General Hospital Psychiatry (GEN HOSP PSYCHIAT )

Publisher: Elsevier


General Hospital Psychiatry explores the linkages and interfaces among psychiatry, medicine and primary care. The Journal emphasizes a biopsychosocial approach to illness and health, and provides a forum for communication among professionals with clinical, academic, and research interests in psychiatry's essential function in "the mainstream of medicine." Building upon those liaison consultation and psychiatric services which have burgeoned in the general hospital setting, the Journal expands beyond this base to encourage new contributions to the understanding and treatment of illness - in inpatient, ambulatory, and community settings. Studies of multisystem relationships of life stresses, physical experience, psychosocial factors, interpersonal and intrapsychic reactions, family structure, ecological change, and institutional forces are especially relevant to the Journal's objectives. General Hospital Psychiatry publishes original articles on biopsychosocial approaches to medicine; liaison-consultation psychiatry; the relationship of psychiatric services to general medical systems; and new directions in medical education which stress psychiatry's role in primary care, family practice, and continuing education. It also features Brief Communications, News and Notes, Book Reviews, and Medical Psychiatric Rounds, of interest to physicians and other professionals and students in this field.

Impact factor 2.90

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  • Website
    General Hospital Psychiatry website
  • Other titles
    General hospital psychiatry (Online)
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  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

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    • Deposit due to Funding Body, Institutional and Governmental policy or mandate only allowed where separate agreement between repository and the publisher exists.
    • Permitted deposit due to Funding Body, Institutional and Governmental policy or mandate, may be required to comply with embargo periods of 12 months to 48 months .
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    • Articles in some journals can be made Open Access on payment of additional charge
    • NIH Authors articles will be submitted to PubMed Central after 12 months
    • Publisher last contacted on 18/10/2013
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background People with schizophrenia experience increased rates of osteoporosis and may be at heightened risk of fractures. We conducted a systematic review and meta-analysis to investigate fractures among people with schizophrenia compared to people without mental illness. Method We systematically searched major electronic databases from inception till 10/2014. Articles were included that reported the number of fractures in people with schizophrenia and a control group. Two independent authors conducted searches, completed methodological assessment and extracted data. Data was narratively synthesised and a random effects incidence rate ratio (IRR) meta-analysis was performed. Results Eight studies were included encompassing 48,384 people with schizophrenia (49.9 -75.2 years, 41-100% female) and 3,945,783 controls. The pooled adjusted rate of fractures per 1000 person years was 5.54 (95% CI 4.92-5.57) in people with schizophrenia and 3.48 (95% CI 3.39-3.64) in control participants. The comparative meta-analysis showed that people with schizophrenia experience an increased rate of fractures compared to control participants (IRR 1.72, 95% CI = 1.24 to 2.39, I2= 49%; n = 168,914). There was insufficient data to conduct a robust moderator analysis, but the narrative review consistently highlighted antipsychotic medication was an important risk factor for fractures. Conclusion People with schizophrenia are at significantly increased risk of fractures. Future research is required to understand the mechanisms and should seek to validate fracture prediction algorithms used in the general population. Importantly there is a need to develop preventative strategies to improve bone health and reduce fracture risk involving the wider multidisciplinary team and incorporating falls prevention strategies.
    General Hospital Psychiatry 01/2015;
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    ABSTRACT: Klinefelter syndrome (KS) is widely associated with cognitive impairment and language problems. KS patients may also exhibit psychiatric symptoms. We present the case of an 18-year-old man with KS who experienced rapidly repeating relapses of manic episodes. He was unresponsive to the usual pharmacotherapies for bipolar disorders such as mood stabilizers and second-generation antipsychotics. Mood was eventually improved with testosterone therapy in addition to pharmacotherapy, with no relapse of manic episodes for 3years after discharge. Testosterone therapy may prevent relapsing manic episodes of bipolar disorder in patients with KS. Copyright © 2014 Elsevier Inc. All rights reserved.
    General Hospital Psychiatry 12/2014;
  • Christopher J. Armitage, Maria Panagioti, Wirda Abdul Rahim, Richard Rowe, Rory C. O’Connor
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    ABSTRACT: Objective Most of the research into suicide and self-harm has been conducted in the US and Europe, yet the volume of research does not reflect the distribution of suicide globally, with Asia accounting for up to 60 percent of all suicides. The present study systematically reviews the literature to assess the prevalence and correlates of suicidal acts in Malaysia in South East Asia. Methods Five relevant databases were searched from inception up to February 2014 and a narrative synthesis of the results from the included studies was performed. Studies were eligible for inclusion if they were: Correlational survey research and archival/observational research describing self-harm and suicide. Outcomes included completed suicides and self-harm including suicide attempts and self-poisoning, suicide plans and suicidal ideation. Results In total, 29 studies met the inclusion criteria. The principal findings were that the prevalence of suicide in Malaysia is approximately 6–8 per 100,000 population per year and that there is an excess of suicide among men, people younger than 40, and the Indian minority group. The past-month prevalence rates of suicidal ideation, plans and attempts are 1.7, 0.9% and 0.5%, respectively whereas the past-year prevalence rates of suicidal ideation range between 6% and 8%. Conclusions The present research marks a first step towards understanding the prevalence and correlates of suicide and self-harm in Malaysia. However, the heterogeneity of the included studies was high. Further research into the antecedents, consequences and interventions for suicide and self-harm in the Malaysian context are required.
    General Hospital Psychiatry 12/2014;
  • General Hospital Psychiatry 12/2014;
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    ABSTRACT: Postoperative cognitive dysfunction (POCD) in liver transplant (LT) recipients is defined as a "more than expected" postoperative deterioration in cognitive domains, including short-term and long-term memory, mood, consciousness and circadian rhythm. It is diagnosed, after exclusion of other neurological complications, by using specific neuropsychological tests that need preoperative baseline. The aim of this systematic review was to assess the prevalence of POCD after LT and to analyze patients' symptoms, type and timing of assessment used. PubMed, MEDLINE and The Cochrane Li-brary were searched up from January 1986 to August 2014. Study eligibility criteria are as follows: prospective and retrospective studies on human adult subjects describing prevalence of POCD and/or its sequelae after LT episodes were included. Eighteen studies were identified. The timing of testing for POCD may vary between different studies and within the single study, ranging from 0.5 to 32weeks. POCD occurs in up to 50% of LT recipient. Future studies should be focused on detecting preoperative and intraoperative factors associated to POCD in order to carry out appropriate strategies aimed at reducing this disabling health condition. Relationship between POCD and long-term outcome needs to be investigated. Copyright © 2014 Elsevier Inc. All rights reserved.
    General Hospital Psychiatry 12/2014;
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    ABSTRACT: The Beck Depression Inventory (BDI) is often used to assess depression symptoms, but its factor structure and its clinical utility have not been evaluated in patients with binge eating disorder (BED) and obesity. A total of 882 treatment-seeking obese patients with BED were administered structured interviews (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders) and completed self-report questionnaires. Exploratory and confirmatory factor analyses supported a brief 16-item BDI version with a three-factor structure (affective, attitudinal and somatic). Both 21- and 16-item versions showed excellent internal consistency (both α=0.89) and had significant correlation patterns with different aspects of eating disorder psychopathology; three factors showed significant but variable associations with eating disorder psychopathology. Area under the curves (AUC) for both BDI versions were significant in predicting major depressive disorder (MDD; AUC=0.773 [16-item], 73.5% sensitivity/70.2% specificity, AUC=0.769 [21-item], 79.5% sensitivity/64.1% specificity) and mood disorders (AUC=0.763 [16-item], 67.1% sensitivity/71.5% specificity, AUC=0.769 [21-item], 84.2% sensitivity/55.7% specificity). The 21-item BDI (cutoff score ≥16) showed higher negative predictive values (94.0% vs. 93.0% [MDD]; 92.4% vs. 88.3% [mood disorders]) than the brief 16-item BDI (cutoff score ≥13). Both BDI versions demonstrated moderate performance as a screening instrument for MDD/mood disorders in obese patients with BED. Advantages and disadvantages for both versions are discussed. A three-factor structure has potential to inform the conceptualization of depression features. Copyright © 2014 Elsevier Inc. All rights reserved.
    General Hospital Psychiatry 12/2014;
  • General Hospital Psychiatry 11/2014;
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    ABSTRACT: The objective was to determine whether obesity screening and weight management program participation and outcomes are equitable for individuals with serious mental illness (SMI) and depressive disorder (DD) compared to those without SMI/DD in Veterans Health Administration (VHA), the largest integrated US health system, which requires obesity screening and offers weight management to all in need. We used chart-reviewed, clinical and administrative VHA data from fiscal years 2010-2012 to estimate obesity screening and participation in the VHA's weight management program (MOVE!) across groups. Six- and 12-month weight changes in MOVE! participants were estimated using linear mixed models adjusted for confounders. Compared to individuals without SMI/DD, individuals with SMI or DD were less frequently screened for obesity (94%-94.7% vs. 95.7%) but had greater participation in MOVE! (10.1%-10.4% vs. 7.4%). MOVE! participants with SMI or DD lost approximately 1 lb less at 6 months. At 12 months, average weight loss for individuals with SMI or neither SMI/DD was comparable (-3.5 and -3.3 lb, respectively), but individuals with DD lost less weight (mean=-2.7 lb). Disparities in obesity screening and treatment outcomes across mental health diagnosis groups were modest. However, participation in MOVE! was low for every group, which limits population impact. Published by Elsevier Inc.
    General Hospital Psychiatry 11/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Traditional analytic approaches may oversimplify the mechanisms by which interventions effect change. Transition probability models can quantify both symptom improvement and sustained reduction in symptoms. We sought to quantify transition probabilities between higher and lower states for four outcome variables and to compare two treatment arms with respect to these transitions. Secondary analysis of a year-long collaborative care intervention for chronic musculoskeletal pain in veterans. Forty-two clinicians were randomized to intervention or treatment as usual (TAU), with 401 patients nested within clinician. The outcome variables, pain intensity, pain interference, depression and disability scores were dichotomized (lower/higher). Probabilities of symptom improvement (transitioning from higher to lower) or sustained reduction (remaining lower) were compared between intervention and TAU groups at 0- to 3-, 3- to 6- and 6- to 12-month intervals. General estimating equations quantified the effect of the intervention on transitions. In adjusted models, the intervention group showed about 1.5 times greater odds of both symptom improvement and sustained reduction compared to TAU, for all the outcomes except disability. Despite no formal relapse prevention program, intervention patients were more likely than TAU patients to experience continued relief from depression and pain. Collaborative care interventions may provide benefits beyond just symptom reduction. Published by Elsevier Inc.
    General Hospital Psychiatry 11/2014;
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    ABSTRACT: The objective was to describe the process of care and treatment outcomes of a 36-year-old man with bipolar disorder treated using a collaborative care model in primary care. We reviewed and summarized relevant clinical data describing the patient's care including the medical record, consultant's reports and discussions with treating clinicians. A meeting was held with experienced consulting psychiatrists to discuss the case. Several barriers to delivery of high-quality care existed including initial loss to follow-up, few social supports and lack of follow-through at the community mental health center existed, along with presence of factors that negatively influence bipolar disorder outcomes including initial unopposed antidepressant use at baseline, concurrent alcohol use and co-occurring anxiety symptoms. Despite these barriers, the collaborative care team was able to engage the patient in care and achieve the patient's and team's treatment goals. Delivery of primary-care-based collaborative care was associated with reduction of bipolar disorder symptoms and improved functioning in a patient with bipolar disorder. Copyright © 2014 Elsevier Inc. All rights reserved.
    General Hospital Psychiatry 11/2014;
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    ABSTRACT: High rates of bipolar disorder (BD) have been found among major depressives with seasonal pattern (SP) consulting in psychiatric departments, as well as among patients seeking primary care. As SP was reported to be common in the latter, the current study was designed to assess (a) the frequency and characteristics of SP among major depressives attending primary care and (b) the prevalence and aspects of BD in this population. Among 400 patients who consulted French general practitioners (GPs) for major depression between February and December 2010, 390 could be included in the study: 167 (42.8%) met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for seasonal pattern [SP(+)], whereas 223 (57.2%) did not meet these criteria [SP(-)]. The two groups were compared on demographic, clinical, family history and temperamental characteristics. Compared to SP(-), SP(+) patients were more frequently female, married and with a later age at first depressive episode, and showed more atypical vegetative symptoms, comorbid bulimia and stimulant abuse. They also exhibited more lifetime depressive episodes, were more often diagnosed as having BD II and met more often bipolarity specifier criteria, with higher rates of bipolar temperaments and a higher BD family loading. Among SP(+) patients, 68.9% met the bipolarity specifier criteria, whereas 31.1% did not. Seasonality was not influenced by climatic conditions. The following independent variables were associated with SP: BD according to bipolarity specifier, female gender, comorbid bulimia nervosa, hypersomnia, number of depressive episodes and family history of substance abuse. Seasonal pattern is frequent among depressive patients attending primary care in France and may be indicative of hidden bipolarity. Given the risks associated with both SP and bipolarity, GPs are likely to have a major role in regard to prevention. Copyright © 2014. Published by Elsevier Inc.
    General Hospital Psychiatry 11/2014;
  • General Hospital Psychiatry 11/2014;
  • General Hospital Psychiatry 11/2014;
  • General Hospital Psychiatry 11/2014;
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    ABSTRACT: Objective NICE recommends the use of structured tools to improve holistic care for patients with cancer. The Distress Thermometer and Problem Checklist (DT) is commonly used for screening in physical health settings. However, it has not been integrated into the clinical pathway within specialist psycho-oncology services. We used the DT to examine the broadexamine the broad clinical effectiveness of psycho-oncology intervention and to ascertain factors from the DTfrom the DT linked to an improved outcome. We also evaluatedadditionally took the opportunity to evaluate patients’ satisfaction with their care. Method 111 adult outpatients referred to York Psycho-oncology Service were asked to complete the DT at their first appointment. Individuals offered a period of psycho-oncology care re-rated their emotional distress, problems and service satisfaction on the DT at discharge. Results Median distress scores decreased significantly (from 6 to 4, Wilcoxon’s z=-4.83, p<0.001) indicating a large clinical effect size (Cohen’s d=1.22). Frequency of emotional problems (anxiety, depression and anger) fell significantly by 15-24%, despite no significant change in patients’ physical health or practical problems. Number of emotional problems was the best predictor of distress at discharge (beta=0.468, p=0.002). Satisfaction was high and correlated with lower distress scores (r=-0.42, p=0.005) and fewer emotional problems (r=-0.31, p=0.04) at discharge but not with number of appointments attended. Qualitative thematic analysis showed patients particularly value supportive listening and advice on coping strategies from professionals independent of their physical care. Conclusion The DT is an acceptable and useful tool for enhancing the delivery of structured psychooncology care. It may also provide evidence to support the effectiveness of specialist psycho-oncology interventions.
    General Hospital Psychiatry 11/2014;
  • General Hospital Psychiatry 11/2014;
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    ABSTRACT: We encountered a patient who presented extreme weight loss and received an eating disorder diagnosis that was later identified as adrenal Cushing's syndrome. A 32-year-old woman with a 2-year history of an eating disorder was admitted to our psychiatric ward due to dehydration, malnutrition and low weight. Her height and body weight were 152.1 cm and 29.8 kg, respectively (body mass index: 12.8). Her other symptoms included a depressed mood, decreased interest, retardation and suicidal ideation. Standard medical cares were prescribed to treat the depressive symptoms and eating disorder, but the depressive episode and low body weight of the patient persisted. Computed tomography of the abdomen revealed an unexpected left adrenal gland tumor. Cushing's syndrome was diagnosed based on several endocrinological examinations. After an enucleation of the left adrenal gland tumor, the patient began eating, and her body weight increased gradually. Her body weight increased to 42.0-47.0 kg (body mass index: 18.2-20.3). Her mental and physical conditions had stabilized. This case suggests that adrenal Cushing's syndrome may resemble eating disorders.
    General Hospital Psychiatry 11/2014;