without previous contact with any statutory psychiatric services, was done. Of this, 75.8% of the participants had visited traditional/faith healers as the first treatment option and have attributed schizophrenia to magico-supernatural causation, despite 70.0% of the participants being educated, while 24.2% of them believed in the natural causation of the illness and presented early to psychiatric hospital. There is a need for community-based psychiatric services that would have mental health education as one of their core mandates; and collaborations with traditional and faith-based healers aimed to reduce delay in their facilities.     

Comparing neurocognitive impairment in schizophrenia and bipolar I disorder using the Screen for Cognitive Impairment in Psychiatry Scale

The purpose of this study was to compare the psychometric properties of the Screen for Cognitive Impairment in Psychiatry (SCIP) when applied to patients diagnosed with schizophrenia (n = 126) or bipolar I disorder (n = 76), and also to compare the cognitive impairment in both samples of patients and a control group (n = 83) using the SCIP and a complete neuropsychological battery. The SCIP is a scale intended to quickly and easily assess cognitive impairment in patients with severe psychiatric disorders. The results showed firstly that, in terms of internal consistency, temporal stability, dimensional structure, and criterion-referenced validity, the SCIP provides reliable and valid scores at an equivalent level in both schizophrenia and bipolar I disorder samples. Secondly, it showed that differential cognitive impairment between the two patient groups occurs only in verbal memory, although the effect size of the difference is small. Finally, compared with the control group, cognitive impairment was present at all levels in both groups of patients using both the SCIP and the neuropsychological battery, which indicates that the SCIP is a good screening tool for cognitive deficits in schizophrenia and bipolar and useful in clinical practice for healthcare professionals.     

the scientific association of the lake of constance psychiatrists 1919-1932 psychoanalytic contributions to the treatment of psychoses

Abstract

From 1919 until 1932, psychiatrists from the mental hospitals near Lake Constance and from the Bellevue-Sanatorium in Kreuzlingen/Switzedand organized regular scientific meetings, where well-known representatives of all the relevant psychiatric and psychotherapeutic schools and important phenomen-ologicai philosophers came together. Getting in touch with psychoanalytical and social psychiatric trends led to a quite lively and fruitful exchange in theory and practice. Through the Reichenau psychiatrist Alfred Schwenninger, Ludwig Binswanger got to know personally the phenomenologic philosophers Alexander Pfander and Edmund Husserl, who also held lectures at meetings there. Hans Wolfgang Maier from the Burghölzli in Zurich and his colleagues from Herisau and Munsterlingen concentrated on the mainly social psychiatric and forensic work diey did. Quite a few of the lectures were published in the TZeitschrift für die gesamte Neurologie und Psychiatrie The paper concentrates on contributions related to psychoanalysis. The Reichenau director Karl Wilmanns showed a sceptical sympathy for psychoanalysis even when applied to schizophrenia. Ludwig Binswanger treated psychotic patients psychoanalytically and tried to combine psychoanalysis, clinical psychiatry and philosophy. Especially phenomenology was for him a fundament of psychopathology. The paper reports in detail some of his contributions at the scientific discussions, theoretical issues as well as issues of a psychoanalytic practice.