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Tolonen J, Jääskeläinen E, Kiviniemi L, Majuri T, Haapea M, Miettunen J, Moilanen K. Functioning, psychiatric symptoms and quality of life of individuals with severe mental disorders after psychiatric rehabilitation. Nord J Psychiatry 2024; 78:54-63. [PMID: 37815430 DOI: 10.1080/08039488.2023.2262448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 09/20/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Psychiatric disorders may have a negative effect on individuals' living, forming intimate relationships, education, and employment. The aim of psychiatric rehabilitation is to promote recovery - finding ways to cope with mental disorders despite debilitating symptoms. This study aimed to explore the outcomes of accommodation, social inclusion, psychiatric symptoms, substance and service use, quality of life and subjective recovery of young adults with severe mental illness after psychiatric rehabilitation. MATERIALS AND METHODS The study population consisted of individuals who had been in residential psychiatric rehabilitation between the ages of 18-29 years. Data on outcomes were collected using a questionnaire after a flexible follow-up period (mean 29 months). The questionnaire was answered by 32 eligible persons. We analysed multiple outcomes and compared the proportion of persons living independently at the start, after psychiatric rehabilitation, and at the follow-up point. RESULTS At the start of the rehabilitation, 33%, at the end, 69%, and at follow-up, 78% lived independently. However, most had not reached competitive employment nor were studying. Cognitive symptoms were the most common psychiatric symptoms, followed by depressive symptoms. More than 80% of the sample felt that they had partly recovered from their severe mental illness. CONCLUSION According to the results of this study residential psychiatric rehabilitation may have positive effects on functioning and independent living at follow-up. Reaching competitive employment is difficult for persons with severe mental disorders and effective rehabilitation interventions need to be implemented. However, this study had limitations, and these results should be considered preliminary.
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Affiliation(s)
- Jonna Tolonen
- Humana Sähäkkä Ltd., Ylivieska, Finland
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Erika Jääskeläinen
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | | | - Tuomas Majuri
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Marianne Haapea
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Jouko Miettunen
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Kristiina Moilanen
- Humana Sähäkkä Ltd., Ylivieska, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
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Williams KE. Evaluation of a mental health service reform program, the Pathways to Community Living Initiative, for people with severe mental illness and complex needs. Australas Psychiatry 2023; 31:806-812. [PMID: 37965777 PMCID: PMC10725626 DOI: 10.1177/10398562231211673] [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] [Indexed: 11/16/2023]
Abstract
OBJECTIVE The Pathways to Community Living Initiative (PCLI) aims to reform mental health care for people with severe and persistent mental illness (SPMI) and complex needs. This study reports independent evaluation findings on transitions from hospital and practice change in mental health services. METHODS Data for this mixed-methods evaluation were obtained from administrative collections and semi-structured interviews with PCLI program managers, teams and executive leads; aged care managers; and leaders in inpatient, community and older people's mental health services. RESULTS Between July 2015 and December 2020, 674 participants (67% of those eligible for the PCLI) were transitioned from hospital to community. Of those transitioned, 21 required subsequent long-stay admissions. The PCLI introduced resources, clearly defined processes, and state-wide networks to guide changes in practice which are becoming embedded in the operations and governance of mental health services across New South Wales. CONCLUSIONS Severe and persistent mental illness and complex needs can be managed in community settings with highly individualised planning and care, supported by specialised clinical teams in partnership with mental health, aged care and disability services. Evaluation findings highlight the importance of continued investment in rehabilitation psychiatry.
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Affiliation(s)
- Kathryn E Williams
- Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
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Lugo-Candelas C, Hwei T, Lee S, Lucchini M, Smaniotto Aizza A, Kahn LG, Buss C, O'Connor TG, Ghassabian A, Padula AM, Aschner J, Deoni S, Margolis AE, Canino G, Monk C, Posner J, Duarte CS. Prenatal sleep health and risk of offspring ADHD symptomatology and associated phenotypes: a prospective analysis of timing and sex differences in the ECHO cohort. LANCET REGIONAL HEALTH. AMERICAS 2023; 27:100609. [PMID: 38106969 PMCID: PMC10725065 DOI: 10.1016/j.lana.2023.100609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 12/19/2023]
Abstract
Background Sleep difficulties are common in pregnancy, yet poor prenatal sleep may be related to negative long-term outcomes for the offspring, including risk for attention-deficit/hyperactivity disorder (ADHD). Existing studies are few and have not examined timing of exposure effects or offspring sex moderation. We thus aimed to test the hypotheses that poor sleep health in pregnancy is associated with increased risk for ADHD symptoms and offspring sleep problems at approximately 4 years of age. Methods Participants were 794 mother-child dyads enrolled in the NIH Environmental Influences on Child Health Outcomes Study (ECHO). Participants self-reported on sleep duration, quality, and disturbances during pregnancy and on children's ADHD symptoms and sleep problems on the Child Behaviour Checklist. Findings Pregnant participants were 32.30 ± 5.50 years and children were 46% female. 44 percent of pregnant participants identified as Hispanic or Latine; 49% identified as White. Second-trimester sleep duration was associated with offspring ADHD symptoms (b = -0.35 [95% CI = -0.57, -0.13], p = 0.026), such that shorter duration was associated with greater symptomatology. Poorer sleep quality in the second trimester was also associated with increased ADHD symptomatology (b = 0.66 [95% CI = 0.18, 1.14], p = 0.037). Greater sleep disturbances in the first trimester were associated with offspring ADHD (b = 1.03 [95% CI = 0.32, 1.03], p = 0.037) and in the second trimester with sleep problems (b = 1.53 [95% CI = 0.42, 2.92], p = 0.026). We did not document substantial offspring sex moderation. Interpretation Poor prenatal sleep health, particularly quality and duration in the second trimester, may be associated with offspring risk of neurodevelopmental disorders and sleep problems in early childhood. Further research is needed to understand mechanisms, yet our study suggests that prenatal maternal sleep may be a modifiable target for interventions aimed at optimizing early neurodevelopment. Funding NIH grants U2COD023375, U24OD023382, U24OD023319, UH3OD023320, UH3OD023305, UH3OD023349, UH3OD023313, UH3OD023272, UH3OD023328, UH3OD023290, K08MH117452 and NARSAD Young Investigator Award 28545.
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Affiliation(s)
- Claudia Lugo-Candelas
- New York State Psychiatric Institute/Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Tse Hwei
- New York State Psychiatric Institute/Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Seonjoo Lee
- New York State Psychiatric Institute/Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | | | - Alice Smaniotto Aizza
- New York State Psychiatric Institute/Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Linda G. Kahn
- NYU Grossman School of Medicine, 227 East 34th Street, Room 811, New York, NY, 10016, USA
| | - Claudia Buss
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstrasse 57, 10117, Berlin, Germany
| | | | - Akhgar Ghassabian
- NYU Grossman School of Medicine, 227 East 34th Street, Room 811, New York, NY, 10016, USA
| | - Amy M. Padula
- University of California, San Francisco, 490 Illinois Street, Box 0132, San Francisco, CA, 94158, USA
| | - Judy Aschner
- Hackensack Meridian School of Medicine, Nutley NJ and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sean Deoni
- Bill & Melinda Gates Foundation, 500 Mercer Str, Seattle, WA, 98275, USA
| | - Amy E. Margolis
- New York State Psychiatric Institute/Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Glorisa Canino
- University of Puerto Rico Medical Sciences Campus, Behavioral Sciences Research Institute, 9th Floor, Rio Piedras, PR, 00935, Puerto Rico
| | - Catherine Monk
- New York State Psychiatric Institute/Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Jonathan Posner
- Duke University, North Pavilion Building, 2400 Pratt Street, Durham, NC, 27705, USA
| | - Cristiane S. Duarte
- New York State Psychiatric Institute/Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
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van Genk C, Roeg D, van Vugt M, van Weeghel J, Van Regenmortel T. Current insights of community mental healthcare for people with severe mental illness: A scoping review. Front Psychiatry 2023; 14:1156235. [PMID: 37143787 PMCID: PMC10151504 DOI: 10.3389/fpsyt.2023.1156235] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/23/2023] [Indexed: 05/06/2023] Open
Abstract
Background For the last four decades, there has been a shift in mental healthcare toward more rehabilitation and following a more humanistic and comprehensive vision on recovery for persons with severe mental illness (SMI). Consequently, many community-based mental healthcare programs and services have been developed internationally. Currently, community mental healthcare is still under development, with a focus on further inclusion of persons with enduring mental health problems. In this review, we aim to provide a comprehensive overview of existing and upcoming community mental healthcare approaches to discover the current vision on the ingredients of community mental healthcare. Methods We conducted a scoping review by systematically searching four databases, supplemented with the results of Research Rabbit, a hand-search in reference lists and 10 volumes of two leading journals. We included studies on adults with SMI focusing on stimulating independent living, integrated care, recovery, and social inclusion published in English between January 2011 and December 2022 in peer-reviewed journals. Results The search resulted in 56 papers that met the inclusion criteria. Thematic analysis revealed ingredients in 12 areas: multidisciplinary teams; collaboration within and outside the organization; attention to several aspects of health; supporting full citizenship; attention to the recovery of daily life; collaboration with the social network; tailored support; well-trained staff; using digital technologies; housing and living environment; sustainable policies and funding; and reciprocity in relationships. Conclusion We found 12 areas of ingredients, including some innovative topics about reciprocity and sustainable policies and funding. There is much attention to individual ingredients for good community-based mental healthcare, but very little is known about their integration and implementation in contemporary, fragmented mental healthcare services. For future studies, we recommend more empirical research on community mental healthcare, as well as further investigation(s) from the social service perspective, and solid research on general terminology about SMI and outpatient support.
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Affiliation(s)
- Caroline van Genk
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- *Correspondence: Caroline van Genk,
| | - Diana Roeg
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- Kwintes Housing and Rehabilitation Services, Zeist, Netherlands
| | - Maaike van Vugt
- Trimbos Institute, Dutch Institute of Mental Health and Addiction, Utrecht, Netherlands
- HVO-Querido, Amsterdam, Netherlands
| | - Jaap van Weeghel
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | - Tine Van Regenmortel
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- Faculty of Social Sciences – HIVA, University of Leuven, Leuven, Belgium
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Poole R, Robinson CA. Breaking out of the citadel: social theory and psychiatry. BJPsych Bull 2022; 47:146-149. [PMID: 35289262 DOI: 10.1192/bjb.2022.17] [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: 11/23/2022] Open
Abstract
British psychiatry has tended to hold itself aloof from social theory. Nonetheless, these ideas have influenced the development of mental health services. Alongside this, the biopsychosocial model cannot reconcile contradictions in the scientific evidence regarding mental illness. We need to develop a more constructive understanding of the implications of social theory.
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Neurophysiology in psychosis: The quest for disease biomarkers. Transl Psychiatry 2022; 12:100. [PMID: 35277479 PMCID: PMC8917164 DOI: 10.1038/s41398-022-01860-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 01/11/2023] Open
Abstract
Psychotic disorders affect 3% of the population at some stage in life, are a leading cause of disability, and impose a great economic burden on society. Major breakthroughs in the genetics of psychosis have not yet been matched by an understanding of its neurobiology. Biomarkers of perception and cognition obtained through non-invasive neurophysiological tools, especially EEG, offer a unique opportunity to gain mechanistic insights. Techniques for measuring neurophysiological markers are inexpensive and ubiquitous, thus having the potential as an accessible tool for patient stratification towards early treatments leading to better outcomes. In this paper, we review the literature on neurophysiological markers for psychosis and their relevant disease mechanisms, mainly covering event-related potentials including P50/N100 sensory gating, mismatch negativity, and the N100 and P300 waveforms. While several neurophysiological deficits are well established in patients with psychosis, more research is needed to study neurophysiological markers in their unaffected relatives and individuals at clinical high risk. We need to harness EEG to investigate markers of disease risk as key steps to elucidate the aetiology of psychosis and facilitate earlier detection and treatment.
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Arnau F, Benito A, Villar M, Ortega ME, López-Peláez L, Haro G. Addressing Dual Disorders in a Medium-Term Admission Unit. Brain Sci 2021; 12:brainsci12010024. [PMID: 35053768 PMCID: PMC8773554 DOI: 10.3390/brainsci12010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Due to the significant functional repercussions suffered by patients with dual disorder, we must evaluate which ones can benefit from intensive rehabilitative therapies in medium-stay psychiatric units. This was a retrospective study of patient medical records which intended to analyze sociodemographic and clinical variables and parameters related to the hospitalization and discharge of patients admitted to the Medium-Stay Unit (MSU) at the Castellón Provincial Hospital Consortium over 2 years (2017 and 2018), according to the presence or absence of dual disorders in these patients. Patients with a dual disorder represented 55.2% of the hospitalized patients. A higher proportion of them were male, were relatively younger, and had an earlier onset of mental illness, fewer associated medical pathologies, and shorter hospital admission times to the Short-Term Hospitalization Unit than those who did not present a dual disorder. A diagnosis on the schizophrenia spectrum with cannabis use or polyconsumption was the most common diagnosis; 98.2% of all the patients responded adequately to admission to the MSU. This work highlighted the need for higher doses of depot paliperidone in patients with dual disorders.
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Affiliation(s)
- Francisco Arnau
- Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castelló de la Plana, Spain; (A.B.); (M.E.O.); (G.H.)
- Consorcio Hospital Provincial de Castellón, 12002 Castelló de la Plana, Spain;
- Correspondence:
| | - Ana Benito
- Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castelló de la Plana, Spain; (A.B.); (M.E.O.); (G.H.)
- Mental Health Unit, Hospital General Universitario de Valencia, 46900 Torrente, Spain
| | - Mariano Villar
- Consorcio Hospital Provincial de Castellón, 12002 Castelló de la Plana, Spain;
| | - María Elena Ortega
- Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castelló de la Plana, Spain; (A.B.); (M.E.O.); (G.H.)
| | | | - Gonzalo Haro
- Department of Medicine and Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castelló de la Plana, Spain; (A.B.); (M.E.O.); (G.H.)
- Consorcio Hospital Provincial de Castellón, 12002 Castelló de la Plana, Spain;
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Killaspy H, Craig T, Dark F, Harvey C, Medalia A. Editorial: Design and Implementation of Rehabilitation Interventions for People With Complex Psychosis. Front Psychiatry 2021; 12:698432. [PMID: 34122199 PMCID: PMC8187747 DOI: 10.3389/fpsyt.2021.698432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Helen Killaspy
- Division of Psychiatry, University College London, London, United Kingdom
| | - Tom Craig
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Frances Dark
- Metro South Addiction and Mental Health Services, Brisbane, QLD, Australia
| | - Carol Harvey
- Psychosocial Research Centre, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Alice Medalia
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, and New York-Presbyterian, New York, NY, United States
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