Measuring racing thoughts in healthy individuals: The Racing and Crowded Thoughts Questionnaire (RCTQ).

Racing thoughts refer to an acceleration and overproduction of thoughts, which have been associated with manic and mixed episodes. Phenomenology distinguishes 'crowded' from 'racing' thoughts, associated with mixed depression and mania, respectively. Recent data suggest racing thoughts might also be present in healthy individuals with sub-affective traits and symptoms. We investigated this assumption, with a 34-item self-rating scale, the Racing and Crowded Thoughts Questionnaire (RCTQ), and evaluated its reliability, factor structure, and concurrent validity. 197 healthy individuals completed the RCTQ, the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego - autoquestionnaire (TEMPS-A), the Beck Depression Inventory (BDI), the Altman Self-Rating Mania scale (ASRM), and the Ruminative Response Scale (RRS). Exploratory factor analysis yielded a three-factor solution, labeled 'thought overactivation', 'burden of thought overactivation', and 'thought overexcitability'. Internal consistency of each of the three subscales of the RCTQ was excellent. The TEMPS-A cyclothymia score was associated with the three factors, suggesting good concurrent validity. The 'thought activation' subscale was selectively associated with current elated mood and included items conveying both the notion of increased amount and velocity of thoughts, whereas the 'burden of thought overactivation' subscale was associated with current low mood. The 'thought overexcitability' subscale included items conveying the notion of distractibility, and was associated with both elated and low mood. Rumination was not a significant predictor of RCTQ subscores. These results suggest that the RCTQ has good psychometric properties. Racing and crowded thoughts, as measured by the RCTQ, are a multi-faceted phenomenon, distinct from rumination, and particularly associated with mood instability even in its milder forms.

Subjective experience of thought overactivation in mood disorders: beyond racing and crowded thoughts.

BACKGROUND: Racing thoughts, crowded thoughts and flight of ideas are frequent symptoms in mood disorders, but the underlying subjective experience of overactivation of thought processes remains poorly documented. METHODS: Qualitative analysis of audiotaped interviews explored subjective experience of thought overactivation in patients with mood disorders (sample 1, n = 45). Quantitative analysis considered the properties of a newly developed rating scale in sample 1, in an additional sample of patients with mood disorders (sample 2, n = 37) and in healthy subjects (sample 3, n = 38). RESULTS: Qualitative analysis of individual interviews revealed that 5 conceptual categories characterized thought overactivation: sequential thought flow, overstimulation, competition for resource allocation, unexpected/unexplained onset, and association with mood and emotions. A principal component analysis of the initial 16-item rating scale indicated that a single component explained 55.9% of the variance, with major and exclusive contributions from 9 items, which were retained in the final 9-item Subjective Thought Overactivation Questionnaire (STOQ; Cronbach's α = 0.95). Total score correlated significantly with activation, depression and perceived conflict subscales of the Internal State Scale (ISS; rs = 0.57-0.66, p < 0.001). It was associated with decreased well-being (ISS; rs = -0.48, p = 0.001) and increased state anxiety (State-Trait Anxiety Inventory; rs = 0.60, p < 0.001). The STOQ score was significantly higher in patients than in healthy subjects. It allowed distinguishing between ISS mood states, with the highest median score in mixed states. LIMITATIONS: Sample size, representativeness, possible bias in qualitative analysis, and quality of expert consensus. CONCLUSIONS: Qualitative analysis of clinical interviews, together with a new short rating scale, contributed to a documentation of subjective thought overactivation, an important but often undetected feature in mood disorders.

Variations in smoking after admission to psychiatric inpatient units and impact of a partial smoking ban on smoking and on smoking-related perceptions.

BACKGROUND: Smoke-related problems are particularly frequent in psychiatry, with additional concerns about iatrogenic effects on smoking in inpatient settings. AIMS: To study the impact of a partial smoking ban on psychiatric patients and staff members. METHODS: Using a pre- and post-intervention design, comparison of smoke-related characteristics and perceptions permitted changes after the introduction of smoking restrictions in 2002 to be studied. Ninety-one inpatients and 110 staff members participated in 2001 before intervention, and 134 inpatients and 85 staff members participated in 2005. RESULTS: After reinforcement of smoking restrictions, no significant changes in smoking prevalence or severity were observed, but there was a change in attitude for patients, more of whom were considering stopping. Daily cigarette consumption after admission changed significantly between 2001 and 2005. A marked decrease after three days in hospital as compared to the week before entry was observed in 2005 (p = 0.005), whereas in 2001 the trend was towards increase (p = 0.06). Furthermore, although the perception of quantity of smoke decreased (p = 0.0005) for both patients and staff, discomfort related to smoke remained unchanged. CONCLUSION: The introduction of a partial smoking ban had favourable effects on patients' cigarette consumption and attitudes, but more efforts need to be pursued.

Tobacco craving and withdrawal symptoms in psychiatric patients during a motivational enhancement intervention based on a 26-hour smoking abstinence period.

INTRODUCTION: In psychiatric patients, tobacco withdrawal symptoms are frequently seen as a barrier to smoking cessation; however, further studies are warranted in this specific population. METHODS: Patients receiving in- or out-patient mental health care participated in a motivational enhancement program including a 26-hour tobacco abstinence experience with professional support and optional nicotine replacement therapy. The study included 174 subjects, of whom 159 were evaluated 1 week before and at the end of the 26-hour abstinence period. Repeated assessments included the Minnesota Nicotine Tobacco Withdrawal Scale Revised (MNWS-R), two items of the Mood and Physical Symptoms Scale (MPSS) regarding craving, the State-Trait Anxiety Inventory (STAI-S), the Beck Depression Inventory (BDI-21), and the World Health Organization Well-Being Index (WHO-5). RESULTS: More than half the participants (52.3%) succeeded in 26-hour smoking abstinence. Craving was the most frequent MNWS-R withdrawal symptom (28.3% scored ≥3 on a 0-4 scale). Comparison of pre- and post-intervention data revealed significant improvements in 13 of 16 MNWS-R symptoms as well as craving (MPSS) and well-being, and significant decreases in anxiety and depression. Increasing MNWS-R craving scores and greater depression were both significantly associated with lower success in the 26-hour smoking abstinence period. CONCLUSIONS: The negative effects of tobacco withdrawal symptoms in psychiatric patients may be substantially overestimated. Participation in a supportive structured motivational intervention with a 26-hour smoking cessation experience was well tolerated and contributed to temporary improvements in mental state. Craving is an interesting symptom to evaluate during smoking cessation attempts.

Racing thoughts revisited: A key dimension of activation in bipolar disorder.

BACKGROUND: Racing and crowded thoughts are frequently reported respectively in manic and mixed episodes of bipolar disorder (BD). However, questionnaires assessing this symptom are lacking. Here we aimed to investigate racing thoughts across different mood episodes of BD through a self-report questionnaire that we developed, the 34-item Racing and Crowded Thoughts Questionnaire (RCTQ). In addition to assessing its factor structure and validity, we were interested in the RCTQ's ability to discriminate mixed and non-mixed depression. METHODS: 221 BD patients and 120 controls were clinically assessed via the YMRS (mania) and the QIDS-C16 (depression), then fulfilled the RCTQ, rumination, worry, and anxiety measures. Three depression groups were operationalized according to YMRS scores: YMRS scores 2 > 6 and YMRS scores = 1 or 2, for respectively mixed and non-pure depression, and YMRS = 0 for pure-depression. RESULTS: Confirmatory factor analysis showed that the three-factor model of the RCTQ yielded the best fit indices, which improved after the removal of redundant items, resulting in a 13-item questionnaire. Hypomanic and anxiety symptoms were the main predictors of scores; rumination was not a significant predictor. RCTQ results were similar between mixed groups and non-pure depression, and both were higher than in pure-depression. LIMITATIONS: Patients' pharmacological treatment might have influenced the results. CONCLUSIONS: The 13-item RCTQ captures different facets of racing thoughts heightened in hypomanic and mixed states, but also in depression with subclinical hypomanic/activation symptoms (e.g. non-pure depression characterized by enhanced subjective irritability), suggesting that it is particularly sensitive to activation symptoms in BD, and could become a valuable tool in the follow-up of patients.

Variations in smoking during hospitalization in psychiatric in-patient units and smoking prevalence in patients and health-care staff.

BACKGROUND: Smoking and exposure to smoke are important concerns, especially in psychiatric in-patient services. AIMS: Our aims were to study variations in smoking after hospitalization for psychiatric in-patients, and to evaluate smoking-related concerns and prevalence for both patients and health-care staff. METHODS: A similar survey was mailed to staff members and proposed individually to all recently admitted patients; participation rates were 39% and 79% respectively. RESULTS: Three days after admission, 4/10 patients had increased and 3/10 had decreased their daily tobacco use. Univariate analysis of variance showed nicotine dependence scores to be associated with variations in consumption (p = .005): whereas 74% of heavy smokers decreased cigarette consumption, 80% of light and 57% of moderate smokers increased their consumption. The prevalence of current smoking was twice as high in patients (72%) as compared to health-care professionals (31%). Patients were also more nicotine dependent (Heaviness of Smoking Index (HSI) = 3.97/vs. 1.81), and half of the patients were heavy smokers (> 20 cigarettes/day), as opposed to only 6.3% of the staff. CONCLUSIONS: Smoking prevalence and daily tobacco consumption are very high in psychiatric patients. After hospitalization, light and moderate smokers increased whereas heavy smokers decreased smoking.

Staff representations and tobacco-related practices in a psychiatric hospital with an indoor smoking ban.

The present study describes representations about smoking and practices related to patient smoking among staff of a large public psychiatric hospital. A survey was performed using a specially designed questionnaire. The return rate was 72.4% (n = 155). A large proportion of staff recognized the importance of both smoking status and mental health for patient's well-being (46.9%), and believed that smoking cessation was possible for psychiatric patients (58.6%). However, the role of the psychiatric hospital was perceived as providing information (85.3%) and helping to diminish cigarette consumption (51%), rather than proposing smoking cessation (29.5%). Staff daily practice included reminding patients of smoking restrictions (43.9%), managing cigarettes (46.5%), and nicotine replacement therapy (24.3%). A principal component analysis of tobacco-related practices revealed two main factors (59.8% of variance): basic hospital actions (factor 1) and more specialized interventions (factor 2), which were significantly associated with higher worries about personally developing smoke-related illnesses (Spearman r = 0.38, P < 0.0001). Compared with non-smokers, smokers reported higher perceived vulnerability to develop an illness due to tobacco and a higher level of worry about this. The discussion highlights the need to redefine roles and expectancies of mental health staff, and improve training and collaboration with experts, in order to improve efficiency concerning tobacco issues.

Smoking in psychiatric inpatients: association with working status, diagnosis, comorbid substance abuse and history of suicide attempts.

The present cross-sectional study investigates the association between smoking and psychopathology (ICD-10 diagnosis), history of suicide attempts and socio-demographic characteristics in a sample of 180 adult hospitalized patients. Results confirmed a high frequency of current smokers (63.3%) and heavy smokers with > or =20 cigarettes/day (47.4%). Smoking was significantly associated with being on invalid pension, social welfare or unemployed (>70% of smokers, p=0.008), a history of suicide attempts (73.2%, p=0.04) and the primary mental health diagnosis (p=0.004). A majority of patients (57.8%) presented at least one comorbid condition. Multivariate logistic regression indicated that disorders due to psychoactive substances, either as a primary diagnosis or as a comorbid condition, were significantly associated with smoking, in addition to significant effects of age group, financial resources and history of suicide attempts. Investigation of health beliefs showed that psychopathology did not compromise a realistic appreciation of smoke-related health risks. These results underline the importance of taking into account socio-demographic factors and substance use comorbidity in designing targeted interventions to reduce smoking in psychiatric patients.