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Bakola M, Peritogiannis V, Kitsou KS, Gourzis P, Hyphantis T, Jelastopulu E. Length of hospital stay in involuntary admissions in Greece: a 10-year retrospective observational study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02653-x. [PMID: 38684516 DOI: 10.1007/s00127-024-02653-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/07/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE The treatment of mental disorders has shifted from inpatient wards to community-based settings in recent years, but some patients may still have to be admitted to inpatient wards, sometimes involuntarily. It is important to maintain the length of hospital stay (LoS) as short as possible while still providing adequate care. The present study aimed to explore the factors associated with the LoS in involuntarily admitted psychiatric patients. METHODS A ten-year retrospective chart review of 332 patients admitted involuntarily to the inpatient psychiatric ward of the General University Hospital of Ioannina, Northwestern Greece, between 2008 and 2017 was conducted. RESULTS The mean LoS was 23.8 (SD = 33.7) days and was relatively stable over the years. Longer-stay hospitalization was associated with schizophrenia-spectrum disorder diagnosis, previous hospitalizations and the use of mechanical restraint, whereas patients in residential care experienced significantly longer LoS (52.6 days) than those living with a caregiver (23.5 days) or alone (19.4 days). Older age at disease onset was associated with shorter LoS, whereas no statistically significant differences were observed with regard to gender. CONCLUSION While some of our findings were in line with recent findings from other countries, others could not be replicated. It seems that multiple factors influence LoS and the identification of these factors could help clinicians and policy makers to design more targeted and cost-effective interventions. The optimization of LoS in involuntary admissions could improve patients' outcomes and lead to more efficient use of resources.
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Affiliation(s)
- Maria Bakola
- Department of Public Health, Medical School, University of Patras, Rio, 26500, Patras, Greece
| | - Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | | | - Philippos Gourzis
- Department of Psychiatry, Medical School, University of Patras, Patras, Greece
| | - Thomas Hyphantis
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleni Jelastopulu
- Department of Public Health, Medical School, University of Patras, Rio, 26500, Patras, Greece.
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Sohn JH, Cho SJ, Lee HW, Kim H, Lee SY, Park Y, Seo HY, Kim ES, Park JE, Hahm BJ. Effectiveness of a Community-Based Intensive Case Management Model on Reducing Hospitalization for People With Severe Mental Illness in Seoul. Psychiatry Investig 2023; 20:1133-1141. [PMID: 38163652 PMCID: PMC10758329 DOI: 10.30773/pi.2023.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/11/2023] [Accepted: 08/31/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE To overcome the limited effectiveness of standard case management services, the Seoul Intensive Case Management program (S-ICM) for patients with serious mental illnesses was introduced in 2017. This study aimed to evaluate its effectiveness in reducing the length of hospital stay. METHODS Monitoring data from April 2019 to March 2020 were retrieved from the Seoul Mental Health Welfare Center. A total of 759 participants with serious mental illnesses were included. The average length of admission per month was compared between the pre-ICM (previous year) and during-ICM periods. For post-ICM observation subgroup, average length of admission per month was compared between pre-ICM, during-ICM, and post-ICM periods. To determine the relative contributions of risk factors for during-ICM and post-ICM admission, multivariate logistic regression analyses were performed. RESULTS The average admission stay for pre-ICM period was significantly longer than that for during-ICM period (1.47 vs. 0.26 days). Among the predictors for during-ICM admission, pre-ICM psychiatric admission was the most important risk factor, followed by medical aid beneficiary and suicidal behavior. In the subgroup analysis of the post-ICM observation period, the pre-ICM, during-ICM, and post-ICM average admission stays were 1.45, 0.29, and 0.57 days/month, respectively. There was a significant difference in the average length of stay between the pre-ICM and during-ICM periods and between the pre-ICM and post-ICM periods. Post-ICM admission risks included pre-ICM admission, S-ICM duration <3 months, and chronic unstable symptoms. CONCLUSION The results suggest that the S-ICM effectively reduces psychiatric hospitalization duration, at least over a short-term period.
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Affiliation(s)
- Jee Hoon Sohn
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Public Health and Medical Services, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Joon Cho
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Hae Woo Lee
- Seoul Mental Health Welfare Center, Seoul, Republic of Korea
- Department of Psychiatry, Seoul Medical Center, Seoul, Republic of Korea
| | - Hyun Kim
- Seoul Mental Health Welfare Center, Seoul, Republic of Korea
| | - Seung Yeon Lee
- Seoul Mental Health Welfare Center, Seoul, Republic of Korea
| | - Yoomi Park
- Citizens’ Health Bureau, Seoul Metopolitan Government, Seoul, Republic of Korea
| | - Hwo Yeon Seo
- Institute of Public Health and Medical Services, Seoul National University Hospital, Seoul, Republic of Korea
- Jongno-gu Community Mental Health Welfare Center, Seoul, Republic of Korea
| | - Eun Soo Kim
- Department of Psychiatry, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jee Eun Park
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bong Jin Hahm
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Pidutti J, Cuperfain AB, Solway E, Duff V, Lurie E. Initiation of Extended-release Depot Buprenorphine in a Patient Subject to a Community Treatment Order for Both Antipsychotic and Opioid Agonist Treatments. J Addict Med 2023; 17:742-744. [PMID: 37934551 DOI: 10.1097/adm.0000000000001215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
ABSTRACT Opioid use disorder (OUD) and schizophrenia are commonly comorbid, and patient outcomes are improved when these conditions are managed concurrently. Medication for OUD such as methadone and buprenorphine are treatments for OUD, yet psychosis introduces additional challenges in retaining patients in care. Extended-release depot buprenorphine is an emerging option for the treatment of moderate-to-severe OUD, and it may provide certain benefits in patients with concurrent OUD and psychosis. We present the case of a 32-year-old man with schizophrenia, traumatic brain injury, and OUD with a history of multiple opioid-related overdoses, followed by an assertive community treatment team, and subject to a community treatment order for both his primary psychotic disorder and OUD treatments. We discuss the role of extended-release depot buprenorphine in this unique patient population and the ethical considerations of involuntary treatment of OUD in patients lacking capacity to consent to treatment.
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Affiliation(s)
- Joel Pidutti
- From the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (JP, ABC); Division Head, Addiction Medicine Service, St. Joseph's Health Centre, Unity Health Toronto, Toronto, Ontario, Canada (ES); Department of Psychiatry, Unity Health Toronto, Toronto, Ontario, Canada (VD); Department of Community and Family Medicine, University of Toronto, Toronto, Ontario, Canada (EL); and Family and Community Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada (EL)
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Hindenoch M, Kostova M, Urdapilleta I, Del Goleto S, Passerieux C. Health and Social Case Management for the Inclusion of People Living with a Schizophrenic Disorder: The PASSVers Experience. Community Ment Health J 2023; 59:1375-1387. [PMID: 37071385 PMCID: PMC10111323 DOI: 10.1007/s10597-023-01125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/30/2023] [Indexed: 04/19/2023]
Abstract
The way the social protection system in France is organized frequently leads to coordination difficulties between the social and healthcare sectors. A health and social program has been implemented in a French medical-psychological center to optimize the coherence of the pathway for people living with schizophrenia. This study evaluated the way users and professionals perceive this program so as to assess the relevance of double case management. Semi-structured interviews were conducted with users (N = 21) and professionals (N = 11) of this program and then analyzed with Alceste software. The results highlight the overall satisfaction of the participants with the program, and the double case management was shown to be beneficial in supporting people living with schizophrenia in their life project. These results indicate that this program enabled the emergence of a collective empowerment, which could assist with the recovery process of schizophrenia.
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Affiliation(s)
- Marie Hindenoch
- Laboratoire Paragraphe (UR 349), Université Paris 8 Vincennes-Saint-Denis, Saint-Denis, France.
- Laboratoire Cognition Humaine et Artificielle - CHArt (UR 4004), Université Paris 8 Vincennes-Saint-Denis, Saint-Denis, France.
- Université Versailles Saint-Quentin-en-Yvelines Paris Saclay, Inserm UMR 1018, CESP, "DevPsy", Villejuif, France.
| | - Milena Kostova
- Laboratoire Paragraphe (UR 349), Université Paris 8 Vincennes-Saint-Denis, Saint-Denis, France
| | - Isabel Urdapilleta
- Laboratoire Cognition Humaine et Artificielle - CHArt (UR 4004), Université Paris 8 Vincennes-Saint-Denis, Saint-Denis, France
| | - Sarah Del Goleto
- Centre Expert Schizophrénie, Hôpital Albert Chenevier, Créteil, France
| | - Christine Passerieux
- Université Versailles Saint-Quentin-en-Yvelines Paris Saclay, Inserm UMR 1018, CESP, "DevPsy", Villejuif, France
- Service de psychiatrie et d'addictologie, Centre Hospitalier de Versailles, Le Chesnay, France
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Mezzina R. Per una salute mentale di comunità: la questione dei Servizi e dei modelli. PSICOTERAPIA E SCIENZE UMANE 2023. [DOI: 10.3280/pu2023-001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
La questione di quali Servizi siano necessari per una piena applicazione della riforma psichiatrica del 1978, costruendo un'alternativa istituzionale globale, viene discussa a partire dai modelli organizzativi e dai loro contesti applicativi, che definiscono l'offerta complessiva di cura. Nel realizzare la presa in carico vanno considerate non solo le evidenze scientifiche, ma anche un ancoraggio etico e valoriale che tenga conto delle esperienze e dei bisogni delle persone che usano i Servizi. Tra i princìpi-cardine sostenuti dall'Organizzazione Mondiale della Sanità spiccano la realizzazione dei diritti umani, con l'abbandono delle pratiche coercitive e dei trattamenti obbligatori routinari, l'empowerment dell'utenza e un approccio multisettoriale per una risposta ai determi-nanti sociali di salute. Dalla pratica discende una serie di indicazioni, dall'apertura sulle 24 ore alla continuità e non frammentazione delle cure. Si descrivono punti di orientamento e princìpi di fun-zionamento dei Servizi territoriali, e si delineano prospettive per un cambio di paradigma che riguardi gli esiti globali sulla vita delle persone.
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Abufarsakh B, Kappi A, Pemberton KM, Williams LB, Okoli CTC. Substance use outcomes among individuals with severe mental illnesses receiving assertive community treatment: A systematic review. Int J Ment Health Nurs 2022; 32:704-726. [PMID: 36534491 DOI: 10.1111/inm.13103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
Assertive Community Treatment (ACT) is a multidisciplinary treatment approach to support people with severe mental illnesses (SMI) in their recovery. While the majority of ACT recipients report co-morbid substance use issues, limited reviews have evaluated the impact of receiving ACT services on substance use outcomes. The purpose of this systematic review was to evaluate the impact of ACT involvement on substance use outcomes among people with SMI. A systematic literature search was conducted including articles published prior to April 2021. Twenty-nine studies were included in this review. Of them, 15 studies implemented a controlled design (six studies demonstrated high quality) and 14 studies implemented a cohort design. From a synthesis of the reviewed studies, five areas of changes associated with substance use emerged including reduced alcohol and drug use severity, lower prevalence of alcohol and drug use, increased stage of change in substance use treatment, and fewer days of hospitalization and intoxication. Thus, future studies should examine the integration of substance use treatment services as part of ACT interventions for opportunities to enhance recovery outcomes among individuals with SMI.
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Affiliation(s)
| | - Amani Kappi
- University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Kylie M Pemberton
- University of Kentucky College of Education, Lexington, Kentucky, USA
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Rohenkohl AC, Daubmann A, Gallinat J, Karow A, Kraft V, Rühl F, Schöttle D, Lambert M, Schröter R. Health-related quality of life in severe psychotic disorders during integrated care: 5-year course, prediction and treatment implications (ACCESS II). Health Qual Life Outcomes 2022; 20:133. [PMID: 36076205 PMCID: PMC9452858 DOI: 10.1186/s12955-022-02039-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Studies on outcomes mapping Quality of Life (QoL) as patient-reported outcome over a longer period in severe psychotic disorders are scarce. However, such data would be particularly important for structuring, implementing and operating effective and efficient care models and for promoting satisfaction with care, service engagement and adherence.
Methods The ACCESS II study is a prospective long-term study of an integrated care model for people with severe psychotic disorders. The model includes Therapeutic Assertive Community Treatment within a cross-sectoral and interdisciplinary network. This publication analyses the course of QoL assessed with the Q-LES-Q-18 using a mixed model for repeated measures. Results Mapping the course of QoL in N = 329 participants, there is a significant increase in the first 6 weeks of treatment (early course). Comparison to a published norm show significant lower QoL for severe psychotic disorders. The variable having a traumatic event before the age of 18 was significantly negatively associated with QoL. A decrease in the severity of depressive as well as in positive symptomatology in the first six weeks after admission was associated with increase of QoL. Conclusion Results indicate that the overall symptom burden at time of inclusion is not decisive for the perceived QoL in the long-term course while the reduction in the severity of depressive and positive symptoms is important. This means focusing even more on the treatment of depressive symptoms and include traumatherapeutic aspects in the long-term treatment of severe psychotic disorders if needed.
Trail registration ClinicalTrials.gov (identifier: NCT01888627).
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Affiliation(s)
- Anja Christine Rohenkohl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany.
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Vivien Kraft
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Friederike Rühl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
| | - Romy Schröter
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany
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Coetzee D, Koen L, Niehaus D, Botha U. Descriptive outcomes for a cohort of high-frequency psychiatric service users in the Western Cape, South Africa after 10 years. S Afr J Psychiatr 2022; 28:1821. [PMID: 35747340 PMCID: PMC9210150 DOI: 10.4102/sajpsychiatry.v28i0.1821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/31/2022] [Indexed: 11/01/2022] Open
Abstract
Background: Assertive community treatment (ACT) is an intervention implemented to manage the effects of deinstitutionalisation. South African studies have reported decreased admissions at 12 and 36 months when a modified ACT intervention is compared with standard care. However, costs associated with the intervention have raised the question of its feasibility in developing countries.Aim: This study aimed to describe the long-term demographic and clinical outcomes of a group of psychiatric high-frequency users (HFUs) included in the first South African ACT study.Setting: Stikland Psychiatric Hospital, Cape Town, South Africa.Methods: Data from 55 HFUs participating in the first South African ACT trial, including both the intervention and control groups, were retrospectively reviewed 10 years after the patients’ inclusion.Results: Of the 55 HFUs initially included, nine remained in the formal ACT programme whilst 16 received standard care over the full 10 years. Five patients died and two were admitted to long-term wards. The mean number of admissions was 3.73 and the mean number of admission days was 261.11 over the 10 years. Twelve patients were never re-admitted; of these, nine came from the original study intervention group.Conclusions: This was the first study looking at the long-term outcomes of a group of psychiatric HFUs in an under-resourced setting receiving either a modified ACT intervention or standard outpatient care. Reflecting broadly on the group, there were a larger number of patients in the original ACT group who had no re-admissions and a comparatively higher utilisation of available services during the 10-year follow-up period.
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Affiliation(s)
- Danell Coetzee
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liezl Koen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Dana Niehaus
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ulla Botha
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Karow A, Luedecke D, Schöttle D, Rohenkohl A, Schimmelmann B, Gallinat J, Lambert M. [Characteristics of psychoses in adolescence-Longitudinal data of integrated care]. DER NERVENARZT 2022; 93:331-340. [PMID: 35277731 DOI: 10.1007/s00115-022-01276-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Integrated care according to the Hamburg model combines therapeutic assertive community treatment (TACT) with initiatives for early detection and early treatment of schizophrenia and affective psychoses. The aim of this study was to identify the clinical characteristics of adolescents in comparison to adult patients and to derive knowledge for transition-specific treatment approaches. METHODOLOGY Sociodemographic and clinical variables as well as treatment performance and clinical outcome were investigated over a period of 12 months in 167 patients with psychoses (16-25 years, n = 88; and >25 years, n = 79). RESULTS Patients with psychosis in adolescence had significantly more outpatient treatment contacts (3.5/week vs. 1.6/week; p < 0.001), while adults were hospitalized for twice as long (10 days vs. 21 days; p = 0.003). The duration of untreated psychoses was significantly shorter in the adolescent group than in adults (122 weeks vs. 208 weeks; p = 0.002). The proportion of comorbid mental disorders was significantly higher in the adolescent group (87% vs. 63%; p < 0.001). In addition, the adolescence patients already showed greater impairment of daily functions and a higher severity of illness at the start of treatment. DISCUSSION The treatment of psychoses in adolescence was characterized by a particularly high need for flexibility across all sectors and support systems, taking comorbid problem areas into account. Care models for adolescents and young adults with psychoses should therefore combine treatment approaches for severely ill patients with transition psychiatric interventions to avoid breaks in care and to meet the complex requirements of young patients with severe mental illnesses.
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Affiliation(s)
- Anne Karow
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Daniel Luedecke
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Daniel Schöttle
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Anja Rohenkohl
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Benno Schimmelmann
- Universitätsklinik für Kinder- und Jugendpsychiatrie, Universität Bern, Bern, Schweiz
| | - Jürgen Gallinat
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - Martin Lambert
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
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StäB - besonders geeignet für die Gerontopsychiatrie? DNP - DER NEUROLOGE & PSYCHIATER 2021. [PMCID: PMC8632201 DOI: 10.1007/s15202-021-4767-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Smeekens MV, Sappelli F, de Vries MG, Bulten BH. Dutch Forensic Flexible Assertive Community Treatment: Operating on the Interface Between General Mental Health Care and Forensic Psychiatric Care. Front Psychol 2021; 12:708722. [PMID: 34630215 PMCID: PMC8492920 DOI: 10.3389/fpsyg.2021.708722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
In the Netherlands, Forensic Flexible Assertive Community Treatment (ForFACT) is used as a specialized form of outpatient intensive treatment. This outreaching type of treatment is aimed at patients with severe and long lasting psychiatric problems that are at risk of engaging in criminal behavior. In addition, these patients often suffer from addiction and experience problems in different areas of their life (e.g., financial debt, unemployment, or lack of daytime activities). The aim of this exploratory study was to gain more insight into the characteristics of the ForFACT patient population. More knowledge about these patients may enhance the effectiveness of ForFACT and therefore (further) reduce the risk of recidivism. Data on 132 ForFACT patients were gathered by studying electronic patient records, criminal records, and by conducting semi-structured interviews with practitioners and patients. Additionally, as part of a cognitive screening, two screening instruments were conducted to gain insight into intelligence and possible mild cognitive impairments. This article gives a broad description of the ForFACT patient population, including demographic data and context variables, diagnostics, recidivism risk and offense history, and aspects related to care. Furthermore, several recommendations are given to further improve ForFACT. Based on the results it can be concluded that the ForFACT patient population shows a high degree of diversity in complex care needs and responsivity issues. Therefore, this article highlights the necessity for ForFACT to collaborate with other mental health institutions, as well as probation officers, and forensic or criminal justice institutions. Moreover, it is important to continually check the inclusion and exclusion criteria when admitting patients to ForFACT, and to examine whether ForFACT is still the most adequate care for patients or if they need to be referred. In addition, the results emphasize the importance of cognitive screening for forensic outpatients. Finally, this study zooms in on the interface between forensic psychiatric care and general mental health care.
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Affiliation(s)
- Marjam V Smeekens
- Department Assessment, Research and Professional Development, Pompefoundation, Nijmegen, Netherlands
| | - Fedde Sappelli
- Department Assessment, Research and Professional Development, Pompefoundation, Nijmegen, Netherlands
| | - Meike G de Vries
- Department Assessment, Research and Professional Development, Pompefoundation, Nijmegen, Netherlands
| | - Berend H Bulten
- Department Assessment, Research and Professional Development, Pompefoundation, Nijmegen, Netherlands.,Faculty of Social Sciences, Radboud University, Nijmegen, Netherlands
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Kennedy‐Hendricks A, Bandara S, Daumit GL, Busch AB, Stone EM, Stuart EA, Murphy KA, McGinty EE. Behavioral health home impact on transitional care and readmissions among adults with serious mental illness. Health Serv Res 2021; 56:432-439. [PMID: 33118187 PMCID: PMC8143677 DOI: 10.1111/1475-6773.13594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To evaluate the impact of Maryland's behavioral health homes (BHHs) on receipt of follow-up care and readmissions following hospitalization among Medicaid enrollees with serious mental illness (SMI). DATA SOURCES Maryland Medicaid administrative claims for 12 232 individuals. STUDY DESIGN Weighted marginal structural models were estimated to account for time-varying exposure to BHH enrollment and time-varying confounders. These models compared changes over time in outcomes among BHH and comparison participants. Outcome measures included readmissions and follow-up care within 7 and 30 days following hospitalization. DATA COLLECTION/EXTRACTION METHODS Eligibility criteria included continuous enrollment in Medicaid for the first two years of the study period; 21-64 years; and use of psychiatric rehabilitation services. PRINCIPAL FINDINGS Over three years, BHH enrollment was associated with 3.8 percentage point (95% CI: 1.5, 6.1) increased probability of having a mental health follow-up service within 7 days of discharge from a mental illness-related hospitalization and 1.9 percentage point (95% CI: 0.0, 3.9) increased probability of having a general medical follow-up within 7 days of discharge from a somatic hospitalization. BHHs had no effect on probability of readmission. CONCLUSIONS BHHs may improve follow-up care for Medicaid enrollees with SMI, but effects do not translate into reduced risk of readmission.
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Affiliation(s)
- Alene Kennedy‐Hendricks
- Department of Health Policy and ManagementJohns Hopkins Center for Mental Health and Addiction PolicyBaltimoreMarylandUSA
| | - Sachini Bandara
- Department of Mental HealthJohns Hopkins Center for Mental Health and Addiction PolicyBaltimoreMarylandUSA
| | - Gail L. Daumit
- Department of MedicineALACRITY Center for Health and Longevity in Mental IllnessJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Alisa B. Busch
- McLean HospitalHarvard Medical SchoolBelmontMassachusettsUSA
| | - Elizabeth M. Stone
- Department of Health Policy and ManagementJohns Hopkins Center for Mental Health and Addiction PolicyBaltimoreMarylandUSA
| | - Elizabeth A. Stuart
- Department of Mental HealthALACRITY Center for Health and Longevity in Mental IllnessJohns Hopkins Center for Mental Health and Addiction PolicyBaltimoreMarylandUSA
| | - Karly A. Murphy
- Department of MedicineALACRITY Center for Health and Longevity in Mental IllnessJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Emma E. McGinty
- Department of Health Policy and ManagementALACRITY Center for Health and Longevity in Mental IllnessJohns Hopkins Center for Mental Health and Addiction PolicyBaltimoreMarylandUSA
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13
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Rampino A, Falcone RM, Giannuzzi A, Masellis R, Antonucci LA, Torretta S. Strategies for Psychiatric Rehabilitation and their Cognitive Outcomes in Schizophrenia: Review of Last Five-year Studies. Clin Pract Epidemiol Ment Health 2021; 17:31-47. [PMID: 34249137 PMCID: PMC8227533 DOI: 10.2174/1745017902117010031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/15/2021] [Accepted: 02/27/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cognitive deficits are core features of Schizophrenia, showing poor response to antipsychotic treatment, therefore non-pharmacological rehabilitative approaches to such a symptom domain need to be identified. However, since not all patients with Schizophrenia exhibit the same cognitive impairment profile, individualized rehabilitative approaches should be set up. OBJECTIVES We explored the last five-year literature addressing the issue of cognitive dysfunction response to rehabilitative methodologies in Schizophrenia to identify possible predictors of response and individualized strategies to treat such a dysfunction. CONCLUSION A total of 76 studies were reviewed. Possible predictors of cognitive rehabilitation outcome were identified among patient-specific and approach-specific variables and a general overview of rehabilitative strategies used in the last five years has been depicted. Studies suggest the existence of multifaced and multi-domain variables that could significantly predict pro-cognitive effects of cognitive rehabilitation, which could also be useful for identifying individual-specific rehabilitation trajectories over time.An individualized rehabilitative approach to cognitive impairment in Schizophrenia is possible if taking into account both patient and approach specific predictors of outcomes.
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Affiliation(s)
- Antonio Rampino
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
- Azienda Ospedaliero-Universitaria Policlinico di Bari, 70124 Bari, Italy
| | - Rosa M. Falcone
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Arianna Giannuzzi
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Rita Masellis
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Linda A. Antonucci
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, 70122 Bari, Italy
| | - Silvia Torretta
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy
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14
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Muusse C, Kroon H, Mulder CL, Pols J. "Caring for a Crisis": Care and Control in Community Mental Health. Front Psychiatry 2021; 12:798599. [PMID: 35095613 PMCID: PMC8793776 DOI: 10.3389/fpsyt.2021.798599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
In the debate on coercion in psychiatry, care and control are often juxtaposed. In this article we argue that this dichotomy is not useful to describe the more complex ways service users, care professionals and the specific care setting interrelate in a community mental health team (CMHT). Using the ethnographic approach of empirical ethics, we contrast the ways in which control and care go together in situations of a psychiatric crisis in two CMHT's: one in Trieste (Italy) and one in Utrecht (the Netherlands). The Dutch and Italian CMHT's are interesting to compare, because they differ with regard to the way community care is organized, the amount of coercive measures, the number of psychiatric beds, and the fact that Trieste applies an open door policy in all care settings. Contrasting the two teams can teach us how in situations of psychiatric crisis control and care interrelate in different choreographies. We use the term choreography as a metaphor to encapsulate the idea of a crisis situation as a set of coordinated actions from different actors in time and space. This provides two choreographies of handling a crisis in different ways. We argue that applying a strict boundary between care and control hinders the use of the relationship between caregiver and patient in care.
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Affiliation(s)
- Christien Muusse
- Trimbos Institute, Utrecht, Netherlands.,Department Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, Netherlands
| | - Hans Kroon
- Trimbos Institute, Utrecht, Netherlands.,Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands
| | - Cornelis Lambert Mulder
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands.,Antes, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Jeannette Pols
- Department Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, Netherlands.,Department of Anthropology, University of Amsterdam, Amsterdam, Netherlands
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15
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Jin H, Tappenden P, Robinson S, Achilla E, Aceituno D, Byford S. Systematic review of the methods of health economic models assessing antipsychotic medication for schizophrenia. PLoS One 2020; 15:e0234996. [PMID: 32649663 PMCID: PMC7351140 DOI: 10.1371/journal.pone.0234996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 06/05/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Numerous economic models have assessed the cost-effectiveness of antipsychotic medications in schizophrenia. It is important to understand what key impacts of antipsychotic medications were considered in the existing models and limitations of existing models in order to inform the development of future models. OBJECTIVES This systematic review aims to identify which clinical benefits, clinical harms, costs and cost savings of antipsychotic medication have been considered by existing models, to assess quality of existing models and to suggest good practice recommendations for future economic models of antipsychotic medications. METHODS An electronic search was performed on multiple databases (MEDLINE, EMBASE, PsycInfo, Cochrane database of systematic reviews, The NHS Economic Evaluation Database and Health Technology Assessment database) to identify economic models of schizophrenia published between 2005-2020. Two independent reviewers selected studies for inclusion. Study quality was assessed using the National Institute for Health and Care Excellence (NICE) checklist and the Cooper hierarchy. Key impacts of antipsychotic medications considered by exiting models were descriptively summarised. RESULTS Sixty models were included. Existing models varied greatly in key impacts of antipsychotic medication included in the model, especially in clinical outcomes used for assessing reduction in psychotic symptoms and types of adverse events considered in the model. Quality of existing models was generally low due to failure to capture the health and cost impact of adverse events of antipsychotic medications and input data not obtained from best available source. Good practices for modelling antipsychotic medications are suggested. DISCUSSIONS This review highlights inconsistency in key impacts considered by different models, and limitations of the existing models. Recommendations on future research are provided.
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Affiliation(s)
- Huajie Jin
- King’s Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King’s College London, London, United Kingdom
| | - Paul Tappenden
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Stewart Robinson
- School of Business and Economics, Loughborough University, Loughborough, United Kingdom
| | - Evanthia Achilla
- King’s Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King’s College London, London, United Kingdom
| | - David Aceituno
- King’s Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King’s College London, London, United Kingdom
| | - Sarah Byford
- King’s Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King’s College London, London, United Kingdom
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16
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Broersen M, Creemers DHM, Frieswijk N, Vermulst AA, Kroon H. Investigating the critical elements and psychosocial outcomes of Youth Flexible Assertive Community Treatment: a study protocol for an observational prospective cohort study. BMJ Open 2020; 10:e035146. [PMID: 32265243 PMCID: PMC7245379 DOI: 10.1136/bmjopen-2019-035146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION When adolescents experience complex psychiatric and social problems, numerous healthcare services usually become involved. In these cases, fragmentation of care services is a risk that often results in both ineffective care and in patients disengaging from care services. To address these issues, Youth Flexible Assertive Community Treatment (Youth Flexible ACT) was developed in the Netherlands. This client-centred service delivery model aims to tackle the fragmented care system by providing psychiatric treatment and support in a flexible and integrated manner. While Youth Flexible ACT is gaining in popularity, the effectiveness of the care model remains largely unexamined. METHODS AND ANALYSIS Here, we present an observational prospective cohort (2017-2021) in which a broad range of treatment outcomes will be monitored. The primary aim of the study is to examine change in treatment outcomes over the course of the Flexible ACT care. The secondary aim is to examine the association between (elements of) Youth Flexible ACT model fidelity and treatment outcomes. An estimated total number of 200 adolescents who receive care from one of the 16 participating Youth Flexible ACT teams will be included in the study. Participants will be asked to complete assessments at four time points in 6-month intervals, resulting in a study duration of 18 months. Latent growth curve analysis will be conducted to examine change in psychosocial functioning over time and its relation to model fidelity. ETHICS AND DISSEMINATION This study received ethical approval from Trimbos Ethics Committee (201607_75-FACT2). This approval applies for all participating institutions. The results of the study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. Results will be disseminated via peer-reviewed academic journals and presentations at conferences. In addition, results will be made available for participating sites, funders and researchers.
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Affiliation(s)
- Marieke Broersen
- GGZ Oost Brabant, Oss, The Netherlands
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | | | | | - Hans Kroon
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
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17
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Assertive Community Programs for Patients with Severe Mental Disorders: Are Benefits Sustained After Discharge? Community Ment Health J 2020; 56:559-567. [PMID: 31807993 DOI: 10.1007/s10597-019-00513-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
Abstract
The benefits of assertive community treatment (ACT) on patients with severe mental disorders are well established over short or medium term. However, studies that investigate long term outcomes are remarkably scarce. Thus, this study aimed to evaluate patient's long term clinical and psychosocial evolution after discharge from ACT. An assessment was conducted on 29 patients characterized by inpatient facilities heavy use and refusal of care, who were included in an ACT program 8.7 (SD = 0.7) years ago and discharged 6.3 (SD = 1.8) years ago. Results of the follow up showed decreased rates of hospitalizations and symptomatology, as well as sustained improvement in adherence to care, in quality of life and in social functioning. This data suggests that ACT programs can help refractory to care patients to gain clinical and psychosocial improvement and lay foundation for better long-term adherence to care. Results also suggest that ACT didn't imply a lifetime treatment.
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18
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Cuddeback GS, Simpson JM, Wu JC. A comprehensive literature review of Forensic Assertive Community Treatment (FACT): Directions for practice, policy and research. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2020. [DOI: 10.1080/00207411.2020.1717054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Gary S. Cuddeback
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Juliet C. Wu
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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19
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Woo SA, Cragg A, Wickham ME, Villanyi D, Scheuermeyer F, Hau JP, Hohl CM. Preventable adverse drug events: Descriptive epidemiology. Br J Clin Pharmacol 2020; 86:291-302. [PMID: 31633827 PMCID: PMC7015751 DOI: 10.1111/bcp.14139] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022] Open
Abstract
AIM Our objective was to identify preventable adverse drug events and factors contributing to their development. METHODS We performed a retrospective chart review combining data from three prospective multicentre observational studies that assessed emergency department patients for adverse drug events. A clinical pharmacist and physician independently reviewed the charts, extracted data and rated the preventability of each adverse drug event. A third reviewer adjudicated all discordant or uncertain cases. We calculated the proportion of adverse drug events that were deemed preventable, performed multivariable logistic regression to explore the characteristics of patients with preventable events, and identified contributing factors. RESULTS We reviewed the records of 1 356 adverse drug events in 1 234 patients. Raters considered 869 (64.1%) of adverse drug events probably or definitely preventable. Patients with mental health diagnoses (OR 1.8; 95% CI 1.3-2.5) and diabetes (OR 1.7; 95% CI 1.2-2.4) were more likely to present with preventable events. The medications most commonly implicated in preventable events were warfarin (9.4%), hydrochlorothiazide (4.5%), furosemide (4.0%), insulin (3.9%) and acetylsalicylic acid (2.7%). Common contributing factors included inadequate patient instructions, monitoring and follow-up, and reassessments after medication changes had been made. CONCLUSIONS Our study suggests that patients with mental health conditions and diabetes require close monitoring. Efforts to address the identified contributing factors are needed.
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Affiliation(s)
| | - Amber Cragg
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Maeve E. Wickham
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Diane Villanyi
- Vancouver General HospitalVancouverBritish ColumbiaCanada
| | | | - Jeffrey P. Hau
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Corinne M. Hohl
- Vancouver General HospitalVancouverBritish ColumbiaCanada
- Department of Emergency MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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20
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Fleming D, Raynsford J, Hosalli P. Reducing long acting antipsychotic injection dosage frequency: A pilot study in a community mental health team. J Ment Health 2020; 30:129-133. [PMID: 31984826 DOI: 10.1080/09638237.2020.1714003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Antipsychotic long acting injections (LAI) allow a range of dosage intervals to be administered. Short intervals can be inconvenient for patients and staff. There are few clinical reasons for using them yet this is common practice. AIMS This study aimed to examine the feasibility of reducing LAI frequency with service user consent. METHODS The study took place in a community mental health team in the north of England. A specialist mental health pharmacist reviewed records of all service users on LAI and drew up an action plan. Each service user then met with the consultant psychiatrist for medication review. RESULT Nineteen out of thirty service users on LAI had intervals less than the maximum licensed. The frequency was reduced in eight cases. After 6 months follow-up, there was no deterioration in symptoms. In nine cases, antipsychotic doses were also reduced as a result of the review. CONCLUSION Where a service user is prescribed a LAI with a short dosage interval consideration should be given to increase the interval. This can free up service user and staff time. A medication focused review can also lead to other benefits such as dosage reduction.
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Affiliation(s)
- D Fleming
- Pharmacy Department, Leeds and York Partnership Foundation Trust, West Yorkshire, UK
| | - J Raynsford
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - P Hosalli
- Leeds and York Partnership Foundation Trust, West Yorkshire, UK
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21
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Almeda N, García-Alonso CR, Salinas-Pérez JA, Gutiérrez-Colosía MR, Salvador-Carulla L. Causal Modelling for Supporting Planning and Management of Mental Health Services and Systems: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030332. [PMID: 30691052 PMCID: PMC6388254 DOI: 10.3390/ijerph16030332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/19/2019] [Accepted: 01/19/2019] [Indexed: 12/17/2022]
Abstract
Mental health services and systems (MHSS) are characterized by their complexity. Causal modelling is a tool for decision-making based on identifying critical variables and their causal relationships. In the last two decades, great efforts have been made to provide integrated and balanced mental health care, but there is no a clear systematization of causal links among MHSS variables. This study aims to review the empirical background of causal modelling applications (Bayesian networks and structural equation modelling) for MHSS management. The study followed the PRISMA guidelines (PROSPERO: CRD42018102518). The quality of the studies was assessed by using a new checklist based on MHSS structure, target population, resources, outcomes, and methodology. Seven out of 1847 studies fulfilled the inclusion criteria. After the review, the selected papers showed very different objectives and subjects of study. This finding seems to indicate that causal modelling has potential to be relevant for decision-making. The main findings provided information about the complexity of the analyzed systems, distinguishing whether they analyzed a single MHSS or a group of MHSSs. The discriminative power of the checklist for quality assessment was evaluated, with positive results. This review identified relevant strategies for policy-making. Causal modelling can be used for better understanding the MHSS behavior, identifying service performance factors, and improving evidence-informed policy-making.
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Affiliation(s)
- Nerea Almeda
- Universidad Loyola Andalucía, Department of Psychology, C/ Energía Solar 1, 41014 Seville, Spain.
| | - Carlos R García-Alonso
- Universidad Loyola Andalucía, Department of Quantitative Methods, C/ Energía Solar 1, 41014 Seville, Spain.
| | - José A Salinas-Pérez
- Universidad Loyola Andalucía, Department of Quantitative Methods, C/ Energía Solar 1, 41014 Seville, Spain.
| | | | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, Australian National University, 63 Eggleston Rd, Acton ACT 2601, Australia.
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22
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Kido Y, Kawakami N, Kayama M. Comparison of hospital admission rates for psychiatric patients cared for by multidisciplinary outreach teams with and without peer specialist: a retrospective cohort study of Japanese Outreach Model Project 2011-2014. BMJ Open 2018; 8:e019090. [PMID: 30121587 PMCID: PMC6104750 DOI: 10.1136/bmjopen-2017-019090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study examined whether having peer specialists (PS) in psychiatric multidisciplinary outreach teams was associated with a lower risk of hospitalisation, improved social functioning and decreased problem behaviours. DESIGN AND SETTING This study was a retrospective cohort study based on medical records. This study was conducted as a part of the Japanese Outreach Model Project 2011-2014, which provides services for persons diagnosed mainly as ICD-10 F0, F2 and F3, who have a high possibility of hospital admission/readmission with regular Japanese outpatient care. PARTICIPANTS A total of 292 participants (clients) from 31 multidisciplinary outreach teams with and without PS (n=108 and 184, respectively) fulfilled the inclusion criteria and were included in the analysis. OUTCOME MEASURES The primary outcome measure was hospitalisation during follow-up. The difference in hospitalisation during the follow-up between teams with and without PS was analysed by Kaplan-Meier survival curves and a Cox proportional hazards model. The secondary outcome measures were social functioning (Global Assessment of Functioning, GAF) and problem behaviours (Social Behaviour Schedule, SBS) of clients, and were assessed at baseline and at 6-month follow-up. Changes in social functioning and problem behaviours were compared between clients cared for by the two team types. Amount and content of the service were also compared. RESULTS The clients cared by teams with PS had a significantly decreased probability of hospitalisation in Cox proportional hazards models adjusting for baseline characteristics (HR=0.53, 95% CI 0.31 to 0.89). The 6-month change in GAF or SBS was not significantly different between the two groups. CONCLUSION This is an observational study in which the presence of a PS appeared to be associated with a reduced rate of hospitalisation. A randomised study would be required to demonstrate a causal relationship.
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Affiliation(s)
- Yoshifumi Kido
- Department of Psychiatric and Mental Health Nursing, Mie Prefectural College of Nursing, Mie, Japan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mami Kayama
- Department of Psychiatric and Mental Health Nursing, Graduate School of Nursing, St Luke’s International University, Tokyo, Japan
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23
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Schloemer T, Schröder-Bäck P. Criteria for evaluating transferability of health interventions: a systematic review and thematic synthesis. Implement Sci 2018; 13:88. [PMID: 29941011 PMCID: PMC6019740 DOI: 10.1186/s13012-018-0751-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 04/18/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Improving the public's health in different countries requires the consideration of diverse health care systems and settings. For evidence-based public health, decision-makers need to consider the transferability of effective health interventions from a primary context to their specific target context. The aim of this systematic review was to develop a model for the assessment of transferability of health interventions through identification and systematization of influencing criteria, including facilitators and barriers. METHODS A systematic literature search was performed in the databases PubMed, Embase, CINAHL, and PsycINFO. Articles were eligible if they were published in English or German and provided a description of transferability criteria. Included articles were ranked based on their thematic relevance and methodological support of transferability criteria. Using a qualitative approach, a thematic synthesis was conducted. RESULTS Thirty-seven articles were included in the review. The thematic synthesis revealed 44 criteria, covered by 4 overarching themes, which influence transferability of health interventions: The population (P), the intervention (I), and the environment (E) represent 30 conditional transferability criteria, and the transfer of the intervention (T) represents 14 process criteria for transferring the intervention to the target context. Transferability (-T) depends on the dynamic interaction of conditional criteria in the primary and target context as well as on the process of transfer. The description of facilitators and barriers deepens the understanding of the criteria. The synthesis resulted in two related models: the conceptual PIET-T model explains the underlying mechanism of transferability of health interventions and the PIET-T process model provides practical guidance for a transferability assessment. CONCLUSIONS Transferability of health interventions is a complex concept, which needs systematic consideration of the primary and target context. It should be anticipated before and evaluated after an intervention is implemented in the target context. Therefore, decision-makers need systematic and practically relevant knowledge on transferability. The synthesized PIET-T conceptual and process models with systematized criteria, facilitators, and barriers are intended as a theoretical basis to determine transferability of health interventions. Further research is needed to develop a practical tool for the PIET-T models and to evaluate the tool's usefulness for decision-making processes and intervention transfer.
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Affiliation(s)
- Tamara Schloemer
- Department of International Health, Faculty of Health, Medicine and Life Sciences, CAPHRI–Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200 MD Maastricht, The Netherlands
| | - Peter Schröder-Bäck
- Department of International Health, Faculty of Health, Medicine and Life Sciences, CAPHRI–Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200 MD Maastricht, The Netherlands
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24
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Lofthus AM, Weimand BM, Ruud T, Rose D, Heiervang KS. "This is not a Life Anyone would want"-A Qualitative Study of Norwegian ACT Service users' Experience with Mental Health Treatment. Issues Ment Health Nurs 2018; 39:519-526. [PMID: 29370562 DOI: 10.1080/01612840.2017.1413459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We discuss Norwegian service users' experiences with community mental health treatment in general, and the interprofessional Assertive Community Treatment (ACT) model in particular. To gain the right to treatment, service users have to accept certain limitations, such as medication and community treatment orders (CTOs). Seventy participants responded to five open-ended questions. In addition, eight of them participated in either focus group or interviews. A collaborative approach, using Stepwise-Deductive Induction (SDI) method was used to analyze the participants' experiences. The results showed that the treatment contributes to an experience of autonomy but also one of restriction. It provides service users with enhanced normalcy, but simultaneously a feeling of deviance. There needs to be an ongoing reflection and discussion about those paradoxes in treatment, and service users have to be involved.
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Affiliation(s)
- Ann-Mari Lofthus
- a Akershus Universitetssykehus HF , Department of Research and Development, Division of Mental Health Services , Lorenskog , Norway.,b National Centre for knowledge through experience in mental health , Skien , Norway.,c University of Oslo, Institute of Clinical Medicine , Oslo , Norway
| | - Bente M Weimand
- a Akershus Universitetssykehus HF , Department of Research and Development, Division of Mental Health Services , Lorenskog , Norway
| | - Torleif Ruud
- a Akershus Universitetssykehus HF , Department of Research and Development, Division of Mental Health Services , Lorenskog , Norway.,c University of Oslo, Institute of Clinical Medicine , Oslo , Norway
| | - Diana Rose
- d King's College London, Institute of Psychiatry, Psychology & Neuroscience , London , United Kingdom of Great Britain and Northern Ireland
| | - Kristin S Heiervang
- a Akershus Universitetssykehus HF , Department of Research and Development, Division of Mental Health Services , Lorenskog , Norway
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25
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Ougrin D, Corrigall R, Poole J, Zundel T, Sarhane M, Slater V, Stahl D, Reavey P, Byford S, Heslin M, Ivens J, Crommelin M, Abdulla Z, Hayes D, Middleton K, Nnadi B, Taylor E. Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial. Lancet Psychiatry 2018; 5:477-485. [PMID: 29731412 PMCID: PMC5994473 DOI: 10.1016/s2215-0366(18)30129-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/09/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intensive community treatment to reduce dependency on adolescent psychiatric inpatient care is recommended in guidelines but has not been assessed in a randomised controlled trial in the UK. We designed a supported discharge service (SDS) provided by an intensive community treatment team and compared outcomes with usual care. METHODS Eligible patients for this randomised controlled trial were younger than 18 years and had been admitted for psychiatric inpatient care in the South London and Maudsley NHS Foundation Trust. Patients were assigned 1:1 to either the SDS or to usual care by use of a computer-generated pseudorandom code with random permuted blocks of varying sizes. The primary outcome was number of inpatient bed-days, change in Strengths and Difficulties Questionnaire (SDQ) scores, and change in Children's Global Assessment Scale (CGAS) scores at 6 months, assessed by intention to treat. Cost-effectiveness was explored with acceptability curves based on CGAS scores and quality-adjusted life-years (QALYs) calculated from the three-level EuroQol measure of health-related quality of life (EQ-5D-3L), taking a health and social care perspective. This study is registered with the ISRCTN Registry, number ISRCTN82129964. FINDINGS Hospital use at 6 months was significantly lower in the SDS group than in the usual care group (unadjusted median 34 IQR 17-63 vs 50 days, 19-125, p=0·04). The ratio of mean total inpatient days for usual care to SDS was 1·67 (95% CI 1·02-2·81, p=0·04), which decreased to 1·65 (0·99-2·77, p=0·057) when adjusted for differences in hospital use before randomisation. Scores for SDQ and CGAS did not differ between groups. The cost-effectiveness acceptability curve based on QALYs showed that the probability of SDS being cost-effective compared with usual care was around 60% with a willingness-to-pay threshold of £20 000-30 000 per QALY, and that based on CGAS showed at least 58% probability of SDS being cost-effective compared with usual care irrespective of willingness to pay. We recorded no adverse events attributable to SDS or usual care. INTERPRETATION SDS provided by an intensive community treatment team reduced bed usage at 6 months' follow-up but had no effect on functional status and symptoms of mental health disorders compared with usual care. The possibility of preventing admissions, particularly through features such as reduced self-harm and improved reintegration into school, with intensive community treatment should be investigated in future studies. FUNDING South London and Maudsley NHS Trust.
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Affiliation(s)
- Dennis Ougrin
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
| | | | - Jason Poole
- South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychology, London South Bank University, London, UK
| | - Toby Zundel
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mandy Sarhane
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paula Reavey
- Department of Psychology, London South Bank University, London, UK
| | - Sarah Byford
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Margaret Heslin
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Ivens
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Zahra Abdulla
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Hayes
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Benita Nnadi
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eric Taylor
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Monroe-DeVita M, Morse G, Mueser KT, McHugo GJ, Xie H, Hallgren KA, Peterson R, Miller J, Akiba C, York M, Gingerich S, Stiles B. Implementing Illness Management and Recovery Within Assertive Community Treatment: A Pilot Trial of Feasibility and Effectiveness. Psychiatr Serv 2018; 69:562-571. [PMID: 29446335 PMCID: PMC6433370 DOI: 10.1176/appi.ps.201700124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In a pilot feasibility and effectiveness study, illness management and recovery (IMR), a curriculum-based program to help people with serious mental illness pursue personal recovery goals, was integrated into assertive community treatment (ACT) to improve participants' recovery and functioning. METHODS A small-scale cluster randomized controlled design was used to test implementation of IMR within ACT teams in two states. Eight high-fidelity ACT teams were assigned to provide IMR (ACT+IMR; four teams) or standard ACT services (ACT only; four teams). Clinical outcomes from 101 individuals with schizophrenia-spectrum or bipolar disorders were assessed at baseline, six months, and one year. RESULTS Exposure to IMR (session attendance and module completion) varied between the ACT+IMR teams, with participants on one team having significantly less exposure. Results from intent-to-treat analyses showed that participants in ACT+IMR demonstrated significantly better outcomes with a medium effect size at follow-up on clinician-rated illness self-management. A nonsignificant, medium effect size was found for one measure of functioning, and small effect sizes were observed for client-rated illness self-management and community integration. Session and module completion predicted better outcomes on four of the 12-month outcome measures. CONCLUSIONS Findings support the feasibility of implementing IMR within ACT teams. Although there were few significant findings, effect sizes on some variables in this small-scale study and the dose-response relationships within ACT+IMR teams suggest this novel approach could be promising for improving recovery for people with serious mental illness. Further large-scale studies utilizing a hybrid effectiveness-implementation design could provide a promising direction in this area.
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Affiliation(s)
- Maria Monroe-DeVita
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Gary Morse
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Kim T Mueser
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Gregory J McHugo
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Haiyi Xie
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Kevin A Hallgren
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Roselyn Peterson
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Joris Miller
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Christopher Akiba
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Mary York
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Susan Gingerich
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Bryan Stiles
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
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Bighelli I, Salanti G, Reitmeir C, Wallis S, Barbui C, Furukawa TA, Leucht S. Psychological interventions for positive symptoms in schizophrenia: protocol for a network meta-analysis of randomised controlled trials. BMJ Open 2018. [PMID: 29540411 PMCID: PMC5857696 DOI: 10.1136/bmjopen-2017-019280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION There is rising awareness that we need multidisciplinary approaches integrating psychological treatments for schizophrenia, but a comprehensive evidence based on their relative efficacy is lacking. We will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomised controlled trials (RCTs) to rank psychological treatments for schizophrenia according to their efficacy, acceptability and tolerability. METHODS AND ANALYSIS We will include all RCTs comparing a psychological treatment aimed at positive symptoms of schizophrenia with another psychological intervention or with a no treatment condition (waiting-list and treatment as usual). We will include studies on adult patients with schizophrenia, excluding specific subpopulations (eg, first-episode patients or patients with psychiatric comorbidities). Primary outcome will be the change in positive symptoms on a published rating scale. Secondary outcomes will be acceptability (dropout), change in overall and negative symptoms of schizophrenia, response, relapse, adherence, depression, quality of life, functioning and adverse events. Published and unpublished studies will be sought through database searches, trial registries and websites. Study selection and data extraction will be conducted by at least two independent reviewers. We will conduct random-effects NMA to synthesise all evidences for each outcome and obtain a comprehensive ranking of all treatments. NMA will be conducted in Stata and R within a frequentist framework. The risk of bias in studies will be evaluated using the Cochrane Risk of Bias tool and the credibility of the evidence will be evaluated using an adaptation of the Grading of Recommendations Assessment, Development and Evaluation framework to NMA, recommended by the Cochrane guidance. Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings. ETHICS AND DISSEMINATION No ethical issues are foreseen. Results from this study will be published in peer-reviewed journals and presented at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42017067795.
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Affiliation(s)
- Irene Bighelli
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technischen Universitat Munchen, Munchen, Germany
| | - Georgia Salanti
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Cornelia Reitmeir
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technischen Universitat Munchen, Munchen, Germany
| | - Sofia Wallis
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technischen Universitat Munchen, Munchen, Germany
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technischen Universitat Munchen, Munchen, Germany
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Schöttle D, Schimmelmann BG, Ruppelt F, Bussopulos A, Frieling M, Nika E, Nawara LA, Golks D, Kerstan A, Lange M, Schödlbauer M, Daubmann A, Wegscheider K, Rohenkohl A, Sarikaya G, Sengutta M, Luedecke D, Wittmann L, Ohm G, Meigel-Schleiff C, Gallinat J, Wiedemann K, Bock T, Karow A, Lambert M. Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia-spectrum and bipolar I disorders: Four-year follow-up of the ACCESS II study. PLoS One 2018; 13:e0192929. [PMID: 29485988 PMCID: PMC5828355 DOI: 10.1371/journal.pone.0192929] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 01/26/2018] [Indexed: 11/18/2022] Open
Abstract
The ACCESS-model offers integrated care including assertive community treatment to patients with psychotic disorders. ACCESS proved more effective compared to standard care (ACCESS-I study) and was successfully implemented into clinical routine (ACCESS-II study). In this article, we report the 4-year outcomes of the ACCESS-II study. Between May 2007 and December 2013, 115 patients received continuous ACCESS-care. We hypothesized that the low 2-year disengagement and hospitalization rates and significant improvements in psychopathology, functioning, and quality of life could be sustained over 4 years. Over 4 years, only 10 patients disengaged from ACCESS. Another 23 left for practical reasons and were successfully transferred to other services. Hospitalization rates remained low (13.0% in year 3; 9.1% in year 4). Involuntary admissions decreased from 35% in the 2 years prior to ACCESS to 8% over 4 years in ACCESS. Outpatient contacts remained stably high at 2.0–2.4 per week. We detected significant improvements in psychopathology (effect size d = 0.79), illness severity (d = 1.29), level of functioning (d = 0.77), quality of life (d = 0.47) and stably high client satisfaction (d = 0.02) over 4 years. Most positive effects were observed within the first 2 years with the exception of illness severity, which further improved from year 2 to 4. Within continuous intensive 4-year ACCESS-care, sustained improvements in psychopathology, functioning, quality of life, low service disengagement and re-hospitalization rates, as well as low rates of involuntary treatment, were observed in contrast to other studies, which reported a decline in these parameters once a specific treatment model was stopped. Yet, stronger evidence to prove these results is required. Trial registration: Clinical Trial Registration Number: NCT01888627
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Affiliation(s)
- Daniel Schöttle
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Benno G. Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
- University Hospital of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friederike Ruppelt
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Bussopulos
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marietta Frieling
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evangelia Nika
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Luise Antonia Nawara
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dietmar Golks
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Kerstan
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Lange
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Schödlbauer
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rohenkohl
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gizem Sarikaya
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mary Sengutta
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Luedecke
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Linus Wittmann
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gunda Ohm
- Strategic University Development Centre, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Meigel-Schleiff
- Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Wiedemann
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Bock
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Brief Report: A Randomized Control Trial Assessing the Influence of a Telephone-based Intervention on Readmissions for Patients with Severe Mental Illness in a Developing Country. Community Ment Health J 2018; 54:197-203. [PMID: 27900649 PMCID: PMC5794800 DOI: 10.1007/s10597-016-0069-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/24/2016] [Indexed: 10/28/2022]
Abstract
Whilst comprehensive post-discharge interventions have been successful in reducing readmissions in our setting, they are possibly not sustainable due to limited resources. We assessed the impact of a more cost-effective telephone-based intervention on readmissions in a developing country over 12 months. 100 patients with severe mental illness were randomized to facilitated care or treatment as usual. All were interviewed prior to discharge and after 12 months. Facilitated care consisted of structured telephonic interviews and motivational support to patients and families. At 12 months no significant differences in either readmissions (p = 0.10) or days in hospital (p = 0.44) could be demonstrated. Substance use was high (64%), particularly methamphetamine (44%) in both groups. The intervention did not have any impact on inpatient usage in our setting. Though this study was limited by its small sample size, the results indicated that affordable post-discharge services may not be comprehensive enough to reduce readmission rates and would have to be tailored to the distinct population of dual diagnosis patients identified in this study.
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Abstract
Abstract-Global consensus and national policies have emphasized deinstitutionalization, or a shift in providing mental health care from institutional to community settings. Yet, psychiatric hospitals and asylums receive the majority of mental health funding in many countries, at odds with research evidence that suggests that services should be delivered in the community. Our aim is to investigate the norms, actors, and strategies that influence the uptake of deinstitutionalization internationally. Our study is informed by prior literature on management and implementation science. The success and failure of mental health care operations depend on identifying and overcoming challenges related to implementing innovations within national contexts. We surveyed 78 experts spanning 42 countries on their knowledge and experiences in expanding community-based mental health care and/or downsizing institution-based care. We also asked them about the contexts in which said methods were implemented in a country. We found that mental health care, whether it is provided in institutions or in the community, does not seem to be standardized across countries. Our analysis also showed that moving deinstitutionalization forward requires meaningful engagement of three types of actors: government officials, health care professionals, and local experts. Progress toward deinstitutionalization depends on the partnerships formed among these actors and with diverse stakeholders, which have the potential to garner resources and to scale-up pilot projects. In conclusion, different countries have adapted deinstitutionalization in ways to meet idiosyncratic situations and population needs. More attention should be given to the management and implementation strategies that are used to augment treatment and preventive services.
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Affiliation(s)
- Gordon C Shen
- a Department of Health Policy and Management, Graduate School of Public Health and Health Policy , City University of New York , New York , NY , USA
| | - Julian Eaton
- b Centre for Global Mental Health, London School of Hygiene and Tropical Medicine , London , UK.,c CBM International , Cambridge , UK
| | - Lonnie R Snowden
- d School of Public Health , University of California at Berkeley , Berkeley , CA , USA
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Starks SL, Arns PG, Padwa H, Friedman JR, Marrow J, Meldrum ML, Bromley E, Kelly EL, Brekke JS, Braslow JT. System Transformation Under the California Mental Health Services Act: Implementation of Full-Service Partnerships in L.A. County. Psychiatr Serv 2017; 68:587-595. [PMID: 28142386 PMCID: PMC6005368 DOI: 10.1176/appi.ps.201500390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study evaluated the effect of California's Mental Health Services Act (MHSA) on the structure, volume, location, and patient centeredness of Los Angeles County public mental health services. METHODS This prospective mixed-methods study (2006-2013) was based in five Los Angeles County public mental health clinics, all with usual care and three with full-service partnerships (FSPs). FSPs are MHSA-funded programs designed to "do whatever it takes" to provide intensive, recovery-oriented, team-based, integrated services for clients with severe mental illness. FSPs were compared with usual care on outpatient services received (claims data) and on organizational climate, recovery orientation, and provider-client working alliance (surveys and semistructured interviews), with regression adjustment for client and provider characteristics. RESULTS In the first year after admission, FSP clients (N=174) received significantly more outpatient services than did usual care clients (N=298) (5,238 versus 1,643 minutes, p<.001), and a larger proportion of these services were field based (22% versus 2%, p<.001). Compared with usual care clients, FSP clients reported more recovery-oriented services (p<.001) and a better provider-client working alliance (p=.01). Compared with usual care providers (N=130), FSP providers (N=42) reported more stress (p<.001) and lower morale (p<.001). CONCLUSIONS Los Angeles County's public mental health system was able to transform service delivery in response to well-funded policy mandates. For providers, a structure emphasizing accountability and patient centeredness was associated with greater stress, despite smaller caseloads. For clients, service structure and volume created opportunities to build stronger provider-client relationships and address their needs and goals.
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Affiliation(s)
- Sarah L Starks
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - Paul G Arns
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - Howard Padwa
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - Jack R Friedman
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - Jocelyn Marrow
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - Marcia L Meldrum
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - Elizabeth Bromley
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - Erin L Kelly
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - John S Brekke
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
| | - Joel T Braslow
- Dr. Starks, Dr. Padwa, Dr. Meldrum, and Dr. Kelly are with the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA). Dr. Meldrum is also with the Department of History, UCLA, where Dr. Braslow is affiliated. Dr. Kelly is also with the School of Social Work, University of Southern California, Los Angeles, where Dr. Brekke is affiliated. Dr. Braslow is also with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, where Dr. Arns and Dr. Bromley are affiliated. Dr. Arns is also with the Los Angeles County Department of Mental Health. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, Greater Los Angeles Veterans Affairs Healthcare System. Dr. Friedman is with the Center for Applied Social Research, University of Oklahoma, Norman. Dr. Marrow is with Health Studies, Westat, Rockville, Maryland
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Gouveia L, Massanganhe H, Mandlate F, Mabunda D, Fumo W, Mocumbi AO, de Jesus Mari J. Family reintegration of homeless in Maputo and Matola: a descriptive study. Int J Ment Health Syst 2017; 11:25. [PMID: 28413439 PMCID: PMC5387388 DOI: 10.1186/s13033-017-0133-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Homelessness is a global and local social problem with underestimated prevalence. It has been shown to increase the risk of mental illness, raising concerns from mental health providers about the need for effective interventions targeting this population. OBJECTIVES The aim of this paper is to describe the mental health status of the homeless people in two urban setting in a low-income country, through using standardised clinical and socio-demographic assessments as well assessing potential predictors of family integration versus non-family integration among a group of homeless individuals receiving psychiatric and psychosocial treatment. METHODS A descriptive study was performed in Maputo and Matola cities between 2008 and 2010. Homeless people with apparent mental illness were mapped and recruited. The participants were referred from community to hospital, using a multidisciplinary treatment model, according to their clinical condition and later entered a family reintegration process. RESULTS Seventy-one homeless people were recruited (93.0% male; 80.3% unemployed). The most common diagnosis was schizophrenia and other psychosis (46; 64.8%), followed by mental and behaviour disorder related to substance misuse (21; 29.6%), and intellectual disability (4; 5.6%). Family reintegration was achieved for 53.5% (38 patients). Patients with intellectual disability were less reintegrated and those with disorders related to substance use had better reinsertion in their families (Chi square (2) = 6.1; p = 0.047). CONCLUSIONS Family reintegration was achieved in more than half of participants after hospitalization. Integration was higher in cases of substance misuse, with those with associated intellectual disability being more difficult to reintegrate. Trial registration Trial Registration Number: NCT02936141, date of registration: 14/10/2016, retrospectively registered.
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Affiliation(s)
- Lídia Gouveia
- Department of Mental Health, Ministry of Health-Mozambique, Av. Eduardo Mondlane/Av. Salvador Allende, P.O.Box 1613, Maputo, Mozambique
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Honório Massanganhe
- Department of Mental Health, Ministry of Health-Mozambique, Av. Eduardo Mondlane/Av. Salvador Allende, P.O.Box 1613, Maputo, Mozambique
| | - Flávio Mandlate
- Department of Mental Health, Ministry of Health-Mozambique, Av. Eduardo Mondlane/Av. Salvador Allende, P.O.Box 1613, Maputo, Mozambique
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Dirceu Mabunda
- Department of Mental Health, Ministry of Health-Mozambique, Av. Eduardo Mondlane/Av. Salvador Allende, P.O.Box 1613, Maputo, Mozambique
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Wilza Fumo
- Department of Mental Health, Ministry of Health-Mozambique, Av. Eduardo Mondlane/Av. Salvador Allende, P.O.Box 1613, Maputo, Mozambique
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Ana Olga Mocumbi
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
- National Health Institute, Ministry of Health-Mozambique, Maputo, Mozambique
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Dieterich M, Irving CB, Bergman H, Khokhar MA, Park B, Marshall M. Intensive case management for severe mental illness. Cochrane Database Syst Rev 2017; 1:CD007906. [PMID: 28067944 PMCID: PMC6472672 DOI: 10.1002/14651858.cd007906.pub3] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Intensive Case Management (ICM) is a community-based package of care aiming to provide long-term care for severely mentally ill people who do not require immediate admission. Intensive Case Management evolved from two original community models of care, Assertive Community Treatment (ACT) and Case Management (CM), where ICM emphasises the importance of small caseload (fewer than 20) and high-intensity input. OBJECTIVES To assess the effects of ICM as a means of caring for severely mentally ill people in the community in comparison with non-ICM (caseload greater than 20) and with standard community care. We did not distinguish between models of ICM. In addition, to assess whether the effect of ICM on hospitalisation (mean number of days per month in hospital) is influenced by the intervention's fidelity to the ACT model and by the rate of hospital use in the setting where the trial was conducted (baseline level of hospital use). SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (last update search 10 April 2015). SELECTION CRITERIA All relevant randomised clinical trials focusing on people with severe mental illness, aged 18 to 65 years and treated in the community care setting, where ICM is compared to non-ICM or standard care. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials, assessed quality, and extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated mean difference (MD) between groups and its 95% CI. We employed a random-effects model for analyses.We performed a random-effects meta-regression analysis to examine the association of the intervention's fidelity to the ACT model and the rate of hospital use in the setting where the trial was conducted with the treatment effect. We assessed overall quality for clinically important outcomes using the GRADE approach and investigated possible risk of bias within included trials. MAIN RESULTS The 2016 update included two more studies (n = 196) and more publications with additional data for four already included studies. The updated review therefore includes 7524 participants from 40 randomised controlled trials (RCTs). We found data relevant to two comparisons: ICM versus standard care, and ICM versus non-ICM. The majority of studies had a high risk of selective reporting. No studies provided data for relapse or important improvement in mental state.1. ICM versus standard careWhen ICM was compared with standard care for the outcome service use, ICM slightly reduced the number of days in hospital per month (n = 3595, 24 RCTs, MD -0.86, 95% CI -1.37 to -0.34,low-quality evidence). Similarly, for the outcome global state, ICM reduced the number of people leaving the trial early (n = 1798, 13 RCTs, RR 0.68, 95% CI 0.58 to 0.79, low-quality evidence). For the outcome adverse events, the evidence showed that ICM may make little or no difference in reducing death by suicide (n = 1456, 9 RCTs, RR 0.68, 95% CI 0.31 to 1.51, low-quality evidence). In addition, for the outcome social functioning, there was uncertainty about the effect of ICM on unemployment due to very low-quality evidence (n = 1129, 4 RCTs, RR 0.70, 95% CI 0.49 to 1.0, very low-quality evidence).2. ICM versus non-ICMWhen ICM was compared with non-ICM for the outcome service use, there was moderate-quality evidence that ICM probably makes little or no difference in the average number of days in hospital per month (n = 2220, 21 RCTs, MD -0.08, 95% CI -0.37 to 0.21, moderate-quality evidence) or in the average number of admissions (n = 678, 1 RCT, MD -0.18, 95% CI -0.41 to 0.05, moderate-quality evidence) compared to non-ICM. Similarly, the results showed that ICM may reduce the number of participants leaving the intervention early (n = 1970, 7 RCTs, RR 0.70, 95% CI 0.52 to 0.95,low-quality evidence) and that ICM may make little or no difference in reducing death by suicide (n = 1152, 3 RCTs, RR 0.88, 95% CI 0.27 to 2.84, low-quality evidence). Finally, for the outcome social functioning, there was uncertainty about the effect of ICM on unemployment as compared to non-ICM (n = 73, 1 RCT, RR 1.46, 95% CI 0.45 to 4.74, very low-quality evidence).3. Fidelity to ACTWithin the meta-regression we found that i.) the more ICM is adherent to the ACT model, the better it is at decreasing time in hospital ('organisation fidelity' variable coefficient -0.36, 95% CI -0.66 to -0.07); and ii.) the higher the baseline hospital use in the population, the better ICM is at decreasing time in hospital ('baseline hospital use' variable coefficient -0.20, 95% CI -0.32 to -0.10). Combining both these variables within the model, 'organisation fidelity' is no longer significant, but the 'baseline hospital use' result still significantly influences time in hospital (regression coefficient -0.18, 95% CI -0.29 to -0.07, P = 0.0027). AUTHORS' CONCLUSIONS Based on very low- to moderate-quality evidence, ICM is effective in ameliorating many outcomes relevant to people with severe mental illness. Compared to standard care, ICM may reduce hospitalisation and increase retention in care. It also globally improved social functioning, although ICM's effect on mental state and quality of life remains unclear. Intensive Case Management is at least valuable to people with severe mental illnesses in the subgroup of those with a high level of hospitalisation (about four days per month in past two years). Intensive Case Management models with high fidelity to the original team organisation of ACT model were more effective at reducing time in hospital.However, it is unclear what overall gain ICM provides on top of a less formal non-ICM approach.We do not think that more trials comparing current ICM with standard care or non-ICM are justified, however we currently know of no review comparing non-ICM with standard care, and this should be undertaken.
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Affiliation(s)
- Marina Dieterich
- Azienda USL Toscana Nord OvestDepartment of PsychiatryLivornoItaly
| | - Claire B Irving
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthUniversity of Nottingham Innovation Park, Triumph RoadNottinghamUKNG7 2TU
| | - Hanna Bergman
- Enhance Reviews LtdCentral Office, Cobweb buildingsThe Lane, LyfordWantageUKOX12 0EE
| | - Mariam A Khokhar
- University of SheffieldOral Health and Development15 Askham CourtGamston Radcliffe RoadNottinghamUKNG2 6NR
| | - Bert Park
- Nottinghamshire Healthcare NHS TrustAMH Management SuiteHighbury HospitalNottinghamUKNG6 9DR
| | - Max Marshall
- The Lantern CentreUniversity of ManchesterVicarage LaneOf Watling Street Road, FulwoodPrestonLancashireUK
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Mateus P, Caldas de Almeida J, de Carvalho Á, Xavier M. Implementing Case Management in Portuguese Mental Health Services: Conceptual Background. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2017. [DOI: 10.1159/000477646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Case management implementation processes are one of the best examples on how an evidence-based practice can influence health services organisation. This practice helped shaping mental health teams, increasing their multidisciplinarity and interdisciplinary work in the last decades. Examples from several countries show how effectiveness research blends into health policy development to meet different needs in each health system, thus influencing case management inception and improvement of care. Portugal followed its own path in case management implementation, determined mostly by mental health services organisation and closely linked with the capacity to implement a national mental health policy in the last years.
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Echiverri-Cohen A, Zoellner LA, Gallop R, Feeny N, Jaeger J, Bedard-Gilligan M. Changes in temporal attention inhibition following prolonged exposure and sertraline in the treatment of PTSD. J Consult Clin Psychol 2016; 84:415-26. [PMID: 26900894 DOI: 10.1037/ccp0000080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Attentional inhibitory deficits expressed as difficulty ignoring irrelevant stimuli in the pursuit of goal-directed behavior may serve as a fundamental mechanism of posttraumatic stress disorder (PTSD). Evidence of inhibitory processes as central to extinction suggests that exposure-based treatments may act more directly on the inhibitory deficits implicated in PTSD, whereas, in facilitating serotonergic neurotransmission, selective serotonin reuptake inhibitors (SSRIs) may be less direct and bring about general neurochemical changes in the fear circuitry. If these inhibitory deficits underlie PTSD, then inhibition should improve with successful treatment, with those treated with prolonged exposure (PE) potentially resulting in greater changes in inhibition than those treated with sertraline. METHOD Changes in temporal attentional inhibition, using an attentional blink (AB) paradigm, were examined at pre- and posttreatment in 49 individuals (74.5% female, 66.7% Caucasian, age M = 37.69, SD = 12.8 years) with chronic PTSD. Participants completed 10 weeks of either PE or sertraline. RESULTS Individuals who made greater improvements with PE showed faster improvements in temporal inhibition on the critical inhibitory lag of AB than those who made greater improvements with sertraline (d = 0.94). These changes could not be accounted for by basic attention. CONCLUSIONS Greater improvement in fundamental attentional inhibitory processes with better treatment response to PE, compared with sertraline, suggests potential specificity in how PTSD treatments normalize inhibitory processes, such that exposure-based treatments like PE may target inhibitory processes and improve basic inhibitory functioning.
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Affiliation(s)
| | | | | | - Norah Feeny
- Department of Psychology, Case Western Reserve University
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Jaeger M, Briner D, Kawohl W, Seifritz E, Baumgartner-Nietlisbach G. Psychosocial functioning of individuals with schizophrenia in community housing facilities and the psychiatric hospital in Zurich. Psychiatry Res 2015; 230:413-8. [PMID: 26416587 DOI: 10.1016/j.psychres.2015.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 07/30/2015] [Accepted: 09/18/2015] [Indexed: 10/23/2022]
Abstract
Individuals with severe mental illness frequently have difficulties in obtaining and maintaining adequate accommodation. If they are not willing or able to adapt to requirements of traditional supported housing institutions they may live in sheltered and emergency accommodation. Adequate mental health services are rarely available in these facilities. The aim of the present study was to evaluate mental health, functional and social status of individuals living in community sheltered housing facilities. A cross-sectional survey of n=338 individuals in sheltered housing compared to a sample of patients at intake in acute inpatient psychiatry (n=619) concerning clinical and social variables was carried out in the catchment area of Zurich. Matched subsamples of individuals with schizophrenia (n=168) were compared concerning functioning and impairments on the Health of the Nation Outcome Scales (HoNOS). Individuals with schizophrenia in sheltered housing (25% of the residents) have significantly more problems concerning substance use, physical illness, psychopathological symptoms other than psychosis and depression, and relationships, daily activities and occupation than patients with schizophrenia at intake on an acute psychiatric ward. Community sheltered accommodation although conceptualized to prevent homelessness in the general population de facto serve as housing facilities for individuals with schizophrenia and other severe mental illness.
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Affiliation(s)
- Matthias Jaeger
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | - David Briner
- Psychiatric-Psychological Service, City of Zurich, Switzerland
| | - Wolfram Kawohl
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Erich Seifritz
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
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Stuen HK, Rugkåsa J, Landheim A, Wynn R. Increased influence and collaboration: a qualitative study of patients' experiences of community treatment orders within an assertive community treatment setting. BMC Health Serv Res 2015; 15:409. [PMID: 26400028 PMCID: PMC4581043 DOI: 10.1186/s12913-015-1083-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 09/21/2015] [Indexed: 11/24/2022] Open
Abstract
Background Since 2009, 14 assertive community treatment (ACT) teams have started up in Norway. Over 30 % of the patients treated by the ACT teams were subject to community treatment orders (CTOs) at intake. CTOs are legal mechanisms to secure treatment adherence for patients with severe mental illness. Little is known about patients’ views and experiences of CTOs within an ACT context. Methods The study was based on qualitative in depth interviews with 15 patients that were followed up by ACT teams and that were currently subjected to CTOs. The data were analyzed by using a modified grounded theory approach. Results While some participants experienced the CTO as a security net and as an important factor for staying well, others described the CTO as a social control mechanism and as a violation of their autonomy. Although experiencing difficulties and tensions, many participants described the ACT team as a different mental health arena from what they had known before, with another frame of interaction. Despite being legally compelled to receive treatment, many participants talked about how the ACT teams focused on addressing unmet needs, the management of future crises, and finding solutions to daily life problems. Assistance with housing and finances, reduced social isolation, and being able to seek help voluntarily were positive outcomes emphasized by many patients. Discussion The participants had different views of being on a CTO within an ACT setting. While some remained clearly negative to the CTO, others described a gradual transition toward regarding the CTO as an acceptablesolution as they gained experience of ACT. Many of the participants valued the supportive relationship withthe ACT team, and communication with the care providers and the care providers’ attitudes could make a significant difference. The study shows that the perception of coercion is context dependent, and that the relationship between care providers and patients is of importance to how patients interpret the providers’ behavior and the restrictive interventions. Conclusions Although some patients focused on loss of autonomy and being compelled to take medications, other patients emphasised the supportive relationships they had with the ACT teams and that they had received help with housing, finances, and other daily life problems. Thus, being on mandated community treatment could be acceptable in the opinion of several of the patients, provided that they received other services that they found beneficial.
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Affiliation(s)
- Hanne Kilen Stuen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brummundal, Norway. .,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.
| | - Jorun Rugkåsa
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway. .,Departement of Psychiatry, University of Oxford, Oxford, UK.
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brummundal, Norway. .,Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway.
| | - Rolf Wynn
- Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway. .,Divison of Mental Health and Addictions, University Hospital of North Norway, Tromsø, Norway.
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Kim TW, Jeong JH, Kim YH, Kim Y, Seo HJ, Hong SC. Fifteen-month follow up of an assertive community treatment program for chronic patients with mental illness. BMC Health Serv Res 2015; 15:388. [PMID: 26376978 PMCID: PMC4573673 DOI: 10.1186/s12913-015-1058-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 09/11/2015] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the effect of an Assertive Community Treatment (ACT) program on psychiatric symptoms, global functioning, life satisfaction, and recovery-promoting relationships among individuals with mental illness. METHODS Participants were patients at the Suwon Mental Health Center. Thirty-two patients were part of the ACT program and 32 patients matched for age, sex, and mental illness were in a standard case-management program and served as a control group. Follow-up with patients occurred every 3 months during the 15 months after a baseline interview. Participants completed the Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning (GAF) Scale, Life Satisfaction Scale, and Recovery-Promoting Relationship Scale (RPRS). RESULTS No significant differences were noted in the sociodemographic characteristics of the ACT and the case-management group. According to the BPRS, the ACT group showed a significant reduction in symptom severity, but the ACT program was not significantly more effective at reducing psychiatric symptoms from baseline to the 15-month follow-up compared to the case-management approach. The ACT group showed more significant improvement than the control group in terms of the GAF Scale. Both groups showed no significant differences in the change of life satisfaction and in the change of recovery-promoting relationships. We observed a significant increase in recovery-promoting relationships in the control group, but the degree of change of recovery-promoting relationships through time flow between groups was not significantly different. DISCUSSION In this study, we observed that ACT was significantly better at improving the GAF than case management and that participation in ACT was associated with a significant decrease in BPRS scores. However, ACT did not demonstrate an absolute superiority over the standard case-management approach in terms of the BPRS and the measures of life satisfaction and recovery-promoting relationships. CONCLUSIONS ACT may have some advantages over a standard case management approach.
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Affiliation(s)
- Tae-Won Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Jong-Hyun Jeong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea. .,Suwon Mental Health Center, Suwon, Gyeonggi do, Korea. .,Department of Psychiatry, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Ji-dong, Paldal-gu, Suwon, 442-723, Korea.
| | - Young-Hee Kim
- Suwon Mental Health Center, Suwon, Gyeonggi do, Korea.
| | - Yura Kim
- Suwon Mental Health Center, Suwon, Gyeonggi do, Korea.
| | - Ho-Jun Seo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Seung-Chul Hong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea. .,Suwon Mental Health Center, Suwon, Gyeonggi do, Korea.
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Theodoridou A, Hengartner MP, Gairing SK, Jäger M, Ketteler D, Kawohl W, Lauber C, Rössler W. Evaluation of a new person-centered integrated care model in psychiatry. Psychiatr Q 2015; 86:153-68. [PMID: 25141779 DOI: 10.1007/s11126-014-9310-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The present study evaluated a new integrated treatment concept offering inpatient care, acute psychiatric day hospital and outpatient treatment by the same therapeutic team. 178 patients participated in this randomized controlled trial. Data on psychopathology, global and social functioning, patient satisfaction, continuity of care and administrative data was gathered on admission, throughout the course of treatment, upon discharge and at 1-year follow-up. In addition, the physicians in charge rated the therapeutic relationship. The data analysis consists of group-wise comparisons and regression analyses (cross-tabulations and χ(2) test statistics for categorical data and Mann-Whitney U tests for continuous data). Differences between groups over time were analyzed with a series of generalized linear mixed model. The integrated care group showed a significant reduction in psychopathological impairment (20.7%) and an improvement of psychosocial functioning (36.8%). The mean number of days before re-admission was higher in the control group when compared to the integrated care group (156.8 vs. 91.5). There was no difference in the number of re-admissions and days spent in psychiatric institutions. This new approach offers a treatment model, which facilitates continuity of care. Beside it improves psychopathological outcome measures and psychosocial functioning in patients with mental illness.
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Affiliation(s)
- Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland,
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Secher RG, Hjorthøj CR, Austin SF, Thorup A, Jeppesen P, Mors O, Nordentoft M. Ten-year follow-up of the OPUS specialized early intervention trial for patients with a first episode of psychosis. Schizophr Bull 2015; 41:617-26. [PMID: 25381449 PMCID: PMC4393691 DOI: 10.1093/schbul/sbu155] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Specialized early intervention programs such as The Danish OPUS treatment are efficient in treating patients with a first episode of psychosis (FEP) at least after 2 and 5 years. Few studies have examined long-term outcomes of these interventions. AIM To examine the effect of 2 years of OPUS vs treatment as usual (TAU) within an FEP cohort, 10 years after inclusion into the OPUS trial. METHODS From 1998 to 2000, participants were randomized to OPUS or TAU. Ten years later, we conducted comprehensive interviews and performed register-based follow-up on all participants in national Danish registers. We analyzed participants according to the intention-to-treat principle. RESULTS Of the 547 participants included in the study, 347 (63.4%) took part in this follow-up. While there was evidence of a differential 10-year course in the development of negative symptoms, psychiatric bed days, and possibly psychotic symptoms in favor of OPUS treatment, differences were driven by effects at earlier follow-ups and had diminished over time. Statistically significant differences in the course of use of supported housing were present even after 8-10 years. There were no differences between OPUS and TAU regarding income, work-related outcomes, or marital status. CONCLUSION Most of the positive short-term effects of the OPUS intervention had diminished or vanished at this long-term follow-up. We observed a clear tendency that OPUS treatment leads to fewer days in supported housing. There is a need for further studies investigating if extending the intervention will improve outcomes more markedly at long-term follow-ups.
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Affiliation(s)
- Rikke Gry Secher
- Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carsten Rygaard Hjorthøj
- Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Aarhus, Denmark;
| | - Stephen F. Austin
- Mental Health Center North Zealand, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Thorup
- Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark;,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Aarhus, Denmark
| | - Pia Jeppesen
- Child & Adolescent Mental Health Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Aarhus, Denmark; ,Research Department P, Aarhus University Hospital, Risskov, Denmark
| | - Merete Nordentoft
- Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark;,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Aarhus, Denmark
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Gühne U, Weinmann S, Arnold K, Becker T, Riedel-Heller SG. S3 guideline on psychosocial therapies in severe mental illness: evidence and recommendations. Eur Arch Psychiatry Clin Neurosci 2015; 265:173-88. [PMID: 25384674 DOI: 10.1007/s00406-014-0558-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 10/27/2014] [Indexed: 01/01/2023]
Abstract
The burden of severe and persistent mental illness is high. Beside somatic treatment and psychotherapeutic interventions, treatment options for patients with severe mental illness also include psychosocial interventions. This paper summarizes the results of a number of systematic literature searches on psychosocial interventions for people with severe mental illness. Based on this evidence appraisal, recommendations for the treatment of people with severe mental illness were formulated and published in the evidence-based guideline series of the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) as an evidence-based consensus guideline ("S3 guideline"). Recommendations were strongly based on study results, but used consensus processes to consider external validity and transferability of the recommended practices to the German mental healthcare system. A distinction is made between system-level interventions (multidisciplinary team-based psychiatric community care, case management, vocational rehabilitation and participation in work life and residential care interventions) and single psychosocial interventions (psychoeducation, social skills training, arts therapies, occupational therapy and exercise therapy). There is good evidence for the efficacy of the majority of psychosocial interventions in the target group. The best available evidence exists for multidisciplinary team-based psychiatric community care, family psychoeducation, social skills training and supported employment. The present guideline offers an important opportunity to further improve health services for people with severe mental illness in Germany. Moreover, the guideline highlights areas for further research.
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Affiliation(s)
- Uta Gühne
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany,
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Modified assertive community treatment: effectiveness on hospitalization and length of stay. Community Ment Health J 2015; 51:171-4. [PMID: 25056686 DOI: 10.1007/s10597-014-9757-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 07/06/2014] [Indexed: 10/25/2022]
Abstract
The objective is to assess the efficacy of a modified Assertive Community treatment (ACT). This is a retrospective cross-sectional study with a comparative group. The study group was patients with schizophrenia who had completed modified ACT, while the control group was those who did not receive modified ACT. The final sample comprises 44 patients in each group. There was no significant difference between both groups in number of admissions and average length of stay. However, in the modified ACT group there was a significant reduction in the number of admissions after the intervention. In conclusion readmission rate was significantly reduced following modified ACT intervention.
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de Jong G, Schout G, Abma T. Prevention of involuntary admission through Family Group Conferencing: a qualitative case study in community mental health nursing. J Adv Nurs 2014; 70:2651-62. [PMID: 24815903 DOI: 10.1111/jan.12445] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2014] [Indexed: 11/29/2022]
Abstract
AIM To understand whether and how Family Group Conferencing might contribute to the social embedding of clients with mental illness. BACKGROUND Ensuring the social integration of psychiatric clients is a key aspect of community mental health nursing. Family Group Conferencing has potency to create conditions for clients' social embedding and subsequently can prevent coercive measures. DESIGN A naturalistic qualitative case study on the process of one conference that was part of 41 conferences that had been organized and studied from January 2011-September 2013 in a public mental health care setting in the north of the Netherlands. METHODS Semi-structured interviews (N = 20) were conducted with four stakeholder groups (N = 13) involved in a conference on liveability problems in a local neighbourhood wherein a man with schizophrenia resides. FINDINGS To prevent an involuntary admission to a psychiatric ward of a man with schizophrenia, neighbourhood residents requested a family group conference between themselves, the sister of the man and the mental health organization. As a possible conference aggravated psychotic problems, it was decided to organize it without the client. Nine months after the conference, liveability problems in the neighbourhood had been reduced and coercive measures adverted. The conference strengthened the community and resulted in a plan countering liveability problems. CONCLUSION The case indicates that social embedding of clients with severe psychiatric problems can be strengthened by Family Group Conferencing and that hence coercive measures can be prevented. A shift is required from working with the individual client to a community driven approach.
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Affiliation(s)
- Gideon de Jong
- Department of Medical Humanities, EMGO+, VU University Medical Center, Amsterdam, the Netherlands
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Lessons from community mental health to drive implementation in health care systems for people with long-term conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:4714-28. [PMID: 24785742 PMCID: PMC4053874 DOI: 10.3390/ijerph110504714] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/08/2014] [Accepted: 04/11/2014] [Indexed: 12/30/2022]
Abstract
This paper aims to identify which lessons learned from the evidence and the experiences accruing from the transformation in mental health services in recent decades may have relevance for the future development of healthcare for people with long-term physical conditions. First, nine principles are discussed which we first identified to guide mental health service organisation, and all of which can be potentially applied to long term care as well (autonomy, continuity, effectiveness, accessibility, comprehensiveness, equity, accountability, co-ordination, and efficiency). Second, we have outlined innovative operational aspects of service user participation, many of which were first initiated and consolidated in the mental health field, and some of which are now also being implemented in long term care (including case management, and crisis plans). We conclude that long term conditions, whether mental or physical, deserve a long-term commitment from the relevant health services, and indeed where continuity and co-ordination are properly funded implemented, this can ensure that the symptomatic course is more stable, quality of life is enhanced, and the clinical outcomes are more favourable. Innovations such as self-management for long-term conditions (intended to promote autonomy and empowerment) need to be subjected to the same level of rigorous scientific scrutiny as any other treatment or service interventions.
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Botha UA, Koen L, Galal U, Jordaan E, Niehaus DJH. The rise of assertive community interventions in South Africa: a randomized control trial assessing the impact of a modified assertive intervention on readmission rates; a three year follow-up. BMC Psychiatry 2014; 14:56. [PMID: 24571621 PMCID: PMC3974055 DOI: 10.1186/1471-244x-14-56] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 02/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many countries have over the last few years incorporated mental health assertive interventions in an attempt to address the repercussions of deinstitutionalization. Recent publications have failed to duplicate the positive outcomes reported initially which has cast doubt on the future of these interventions. We previously reported on 29 patients from a developing country who completed 12 months in an assertive intervention which was a modified version of the international assertive community treatment model. We demonstrated reduction in readmission rates as well as improvements in social functioning compared to patients from the control group. The obvious question was, however, if these outcomes could be sustained for longer periods of time. This study aims to determine if modified assertive interventions in an under-resourced setting can successfully maintain reductions in hospitalizations. METHODS Patients suffering from schizophrenia who met a modified version of Weidens' high frequency criteria were randomized into two groups. One group received a modified assertive intervention based on the international assertive community treatment model. The other group received standard care according to the model of service delivery in this region. Data was collected after 36 months, comparing readmissions and days spent in hospital. RESULTS The results demonstrated significant differences between the groups. Patients in the intervention group had significantly less readmissions (p = 0.007) and spent less days in hospital compared to the patients in the control group (p = 0.013). CONCLUSION Modified assertive interventions may be successful in reducing readmissions and days spent in hospital in developing countries where standard care services are less comprehensive. These interventions can be tailored in such a way to meet service needs and still remain affordable and feasible within the context of an under-resourced setting.
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Affiliation(s)
- Ulla A Botha
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, PO Box 19063, Tygerberg 7505, South Africa.
| | - Liezl Koen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, PO Box 19063, Tygerberg 7505, South Africa
| | - Ushma Galal
- Medical Research Council, Bellville, South Africa,Department of Statistical Sciences, University of Cape Town, Rondebosch, South Africa
| | - Esme Jordaan
- Medical Research Council, Bellville, South Africa
| | - Daniel JH Niehaus
- Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, PO Box 19063, Tygerberg 7505, South Africa
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Stobbe J, Wierdsma AI, Kok RM, Kroon H, Roosenschoon BJ, Depla M, Mulder CL. The effectiveness of assertive community treatment for elderly patients with severe mental illness: a randomized controlled trial. BMC Psychiatry 2014; 14:42. [PMID: 24528604 PMCID: PMC3928976 DOI: 10.1186/1471-244x-14-42] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 02/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to fragmented mental, somatic, and social healthcare services, it can be hard to engage into care older patients with severe mental illness (SMI). In adult mental health care, assertive community treatment (ACT) is an organizational model of care for treating patients with SMI who are difficult to engage. So far all outcome studies of assertive community treatment have been conducted in adults. METHODS In a randomized controlled trial design we compared the effectiveness of ACT for elderly patients with that of treatment as usual (TAU). Sixty-two outpatients (60 years and older) with SMI who were difficult to engage in psychiatric treatment were randomly assigned to the intervention or control group (32 to ACT for elderly patients and 30 to TAU). Primary outcomes included number of patients who had a first treatment contact within 3 months, the number of dropouts (i.e. those discharged from care due to refusing care or those who unintentionally lost contact with the service over a period of at least 3 months); and patients' psychosocial functioning (HoNOS65+ scores) during 18 months follow-up. Secondary outcomes included the number of unmet needs and mental health care use. Analyses were based on intention-to-treat. RESULTS Of the 62 patients who were randomized, 26 were lost to follow-up (10 patients in ACT for elderly patients and 16 in TAU). Relative to patients with TAU, more patients allocated to ACT had a first contact within three months (96.9 versus 66.7%; X2 (df = 1) = 9.68, p = 0.002). ACT for elderly patients also had fewer dropouts from treatment (18.8% of assertive community treatment for elderly patients versus 50% of TAU patients; X2 (df = 1) = 6.75, p = 0.009). There were no differences in the other primary and secondary outcome variables. CONCLUSIONS These findings suggest that ACT for elderly patients with SMI engaged patients in treatment more successfully. TRIAL REGISTRATION NTR1620.
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Affiliation(s)
- Jolanda Stobbe
- Department of Psychiatry, Epidemiological and Social Psychiatric Research institute, Erasmus MC, PO Box 2040 Dp-0122, Rotterdam, CA 3000, The Netherlands.
| | - André I Wierdsma
- Department of Psychiatry, Epidemiological and Social Psychiatric Research institute, Erasmus MC, PO Box 2040 Dp-0122, Rotterdam, CA 3000, The Netherlands
| | - Rob M Kok
- Parnassia Psychiatric Institute, department Parnassia, Centre for Mental Health Care, Monsterweg, The Hague, The Netherlands
| | - Hans Kroon
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Da Costakade, The Netherlands
| | - Bert-Jan Roosenschoon
- Department of Psychiatry, Epidemiological and Social Psychiatric Research institute, Erasmus MC, PO Box 2040 Dp-0122, Rotterdam, CA 3000, The Netherlands,Parnassia Psychiatric Institute, department BavoEuropoort, Centre for Mental Health Care, Prins Constantijnweg, Rotterdam, The Netherlands
| | - Marja Depla
- Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorsstraat, Amsterdam, The Netherlands
| | - Cornelis L Mulder
- Department of Psychiatry, Epidemiological and Social Psychiatric Research institute, Erasmus MC, PO Box 2040 Dp-0122, Rotterdam, CA 3000, The Netherlands,Parnassia Psychiatric Institute, department BavoEuropoort, Centre for Mental Health Care, Prins Constantijnweg, Rotterdam, The Netherlands
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Lincoln TM, Heumann K, Teichert M. Das letzte Mittel? Ein Überblick über die politische Diskussion und den Forschungsstand zum Einsatz medikamentöser Zwangsbehandlung in der Psychiatrie. VERHALTENSTHERAPIE 2013. [DOI: 10.1159/000357649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Mas-Expósito L, Amador-Campos JA, Gómez-Benito J, Lalucat-Jo L. Considering variables for the assignment of patients with schizophrenia to a case management programme. Community Ment Health J 2013; 49:831-40. [PMID: 23775241 DOI: 10.1007/s10597-013-9621-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 06/03/2013] [Indexed: 12/16/2022]
Abstract
The elements and intensity of case management (CM) practices should be established according to patients' needs. Therefore, greater understanding of patients' needs in such community-based programmes is essential. This paper addresses this issue by characterizing two groups of patients receiving CM or a standard treatment programme (STP) and identifying the characteristics of patients receiving CM services. We recruited 241 patients with schizophrenia from 10 Adult Mental Health Centres in Barcelona (Catalonia, Spain). We analyzed the profile of new patients included in a clinical, non-intensive CM program against that of patients in a STP. CM patients, compared with STP patients, have a lower educational level and quality of life; greater use of health care services, and higher levels of psychiatric symptoms, disability and unmet needs. Community psychiatric visits, social services, education, physical health and needs were significantly associated with CM services. This study may help in identifying patients' needs and strengthening the CM programme.
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Affiliation(s)
- Laia Mas-Expósito
- Department of Research, Centre d'Higiene Mental Les Corts, c/Numància 103-105 baixos, 08029, Barcelona, Spain
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Hansen JP, Østergaard B, Nordentoft M, Hounsgaard L. The feasibility of cognitive adaptation training for outpatients with schizophrenia in integrated treatment. Community Ment Health J 2013; 49:630-5. [PMID: 23064969 DOI: 10.1007/s10597-012-9557-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 09/18/2012] [Indexed: 11/25/2022]
Abstract
Cognitive adaptation training (CAT) has been tested as a psychosocial treatment, showing promising results. To date there are no reported tests of CAT treatment outside the United States. Thus, we decided to adjust CAT treatment and apply it to an Integrated Treatment setting in Denmark. In this article we describe and discuss the feasibility of using CAT treatment in a randomized clinical trial in Denmark. The treatment period was shorter and the patients were instructed in prompting for specific actions by using newer tools such as schedules in their mobile phones. Social functioning, symptoms and quality of life were assessed using instruments validated in a Danish context. It was judged that, after some adjustments to fit the Danish assertive community treatment, CAT treatment was feasible in a Danish setting.
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Affiliation(s)
- Jens Peter Hansen
- Psychiatric Unit, Esbjerg, The Region of Southern Denmark, Gl. Vardevej 101, 6715, Esbjerg, Denmark,
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Drukker M, Visser E, Sytema S, van Os J. Flexible Assertive Community Treatment, Severity of Symptoms and Psychiatric Health Service Use, a Real life Observational Study. Clin Pract Epidemiol Ment Health 2013; 9:202-9. [PMID: 24358050 PMCID: PMC3866708 DOI: 10.2174/1745017901309010202] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 09/12/2013] [Accepted: 09/16/2013] [Indexed: 11/22/2022]
Abstract
Background: Introduction of Flexible Assertive Community Treatment (FACT) may be associated with increased remission rates and changes in patterns of care. The present paper reports on differences in psychosocial functioning and health care use between patients in FACT and two groups of patients not currently provided with a specific model of community service.
Methods: The ongoing "Pharmacotherapy Monitoring and Outcome Survey" provided routine outcome measures of patients using antipsychotics in the north of the Netherlands. Level of psychosocial functioning was assessed using the Health of the Nations Outcome Scales (HoNOS) and matched with psychiatric health care consumption obtained from the Psychiatric Case Register. Patients who never received FACT, patients ever in FACT but not at assessment date, and patients in FACT were identified. Data were subjected to multilevel linear regression analysis.
Results: Data showed that most patients in FACT also had non-FACT episodes after the start of FACT. Furthermore, patients in FACT displayed higher levels of psychosocial functioning and used more outpatient care than the other two groups.
Conclusions: Patients in FACT receive more outpatient care and have better psychosocial functioning. However, causal inferences cannot be derived from these data. In addition, membership of a FACT-team in this setting did not last indefinitely.
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Affiliation(s)
- Marjan Drukker
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience MHeNS, Maastricht University, p.o. box 616, Location Vijverdal, 6200 MD, Maastricht, the Netherlands
| | - Ellen Visser
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Rob Giel Centre, p.o. box 30.001, 9700 RB Groningen, the Netherlands
| | - Sjoerd Sytema
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Rob Giel Centre, p.o. box 30.001, 9700 RB Groningen, the Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience MHeNS, Maastricht University, p.o. box 616, Location Vijverdal, 6200 MD, Maastricht, the Netherlands ; King's College London, King's Health Partners Department of Psychosis Studies; Institute of Psychiatry, London, UK
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