Patient adherence to out-patient psychiatric care for neurotic and affective disorders (Should I stay, or should I go?)

Introduction

Referral is not a necessity for a patient who wants to get psychiatrist consultation in Latvia. The good thing about it is the availability and the possibility to consult with highest educated mental health specialist for any person in society without barriers. On the other hand, there is an overwhelming work load for psychiatrists.

Objectives

To explore the prevalence of self-referred patients in out-patient care and the adherence to psychiatrist recommendations.

Methods

The medical documentation of all consecutive first-time out-patient center “Pardaugava” psychiatrist patients over the period of 01.01.2020. to 30.04.2020. with one year follow-up was analyzed.

Results

236 patients were included in the study, 31.2% of them were men. The average age was 49 (SD ± 22.65) years. Patients with Affective (F3X) and Neurotic (F4X) disorders were self-referred more often compared to Organic mental (F0X) disorder or other spectrum patients (83.3% and 77.5% vs 33.3% or 56.0%, p<0.001). Median appointment count was 4, higher in F4X (6) and lower in F3X patients (2). Majority of F4X patients (61,6%) did not follow the recommendations or stopped seeing psychiatrist, while only 13,7% were persistent. Сonversely, 48,4% of F3X patients followed the recommendations and only 43,5% stopped. In comparison, other spectrum patients followed recommendations in 32.0% of cases and ignored - in 56.6%.

Conclusions

Patients were actively self-referring themselves to psychiatrist. Highest adherence to psychiatrist recommendations was found in patients with affective disorders compared to other spectrum patients. In contrast, adherence was the lowest in patients with neurotic disorders.

Disclosure

No significant relationships.

Mapping of multiple muscles with transcranial magnetic stimulation: absolute and relative test-retest reliability

The spatial accuracy of transcranial magnetic stimulation (TMS) may be as small as a few millimeters. Despite such great potential, navigated TMS (nTMS) mapping is still underused for the assessment of motor plasticity, particularly in clinical settings. Here, we investigate the within-limb somatotopy gradient as well as absolute and relative reliability of three hand muscle cortical representations (MCRs) using a comprehensive grid-based sulcus-informed nTMS motor mapping. We enrolled 22 young healthy male volunteers. Two nTMS mapping sessions were separated by 5-10 days. Motor evoked potentials were obtained from abductor pollicis brevis (APB), abductor digiti minimi, and extensor digitorum communis. In addition to individual MRI-based analysis, we studied normalized MNI MCRs. For the reliability assessment, we calculated intraclass correlation and the smallest detectable change. Our results revealed a somatotopy gradient reflected by APB MCR having the most lateral location. Reliability analysis showed that the commonly used metrics of MCRs, such as areas, volumes, centers of gravity (COGs), and hotspots had a high relative and low absolute reliability for all three muscles. For within-limb TMS somatotopy, the most common metrics such as the shifts between MCR COGs and hotspots had poor relative reliability. However, overlaps between different muscle MCRs were highly reliable. We, thus, provide novel evidence that inter-muscle MCR interaction can be reliably traced using MCR overlaps while shifts between the COGs and hotspots of different MCRs are not suitable for this purpose. Our results have implications for the interpretation of nTMS motor mapping results in healthy subjects and patients with neurological conditions.