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Lear R, Ellis S, Ollivierre-Harris T, Long S, Mayer EK. Video Recording Patients for Direct Care Purposes: Systematic Review and Narrative Synthesis of International Empirical Studies and UK Professional Guidance. J Med Internet Res 2023; 25:e46478. [PMID: 37585249 PMCID: PMC10468707 DOI: 10.2196/46478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Video recordings of patients may offer advantages to supplement patient assessment and clinical decision-making. However, little is known about the practice of video recording patients for direct care purposes. OBJECTIVE We aimed to synthesize empirical studies published internationally to explore the extent to which video recording patients is acceptable and effective in supporting direct care and, for the United Kingdom, to summarize the relevant guidance of professional and regulatory bodies. METHODS Five electronic databases (MEDLINE, Embase, APA PsycINFO, CENTRAL, and HMIC) were searched from 2012 to 2022. Eligible studies evaluated an intervention involving video recording of adult patients (≥18 years) to support diagnosis, care, or treatment. All study designs and countries of publication were included. Websites of UK professional and regulatory bodies were searched to identify relevant guidance. The acceptability of video recording patients was evaluated using study recruitment and retention rates and a framework synthesis of patients' and clinical staff's perspectives based on the Theoretical Framework of Acceptability by Sekhon. Clinically relevant measures of impact were extracted and tabulated according to the study design. The framework approach was used to synthesize the reported ethico-legal considerations, and recommendations of professional and regulatory bodies were extracted and tabulated. RESULTS Of the 14,221 abstracts screened, 27 studies met the inclusion criteria. Overall, 13 guidance documents were retrieved, of which 7 were retained for review. The views of patients and clinical staff (16 studies) were predominantly positive, although concerns were expressed about privacy, technical considerations, and integrating video recording into clinical workflows; some patients were anxious about their physical appearance. The mean recruitment rate was 68.2% (SD 22.5%; range 34.2%-100%; 12 studies), and the mean retention rate was 73.3% (SD 28.6%; range 16.7%-100%; 17 studies). Regarding effectiveness (10 studies), patients and clinical staff considered video recordings to be valuable in supporting assessment, care, and treatment; in promoting patient engagement; and in enhancing communication and recall of information. Observational studies (n=5) favored video recording, but randomized controlled trials (n=5) did not demonstrate that video recording was superior to the controls. UK guidelines are consistent in their recommendations around consent, privacy, and storage of recordings but lack detailed guidance on how to operationalize these recommendations in clinical practice. CONCLUSIONS Video recording patients for direct care purposes appears to be acceptable, despite concerns about privacy, technical considerations, and how to incorporate recording into clinical workflows. Methodological quality prevents firm conclusions from being drawn; therefore, pragmatic trials (particularly in older adult care and the movement disorders field) should evaluate the impact of video recording on diagnosis, treatment monitoring, patient-clinician communication, and patient safety. Professional and regulatory documents should signpost to practical guidance on the implementation of video recording in routine practice. TRIAL REGISTRATION PROSPERO CRD42022331825: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=331825.
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Affiliation(s)
- Rachael Lear
- Imperial Clinical Analytics, Research & Evaluation (iCARE), London, United Kingdom
- National Institute for Health and Care Research North West London Patient Safety Research Collaborative, Institute of Global Health Innovation, Imperial College London - St Mary's Hospital Campus, London, United Kingdom
| | - Sophia Ellis
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Hillingdon NHS Foundation Trust, London, United Kingdom
| | | | - Susannah Long
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Erik K Mayer
- Imperial Clinical Analytics, Research & Evaluation (iCARE), Digital Collaboration Space, London, United Kingdom
- National Institute for Health and Care Research North West London Patient Safety Research Collaborative, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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Latgé-Tovar S, Bertrand E, Cosentino S, Dourado MC, Laks J, Landeira-Fernandez J, Morris RG, Mograbi DC. Self- and Other-Evaluation in Alzheimer’s Disease. J Alzheimers Dis 2022; 90:283-294. [DOI: 10.3233/jad-220453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Impaired awareness of ability is common in dementia and has important clinical implications. Evidence from different clinical groups has shown that awareness can vary according to whether evaluation refers to self or other performance. Objective: The present study aimed to investigate awareness for self- and other-performance in Alzheimer’s disease (AD) patients, exploring if results vary according to cognitive domain of the tasks. It was hypothesized that, particularly for memory tasks, AD patients would be inaccurate in relation to self-but not other-performance. Methods: Twenty-two mild to moderate AD patients and twenty-two healthy older adults participated. Two tasks, with reaction time (RT) and working memory tasks, were carried out, and each had a success and a failure condition. Participants were asked to estimate their own performance, as well as the performance of another person they observed. Awareness of performance was measured comparing participant estimations of performance with actual performance. Results: For both the RT and working memory tasks, results indicate that participants from both groups overestimated the performance in the failure condition and underestimated the performance in the success condition. They tended to overestimate more the performance of the other person compared to themselves. Additionally, for the working memory task, AD patients tended to overestimate more performances compared to controls. Conclusion: Findings suggest that the AD and control groups present the same pattern, with attribution of better performance to another person. For the AD group, the pattern of response was different for memory tasks, which may suggest domain-specific limited awareness.
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Affiliation(s)
- Sofia Latgé-Tovar
- Federal University of Rio de Janeiro (UFRJ), Institute of Psychiatry, Center for Alzheimer’s Disease, Rio deJaneiro, RJ, Brazil
- These authors contributed equally to this work
| | - Elodie Bertrand
- Université Paris-Cité, Institut de Psychologie, Paris, France
- These authors contributed equally to this work
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
- Cognitive Neuroscience Division of the Gertrude H.Sergievsky Center, Columbia University Medical Center, New York, NY, USA
- Cognitive Neuroscience Division of the Department of Neurology, Columbia University Medical Center, NewYork, NY, USA
| | - Marcia C.N. Dourado
- Federal University of Rio de Janeiro (UFRJ), Institute of Psychiatry, Center for Alzheimer’s Disease, Rio deJaneiro, RJ, Brazil
| | - Jerson Laks
- Federal University of Rio de Janeiro (UFRJ), Institute of Psychiatry, Center for Alzheimer’s Disease, Rio deJaneiro, RJ, Brazil
| | - Jesus Landeira-Fernandez
- Pontifical Catholic University of Rio de Janeiro(PUC-Rio), Department of Psychology, Rio de Janeiro, RJ, Brazil
| | - Robin G. Morris
- King’s College London, Institute of Psychiatry - Psychology & Neuroscience, London, United Kingdom
| | - Daniel C. Mograbi
- Federal University of Rio de Janeiro (UFRJ), Institute of Psychiatry, Center for Alzheimer’s Disease, Rio deJaneiro, RJ, Brazil
- Pontifical Catholic University of Rio de Janeiro(PUC-Rio), Department of Psychology, Rio de Janeiro, RJ, Brazil
- King’s College London, Institute of Psychiatry - Psychology & Neuroscience, London, United Kingdom
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Phelan S, Sigala N. The effect of treatment on insight in psychotic disorders - A systematic review and meta-analysis. Schizophr Res 2022; 244:126-133. [PMID: 35661550 DOI: 10.1016/j.schres.2022.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/25/2022] [Accepted: 05/21/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND For people with a psychotic disorder lack of insight can be detrimental on their condition and recovery. For this reason, insight has been considered as a target for therapy. We conducted a systematic review of the literature on pharmacological, psychological and other treatments to test the hypothesis that these interventions could improve insight. METHODS We performed a literature search (1970-2020) across the following databases: PubMed, EMBASE, PsychINFO, Medline and Web of Science. Within each database the following search terms and the associated Boolean operatives were used: "Insight AND (treatment OR therapy) AND (psychosis OR schizophrenia) AND (awareness or denial)". Further filters were applied to identify peer reviewed controlled trials on adults. Following assessment for bias and inclusion criteria, we calculated the effect size (Cohen's d) for each study and overall, using a random effects model with 95% confidence intervals. RESULTS Of 94 articles found in the initial literature search, 30 studies that examined the treatment of insight in psychosis met the initial selection criteria and were assessed for bias. A total of 21 studies were included in the final meta-analysis. The overall calculated mean effect size for all interventions was 0.441 (95% CI, 0.23-0.66), representing a medium effect size. The effect of psychoeducation studies alone was medium (0.613, 95% CI, -0.35-2.06), but not significant. The effect of CBT studies was small (0.235, 95% CI, 0.01-0.46), and significant. The effect of combined antipsychotic medication and psychosocial intervention was of medium size and significant (0.683, 95% CI = 0.54-0.83). Finally, tDCS over the left fronto-temporal cortex, produced a very large and significant improvement of insight 1.153 (95% CI = 0.61-1.70), which was present for at least a month after the intervention. CONCLUSIONS Despite the variation and small number and size of trials into possible interventions, the hypothesis that insight could be improved was confirmed. Whilst most research focuses on psychotherapies, there is scope and potential for pharmacological, as well as other interventions (e.g. physical exercise, self-video observation, Direct Current Stimulation) to improve insight over and above treatment as usual. Given the association of insight with illness severity and treatment adherence, it is important to direct efforts in therapies that target insight improvement in psychosis.
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Affiliation(s)
- Sean Phelan
- Brighton and Sussex Medical School, University of Sussex, UK
| | - Natasha Sigala
- Brighton and Sussex Medical School, University of Sussex, UK.
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A Case of Catatonia and Psychosis: A Multidisciplinary Approach and Perspective. Harv Rev Psychiatry 2022; 30:155-161. [PMID: 34731881 DOI: 10.1097/hrp.0000000000000317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schandrin A, Picot MC, Marin G, André M, Gardes J, Léger A, O'Donoghue B, Raffard S, Abbar M, Capdevielle D. Video self-confrontation as a therapeutic tool in schizophrenia: A randomized parallel-arm single-blind trial. Schizophr Res 2022; 240:103-112. [PMID: 34991040 DOI: 10.1016/j.schres.2021.12.016] [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] [Received: 03/29/2021] [Revised: 09/22/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Lack of insight is a barrier to treating psychosis. Preliminary studies have suggested that showing people videos of their psychotic behaviour may improve personal insight. This clinical trial aimed to assess the effect of video self-confrontation. METHODS Inpatients between 18 and 65 years old with schizophrenia or schizoaffective disorder were filmed upon admission to two psychiatric hospitals while experiencing acute psychosis. After stabilization, individuals were randomized 1:1 to the "self-video" group where they watched their own video or to the "no video" control group. The primary outcome was the Scale to assess Unawareness of Mental Disorder (SUMD) at 48 h by a blinded assessor. Secondary objectives included psychotic and depressive symptoms, medication adherence and functioning using the Functional Remission of General Schizophrenia. Patients were followed up for four months. RESULTS 60 participants were randomized and the level of insight did not differ between groups at 48 h (p = 0.98). There was no impact on SUMD subscores or the other insight questionnaires at any timepoint, nor on psychopathology or medication adherence. At one month, the level of functioning of those in the "self-video" group (n = 23) was higher (61.8 vs 53.5, p = 0.02), especially concerning "Treatment" and "Daily life". No adverse effects were reported. After video self-confrontation, people expressed more positive than negative emotions and were less lost to follow-up. CONCLUSION Video self-confrontation did not change levels of insight, but may have a therapeutic impact nonetheless, by improving levels of self-care and adherence to care, indicating that this innovative therapeutic tool requires further study. TRIAL REGISTRATION NUMBER NCT02664129.
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Affiliation(s)
- A Schandrin
- Department of Adult Psychiatry, Nimes University Hospital, University of Montpellier, Nîmes, France; Orygen, Parkville, Victoria, Australia.
| | - M-C Picot
- Clinical Research, Biostatistics and Epidemiology Unit, Department of Medical Information, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - G Marin
- Clinical Research, Biostatistics and Epidemiology Unit, Department of Medical Information, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - M André
- Department of Adult Psychiatry, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - J Gardes
- Department of Adult Psychiatry, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - A Léger
- Department of Adult Psychiatry, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | - B O'Donoghue
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - S Raffard
- Department of Adult Psychiatry, Montpellier University Hospital, University of Montpellier, Montpellier, France; University Paul Valéry Montpellier 3, EPSYLON EA, Montpellier, France
| | - M Abbar
- Department of Adult Psychiatry, Nimes University Hospital, University of Montpellier, Nîmes, France
| | - D Capdevielle
- Department of Adult Psychiatry, Montpellier University Hospital, University of Montpellier, Montpellier, France; Inserm 1061, Montpellier, France
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Bomilcar I, Bertrand E, Morris RG, Mograbi DC. The Seven Selves of Dementia. Front Psychiatry 2021; 12:646050. [PMID: 34054604 PMCID: PMC8160244 DOI: 10.3389/fpsyt.2021.646050] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
The self is a complex and multifaceted phenomenon, encompassing a variety of cognitive processes and psychosocial influences. Considering this, there is a multiplicity of "selves," the current review suggesting that seven fundamental self-processes can be identified that further our understanding of the experience of dementia. These include (1) an embodied self, manifest as corporeal awareness; (2) an agentic self, related to being an agent and influencing life circumstances; (3) an implicit self, linked to non-conscious self-processing; (4) a critical self, which defines the core of self-identity; (5) a surrogate self, based on third-person perspective information; (6) an extended self, including external objects or existences that are incorporated into the self; and, finally, (7) an emergent self, a property of the self-processes that give rise to the sense of a unified self. These are discussed in relation to self-awareness and their use in making sense of the experience of dementia.
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Affiliation(s)
- Iris Bomilcar
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elodie Bertrand
- Laboratoire Mémoire, Cerveau et Cognition (LMC2, URP 7536), Institut de Psychologie, Université de Paris, Paris, France
| | - Robin G. Morris
- Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Daniel C. Mograbi
- Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
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7
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Affiliation(s)
- Hannah E Brown
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Sydney Feinstein
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - David C Henderson
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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du Mortier JAM, Visser HAD, van Geijtenbeek - de Vos van Steenwijk MFR, van Megen HJGM, van Balkom AJLM. Use of videotaped personal compulsions to enhance motivation in obsessive-compulsive disorder. BJPsych Open 2019; 5:e11. [PMID: 30762503 PMCID: PMC6381413 DOI: 10.1192/bjo.2018.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 10/13/2018] [Accepted: 11/09/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Watching videotaped personal compulsions together with a therapist might enhance the effect of cognitive-behavioural therapy in obsessive-compulsive disorder (OCD) but little is known about how patients experience this.AimsTo performed a qualitative study that describes how watching these videos influences motivation for treatment and whether patients report any adverse events. METHOD In this qualitative study, data were gathered in semi-structured interviews with 24 patients with OCD. The transcripts were coded by two researchers. They used a combination of open and thematic coding and discrepancies in coding were discussed. RESULTS The experience of watching videos with personal compulsions helped patients to realise that these compulsions are aberrant and irrational. Patients report increased motivation to resist their OCD and to adhere to therapy. No adverse events were reported. CONCLUSIONS Videos with personal compulsions create more awareness in patients with OCD that compulsions are irrational, leading to enhanced motivation for treatment.Declaration of interestNone.
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Affiliation(s)
| | | | | | | | - Anton J. L. M. van Balkom
- Professor and Psychiatrist, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health and GGZ ingeest, the Netherlands
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Bertrand E, Landeira-Fernandez J, Mograbi DC. Metacognition and Perspective-Taking in Alzheimer's Disease: A Mini-Review. Front Psychol 2016; 7:1812. [PMID: 27909421 PMCID: PMC5112262 DOI: 10.3389/fpsyg.2016.01812] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/02/2016] [Indexed: 12/22/2022] Open
Abstract
Metacognition refers to the monitoring and regulation of cognitive processes and its impairment can lead to a lack of self-awareness of deficits, or anosognosia. In the context of different neurological and psychiatric disorders (e.g., traumatic brain injury, dementia, and schizophrenia), studies have shown that patients who present impairments in metacognitive abilities may be able to recognize such difficulties in others and in themselves when exposed to material in a third-person perspective. Considering that metacognitive impairments are an important characteristic of dementia, especially in Alzheimer's Disease (AD), studies of the relationship between metacognition and perspective-taking may be relevant to improve the quality of life of people with dementia. The current paper first briefly addresses the theme of metacognition and the impact of metacognitive deficits in people with AD. The focus then turns to the relationship between metacognition and perspective-taking in different neurological and psychiatric disorders, particularly AD. This relationship is also discussed based on theoretical models, particularly the Cognitive Awareness Model (CAM). Specifically, the CAM suggests the existence of distinct memory systems for self- and other-information, an idea which is supported by neuroimaging findings. We suggest that the Default Mode Network, as it has been shown to be implicated in self vs. other processing and is affected early in AD, could explain the impact of perspective-taking on awareness of deficits in AD. Finally, we present possible clinical implications of the relationship between metacognition and perspective-taking in AD. Indeed, we considered the possibility of improving patient's awareness through the use of a third-person perspective, which, consequently, may decrease the negative impacts of anosognosia in AD.
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Affiliation(s)
- Elodie Bertrand
- Department of Psychology, Pontifícia Universidade Católica do Rio de JaneiroRio de Janeiro, Brazil
| | - Jesus Landeira-Fernandez
- Department of Psychology, Pontifícia Universidade Católica do Rio de JaneiroRio de Janeiro, Brazil
| | - Daniel C. Mograbi
- Department of Psychology, Pontifícia Universidade Católica do Rio de JaneiroRio de Janeiro, Brazil
- Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondon, UK
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Targeting Insight in First Episode Psychosis: A Case Study of Metacognitive Reflection Insight Therapy (MERIT). JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-016-9332-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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11
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Liu CH, Keshavan MS, Tronick E, Seidman LJ. Perinatal Risks and Childhood Premorbid Indicators of Later Psychosis: Next Steps for Early Psychosocial Interventions. Schizophr Bull 2015; 41:801-16. [PMID: 25904724 PMCID: PMC4466191 DOI: 10.1093/schbul/sbv047] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Schizophrenia and affective psychoses are debilitating disorders that together affect 2%-3% of the adult population. Approximately 50%-70% of the offspring of parents with schizophrenia manifest a range of observable difficulties including socioemotional, cognitive, neuromotor, speech-language problems, and psychopathology, and roughly 10% will develop psychosis. Despite the voluminous work on premorbid vulnerabilities to psychosis, especially on schizophrenia, the work on premorbid intervention approaches is scarce. While later interventions during the clinical high-risk (CHR) phase of psychosis, characterized primarily by attenuated positive symptoms, are promising, the CHR period is a relatively late phase of developmental derailment. This article reviews and proposes potential targets for psychosocial interventions during the premorbid period, complementing biological interventions described by others in this Special Theme issue. Beginning with pregnancy, parents with psychoses may benefit from enhanced prenatal care, social support, parenting skills, reduction of symptoms, and programs that are family-centered. For children at risk, we propose preemptive early intervention and cognitive remediation. Empirical research is needed to evaluate these interventions for parents and determine whether interventions for parents and children positively influence the developmental course of the offspring.
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Affiliation(s)
- Cindy H Liu
- Department of Psychiatry, Harvard Medical School, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA; Department of Psychology, University of Massachusetts, Boston, MA;
| | - Matcheri S Keshavan
- Department of Psychiatry, Harvard Medical School, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ed Tronick
- Department of Psychology, University of Massachusetts, Boston, MA; Department of Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School, Massachusetts Mental Health Center Division of Public Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA; Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
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Välimäki M, Hätönen HM, Lahti ME, Kurki M, Hottinen A, Metsäranta K, Riihimäki T, Adams CE. Virtual reality for treatment compliance for people with serious mental illness. Cochrane Database Syst Rev 2014; 2014:CD009928. [PMID: 25300174 PMCID: PMC8078301 DOI: 10.1002/14651858.cd009928.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Virtual reality (VR) is computerised real-time technology, which can be used an alternative assessment and treatment tool in the mental health field. Virtual reality may take different forms to simulate real-life activities and support treatment. OBJECTIVES To investigate the effects of virtual reality to support treatment compliance in people with serious mental illness. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (most recent, 17th September 2013) and relevant reference lists. SELECTION CRITERIA All relevant randomised studies comparing virtual reality with standard care for those with serious mental illnesses. We defined virtual reality as a computerised real-time technology using graphics, sound and other sensory input, which creates the interactive computer-mediated world as a therapeutic tool. DATA COLLECTION AND ANALYSIS All review authors independently selected studies and extracted data. For homogeneous dichotomous data the risk difference (RD) and the 95% confidence intervals (CI) were calculated on an intention-to-treat basis. For continuous data, we calculated mean differences (MD). We assessed risk of bias and created a 'Summary of findings' table using the GRADE approach. MAIN RESULTS We identified three short-term trials (total of 156 participants, duration five to 12 weeks). Outcomes were prone to at least a moderate risk of overestimating positive effects. We found that virtual reality had little effects regarding compliance (3 RCTs, n = 156, RD loss to follow-up 0.02 CI -0.08 to 0.12, low quality evidence), cognitive functioning (1 RCT, n = 27, MD average score on Cognistat 4.67 CI -1.76 to 11.10, low quality evidence), social skills (1 RCT, n = 64, MD average score on social problem solving SPSI-R (Social Problem Solving Inventory - Revised) -2.30 CI -8.13 to 3.53, low quality evidence), or acceptability of intervention (2 RCTs, n = 92, RD 0.05 CI -0.09 to 0.19, low quality evidence). There were no data reported on mental state, insight, behaviour, quality of life, costs, service utilisation, or adverse effects. Satisfaction with treatment - measured using an un-referenced scale - and reported as "interest in training" was better for the virtual reality group (1 RCT, n = 64, MD 6.00 CI 1.39 to 10.61,low quality evidence). AUTHORS' CONCLUSIONS There is no clear good quality evidence for or against using virtual reality for treatment compliance among people with serious mental illness. If virtual reality is used, the experimental nature of the intervention should be clearly explained. High-quality studies should be undertaken in this area to explore any effects of this novel intervention and variations of approach.
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Affiliation(s)
- Maritta Välimäki
- University of TurkuDepartment of Nursing ScienceTurkuFinland
- Turku University HospitalTurkuFinland
| | - Heli M Hätönen
- University of TurkuDepartment of Nursing ScienceTurkuFinland
| | - Mari E Lahti
- University of TurkuDepartment of Nursing ScienceTurkuFinland
- Turku University of Applied SciencesHealth and Social ScienceRusikatu 8TurkuFinland20720
| | - Marjo Kurki
- University of TurkuDepartment of Nursing ScienceTurkuFinland
| | - Anja Hottinen
- University of TurkuDepartment of Nursing ScienceTurkuFinland
| | - Kiki Metsäranta
- University of TurkuDepartment of Nursing ScienceTurkuFinland
| | - Tanja Riihimäki
- The Helsinki University Central HospitalPsychiatric Unit, Outpatient Clinic for AdolescentsTammipääntie 40EspooUusimaaFinland02730
| | - Clive E Adams
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthUniversity of Nottingham Innovation Park, Triumph Road,NottinghamUKNG7 2TU
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Dresler M, Wehrle R, Spoormaker VI, Steiger A, Holsboer F, Czisch M, Hobson JA. Neural correlates of insight in dreaming and psychosis. Sleep Med Rev 2014; 20:92-9. [PMID: 25092021 DOI: 10.1016/j.smrv.2014.06.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 06/06/2014] [Accepted: 06/14/2014] [Indexed: 12/17/2022]
Abstract
The idea that dreaming can serve as a model for psychosis has a long and honourable tradition, however it is notoriously speculative. Here we demonstrate that recent research on the phenomenon of lucid dreaming sheds new light on the debate. Lucid dreaming is a rare state of sleep in which the dreamer gains insight into his state of mind during dreaming. Recent electroencephalogram (EEG) and functional magnetic resonance imaging (fMRI) data for the first time allow very specific hypotheses about the dream-psychosis relationship: if dreaming is a reasonable model for psychosis, then insight into the dreaming state and insight into the psychotic state should share similar neural correlates. This indeed seems to be the case: cortical areas activated during lucid dreaming show striking overlap with brain regions that are impaired in psychotic patients who lack insight into their pathological state. This parallel allows for new therapeutic approaches and ways to test antipsychotic medication.
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Affiliation(s)
- Martin Dresler
- Max Planck Institute of Psychiatry, Munich, Germany; Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands.
| | | | | | - Axel Steiger
- Max Planck Institute of Psychiatry, Munich, Germany
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Besharati S, Kopelman M, Avesani R, Moro V, Fotopoulou A(K. Another perspective on anosognosia: Self-observation in video replay improves motor awareness. Neuropsychol Rehabil 2014; 25:319-52. [DOI: 10.1080/09602011.2014.923319] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Palmer EC, David AS. More work on lack of awareness and insight in healthy people and psychiatric patients will assist model building. Cogn Neurosci 2013; 4:206-7. [DOI: 10.1080/17588928.2013.854759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Emma C. Palmer
- Section of Cognitive Neuropsychiatry, Department of Psychosis Studies, Institute of Psychiatry, King’s College, London, UK
| | - Anthony S. David
- Section of Cognitive Neuropsychiatry, Department of Psychosis Studies, Institute of Psychiatry, King’s College, London, UK
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Current world literature. Curr Opin Psychiatry 2013; 26:231-6. [PMID: 23364282 DOI: 10.1097/yco.0b013e32835dd9de] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pijnenborg GHM, van Donkersgoed RJM, David AS, Aleman A. Changes in insight during treatment for psychotic disorders: a meta-analysis. Schizophr Res 2013; 144:109-17. [PMID: 23305612 DOI: 10.1016/j.schres.2012.11.018] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 11/08/2012] [Accepted: 11/19/2012] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Poor insight, or awareness of illness, has a negative impact on the outcome of the psychosis, and is therefore a logical target for treatment. A meta-analysis of the effect of psychological and pharmacological treatments on insight in psychosis was conducted to give a comprehensive overview of effective interventions. METHODS An inclusive literature search (1975-April 2012) was performed in PubMed, ISI Web of Science, and EMBASE. The search terms used were "Insight", "Awareness", "Treatment", "Psychosis", "Therapy" and "Schizophrenia", no language specified. A cross-reference search of eligible articles was performed to identify studies not found in the computerized search. Effect sizes (Cohen's d) of each study and overall were calculated under a random effects model with 95% confidence intervals. RESULTS Our literature search resulted in approximately 350 abstracts. Nineteen RCTs that examined treatment effects on insight in patients with psychotic disorders were included. Overall, the interventions had a medium effect (d=.34, 95% CI, 0.12-0.57). The effects of CBT, adherence therapy and psycho-education were small to moderate, but not significant, probably due to a lack of power. There were insufficient data to allow a statistical evaluation of the effect of skills training, medication, video-confrontation and comprehensive intervention programs consisting of multiple components. Few adverse effects on mood were documented but this aspect was seldom quantified. CONCLUSION There is a paucity of studies providing data regarding treatment for impaired insight in psychosis. Nevertheless, from the published literature in this meta-analysis, we can confirm that it is a potential therapeutic target and that it is amenable to improvement. Comprehensive intervention programs consisting of multiple components may be particularly promising. Improvements in insight did not seem to be associated with increased depression.
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Affiliation(s)
- Gerdina H M Pijnenborg
- Dept. of Psychotic Disorders, GGZ-Drenthe, Dennenweg 9, 9404 LA, Assen, The Netherlands.
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