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Martin S. Why using “consciousness” in psychotherapy? Insight, metacognition and self-consciousness. NEW IDEAS IN PSYCHOLOGY 2023. [DOI: 10.1016/j.newideapsych.2023.101015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Frank D, Fan E, Georghiou A, Verter V. Community Treatment Order Outcomes in Quebec: A Unique Jurisdiction. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:484-491. [PMID: 31818137 PMCID: PMC7298585 DOI: 10.1177/0706743719892718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We study compulsory community treatment orders (CTOs) for patients with severe and persistent mental illness (SPMI). Focusing on a unique jurisdiction in Canada that allows for long duration CTOs with strict enforcement procedures, our objectives are to determine whether extended duration CTOs are effective and to determine whether associated hospitalization costs are reduced. METHOD A mirror image, naturalistic design was employed using patients as their own controls to enhance external validity. No inclusive or exclusive criteria were employed for the 367 SPMI clinic patients who were studied over a 5-year period. Detailed documentation of the dates of all CTOs, long-acting antipsychotic injections (LAIs), emergency visits, hospitalizations, duration of hospitalizations, crimes and/or police involvement were collected. To study the relation between CTO and injection adherence, we use a mixed-effect linear regression model. To study the effect of injection adherence and hospitalization, we use survival analysis via Kaplan-Meier and Cox survival models. RESULTS CTO and non-CTO patients did not differ with respect to demographics, but CTO patients were significantly more severely ill. Following a CTO, adherence to LAIs increased over time (P < 0.001). The average time the patients spent in the community, that is, outside the hospital, was significantly longer under a CTO, and the duration of hospitalizations was decreased. CONCLUSIONS LAI adherence and outpatient office visits were enhanced by extended duration CTOs, as was time out of the hospital. The shorter duration of hospital stays implies cost savings. These must be weighed against their undesirable coercive nature.
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Affiliation(s)
- Daniel Frank
- Jewish General Hospital, Montreal, Quebec, Canada.,McGill University, Montreal, Quebec, Canada
| | - E Fan
- McGill University, Montreal, Quebec, Canada
| | | | - Vedat Verter
- Michigan State University, East Lansing, MI, USA
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Wang L, Xu J, Zou H, Zhang H, Qu Y. Violence against primary caregivers of people with severe mental illness and their knowledge and attitudes towards violence: A cross-sectional study in China. Arch Psychiatr Nurs 2019; 33:167-176. [PMID: 31753224 DOI: 10.1016/j.apnu.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/04/2019] [Accepted: 08/18/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study is to investigate the current situation of violence on primary caregivers of people with severe mental illness outside the hospital and the cognition of primary caregivers about violence among mental patients. METHODS A self-designed questionnaire was used to investigate the primary caregivers (N = 208) of people with severe mental illness in a psychiatric hospital in Beijing. RESULTS The incidence rate of violence suffered by primary caregivers was 74.03%, of which 61.54% had experienced verbal attacks, 54.33% had experienced threats, and 45.19% experienced physical attacks. Physical violence, mainly by unarmed attacks, has resulted in soft tissue injury and pain in the majority of caregivers. Multiple admission times, a lower educational level, single in marital status and involuntary hospitalizations were risk factors; growing older was protective factor. The causes of violence were dominated by mental symptoms in 120 cases (57.69%). Tolerance and avoidance were the coping styles of most caregivers adopted after violence, accounting for 51.44%. Furthermore, most of primary caregivers have limited knowledge of violence and adopted an attitude of pessimism towards patients' violence. CONCLUSIONS It was reported that violence was suffered by primary caregivers of persons with severe mental illness outside the hospital. The study indicated that formulating reasonable nursing intervention, providing health education as well as organizing training towards violence of patients are required to play an important role in effectively preventing and reducing the violence among the people with severe mental illness in China. More information and support needs to be obtained to help caregivers fulfill their duty of care outside the hospital.
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Affiliation(s)
- Lu Wang
- School of Nursing, Peking Union Medical College, 33 Badachu Road, Beijing 100144, China
| | - Jiangling Xu
- Department of Nursing, Anding Hospital, Capital Medical University, 5 Ankang Lane, Beijing 100088, China
| | - Haiou Zou
- School of Nursing, Peking Union Medical College, 33 Badachu Road, Beijing 100144, China.
| | - Haiyu Zhang
- School of Nursing, Peking Union Medical College, 33 Badachu Road, Beijing 100144, China
| | - Yanhua Qu
- School of Nursing, Peking Union Medical College, 33 Badachu Road, Beijing 100144, China
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Ramu N, Kolliakou A, Sanyal J, Patel R, Stewart R. Recorded poor insight as a predictor of service use outcomes: cohort study of patients with first-episode psychosis in a large mental healthcare database. BMJ Open 2019; 9:e028929. [PMID: 31196905 PMCID: PMC6577359 DOI: 10.1136/bmjopen-2019-028929] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate recorded poor insight in relation to mental health and service use outcomes in a cohort with first-episode psychosis. DESIGN We developed a natural language processing algorithm to ascertain statements of poor or diminished insight and tested this in a cohort of patients with first-episode psychosis. SETTING The clinical record text at the South London and Maudsley National Health Service Trust in the UK was used. PARTICIPANTS We applied the algorithm to characterise a cohort of 2026 patients with first-episode psychosis attending an early intervention service. PRIMARY AND SECONDARY OUTCOME MEASURES Recorded poor insight within 1 month of registration was investigated in relation to (1) incidence of psychiatric hospitalisation, (2) odds of legally enforced hospitalisation, (3) number of days spent as a mental health inpatient and (4) number of different antipsychotic agents prescribed; outcomes were measured over varying follow-up periods from 12 months to 60 months, adjusting for a range of sociodemographic and clinical covariates. RESULTS Recorded poor insight, present in 48.9% of the sample, was positively associated with youngest and oldest age groups, unemployment and schizophrenia (compared with bipolar disorder) and was negatively associated with Asian ethnicity, married status, home ownership and recorded cannabis use. It was significantly associated with higher levels of all four outcomes over the succeeding 12 months. Associations with hospitalisation incidence and number of antipsychotics remained independently significant when measured over 60 and 48 months, respectively. CONCLUSIONS Recorded poor insight in people with recent onset psychosis predicted higher subsequent inpatient mental healthcare use. Improving insight might benefit patients' course of illness as well as reduce mental health service use.
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Affiliation(s)
- Neha Ramu
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Anna Kolliakou
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jyoti Sanyal
- South London and Maudsley NHS Foundation Trust, King’s College London, London, UK
| | - Rashmi Patel
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, King’s College London, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, King’s College London, London, UK
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Moulin V, Palix J, Golay P, Dumais A, Gholamrezaee MM, Azzola A, Baumann PS, Alameda L, Conus P. Violent behaviour in early psychosis patients: Can we identify clinical risk profiles? Early Interv Psychiatry 2019; 13:517-524. [PMID: 29143486 DOI: 10.1111/eip.12512] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/07/2017] [Accepted: 09/13/2017] [Indexed: 01/29/2023]
Abstract
AIMS The objective of this study is to explore, within a sample of early psychosis patients (EPP), if subgroups regarding rate of violent behaviour (VB) against others can be identified on the basis of dynamic risk factors (treatment modifiable characteristics). METHODS In a sample of 265 EPP, treated at the Treatment and Early Intervention in Psychosis Program in Lausanne, we conducted a latent-class analysis on the basis of the main dynamic VB risk factors (substance use disorder [SUD], positive symptoms, insight, and impulsivity). VB were restricted to "serious violence" and were assessed through patients self-report, interview with relatives or forensic services and with a standardized instrument. RESULTS The analysis confirmed the heterogeneity of the sample regarding rate of VB. Patients could be stratified within 4 subgroups, 3 of which were at increased risk of VB. The two groups with the highest rates of VB displayed specific clinical profiles. The first one was characterized by high levels of impulsivity, hostility, positive symptoms and SUD, and the second, by low level of insight and low social functioning. These patterns suggest that significant difficulties in social interaction may contribute to the emergence of aggressive reactions against others. CONCLUSIONS Identification of EPP at increased risk of VB seems possible on the basis of dynamic risk factors. If confirmed prospectively, this could pave the way to the development of preventive strategies and specific interventions.
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Affiliation(s)
- Valerie Moulin
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Julie Palix
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Golay
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Alexandre Dumais
- Institut Philippe-Pinel de Montréal and Department of Psychiatry, Faculty of Medicine, University of Montréal, Quebec, Canada
| | - Mohammad Mehdi Gholamrezaee
- Centre for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Agathe Azzola
- Unit for Research in Legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philipp S Baumann
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Luis Alameda
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Moulin V, Palix J, Alameda L, Gholamrezaee MM, Baumann PS, Gasser J, Elowe J, Solida A, Conus P. [Insight and Violent Behavior in a Cohort of Early Psychosis Patients]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:20-29. [PMID: 28655283 PMCID: PMC5788119 DOI: 10.1177/0706743717718173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES: An important proportion of patients with first episode psychosis behave in a violent, hetero-aggressive manner. This study aims to explore the association between insight and violent behavior (VB), and insight evolution in the follow-up period. METHOD: The study was carried out with a prospective cohort of 265 patients recruited from the early treatment and intervention for psychotic disorders program, and followed for a 3-year period. Insight assessing is based on a 3-item scale and the insight item in Positive and Negative Syndrome Scale (PANSS). VBs were evaluated by case managers, information from forensic services and through a record of VBs noted during hospitalization. Univariate and multivariate logistic regression analyses, t-tests and correlations were conducted. RESULTS: The significant effect of insight as a factor associated with VBs that was found in univariate analyses disappears after controlling for the effect of positive symptoms, substance addiction diagnosis, impulsivity and treatment compliance. CONCLUSION: If patient insight in their illness develops positively during treatment, our results suggest that the risk of VBs occurring is not influenced by insight level. On the other hand, it is significantly linked to substance abuse and impulsivity, which might implicate focusing on these 2 dimensions in preventive strategies. Insight impact on VB should be further explored in more focused prospective analyses.
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Affiliation(s)
- Valerie Moulin
- 1 Unité de Recherche en Psychiatrie et Psychologie Légales, Institut de Psychiatrie légale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Julie Palix
- 1 Unité de Recherche en Psychiatrie et Psychologie Légales, Institut de Psychiatrie légale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Luis Alameda
- 2 Service de Psychiatrie Générale, Service de Psychiatrie de Liaison et Centre de Neuroscience Psychiatrique, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - M Mehdi Gholamrezaee
- 3 Centre d'épidémiologie psychiatrique et psychopathologie, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Philipp S Baumann
- 4 Service de Psychiatrie Générale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Jacques Gasser
- 5 Institut de Psychiatrie légale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Julien Elowe
- 6 Secteur psychiatrique ouest, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Prangins, Suisse
| | - Alessandra Solida
- 4 Service de Psychiatrie Générale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
| | - Philippe Conus
- 4 Service de Psychiatrie Générale, Département de Psychiatrie du Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse
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Fovet T, Bertrand M, Horn M, Si Mohammed W, Dandelot D, Dalle MC, Thomas P, Amad A. [Involuntary psychiatric care for inmates in France: Only for "dangerous" patients?]. Encephale 2017; 44:568-570. [PMID: 29191374 DOI: 10.1016/j.encep.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 08/23/2017] [Accepted: 09/06/2017] [Indexed: 11/25/2022]
Abstract
The unités hospitalières spécialement aménagées (UHSA) are full-time inpatient psychiatric units for inmates in France. Their creation has been associated with several advances in access to psychiatric care for inmates in recent years. However, there is still only one means of involuntary hospitalization for prisoners in France: care by decision of a representative of the state (les soins sur décision d'un représentant de l'état [SDRE]). Interestingly, for SDRE to be recognized as legal by the French judge, the patient must be "a danger to himself or to the others". Thus, there is a major difference with involuntary hospitalization outside the prison, and there are specific criteria for involuntary psychiatric hospitalization for inmates in France. This situation questions the general framework of involuntary psychiatric care and is very inconsistent with French law. Indeed, the goal of the loi no 94-43 du 18 janvier 1994 relating to public health and social protection is to ensure equivalent care for all patients, incarcerated or not.
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Affiliation(s)
- T Fovet
- Pôle de psychiatrie, CHU de Lille, 59000 Lille, France; CNRS UMR 9193, laboratoire de sciences cognitives et sciences affectives (SCALab-PsyCHIC), université de Lille, 59000 Lille, France.
| | - M Bertrand
- Pôle de psychiatrie, CHU de Lille, 59000 Lille, France
| | - M Horn
- Pôle de psychiatrie, CHU de Lille, 59000 Lille, France; CNRS UMR 9193, laboratoire de sciences cognitives et sciences affectives (SCALab-PsyCHIC), université de Lille, 59000 Lille, France
| | - W Si Mohammed
- UHSA de Cadillac, pole psychiatrie médico-légale, centre hospitalier de Cadillac s/Garonne, 33410 Cadillac, France
| | - D Dandelot
- UHSA de Cadillac, pole psychiatrie médico-légale, centre hospitalier de Cadillac s/Garonne, 33410 Cadillac, France
| | - M-C Dalle
- Pôle de psychiatrie, CHU de Lille, 59000 Lille, France
| | - P Thomas
- Pôle de psychiatrie, CHU de Lille, 59000 Lille, France; CNRS UMR 9193, laboratoire de sciences cognitives et sciences affectives (SCALab-PsyCHIC), université de Lille, 59000 Lille, France
| | - A Amad
- Pôle de psychiatrie, CHU de Lille, 59000 Lille, France; CNRS UMR 9193, laboratoire de sciences cognitives et sciences affectives (SCALab-PsyCHIC), université de Lille, 59000 Lille, France
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