The International Journal of Psychiatry in Medicine (INT J PSYCHIAT MED )

Publisher: Baywood Publishing


The goal of the International Journal of Psychiatry in Medicine is to address the complex relationships among biological, psychological, social, religious and cultural factors in patient care. The aim of the Journal is to provide a forum where researchers and clinicians in psychiatry, medicine, and surgery from around the world can educate each other and advance knowledge concerning biological, psychological, and social theory, methods, and treatment as they apply to patient care. Topics of interest include, but are not limited to: psychobiological, psychological, social, religious, and cultural modifiers of illness; the minor and moderate mental disorders seen and treated in medical practice; doctor-patient interactions; ethical issues in medicine; biomedical etiologies of mental symptoms; research from successful collaborative, multidisciplinary models such as geriatrics; and, health services research. The Journal will publish original research, review articles, innovative educational programs, and illustrative case reports.

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    International Journal of Psychiatry in Medicine, The website
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    International journal of psychiatry in medicine
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    Periodical, Internet resource
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Baywood Publishing

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Publications in this journal

  • The International Journal of Psychiatry in Medicine 09/2013; 45(4):311-322.
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    ABSTRACT: Delusional disorder is an infrequent diagnosis in outpatient clinical practice. While delusional thought processes are a fairly common part of symptom clusters in chronic psychiatric disorders such as schizophrenia and bipolar disorders, true delusional disorders are believed to be fairly rare. In this article, we review scientific data on incidence, diagnosis, and treatment of delusional disorders. This was done by PubMed search utilizing the search terms "delusional disorder," "oncology," "diagnosis," and "treatment." Relevant articles were excluded if they dealt predominantly with schizophrenia instead of primary delusional disorder. We present a case of a patient diagnosed with follicular lymphoma and an apparent longstanding history of persecutory delusions. The patient's symptoms eventually led to intervention in the oncology practice involving the medical center faculty and staff, as well as local police and the court system. Delusional disorder is an under-researched condition, and limited information is known regarding the treatment of this condition when it impacts upon medical care. Future research directions are proposed.
    The International Journal of Psychiatry in Medicine 01/2013; 45(3):237-43.
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    ABSTRACT: In Japan, the prevalence of overweight/obesity in the general population is considerably lower and the mean duration of hospitalization of patients with schizophrenia is much longer than those in Europe and North America. The aim of this study was to investigate whether these differences in ethnics or healthcare systems influence the nutritional status of patients with schizophrenia. Body mass index (BMI) and blood biochemistry tests were determined at hospitalization and at discharge for 171 Japanese patients who were hospitalized for the treatment of acute phase schizophrenia. For 56 patients who were overweight/obese at hospitalization, BMI (p < 0.001), fasting plasma glucose (p = 0.039), and low-density lipoprotein (p = 0.027) were significantly lower at discharge than at hospitalization. BMI at hospitalization, duration of hospitalization, and age were associated with a decrease in BMI during hospitalization. Among the 115 patients who were not overweight/obese at hospitalization, there were no changes in BMI and blood biochemistry tests between hospitalization and discharge. Compared with inpatients, outpatients with schizophrenia may be more likely to be overweight/obese in Japan.
    The International Journal of Psychiatry in Medicine 01/2013; 45(3):261-8.
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    ABSTRACT: To compare the prevalence of co-morbid depression between patients with chronic primary headache syndromes and chronic posttraumatic headaches. A prospective cross-sectional analysis of all patients presenting sequentially to a community-based general neurology clinic during a 2-year period for evaluation of chronic headache pain was conducted. Headache diagnosis was determined according to the International Headache Society's Headache Classification criteria. Depression was determined through a combination of scores on the clinician administered Hamilton Rating Scale for Depression and patients' self-report. An additional group of patients who suffered traumatic brain injuries (TBI) but did not develop post-traumatic headaches was included for comparison. A total of 83 patients were included in the study: 45 with chronic primary headaches (24 with chronic migraine headaches, 21 with chronic tension headaches), 24 with chronic post-traumatic headaches, and 14 with TBI but no headaches. Depression occurred less frequently among those with chronic post-traumatic headaches (33.3%) compared to those with chronic migraine (66.7%) and chronic tension (52.4%) headaches (Chi-Square = 7.68; df = 3; p = 0.053), and did not significantly differ from TBI patients without headaches. A multivariate logistic regression model using depression as the outcome variable and including headache diagnosis, gender, ethnicity, and alcohol and illicit substance use was statistically significant (Chi-Square = 27.201; df = 10; p < 0.01) and identified primary headache (migraine and tension) diagnoses (Score = 7.349; df = 1; p = 0.04) and female gender (Score = 15.281; df = 1; p < 0.01) as significant predictor variables. The overall model accurately predicted presence of co-morbid depression in 74.7% of the cases. Co-morbid depression occurs less frequently among patients with chronic post-traumatic headaches and TBI without headaches than among those with chronic primary headaches.
    The International Journal of Psychiatry in Medicine 01/2013; 45(3):227-36.
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    ABSTRACT: Reviewing with resident physicians their preciously recorded video of patient encounters is an effective method for teaching not only communications and interpersonal skills but also such subjects as agenda negotiation, visit efficiency, shared decision making, and overall medical care. Video allows for effective coaching while minimizing observer effect. Many residency programs use video review processes for evaluation and coaching, yet there is paucity of literature on the subject, and no consensus on best processes or equipment. Recent advances in the design of digital media devices has made it easier to conduct video review in everyday medical settings, but also creates new challenges in ensuring security and confidentiality. In this article, we have outlined the infrastructure and process needed to design and implement such a program as well as possible pitfalls that should be attended to in order to ensure patient confidentiality as well as resident safety.
    The International Journal of Psychiatry in Medicine 01/2013; 45(4):413-22.
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    ABSTRACT: This study examined whether coercive measures or perceived coercion experienced by mentally disabled patients in the hospitalization process could be justified under paternalism. To find out whether coercion can be justified by paternalism, a year of follow-up research was conducted to examine the impact of coercive measures and perceived coercion experienced during hospitalization on the patients' therapeutic benefit. A 6-month period and a 1-year period of follow-up research was conducted with 266 patients to assess whether the coercion they experienced during hospitalization (coercive measures and perceived coercion) had an effect on changing the patients' mental symptoms and insight. The results showed a decrease in both mental symptoms and insight over time. However, it was found that neither coercive measures nor perceived coercion had a significant effect on the change of mental symptoms and that, thus, coercion had little contribution to the declining of symptoms. Coercive measures had no effect on the change of insight but perceived coercion was shown to have a positive effect on a change in insight. Patient insight was shown to improve with increased perceived coercion. Paternalism provides a partial explanation to serve as a basis for justifying perceived coercion. Limitations and suggestions for further study are discussed.
    The International Journal of Psychiatry in Medicine 01/2013; 45(3):279-98.
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    ABSTRACT: This observational study evaluates the long-term outcome of switching to ziprasidone in patients with schizophrenia in the clinical practice setting. Patients (208) with schizophrenia who had been switched to ziprasidone monotherapy due to partial response or tolerability problems were followed for 1 year. Efficacy was assessed at baseline and months 1, 3, and 12 with Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression-severity (CGI-S), and CGI-improvement. Quality of life, functionality, and safety measures, including metabolic parameters, were also assessed; 195 subjects comprised the per protocol analysis population. A reduction > or = 30% in BPRS total score was observed in 42.5% of the subjects. Mean scores of the BPRS (global and positive and negative clusters), CGI-S and CGI-I significantly decreased at endpoint (p < 0.001). Ziprasidone treatment was also associated with statistically significant improvements in the GAF, WHO-DAS-II, and SF-12. After 1-year follow-up, a mean weight decrease of -1.6 kg (p < 0.05) was observed. Mean levels of LDL cholesterol and triglycerides also decreased (p < 0.01) while HDL cholesterol levels increased (p < 0.05) at endpoint. No significant changes in mean glucose levels at study end were detected. These findings suggest that switching to ziprasidone is effective and well tolerated in patients with schizophrenia requiring a change in antipsychotic medication.
    The International Journal of Psychiatry in Medicine 01/2013; 45(2):125-42.
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    ABSTRACT: Dealing with complexity in a healthcare context requires the recognition of multiple variables impacting the interaction between the patient, the provider, and the care delivery system, resulting in situations in which usual treatments do not work as well as patients and clinicians expect. The Complex Continuity Clinic is presented as an innovative model for understanding and responding to complexity, particularly in a medical education setting, and for implementing different patient-engagement strategies. "Real world" clinical examples are provided to illustrate how pioneering approaches that embrace complex biopsychosocial health issues can result in higher quality of care and potentially reduced costs.
    The International Journal of Psychiatry in Medicine 01/2013; 45(4):377-87.
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    ABSTRACT: Motivational Interviewing (MI) is an evidence-based approach to facilitating behavior change. This approach has been applied in multiple settings (e.g., healthcare, drug and alcohol treatment, psychotherapy, health and wellness coaching, etc.). This article applies MI in a pedagogical context with medical residents as a semi-directive, learner-centered teaching style for eliciting clinical behavior change. Herein we present the foundational theories that inform this approach, describe the process of teaching, address barriers and challenges, and conclude with a review of performance to date including residents' narrative accounts of their experience with the curriculum.
    The International Journal of Psychiatry in Medicine 01/2013; 45(4):389-99.
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    ABSTRACT: Motherhood is a critical situation characterized by role conflicts. These conflicts between the roles of mother, worker, and wife are the norm in the postpartum period and may jeopardize a mother's well-being. The purpose of this study was to explore the relationships between postpartum adaptation and depression among new mothers who live in northern Taiwan. A total of 186 first pregnancy mothers were recruited via convenience sampling methods and they completed mailed questionnaires between 1 week and 2 months after giving birth. Structured questionnaires including Demographic Inventory Scale, Postpartum Self-Evaluation Questionnaire, and Edinburgh Postnatal Depression Scale were used. Ninety-four (50.5%) women exhibited depressive symptoms (EPDS > 10) and 73 (39.2%) women needed to consult the doctor (EPDS > 12). The risk factors for postpartum depression symptoms included unplanned birth, low socioeconomic status, and part-time employment. The correlation between women's different aspects of postpartum adaptation and depression ranged was from low to medium. The best predictors of postpartum depression were confidence in their own competence of motherhood tasks, satisfaction with life circumstances, and partner participating in child care. These three subsets explained 44.8% of the total variance. This study shows that healthcare providers who work with primiparas during the first 2 months after giving birth should pay more attention to postpartum depression, keeping in mind associated risk factors. A new mother's confidence in her own abilities as a new mother may be particularly important in determining the likelihood of postpartum depression.
    The International Journal of Psychiatry in Medicine 01/2013; 45(1):1-13.
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    ABSTRACT: The long-term efficacy and safety of electroconvulsive therapy (ECT) for refractory schizophrenia is rarely reported. We report the case of a 38-year-old female patient with refractory schizophrenia who was treated with ECT for 14 years (from 24 years of age). Case records of clinical treatment and laboratory tests are described and analyzed. During the first 11 years, the patient was treated with ECT as an adjunct to antipsychotic drugs, but the effectiveness was unstable. For the remaining 3 years she was treated with antipsychotic drugs as an adjunct to ECT and her condition stabilized as she gradually recovered social function. We summarize the clinical characteristics, therapy regimen, long-term effectiveness, and safety of this interesting case.
    The International Journal of Psychiatry in Medicine 01/2013; 45(3):245-60.
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    ABSTRACT: Studies have shown that patients with end-stage kidney disease (ESKD) are at risk of experiencing suicidal ideation and suicide attempt. The aim of the present review was to investigate whether there was a relationship between dialysis and suicide. A careful systematic review of the literature was conducted to determine the potential association between dialysis and suicide. Abstracts that did not explicitly mention suicide and dialysis were excluded. We identified as specific fields of interest in the analysis of dialysis or ESRD and suicidal behavior. A total of 26 articles from peer-reviewed journals were considered and the most relevant articles (N = 13) were selected for this review. It has been posited that suicidal ideation, occurring in dialysis, may arise from co-morbid depression and psychiatric symptoms are frequent in patients who underwent dialysis. The present review should be considered in the light of some limitations. We did not carry out a meta-analysis because data from most of the studies did not permit it. Samples included different measurements and different outcomes, and they assessed patients at different time points. The available data suggest that the risk of self-harm may be higher than expected in dialysis patients especially in those who suffer by depression and anxiety. Moreover, although the majority of deaths among dialysis patients is preceded by withdrawal from treatment, suicide remains a separate phenomenon.
    The International Journal of Psychiatry in Medicine 01/2013; 46(1):85-108.
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    ABSTRACT: This study investigated the potential association between Obsessive-Compulsive Disorder (OCD) and a functional polymorphism of IL-1beta-511 C/T in Chinese Han population. The authors genotyped the IL-1beta-511 C/T of 241 OCD patients and 444 healthy control subjects and then performed a case-control association analysis. No difference was found in IL-1beta-511 C/T genotypic and allelic frequencies between OCD cases and controls (chi2 = 0.501, df = 2, P = 0.78 by genotype; chi2 = 0.487, df = 1, P = 0.49 by allele). IL-1beta-511 polymorphism may not play a major role in the genetic predisposition to OCD in Chinese Han population. Given that this is an early investigation of this gene in OCD, further studies are required to draw firm conclusions.
    The International Journal of Psychiatry in Medicine 01/2013; 46(2):145-52.
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    ABSTRACT: Historical evidence and prior research suggest that psychiatry is biased against religion, and religious physicians are biased against the mental health professions. Here we examine whether religious and non-religious physicians differ in their treatment recommendations for a patient with medically unexplained symptoms. We conducted a national survey of primary care physicians and psychiatrists. We presented a vignette of a patient with medically unexplained symptoms, and experimentally varied whether the patient was religiously observant. We asked whether physicians would recommend six interventions: antidepressant medication, in-office counseling, referral to a psychiatrist, referral to a psychologist or licensed counselor, participation in meaningful relationships and activities, and involvement in religious community. Predictors included the physician's specialty and the physician's attendance at religious services. The response rate was 63% (896 of 1427) primary care physicians and 64% (312 of 487) psychiatrists. We did not find evidence that religious physicians were less likely to recommend mental health resources, nor did we find evidence that psychiatrists were less likely to recommend religious involvement. Primary care physicians (but not psychiatrists) were more likely to recommend that the patient get more involved in their religious community when the patient was more religiously observant, and when the physician more frequently attended services. We did not find evidence that mental health professionals are biased against religion, nor that religious physicians are biased against mental health professionals. Historical tensions are potentially being replaced by collaboration.
    The International Journal of Psychiatry in Medicine 01/2013; 45(1):31-44.
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    ABSTRACT: Postoperative delirium after cardiac surgery is associated with many consequences such as poorer functional recovery, more frequent postoperative complications, higher mortality, increased length of hospital stay, and higher hospital costs. The aim of this study was to evaluate the efficacy of perioperative psycho-educational intervention in preventing postoperative delirium in post cardiac surgery patients. We conducted a comparative retrospective study between 49 patients who had received perioperative psycho-educational intervention and 46 patients who had received standard care. The primary outcome was the incidence of postoperative delirium. Secondary outcomes included length of ICU stay, and severity and duration of postoperative delirium among the patients who had developed delirium. The incidence of postoperative delirium was significantly lower in the intervention group than that in the control group (12.24% vs. 34.78%, P = 0.009). Among the patients who had developed postoperative delirium, there was no statistical difference between the two groups regarding secondary outcomes. Our results show that the patients who received perioperative psycho-educational intervention were associated with a lower incidence of postoperative delirium after cardiac surgery than those who received standard care. Clinicians would be able to implement this psycho-educational intervention as part of routine practice to reduce delirium.
    The International Journal of Psychiatry in Medicine 01/2013; 45(2):143-58.
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    ABSTRACT: The current article describes the results of posttraumatic stress educational outreach and screening offered to 141 citizens of Japan who attended a public-service mental health training regarding post-disaster coping 40 days after a 6.8 Richter Scale earthquake, local and regional deaths, and an ongoing nuclear radiation threat. Attendees were given access to anonymous questionnaires that were integrated into the training as a tool to help enhance mental health literacy and bridge communication gaps. Questionnaires were turned in by a third of those in attendance. Among respondents, multiple exposures to potentially-traumatic events were common. More than a quarter of respondents met criteria for probable PTSD. Physical health and loss of sense of community were related to PTSD symptoms. Associations and diagnosis rates represented in these data are not generalizable to the population as a whole or intended for epidemiological purposes; rather, they are evidence of a potentially useful approach to post-disaster clinical screening, education, and engagement. Results are presented in the context of previous findings in Japan and ecologically-supportive post-disaster field research is discussed.
    The International Journal of Psychiatry in Medicine 01/2013; 45(2):159-74.
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    ABSTRACT: To examine the association of anxiety and depression with pulmonary-specific symptoms of Chronic Obstructive Pulmonary Disease (COPD), and to determine the extent to which disease severity and functional capacity modify this association. Patients (N = 162) enrolled in the INSPIRE-II study, an ongoing randomized, clinical trial of COPD patients and their caregivers who received either telephone-based coping skills training or education and symptom monitoring. Patients completed a psychosocial test battery including: Brief Fatigue Inventory, St. George's Respiratory Questionnaire, UCSD Shortness of Breath Questionnaire, State-Trait Anxiety Inventory, and Beck Depression Inventory. Measures of disease severity and functional capacity (i.e., FEV1 and six-minute walk test) were also obtained. After covariate adjustment, higher anxiety and depression levels were associated with greater fatigue levels (ps < .001, deltaR2 = 0.16 and 0.29, respectively), shortness of breath (ps < .001, deltaR2 = 0.12 and 0.10), and frequency of COPD symptoms (ps < .001, deltaR2 = 0.11 and 0.13). In addition, functional capacity was a moderator of anxiety and pulmonary-specific COPD symptoms. The association between anxiety and shortness of breath (p = 0.009) and frequency of COPD symptoms (p = 0.02) was greater among patients with lower functional capacity. Anxiety and depression were associated with higher levels of fatigue, shortness of breath, and frequency of COPD symptoms. It is important for clinicians to be aware of the presence of anxiety and depression in COPD patients, which appears to correlate with pulmonary-specific COPD symptoms, especially in patients with lower functional capacity. Prospective design studies are needed to elucidate the causal relationships between anxiety and depression and pulmonary-specific symptoms in COPD patients.
    The International Journal of Psychiatry in Medicine 01/2013; 45(2):189-202.
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    ABSTRACT: Depression and anxiety frequently co-occur in patients with. cirrhosis, but their underlying biological substrates are unclear. There is now evidence to suggest that depression is accompanied by signs of an immune response. This study investigated the correlation between depression/anxiety and T-lymphocyte subsets in liver cirrhosis patients. A total of 59 patients (37 males and 22 females; aged between 26-81 years) with cirrhosis were enrolled in the study. Severity of depression and anxiety were assessed through the Hamilton depressive scale (HAMD, the 24-item version) and the Hamilton anxiety scale (HAMA). T-lymphocyte subsets (CD3, CD4, and CD8) in peripheral blood were determined by flow cytometry. The relationship between lymphocyte subsets and depression/anxiety scores was studied by correlation analysis. The mean total HAMD and HAMA scores for the 59 subjects were 12.8 +/- 10.4 (range = 0-46) and 7.0 +/- 5.7 (range = 0-26), respectively. Fourteen of 59 subjects (23.7%) had HAMD scores equal to or above 20, indicative of depression. The percentage of CD8, but not CD3 or CD4, in T-lymphocyte subsets was positively correlated with depression (HAMD) (r = 0.268, P = 0.043) and anxiety severity (HAMA) (r = 0.321, P = 0.013). After controlling for age and Child-Pugh scores, the correlations were still significant. Around one-fourth of cirrhosis patients may have depression, although depression is not related to cirrhosis severity. Our findings are the first to show that depression and anxiety may be associated with increased levels of CD8 in T-lymphocyte subsets in cirrhosis patients, suggesting that an imbalance of T-lymphocyte subsets may be a factor facilitating depression and anxiety in cirrhotic patients. Examination of CD8 T-lymphocytes may prove useful in assessing the potential relationship between depression, anxiety, immunity, and liver cirrhosis.
    The International Journal of Psychiatry in Medicine 01/2013; 45(1):15-29.
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    ABSTRACT: Previous research has shown a high rate and a unique pattern of suicide in China. We aim to present the current suicide rates and patterns in the Yunnan province, a multi-ethnic region in Southwestern China. This is a descriptive study based on the 3rd Chinese national mortality survey. We reported the suicide rates by sex, 5-year age group, region (urban or rural), and minority group from 2004 to 2005 in the Yunnan province. We estimated a mean annual suicide rate of 19.82 per 100,000 and a total of 8751 suicide deaths per year. Sex-specific rate estimates were 21.09 per 100,000 and 18.46 per 100,000 for males and females, respectively. The male/female ratio was 1.14. Region-specific rate estimates were 20.60 per 100,000 and 19.18 per 100,000 for rural and urban regions, respectively. The rural-to-urban ratio was 1.07. Suicide accounted for 4.83% of all deaths in the Yunnan province and represented the fifth leading cause of death. In minority groups, the highest suicide rates were found in the Li su minority (50.75 per 100,000), the Jing po minority (36.38 per 100,000), the Meng gu minority (32.65 per 100,000) and the Miao minority (30.75 per 100,000). The lowest rates were found in the Hui minority (0.96 per 100,000) and the Ha ni minority (1.64 per 100,000). The suicide characteristics of this multi-ethnic region of China are different from those of the rest of China and the world, which indicates that the development of a special intervention strategy in multi-ethnic areas for suicide prevention is needed.
    The International Journal of Psychiatry in Medicine 01/2013; 45(1):83-96.

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