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Ruud T, Hasselberg N, Siqveland J, Holgersen KH. Patient-reported outcome, clinician-reported outcome, and patient satisfaction with treatment by crisis resolution teams: a multicenter pre-post study of outcome and associated factors in Norway. BMC Psychiatry 2024; 24:82. [PMID: 38297302 PMCID: PMC10829386 DOI: 10.1186/s12888-024-05543-3] [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: 11/08/2023] [Accepted: 01/20/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Crisis resolution teams (CRTs) have become a part of mental health services in many high-income countries. Many studies have investigated the impact of CRTs on acute admissions to inpatient units, but very few studies have investigated patient-reported and clinician-reported outcomes for CRT service users. Our aims were to study patient-reported and clinician-reported outcomes of CRT treatment, how the outcomes were associated with characteristics of the service user and the treatment, and whether outcomes were different across CRTs. METHODS The study was a pre-post observational multicenter study of 475 patients receiving treatment from 25 CRTs in urban and rural areas in Norway. There was no control group. Outcomes were change in mental health status reported by service users using CORE-10 and by clinicians using HoNOS. Patient satisfaction was measured using CSQ-8 at the end of the treatment. Components of CRT accessibility and interventions were measured by clinicians reporting details on each session with the service user. CRT model fidelity was measured using the CORE CRT Fidelity Scale version 2. We used paired t-tests to analyze outcomes and linear mixed modeling to analyze associations of the outcomes with the characteristics of service users and the treatment provided. Using independent t-tests, we analyzed differences in outcomes and patient satisfaction between two clusters of CRTs with differences in accessibility. RESULTS The patient-reported outcomes and the clinician-reported outcomes were significantly positive and with a large effect size. Both were significantly positively associated with practical support and medication management and negatively associated with collaboration with mental health inpatient units. Patient satisfaction was high at the end of the treatment. CRTs with higher accessibility had a significantly better clinician-reported outcome, but no significant differences were reported for patient-reported outcomes or patient satisfaction. CONCLUSIONS CRT treatment led to improved symptom status as reported by patients and clinicians, as well as high patient satisfaction. Practical support and medication management were the interventions most strongly associated with positive outcomes. Some of the variations in outcomes were at the team level. Patient- and clinician-reported outcomes should be used more in studies on the effect of treatment provided by crisis resolution teams.
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Affiliation(s)
- T Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - N Hasselberg
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - J Siqveland
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- National Center for Suicide Research and Prevention, University of Oslo, Oslo, Norway
| | - K H Holgersen
- Nidelv Community Mental Health Centre, Tiller, Department of Mental Health, St. Olavs Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Ranney R, Maguen S, Woods A, Seal KH, Neylan TC, Bernardy N, Wiechers I, Ryder A, Cohen BE. Comparison of mental health outcomes of augmenting medications for patients with posttraumatic stress disorder: A national veterans affairs study. J Eval Clin Pract 2023; 29:191-202. [PMID: 35709244 DOI: 10.1111/jep.13726] [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: 03/15/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 01/18/2023]
Abstract
RATIONALE Posttraumatic stress disorder (PTSD) is highly prevalent among veterans. Many veterans with PTSD respond well to serotonin reuptake inhibitors (SRIs). Nonresponders may be prescribed augmenting medications, which are not as well-studied in PTSD. AIMS AND OBJECTIVES We used Veterans Health Administration electronic records to compare mental health outcomes (PTSD symptoms and rates of mental health hospitalizations and psychiatric emergency room visits) in patients with PTSD who were prescribed four different groups of augmenting medications (atypical antipsychotics, mirtazapine, prazosin or tricyclic antidepressants) in addition to SRIs-from the year before to the year after the start of the augmenting medication. METHOD We included data from 169,982 patients with a diagnosis of PTSD (excluding patients with comorbid bipolar or psychotic disorders) seen in Veterans Affairs care from 2007 to 2015 who were taking an SRI and filled a new prescription for one of the four augmenting medications for at least 60 days. RESULTS Patients evidenced minimal (<2%) reduction in PTSD symptoms and a larger reduction in psychiatric hospitalizations and psychiatric emergency room visits after receiving augmenting medications; this effect was largely similar across the four medication groups. Initiating augmenting medications was preceded by increases in PTSD symptoms, psychiatric hospitalizations and psychiatric emergency room visits. After initiating an augmenting medication, PTSD symptoms/hospitalizations/emergency room visits returned to baseline levels (before the start of the augmenting medication), but generally did not improve beyond baseline. CONCLUSION Importantly, these effects could be explained by regression to the mean, additional interventions or confounding. These findings should be further explored with placebo controlled randomized clinical trials.
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Affiliation(s)
- Rachel Ranney
- Veterans Affairs San Francisco Health Care System, San Francisco, California, USA.,Department of Psychiatry and Behavioral Sciences, San Francisco School of Medicine, University of California, San Francisco, California, USA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, California, USA
| | - Shira Maguen
- Veterans Affairs San Francisco Health Care System, San Francisco, California, USA.,Department of Psychiatry and Behavioral Sciences, San Francisco School of Medicine, University of California, San Francisco, California, USA
| | - Anne Woods
- Veterans Affairs San Francisco Health Care System, San Francisco, California, USA.,Northern California Institute for Research and Education, San Francisco, California, USA
| | - Karen H Seal
- Veterans Affairs San Francisco Health Care System, San Francisco, California, USA.,Department of Psychiatry and Behavioral Sciences, San Francisco School of Medicine, University of California, San Francisco, California, USA.,Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, California, USA
| | - Thomas C Neylan
- Veterans Affairs San Francisco Health Care System, San Francisco, California, USA.,Department of Psychiatry and Behavioral Sciences, San Francisco School of Medicine, University of California, San Francisco, California, USA
| | - Nancy Bernardy
- Veterans Affairs White River Junction Health Care System, White River Junction, Vermont, USA
| | - Ilse Wiechers
- Department of Psychiatry and Behavioral Sciences, San Francisco School of Medicine, University of California, San Francisco, California, USA.,Department of Veterans Affairs, Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, New Haven, USA
| | - Annie Ryder
- Veterans Affairs San Francisco Health Care System, San Francisco, California, USA.,Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, California, USA
| | - Beth E Cohen
- Veterans Affairs San Francisco Health Care System, San Francisco, California, USA.,Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, California, USA
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Phiri P, Clarke I, Baxter L, Zeng YT, Shi JQ, Tang XY, Rathod S, Soomro MG, Delanerolle G, Naeem F. Evaluation of a culturally adapted cognitive behavior therapy-based, third-wave therapy manual. World J Psychiatry 2023; 13:15-35. [PMID: 36687373 PMCID: PMC9850872 DOI: 10.5498/wjp.v13.i1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/25/2022] [Accepted: 11/30/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Recommendations for psychotherapy have evolved over the years, with cognitive behavioral therapy (CBT) taking precedence since its inception within clinical guidelines in the United Kingdom and United States. The use of CBT for severe mental illness is now more common globally.
AIM To investigate the feasibility and acceptability of a culturally adapted, CBT-based, third-wave therapy manual using the Comprehend, Cope, and Connect approach with individuals from a diverse population presenting to primary and secondary healthcare services.
METHODS A pilot study was used to assess the feasibility and acceptability of the manualised intervention. Outcome measures were evaluated at baseline, post-intervention and 12 wk-follow up. 32 participants with mental health conditions aged 20-53 years were recruited. Assessments were completed at three time points, using Clinical Outcomes in Routine Evaluation (CORE), Hospital Anxiety and Depression Scale (HADS), Bradford Somatic Inventory and World Health Organization Disability Assessment Schedule 2.0 (WHODAS). The Patient Experience Ques-tionnaire was completed post-treatment.
RESULTS Repeated measures of analysis of variance associated with HADS depression, F (2, 36) = 12.81, P < 0.001, partial η2 = 0.42 and HADS anxiety scores, F (2, 26) = 9.93, P < 0.001, partial η2 = 0.36; CORE total score and WHODAS both showed significant effect F (1.25, 18.72) = 14.98, P < 0.001, partial η2 = 0.5. and F (1.29, 14.18) = 6.73, P < 0.001, partial η2 = 0.38 respectively.
CONCLUSION These results indicate the effectiveness and acceptability of the culturally adapted, CBT-based, third-wave therapy manual intervention among minoritized groups with moderate effect sizes. Satisfaction levels and acceptability were highly rated. The viability and cost-effectiveness of this approach should be explored further to support universal implementation across healthcare systems.
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Affiliation(s)
- Peter Phiri
- Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Isabel Clarke
- Department of Italk, Southern Health NHS Foundation Trust, Southampton SO50 9FH, United Kingdom
| | - Lydia Baxter
- Department of Italk Step 3, Southern Health NHS Foundation Trust, Southampton SO51 9FH, United Kingdom
| | - Yu-Tian Zeng
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
| | - Jian-Qing Shi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
- National Center for Applied Mathematics Shenzhen, Shenzhen 518055, Guangdong Province, China
| | - Xin-Yuan Tang
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
| | - Shanaya Rathod
- Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Mustafa G Soomro
- Research & Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Gayathri Delanerolle
- Nuffield Department of Primary Health Care Science, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Farooq Naeem
- Centre for Addition and Mental Health, University of Toronto, Toronto ON M5S, Canada
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Holgersen KH, Pedersen SA, Brattland H, Hynnekleiv T. A scoping review of studies into crisis resolution teams in community mental health services. Nord J Psychiatry 2022; 76:565-574. [PMID: 35148238 DOI: 10.1080/08039488.2022.2029941] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE OF ARTICLE Crisis Resolution Teams (CRT) for rapid assessment and short-term treatment of mental health problems have increasingly been implemented internationally over the last decades. Among the Nordic countries, the CRT model has been particularly influential in Norway, where 'Ambulante akutteam (AAT)' is a widespread psychiatric emergency service for adult patients. However, the clinical practice of these teams varies significantly. To aid further development of the service and guide future research efforts, we carried out a scoping review to provide an up-to-date overview of research available in primary studies focusing on phenomena related to CRTs in English and Scandinavian literature. METHODS A systematic literature search was conducted in the bibliometric databases MEDLINE, Embase, PsychINFO, Scopus, and SveMed+. Included studies were thematically analyzed using a qualitative method. RESULTS The search identified 1516 unique references, of which 129 were included in the overview. Thematic analysis showed that the studies could be assigned to: (1) Characteristics of CRTs (k = 45), which described key principles or specific interventions; (2) Implementation of CRTs (k = 54), which were descriptive about implementation in different teams, or normative about what clinical practice should include; and (3) Effect of CRTs (k = 38). CONCLUSIONS The international research literature on CRTs or equivalent teams is extensive. Many sub-themes have been studied with various research methodologies. Recent studies provide a better evidence base for how to organize services and to select therapeutic interventions, but there is still a need for more controlled studies in the field.
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Affiliation(s)
- Katrine Høyer Holgersen
- Nidelv Community Mental Health Center, Tiller, Clinic of Mental Health, St Olavs Hospital, Trondheim, Norway.,Department of Psychology, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Sindre Andre Pedersen
- Library Section for Medicine and Health Sciences, NTNU University Library, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Heidi Brattland
- Nidelv Community Mental Health Center, Tiller, Clinic of Mental Health, St Olavs Hospital, Trondheim, Norway
| | - Torfinn Hynnekleiv
- Department for Acute Psychiatry and Psychosis Treatment, Psychiatric Health Services Division, Sykehuset Innlandet Trust, Reinsvoll, Norway
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Kouvaras S, Guiotto M, Schrank B, Slade M, Riches S. Character Strength-Focused Positive Psychotherapy on Acute Psychiatric Wards: A Feasibility and Acceptability Study. Psychiatr Serv 2022; 73:1051-1055. [PMID: 35378993 DOI: 10.1176/appi.ps.202100316] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A manualized single-session positive psychotherapy intervention was developed and tested on acute psychiatric wards. METHODS Participants were invited in 2018-2019 to identify positive experiences, link them to a personal character strength, and plan a strengths-based activity. The intervention's feasibility was evaluated through fidelity to session components, character strengths identification, and activity completion. Acceptability was evaluated with self-reported pre- and postsession mood ratings, a postsession helpfulness rating, and narrative feedback. RESULTS Participants (N=70) had complex and severe mental health conditions. In 18 group sessions, 89% of components were delivered with fidelity; 80% of the participants identified a character strength, of whom 71% identified a strengths-based activity, and 58% completed the activity. The mean±SD helpfulness rating (N=23) was 8.5±1.5 (on a 10-point Likert scale), and positive mood significantly increased postsession (5.9 presession vs. 7.2 postsession). CONCLUSIONS Positive psychotherapy is feasible in challenging inpatient settings, and service users with severe and complex mental health conditions find it helpful.
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Affiliation(s)
- Stef Kouvaras
- South London and Maudsley NHS Foundation Trust, Beckenham, Kent, United Kingdom (Kouvaras, Guiotto, Riches); Salomons Institute of Applied Psychology, Faculty of Social and Applied Sciences, Canterbury Christ Church University, Tunbridge Wells, Kent, United Kingdom (Kouvaras); Department of Psychiatry, Karl Landsteiner University of Health Sciences, Krems, Austria (Schrank); Institute of Mental Health, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom (Slade); Social, Genetic and Developmental Psychiatry Centre and Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London (Riches)
| | - Martina Guiotto
- South London and Maudsley NHS Foundation Trust, Beckenham, Kent, United Kingdom (Kouvaras, Guiotto, Riches); Salomons Institute of Applied Psychology, Faculty of Social and Applied Sciences, Canterbury Christ Church University, Tunbridge Wells, Kent, United Kingdom (Kouvaras); Department of Psychiatry, Karl Landsteiner University of Health Sciences, Krems, Austria (Schrank); Institute of Mental Health, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom (Slade); Social, Genetic and Developmental Psychiatry Centre and Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London (Riches)
| | - Beate Schrank
- South London and Maudsley NHS Foundation Trust, Beckenham, Kent, United Kingdom (Kouvaras, Guiotto, Riches); Salomons Institute of Applied Psychology, Faculty of Social and Applied Sciences, Canterbury Christ Church University, Tunbridge Wells, Kent, United Kingdom (Kouvaras); Department of Psychiatry, Karl Landsteiner University of Health Sciences, Krems, Austria (Schrank); Institute of Mental Health, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom (Slade); Social, Genetic and Developmental Psychiatry Centre and Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London (Riches)
| | - Mike Slade
- South London and Maudsley NHS Foundation Trust, Beckenham, Kent, United Kingdom (Kouvaras, Guiotto, Riches); Salomons Institute of Applied Psychology, Faculty of Social and Applied Sciences, Canterbury Christ Church University, Tunbridge Wells, Kent, United Kingdom (Kouvaras); Department of Psychiatry, Karl Landsteiner University of Health Sciences, Krems, Austria (Schrank); Institute of Mental Health, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom (Slade); Social, Genetic and Developmental Psychiatry Centre and Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London (Riches)
| | - Simon Riches
- South London and Maudsley NHS Foundation Trust, Beckenham, Kent, United Kingdom (Kouvaras, Guiotto, Riches); Salomons Institute of Applied Psychology, Faculty of Social and Applied Sciences, Canterbury Christ Church University, Tunbridge Wells, Kent, United Kingdom (Kouvaras); Department of Psychiatry, Karl Landsteiner University of Health Sciences, Krems, Austria (Schrank); Institute of Mental Health, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom (Slade); Social, Genetic and Developmental Psychiatry Centre and Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London (Riches)
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