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.

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

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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

  • General Hospital Psychiatry 12/2014;
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    ABSTRACT: Objective To understand collaborative care psychiatric consultants’ views and practices on making the diagnosis of and recommending treatment for bipolar disorder in primary care using collaborative care. Method We conducted a focus group at the University of Washington in December 2013 with nine psychiatric consultants working in primary care-based collaborative care in Washington State. A grounded theory approach with open coding and the constant comparative method revealed categories where emergent themes were saturated and validated through member checking, and a conceptual model was developed. Results Three major themes emerged from the data including the importance of working as a collaborative care team, the strengths of collaborative care for treating bipolar disorder, and the need for psychiatric consultants to adapt specialty psychiatric clinical skills to the primary care setting. Other discussion topics included gathering clinical data from multiple sources over time, balancing risks and benefits of treating patients indirectly, tracking patient care outcomes with a registry, and effective care. Conclusion Experienced psychiatric consultants working in collaborative care teams provided their perceptions regarding treating patients with bipolar illness including identifying ways to adapt specialty psychiatric skills, developing techniques for providing team-based care, and perceiving the care delivered through collaborative care as high quality.
    General Hospital Psychiatry 11/2014;
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    ABSTRACT: Objective The purpose of this study was to investigate the independent effects of socioeconomic and psychological social determinants of health on diabetes knowledge, self-care, diabetes outcomes and quality of life. Research Design and Methods Cross-sectional sample of 615 adults from two adult primary care clinics in the southeastern United States. Primary outcome variables were diabetes knowledge, self-care behaviors (diet, exercise, medication adherence, blood sugar testing, foot care) and diabetes outcomes (HbA1c, LDL, blood pressure, PCS, MCS). Covariates included age, sex, race/ethnicity, marital status, health literacy and comorbidity. Linear regression models were used to assess independent associations controlling for covariates. Results In final adjusted models, significant associations for HbA1c included education (β = -0.72, 95% CI -1.36, -0.08), income (β = -0.66, CI -1.30, -0.16), self-efficacy (β = -0.12, CI -0.15, -0.08), and diabetes distress (β = 0.43, CI 0.14, 0.72). Significant associations for self-care included medication adherence with diabetes distress (β = -0.58, CI -0.91, -0.25), and perceived stress (β = -0.12, CI -0.18, -0.05); and exercise with depression (β = -0.06, CI -0.10, -0.01), and self-efficacy (β = 0.06, CI 0.01, 0.10). Significant associations for quality of life included depression (β = -0.08, CI -0.12, -0.03), SPD (β = -0.09, CI -0.12, -0.05), social support (β = 0.01, CI 0.001, 0.02), and perceived stress (β = -0.12, CI -0.19, -0.06). Conclusions Social determinants of health were significantly associated with diabetes self-care and outcomes with socioeconomic factors being most often associated with diabetes outcomes and psychological factors, specifically self-efficacy and perceived stress being most often associated with self-care and quality of life.
    General Hospital Psychiatry 11/2014;
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    ABSTRACT: Introduction and objectives Heart transplantation (HT) is a potentially life-saving procedure for people with terminal cardiac disease. In the last decades researchers of HT programs have attempted to identify the existence of psychosocial factors that might influence the clinical outcome before and after the transplantation. The main objective of this study was to describe epidemiological, psychiatric and psychological features of a large sample of HT candidates. Methods Cross-sectional, observational and descriptive study. A psychiatric and psychological assessment of 125 adult patients was performed at the moment of being included in the HT waiting list, between 2006 and 2012. The assessment consisted in: Clinical, epidemiological and psychosocial form; Spanish version of Hospital Anxiety and Depression Scale; Structured Clinical Interview for DSM-IV axis I disorders; Coping questionnaire (COPE); Five Factors Inventory Revised (NEO-FFI-R); Apgar-Family questionnaire and the Multidimensional Health Locus of Control scale. Results Axis I diagnoses were present in a 30.4% of patients. COPE showed that this group of patients used most frequently engagement strategies. Personality factors profile of NEO-FFI-R were similar to general population and locus of control scale also presented similar scores compared with other chronic diagnostic groups. Statistically significant associations were found between personality factors and COPE scales/dimensions and psychopathology, mainly neuroticism and disengagement. Conclusions This is the first study that assess systematically psychosocial factors in a large sample of HT candidates. We have found that around one third of these patients have a psychiatric disorder. Neuroticism and disengagement coping styles, can serve as markers of emotional distress.
    General Hospital Psychiatry 11/2014;
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    ABSTRACT: Disulfiram is widely used for aversive treatment of alcoholism. Neuropathy is one of the most severe side effects of disulfiram therapy. We report the case of a young man who developed a neuropathy following disulfiram administration, with a virtually complete recovery within 2 months.
    General Hospital Psychiatry 10/2014;
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    ABSTRACT: Objectives The aim of this study was to evaluate the relationship between psychological symptoms and quality of life (QOL) and clinical variables in a cohort of children and adolescents with non-cystic fibrosis (non-CF) bronchiectasis. Methods Seventy six patients (aged 8-17 years) participated in this study. Questionnaires were used to evaluate the psychological status and QOL of the patients and healthy controls. The patient and control groups were divided into child and adolescent groups to exclude the effect of puberty on psychological status. Results No significant difference was found between patient and control groups for mean depression and trait anxiety scores. Only the child-rated physical health QOL scores were significantly lower for patients than the controls. Also, excepting physical health scores in adolescent group, all of the parent-rated QOL scores were significantly lower in both group and total subjects. Regarding determinants of QOL, age of children and FEV1/FVC percent predicted, had positive effects, while dyspnea severity and trait anxiety had negative effects, for the sample as a whole. Conclusions Non-CF bronchiectasis is associated with poorer QOL in childhood. The impact of the disease on QOL occurs through both clinical and psychological variables.
    General Hospital Psychiatry 10/2014; 36(5):528-532.
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    ABSTRACT: Objective The aims of the study were to examine the prevalence of self-reported psychological distress, examine the prevalence of interview-rated psychiatric diagnoses, identify correlates of psychological distress and psychiatric diagnosis, and examine racial/ethnic group differences on measures of psychological distress among primary caregivers of children preparing to undergo hematopoietic stem cell transplant (HSCT). Methods Caregivers (N = 215) completed the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Impact of Events Scale (IES), and a psychiatric interview assessing major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD). Regression analyses examined correlates of distress and psychiatric diagnosis. Comparisons were made between racial/ethnic groups. Results Posttraumatic stress symptoms were reported by 54% of caregivers during the time preparing for the child’s HSCT. Twenty-seven percent of caregivers met diagnostic criteria for at least one of the psychiatric diagnoses during this time. Few factors were associated with distress or psychiatric diagnosis, except the child scheduled for allogeneic transplant, being married, and prior psychological/psychiatric care. Socio-demographic factors accounted for racial/ethnic group differences, except Hispanic/Latino caregivers reported higher BDI scores than non-Hispanic White caregivers. Conclusion Caregivers may be at greater risk of posttraumatic stress symptoms than anxiety or depression. Prior psychological/psychiatric treatment is a risk factor for greater psychological distress and psychiatric diagnosis during this time. Racial differences are mostly due to socio-demographic factors.
    General Hospital Psychiatry 09/2014;
  • General Hospital Psychiatry 09/2014;
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    ABSTRACT: Objective We aimed to systematically compare patients with major depressive disorder (MDD) from three different treatment settings (a primary care outpatient, a secondary care outpatient and one inpatient sample), with regard to metabolic syndrome (MetSyn) prevalences, individual MetSyn components and related metabolic variables. Method The outpatient samples were drawn from the ongoing Netherlands Study of Depression and Anxiety (NESDA; 302 primary care and 445 secondary care outpatients). The inpatient sample (n = 80) was recruited from five Dutch mental health hospitals. The assessments of MetSyn and related variables (waist circumference (WC), high-density and low-density lipoprotein cholesterol (HDL), triglycerides, glucose, and systolic and diastolic blood pressure (SBP, DBP), body mass index (BMI), waist hip ratio (WHR), low-density lipoprotein and total cholesterol (LDL, TC)) were compared using analysis of (co)variance and regression analysis, whereas medication analyses examined the extent to which clinical differences (e.g. depression severity or medication use) mediated the observed metabolic differences across setting. Results MetSyn prevalences (26% primary, 24% secondary care and 28% inpatients) did not significantly differ (P = .71). WC, BMI, LDL cholesterol, glucose and DBP were not significantly different across settings. However, WHR, total cholesterol and triglyceride levels were higher in inpatients than in both outpatients groups, while HDL cholesterol levels and SBP were lower. There was some mediating role for tricyclic and non-SSRI antidepressant use, but overall the mediating role of clinical differences was limited. Conclusions Although overall MetSyn prevalences did not differ, patterns of individual MetSyn-related variables differed more markedly across depressed inpatients and outpatients. Inpatients showed more adverse WHR and serum lipid profiles, while systolic blood pressure levels were lower.
    General Hospital Psychiatry 09/2014;
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    ABSTRACT: Objective To examine factors predicting psychiatric morbidity, taking into account the full range of psychiatric disorders before and after burn injury. Method A cohort of 107 patients consecutively admitted to a Swedish national burn center was examined for lifetime psychiatric morbidity, and 94 patients at one year postinjury. Sixty-seven individuals, some from that same cohort, were interviewed at 2 to 7 years postinjury. The predictive effects of psychiatric history, personality, and other risk factors for psychiatric morbidity following burn were evaluated with multiple regression analyses. Results The prevalence of having a psychiatric disorder preburn was 57%. One year postinjury 19% had minor or major depression and 23% had subsyndromal or full PTSD. At 2 to 7 years 31% fulfilled criteria for a psychiatric disorder. The strongest contributing factors were a history of psychiatric morbidity and neuroticism. Conclusions Two thirds of the patients had a lifetime psychiatric disorder and one third had a psychiatric diagnosis 2 to 7 years postburn. Mental health problems can have a major impact on daily life and functional abilities. Thus identification and treatment of a range of psychiatric disorders, taking into account preburn psychiatric disorders and personality, is important for optimal adjustment after burn.
    General Hospital Psychiatry 09/2014;
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    ABSTRACT: Objective To determine the 12-month cost-effectiveness of a collaborative care (CC) program for treating depression following coronary artery bypass graft (CABG) surgery versus physicians’ usual care (UC). Methods We obtained 12 continuous months of Medicare and private medical insurance claims data on 189 patients who screened positive for depression following CABG surgery, met criteria for depression when reassessed by telephone two-weeks following hospitalization (9-item Patient Health Questionnaire ≥ 10), and were randomized to either an 8-month centralized, nurse-provided, and telephone-delivered collaborative care (CC) intervention for depression or to their physicians’ usual care (UC). Results At 12-months following randomization, CC patients had $2,068 lower but statistically similar estimated median costs compared to UC (P = 0.30) and a variety of sensitivity analyses produced no significant changes. The incremental cost effectiveness ratio of CC was -$9,889 (-$11,940 to -$7,838) per additional quality-adjusted life-year (QALY), and there was 90% probability it would be cost-effective at the willingness to pay threshold of $20,000 per additional QALY. A bootstrapped cost-effectiveness plane also demonstrated a 68% probability of CC “dominating” UC (more QALYs at lower cost). Conclusions Centralized, nurse-provided, and telephone-delivered CC for post-CABG depression is a quality-improving and cost-effective treatment that meets generally accepted criteria for high-value care.
    General Hospital Psychiatry 09/2014;
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    ABSTRACT: Psychiatric adverse effects associated with the use of clomiphene are relatively uncommon. Though case reports link mood swings to be associated with clomiphene, it is not known to be associated with a syndromal affective episode. Being a selective oestrogen receptor modulator, clomiphene affects the hypothalamus-pituitary-gonadal axis and can have potential neuropsychiatric effects in vulnerable persons. Herein we report a case of clomiphene induced manic episode in a known bipolar male patient.
    General Hospital Psychiatry 09/2014;
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    ABSTRACT: Objective Depression is one of the most common mental illnesses. The reliability and the validity of the Patient Health Questionnaire (PHQ)-9, a depression screening tool, have not been examined in the general population in China. Thus, this study evaluated the reliability and the validity of the Chinese version of the PHQ-9 in detecting major depression in residents of a Chinese community. Methods A total of 1,045 participants from a Shanghai community were enrolled in our study. Participants completed the Chinese versions of the PHQ-9, the Self-rating Depression Scale (SDS), the 36-Item Short Form Health Survey (SF-36), and the Mini International Neuropsychiatric Interview (MINI). One hundred participants were randomly selected to complete the PHQ-9 again two weeks after the initial assessment. The reliability, the validity, and the receiver operating characteristic (ROC) curve of the PHQ-9 were analyzed. Results Cronbach’s alpha for the internal consistency reliability of the Chinese version of the PHQ-9 was 0.86 for the entire scale. The correlation coefficient for the 2-week test-retest of the total score was 0.86. The PHQ-9 scale correlated positively with the SDS (r = 0.29, p < 0.001) and correlated negatively with all subscale scores of the SF-36 (correlation coefficients ranged from -0.11 to -0.47, p < 0.001). The area under the curve (AUC) of the ROC was 0.92 (95%CI: 0.86-0.97). A cut-off score of 7 or higher on the PHQ-9 had a sensitivity of 0.86 and a specificity of 0.86. Conclusions In the general Chinese population, the Chinese version of the PHQ-9 is a valid and efficient tool for screening depression, with a recommended cut-off score of 7 or more.
    General Hospital Psychiatry 09/2014;
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    ABSTRACT: Objective We investigated the association between personality traits and treatment outcomes in male Korean patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). Method We evaluated the personality traits and the severity of LUTS/BPH symptoms at baseline using the Korean versions of the 44-item Big Five Inventory (BFI-K) and International Prostate Symptom Score (IPSS), respectively. The IPSS was re-administered following a 12-week routine treatment regime, and we examined the relationship between treatment outcome and personality traits. Results Of the 176 patients initially screened, 101 agreed to participate in the study. Of those, 93 (92.1%) completed the 12-week trial and the BFI-K. Neuroticism was associated with a significantly worse treatment response, whereas extraversion was associated with a significantly better treatment response, and openness was associated with a high responder rate. Agreeableness, openness, and conscientiousness were associated with improved week-12 IPSS total scores; however, the results were not statistically significant. Conclusions We found an association between treatment response and personality traits of neuroticism, extraversion, and openness in patients with LUTS/BPH. However, further studies with larger samples and an improved design are needed to support our findings.
    General Hospital Psychiatry 09/2014;