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Farr J, Rhodes JE, Baruch E, Smith JA. Early intervention in psychosis for first episode psychotic mania: the experience of people diagnosed with bipolar disorder. J Ment Health 2024:1-7. [PMID: 38588707 DOI: 10.1080/09638237.2024.2332805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/03/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Early intervention for people diagnosed with bipolar disorder has been identified as a priority, but little is known about how existing early intervention services are experienced by this group or could be tailored to their needs. AIMS This study examined the experience of early intervention in psychosis (EIP) services for people diagnosed with bipolar disorder, following first episode psychotic mania. METHOD Semi-structured interviews were conducted with 11 adults in EIP services and analysed using Interpretative Phenomenological Analysis. RESULTS One superordinate theme was formed, Rebuilding within EIP service, consisting of five subthemes: (i) Piecing together episode through talking to staff; (ii) Exploring other perspectives during CBT; (iii) Empowered through shared decision-making; (iv) Reconsidering future and purpose; (v) Service as safety-net. EIP provision was pivotal in helping participants understand their episode, adjust their perspective, build confidence and progress. CONCLUSIONS Aspects of the service that were valued, including person-centred relationships with staff, shared decision-making and the development of motivation and opportunities, reflect key principles of mental health care for young people following first episode psychosis. Furthermore, findings point to elements that may be particularly relevant to early intervention following first episode psychotic mania including managing mood escalation and individualised approaches to goals.
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Affiliation(s)
- Joanna Farr
- Birkbeck University of London, London, United Kingdom
| | - John E Rhodes
- Birkbeck University of London, London, United Kingdom
| | - Ella Baruch
- Tower Hamlets Early Intervention Service, Three Colts Lane, London, United Kingdom
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Agrest M, Tapia-Munoz T, Encina-Zúñiga E, Vidal-Zamora I, Geffner N, Ardila-Gómez S, Alvarado R, Leiderman EA, Reavley N. Development of mental health first-aid guidelines for psychosis: a Delphi expert consensus study in Argentina and Chile. BMC Psychiatry 2024; 24:113. [PMID: 38336694 PMCID: PMC10858466 DOI: 10.1186/s12888-024-05501-z] [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: 07/11/2023] [Accepted: 01/06/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Psychotic symptoms may be less common than anxiety or affective symptoms, but they are still frequent and typically highly debilitating. Community members can have a role in helping to identify, offer initial help and facilitate access to mental health services of individuals experiencing psychosis. Mental health first aid guidelines for helping a person experiencing psychosis have been developed for the global north. This study aimed to adapt the English- language guidelines for Chile and Argentina. METHODS A Delphi expert consensus study was conducted with two panels of experts, one of people with lived experience of psychosis (either their own or as a carer; n = 29) and another one of health professionals (n = 29). Overall, 249 survey items from the original English guidelines and 26 items suggested by the local team formed a total of 275 that were evaluated in the first round. Participants were invited to rate how essential or important those statements were for Chile and Argentina, and encouraged to suggest new statements if necessary. These were presented in a second round. Items with 80% of endorsement by both panels were included in the guidelines for Chile and Argentina. RESULTS Data were obtained over two survey rounds. Consensus was achieved on 244 statements, including 26 statements locally generated for the second round. Almost 20% of the English statements were not endorsed (n = 50), showing the applicability of the original guidelines but also the importance of culturally adapting them. Attributions and tasks expected to be delivered by first aiders were shrunk in favour of a greater involvement of mental health professionals. Self-help strategies were mostly not endorsed and as were items relating to respecting the person's autonomy. CONCLUSIONS While panellists agreed that first aiders should be aware of human rights principles, items based on recovery principles were only partially endorsed. Further research on the dissemination of these guidelines and development of a Mental Health First Aid training course for Chile and Argentina is still required.
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Affiliation(s)
- Martín Agrest
- Proyecto Suma, Güemes 4130 (1425), Ciudad Autónoma de Buenos Aires, Argentina.
- Universidad de Buenos Aires, Facultad de Psicología, Instituto de Investigaciones, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Thamara Tapia-Munoz
- Department of Behavioural Science and Health, University College London, London, UK
| | - Esteban Encina-Zúñiga
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Psychology, Faculty of Social Sciences, Universidad de Chile, Santiago, Chile
| | - Isidora Vidal-Zamora
- Department of Psychology, Faculty of Social Sciences, Universidad de Chile, Santiago, Chile
| | - Norma Geffner
- Proyecto Suma, Güemes 4130 (1425), Ciudad Autónoma de Buenos Aires, Argentina
| | - Sara Ardila-Gómez
- Universidad de Buenos Aires, Facultad de Psicología, Instituto de Investigaciones, Ciudad Autónoma de Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Rubén Alvarado
- Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Eduardo A Leiderman
- Departamento de Neurociencias, Facultad de Ciencias Sociales, Universidad de Palermo, Ciudad Autónoma de Buenos Aires, Argentina
| | - Nicola Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
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Darker CD, Nicolson G, Reddon H, O'Connor K, Jennings R, O'Connell N. Monthly engagement with EIP keyworkers was associated with a five-fold increase in the odds of engagement with psychosocial interventions. BMC Psychiatry 2024; 24:96. [PMID: 38317157 PMCID: PMC10840293 DOI: 10.1186/s12888-024-05577-7] [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: 04/24/2023] [Accepted: 02/01/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Early intervention in psychosis (EIP) supports people who are experiencing their first episode of psychosis (FEP). A new Model of Care (MoC) for EIP services was launched in Ireland in 2019. Three EIP demonstration sites were chosen to test this MoC through a 'hub and spoke' approach. These services were a new way of organising care for people experiencing FEP, based upon a recovery model of care, and which sought to standardise care, improve access by clinically led multidisciplinary teams. This included newly created EIP keyworker roles whereby keyworkers assumed responsibilities regarding assessment, comprehensive individual care planning and coordination of care. METHODS A mixed methods design utilising the UK Medical Research Council's process evaluation framework. Purposive sampling techniques were utilised. Descriptive analyses and logistic regression were performed to examine how increased keyworker engagement influenced the use of other psychosocial interventions within the EIP demonstration sites. Thematic analyses was used for qualitative data. RESULTS There was a strong positive relationship between keyworker contacts and psychosocial interventions offered. Specifically, the odds of achieving at least monthly engagement with cognitive behavioural therapy for psychosis (CBTp; (5.76 (2.43-13.64), p < 0.001), and behavioural family therapy (BFT; (5.52(1.63-18.69, p < 0.006)) increased by fivefold with each additional monthly keyworker contact. For individual placement support (IPS) each additional monthly keyworker contact was associated with a three-fold increase in the odds of achieving monthly attendance with IPS (3.73 (1.64-8.48), p < 0.002). Qualitative results found that the EIP keyworker role as viewed by both service users and staff as a valuable nodal point, with a particular emphasis on care coordination and effective communication. CONCLUSIONS This study advances the understanding of keyworker effects through qualitative evidence of keyworkers functioning as a "linchpin" to the service, while the positive response association between keyworker contacts and engagement with other services provides quantitative support for keyworkers reducing the organisational or structural barriers to service access. Given the importance of these positions, health systems should ensure that EIP programmes identify qualified and experienced staff to fill these roles, as well as allocate the appropriate funding and protected time to support keyworker engagement and impact.
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Affiliation(s)
- C D Darker
- Discipline of Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - G Nicolson
- Health Promotion and Improvement Department, HSE Health and Wellbeing, 1st Floor Old National Ambulance Training Building, St Marys Hospital Campus, Phoenix Park, Dublin 20, Chapelizod, D20 TY72, Ireland
| | - H Reddon
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - K O'Connor
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
- Rise, South Lee Mental Health Services, Cork & Department of Psychiatry, University College Cork, Cork, Ireland
| | - R Jennings
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
| | - N O'Connell
- Sexual Health and Crisis Pregnancy Programme, HSE Health and Wellbeing, Strategy and Research, 89-94 Capel St, Dublin 1, Dublin, D01 P281, Ireland
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Shaikh M, Eilender C, O'Brien M, O'Driscoll C. Exploring the efficacy of a low intensity psychological intervention for family members and carers of individuals with a first episode of psychosis in early intervention services. Early Interv Psychiatry 2023; 17:1087-1094. [PMID: 36647562 DOI: 10.1111/eip.13403] [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: 04/04/2022] [Revised: 12/08/2022] [Accepted: 01/01/2023] [Indexed: 01/18/2023]
Abstract
AIM The study aimed to evaluate the efficacy, and explore carers' experience, of a brief carer focussed intervention in an Early Intervention in Psychosis (EIP) service using a mixed methods approach. METHODS Carers within EIP services were invited to have the intervention, comprising a psychoeducation and wellbeing component, and 153 carers completed routine outcome measures including the Brief Experience of Caregiving Inventory (BECI), The Warwick-Edinburgh Mental Well-being Scale (WEMWEBS) and the Hospital Anxiety and Depression Scale (HADS) at baseline and after the completion of the intervention. Separately, nine carers took part in semi-structured interviews about their experience of the intervention. RESULTS The intervention resulted in improvement of overall well-being, a reduction in self-reported anxiety and caregiving experience relating to difficult behaviours and stigma/effects on the family. Overall, the carers' subjective experiences of the intervention were positive. Thematic analysis indicated epistemic trust indexed by the connection carers achieved with the service, an experience of being valued and of experiencing change through the intervention. CONCLUSION A short, 8 weeks intervention delivered by assistant psychologists, may offer an effective method for facilitating understanding of the illness and acclimatizing to new challenges. Exploring the effectiveness of psychoeducation and capturing this with specific measures may allow the service to make meaningful adaptations to their intervention.
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Affiliation(s)
- Madiha Shaikh
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Early Intervention in Psychosis Services, North East London NHS Foundation Trust, London, UK
| | - Cara Eilender
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Melanie O'Brien
- Early Intervention in Psychosis Services, North East London NHS Foundation Trust, London, UK
| | - Ciarán O'Driscoll
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Lindgren M, Therman S, From T, Hietala J, Laurikainen H, Salokangas RKR, Suvisaari J. Sense of mastery in first-episode psychosis-a one-year follow-up study. Front Psychiatry 2023; 14:1200669. [PMID: 37743988 PMCID: PMC10512717 DOI: 10.3389/fpsyt.2023.1200669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction A sense of mastery refers to beliefs about having control over one's life and has been found to protect health and buffer the effect of stressful experiences. Methods We investigated sense of mastery in first-episode psychosis (FEP) patients and population controls at baseline and at one-year follow-up. Pearlin and Schooler's Sense of Mastery scale was completed by 322 participants at baseline and by 184 participants at follow-up. Results People having experienced FEP reported lower mastery than controls at both time points, but a modest increase was seen in patients at follow-up. The strongest correlates of high baseline mastery in FEP were lower depressive symptoms and higher perceived social support, whereas positive or negative psychotic symptoms did not associate with mastery. Current depressive symptoms also correlated with mastery at the follow-up point, and change in depressive symptoms correlated with change in mastery. Higher mastery at treatment entry predicted remission of psychotic symptoms one year later. Sense of mastery was also found to mediate the association of perceived social support with depressive symptoms. Discussion The usefulness of mastery measures should be further tested for estimations of patient prognosis in early psychosis.
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Affiliation(s)
- Maija Lindgren
- Mental Health, Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sebastian Therman
- Mental Health, Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tiina From
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
| | - Heikki Laurikainen
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
| | - Raimo K. R. Salokangas
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Jaana Suvisaari
- Mental Health, Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Iyer SN, Taksal A, Malla A, Martin H, Levasseur MA, Pope MA, Rangaswamy T, Ramachandran P, Mohan G. Show me you care: A patient- and family-reported measure of care experiences in early psychosis services. Early Interv Psychiatry 2023; 17:662-669. [PMID: 36200407 PMCID: PMC10076446 DOI: 10.1111/eip.13360] [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: 02/27/2022] [Revised: 07/15/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022]
Abstract
AIM Despite their emphasis on engagement, there has been little research on patients' and families' experiences of care in early intervention services for psychosis. We sought to compare patients' and families' experiences of care in two similar early psychosis services in Montreal, Canada and Chennai, India. Because no patient- or family-reported experience measures had been used in a low- and middle-income context, we created a new measure, Show me you care. Here we present its development and psychometric properties. METHODS Show me you care was created based on the literature and stakeholder inputs. Its patient and family versions contain the same nine items (rated on a 7-point scale) about various supportive behaviours of treatment providers towards patients and families. Patients (N = 293) and families (N = 237) completed the measure in French/English in Montreal and Tamil/English in Chennai. Test-retest reliability, internal consistency, convergent validity, and ease of use were evaluated. RESULTS Test-retest reliability (intra-class correlation coefficients) ranged from excellent (0.95) to good (0.66) across the patient and family versions, in Montreal and Chennai, and in English, French, and Tamil. Internal consistency estimates (Cronbach's alphas) were excellent (≥0.87). The measure was reported to be easy to understand and complete. CONCLUSION Show me you care fills a gap between principles and practice by making engagement and collaboration as central to measurement in early intervention as it is to its philosophy. Having been co-designed and developed in three languages and tested in a low-and-middle-income and a high-income context, our tool has the potential for global application.
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Affiliation(s)
- Srividya N. Iyer
- Department of Psychiatry, McGill University, Montreal; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Aarati Taksal
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal; and Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | - Helen Martin
- Department of Psychiatry, McGill University, Montreal; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | | | - Megan A. Pope
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada
| | | | | | - Greeshma Mohan
- Schizophrenia Research Foundation (SCARF), Chennai, India
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7
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Brown K, Parry S. How do people with first episode psychosis experience therapeutic relationships with mental health practitioners? A narrative review. PSYCHOSIS 2022. [DOI: 10.1080/17522439.2022.2160487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Katrina Brown
- Faculty of Health and Medicine, Lancaster University, Lancaster
| | - Sarah Parry
- Faculty of Health and Medicine, Lancaster University, Lancaster
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Le PD, Choe K, Burrone MS, Bello I, Velasco P, Arratia T, Tal D, Mascayano F, Jorquera MJ, Schilling S, Ramírez J, Arancibia D, Fader K, Conover S, Susser E, Dixon L, Alvarado R, Yang LH, Cabassa LJ. Initial adaptation of the OnTrack coordinated specialty care model in Chile: An application of the Dynamic Adaptation Process. FRONTIERS IN HEALTH SERVICES 2022; 2:958743. [PMID: 36925802 PMCID: PMC10012675 DOI: 10.3389/frhs.2022.958743] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/10/2022] [Indexed: 05/31/2023]
Abstract
Background In 2005, Chile became the first country in Latin America to guarantee universal free access for the diagnosis and treatment of schizophrenia. A cluster randomized control trial utilizing the Dynamic Adaptation Process framework is underway to adapt and test the OnTrack coordinated specialty care model to provide recovery-oriented, person-centered care by a multidisciplinary team for individuals with first episode psychosis (FEP) in Chile. Methods A qualitative formative research study was conducted to inform the initial adaptation of the OnTrack Chile (OTCH) program. We conducted key informant interviews (n = 17) with various stakeholders (policymakers; directors/managers of community mental health centers; mental health professionals) and focus group discussions (n = 6) with individuals with FEP and caregivers (n = 35 focus group participants total). Data was analyzed using thematic analysis, organized by participants' perspectives on the benefits, barriers, and recommendations for the key principles, multidisciplinary team, psychosocial components, and the training and supervision model of OnTrack. Results Participants expressed enthusiasm and support for OnTrack's recovery-oriented and person-centered principles of care. While many participants lauded the emphasis on shared decision-making and family involvement, some reported reticence, citing that it is culturally normative for patients and families to adopt a passive role in treatment. Peer specialists, and the family psychoeducation and support and supported education and employment components were perceived as aspects that could encourage the promotion of personhood and autonomy development. However, implementation challenges, including the prevailing biomedical approach, professional hierarchy, and the lack of infrastructure, human, and financial resources necessitate some modifications to these aspects. Some mental health professionals further conveyed reservations regarding the perceived hierarchical structure of the supervision model. Conclusion OnTrack represents a shift from a biomedical model to a valued, aspirational, person-centered and culturally responsive model that focuses on recovery, shared decision-making and psychosocial care. With the appropriate governmental and agency-level provision of resources and modifications to some of the program components, particularly regarding the shared decision-making framework, peer specialist, family engagement, and the training supervision model, OTCH could be a transformative program for a more comprehensive, evidence-based care for individuals with FEP in Chile.
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Affiliation(s)
- PhuongThao D. Le
- School of Global Public Health, New York University, New York, NY, United States
| | - Karen Choe
- School of Global Public Health, New York University, New York, NY, United States
| | | | - Iruma Bello
- New York State Psychiatric Institute, New York, NY, United States
| | - Paola Velasco
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | - Tamara Arratia
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | - Danielle Tal
- Department of Clinical Psychology, Teachers College Columbia University, New York, NY, United States
| | - Franco Mascayano
- New York State Psychiatric Institute, New York, NY, United States
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - María José Jorquera
- Departamento de Atención Primaria y Salud Familiar, Universidad de Chile, Santiago, Chile
| | - Sara Schilling
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Jorge Ramírez
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Diego Arancibia
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Kim Fader
- New York State Psychiatric Institute, New York, NY, United States
| | - Sarah Conover
- Silberman School of Social Work, Hunter College, New York, NY, United States
| | - Ezra Susser
- New York State Psychiatric Institute, New York, NY, United States
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, NY, United States
- Division of Behavioral Health Services and Policy Research & Center for Practice Innovations, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Rubén Alvarado
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Lawrence H. Yang
- School of Global Public Health, New York University, New York, NY, United States
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Leopoldo J. Cabassa
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, MO, United States
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Rajagukguk S, Suryani S, Sutini T, Tasijawa FA. The Experience of Caregivers with First-Episode Psychosis Children at General Hospital of Dumai, Riau Province. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Caregivers with first-episode psychosis (FEP) children often encounter problems and challenges. The importance of caregiver role in managing FEP appropriately will influence the life quality of a person with psychosis.
AIM: The study aimed to explore the experience of caregivers who have children with FEP at General Hospital of Dumai.
METHODS: The study was a qualitative study with a phenomenology approach. In-depth interviews were conducted with eight primary caregivers aged 41–58 years with FEP children at General Hospital of Dumai. The interview transcript was analyzed using the Colaizzi method.
RESULTS: Based on the study, five essential themes emerged, for example, caring for FEP is harder than looking after a thousand buffaloes, mixed feelings, believing that the child experiences mystical things, the extended family is a supporter in caring for FEP, and praying and surrender to God.
CONCLUSION: The implications for nursing practice are implementing support group therapy and family psychoeducation programs for reduce the caregiver burden.
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Johansen KK, Marcussen J, Hansen JP, Hounsgaard L, Fluttert F. Early recognition method for patients with schizophrenia or bipolar disorder in community mental health care: Illness insight, self-management and control. J Clin Nurs 2021; 31:3535-3549. [PMID: 34935221 DOI: 10.1111/jocn.16181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVE To investigate how participating in the early recognition method treatment strategy affect illness insight and management, in patients with schizophrenia or bipolar disorder in community mental healthcare. BACKGROUND The current practice in mental healthcare focus on shared decision-making and self-managing capacity, but poor insight is a predictor of poor adherence and dropout. Engagement in illness management and recovery predict the treatment response. DESIGN Semi-structured interviews with a phenomenological-hermeneutic approach. METHODS We conducted 36 semi-structured interviews with 26 patients. The interviews were conducted before and after participating in the intervention using the early recognition method strategy. The analysis was based on Ricoeur's theory of interpretation: Naive reading, structural analysis, interpretation and discussion. The COREQ checklist was used as reporting guideline. RESULTS The experience of participating in treatment as usual and early recognition method revealed two main themes. The first theme 'patient care' describes how dialogue and collaboration increase awareness of the illness and how to gain control. The second theme 'insight and experience' describes how illness affects personality and self-image, and how insight entails control and self-confidence. CONCLUSION Managing life with severe mental illness is complex and challenging. However, the experience of guidance, support and collaboration between patient and nurse are essential to improve these circumstances. RELEVANCE TO CLINICAL PRACTICE A systematic approach to the patient' symptoms, as in the early recognition method strategy, enhances knowledge of the individual patient' symptoms, both for nurse and patient. A knowledge that is significant for meeting individual treatment needs. Therefore, applying this strategy is likely to enhance collaboration and improve treatment outcome.
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Affiliation(s)
- Kirsten Kjaer Johansen
- Mental Health Department Esbjerg, University Clinic Region of Southern Denmark, Esbjerg N, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark, Aarhus C, Denmark
| | - Jette Marcussen
- OPEN, Institute of Clinical Research, University of Southern Denmark, Aarhus C, Denmark.,Department of Nursing and Health Sciences, University of Greenland, Nuuk, Greenland.,Faculty of Nursing, Health Science Research Center, University College Lillebaelt, Svendborg, Denmark
| | - Jens Peter Hansen
- Mental Health Department Esbjerg, University Clinic Region of Southern Denmark, Esbjerg N, Denmark.,Faculty of Health Sciences, CPS/Institute of Regional Health Research, University of Southern Denmark, Aarhus C, Denmark
| | - Lise Hounsgaard
- OPEN, Institute of Clinical Research, University of Southern Denmark, Aarhus C, Denmark.,Faculty of Health Sciences, CPS/Institute of Regional Health Research, University of Southern Denmark, Aarhus C, Denmark
| | - Frans Fluttert
- Faculty of Health Sciences, CPS/Institute of Regional Health Research, University of Southern Denmark, Aarhus C, Denmark.,FPC Dr. S. Van Mesdag, Groningen, The Netherlands.,Molde University College & Oslo University Hospital, Molde, Norway
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11
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Gire N, Caton N, McKeown M, Mohmed N, Duxbury J, Kelly J, Riley M, J Taylor P, Taylor CDJ, Naeem F, Chaudhry IB, Husain N. 'Care co-ordinator in my pocket': a feasibility study of mobile assessment and therapy for psychosis (TechCare). BMJ Open 2021; 11:e046755. [PMID: 34785541 PMCID: PMC8596054 DOI: 10.1136/bmjopen-2020-046755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The aim of the project was to examine the acceptability and feasibility of a mobile phone application-based intervention 'TechCare', for individuals with psychosis in the North West of England. The main objectives were to determine whether appropriate individuals could be identified and recruited to the study and whether the TechCare App would be an acceptable intervention for individuals with psychosis. METHODS This was a mixed methods feasibility study, consisting of a test-run and feasibility evaluation of the TechCare App intervention. SETTING Early Intervention Services (EIS) for psychosis, within an NHS Trust in the North West of England. PARTICIPANTS Sixteen participants (test-run n=4, feasibility study n=12) aged between 18 and 65 years recruited from the East, Central and North Lancashire EIS. INTERVENTION A 6-week intervention, with the TechCare App assessing participants' symptoms and responses in real-time and providing a personalised-guided self-help-based psychological intervention based on the principles of Cognitive Behaviorual Therapy (CBT). RESULTS A total of 83.33% (n=10) of participants completed the 6-week feasibility study, with 70% of completers achieving the set compliance threshold of ≥33% engagement with the TechCare App system. Analysis of the qualitative data suggested that participants held the view that the TechCare was both an acceptable and feasible means of delivering interventions in real-time. CONCLUSION Innovative digital clinical technologies, such as the TechCare App, have the potential to increase access to psychological interventions, reduce health inequality and promote self-management with a real-time intervention, through enabling access to mental health resources in a stigma-free, evidence-based and time-independent manner. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT02439619.
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Affiliation(s)
- Nadeem Gire
- Research, Lancashire Care NHS Trust, Preston, UK
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Neil Caton
- Research, Lancashire Care NHS Trust, Preston, UK
| | - Mick McKeown
- School of Nursing, University of Central Lancashire, Preston, UK
| | - Naeem Mohmed
- Research and Development, Lancashire Care NHS Foundation Trust, Blackburn, UK
| | - Joy Duxbury
- Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, UK
| | - James Kelly
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Miv Riley
- Research, Lancashire Care NHS Trust, Preston, UK
| | - Peter J Taylor
- Psychology and Mental Health, University of Manchester School of Psychological Sciences, Manchester, UK
| | - Christopher D J Taylor
- Secondary Care Psychological Therapies Service, Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Farooq Naeem
- Psychiatry, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Imran Bashir Chaudhry
- Psychiatry, Ziauddin University, Karachi, Pakistan
- Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Nusrat Husain
- Research, Lancashire Care NHS Trust, Preston, UK
- School of Health Sciences, Division of Psychology & Mental Health, The University of Manchester, Manchester, UK
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12
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Phillips R, McSherry P, Pinto C, Maguire T. Exploring Therapists' Experiences of Applying EMDR Therapy With Clients Experiencing Psychosis. JOURNAL OF EMDR PRACTICE AND RESEARCH 2021. [DOI: 10.1891/emdr-d-21-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Little is known of the usability of eye movement desensitization and reprocessing (EMDR) as an intervention for those experiencing psychosis. This study aimed to explore therapists' experience of using EMDR with this population. A qualitative design was employed using an inductive approach and a thematic analysis. Twenty therapists, who had used EMDR with this client group, took part in a semi-structured interview to explore their experiences of the intervention. Key themes were generated from the data: (a) familiarity with psychosis and EMDR, (b) acceptability of EMDR, (c) the importance of systemic factors, and (d) keeping key therapy principles in mind. Findings highlighted the importance of supervision to build therapist confidence, the value of the multidisciplinary team, and the need for a shift in beliefs surrounding the usefulness of EMDR to the wider system. Recommendations for individuals and services are provided.
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13
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Oluwoye O, Cheng SC, Fraser E, Stokes B, McDonell MG. Family Experiences Prior to the Initiation of Care for First-Episode Psychosis: A Meta-Synthesis of Qualitative Studies. JOURNAL OF CHILD AND FAMILY STUDIES 2020; 29:2530-2541. [PMID: 32863696 PMCID: PMC7454997 DOI: 10.1007/s10826-019-01695-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This study systematically reviewed existing qualitative evidence of family members' experiences prior to the initiation of mental health services for a loved one experiencing their first episode of psychosis (FEP). METHODS A meta-synthesis review of published peer-reviewed qualitative studies conducted between 2010 and 2019 were included. Keyword searches were performed in four electronic databases and the reference lists of primary manuscripts. Two independent reviewers used the Critical Appraisal Skills Programme (CASP) qualitative checklist to assess methodological quality of each study. RESULTS A total of 365 articles were initially identified and 9 were articles identified in a secondary review and literature search. A total of 21 met inclusion criteria. Of those included in this review 169, mothers were the primary family to recall experiences. The meta-synthesis identified four major themes related to family member experiences prior to the initiation of mental health services for FEP: the misinterpretation of signs, the emotional impact of FEP on family members, the effect of stigma on family members, and engaging with resources prior to mental health services for FEP. CONCLUSIONS Additional research is needed to develop healthy communication strategies that effectively deliver educational information about psychosis. This meta-synthesis also identified the need to understand help-seeking behaviors among families of those with FEP in effort to reduce the duration of untreated psychosis and improve pathways to care often initiated by a family member.
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Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Sunny Chieh Cheng
- Department of Nursing and Healthcare Leadership, University of Washington, Tacoma, WA, USA
| | - Elizabeth Fraser
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Bryony Stokes
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Michael G. McDonell
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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14
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Machado DM, Murta SG, da Costa II. Applying intervention mapping approach to a program for early intervention in first-episode mental crisis of a psychotic type. ACTA ACUST UNITED AC 2020; 33:3. [PMID: 32170555 PMCID: PMC7070112 DOI: 10.1186/s41155-020-00141-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 02/13/2020] [Indexed: 11/10/2022]
Abstract
The holotropic mind perspective, an integral part of the framework of transpersonal psychology, has been considered a revolutionary approach to a certain spectrum of experiences in Non-ordinary states of consciousness (NOSC) which conventional approaches tend to treat indiscriminately as pathological processes, because PHM recognizes in these experiences their healing and evolutionary potential. This article describes the needs assessment, implementation, and evaluation of an experiential and educational program on the holotropic mind perspective and its praxis, Holotropic Breathwork® (HB), with students and professionals from the Group for Early Intervention in First-Episode Mental Crisis of a Psychotic Type of the University of Brasilia. The intervention aimed to establish change goals and objectives that would promote the adoption of the holotropic mind perspective's elements, such as a framework to broaden and strengthen mental health programs that assist people experiencing NOSC. The stages developed, inspired by the Intervention Mapping protocol, included a needs assessment; elaboration of change objective matrices; selection and description of methods based on theory and their applications; conception, planning, and implementation of the intervention; and results evaluation. Participants reported that the intervention allowed the expansion of their theoretical-conceptual and technical frameworks, giving them a less pathologizing understanding of and approach to NOSC and allowing them to perceive and manage such states, not as indiscriminately pathological expressions, but as phenomena inherent to the human condition that can be accepted and cared for without the exclusionary and exhaustive bias of mental disorders. Limitations and practical implications are discussed.
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Affiliation(s)
- Daniela Martins Machado
- Department of Clinical Psychology, University of Brasília, Campus Darcy Ribeiro, Brasília, DF, 70910-900, Brazil. .,Health Sciences School, Foundation for Teaching and Research in Health Sciences of the State Health Department of the Federal District, Brasilia, Brazil.
| | - Sheila Giardini Murta
- Department of Clinical Psychology, University of Brasília, Campus Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Ileno Izídio da Costa
- Department of Clinical Psychology, University of Brasília, Campus Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
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15
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Loughlin M, Bucci S, Brooks J, Berry K. Service users' and carers' experiences of engaging with early intervention services: A meta-synthesis review. Early Interv Psychiatry 2020; 14:26-36. [PMID: 30912274 DOI: 10.1111/eip.12803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 01/14/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Abstract
AIM The provision and implementation of early intervention for psychosis services (early intervention services [EIS]) has received increasing attention over recent years. Maximizing engagement with EIS is of clinical and economic importance, and exploring the experiences of those who access EIS is vital. Although research has been conducted exploring the experiences of engaging with EIS from both a service user and carer/family member point of view, these data have not been systematically collated to generate new understanding. The primary aim of this study is to review, critically appraise and synthesize qualitative findings relating to the experiences of service users and/or carers and family members engaging with EIS. METHODS Four databases were systematically searched. Studies were analysed using an inductive thematic analysis approach, within a critical realist epistemological framework. Studies were critically appraised using the critical appraisal skills programme tool. RESULTS Fourteen papers were identified for inclusion. Three main themes were identified: the importance of a personal relationship with an EIS staff member, the impact of this relationship and consideration of life after EIS. The importance of a strong relationship with EIS staff was the most prominent theme throughout the papers reviewed. CONCLUSIONS The quality of the therapeutic relationship with at least one EIS staff member was the single most important factor in determining whether the experience of accessing EIS was a positive or negative one. The majority of the studies reviewed were conducted in the United Kingdom or Australia. Therefore, more research across countries is needed to understand transferability of findings.
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Affiliation(s)
- Matthew Loughlin
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Joanna Brooks
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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16
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Mui EYW, Chan SKW, Chan PY, Hui CLM, Chang WC, Lee EHM, Chen EYH. Systematic review (meta-aggregation) of qualitative studies on the experiences of family members caring for individuals with early psychosis. Int Rev Psychiatry 2019; 31:491-509. [PMID: 31547726 DOI: 10.1080/09540261.2019.1659236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the importance of the role of caregivers of people with psychosis being widely recognized, comprehensive understanding of their experience is limited. A thorough understanding of the experience of caregivers over the journey of the illness, particularly during its early stages, is crucial. Qualitative studies published between 1 January 1949 and 31 January 2018 were obtained from seven databases based on PICo search strategy. Meta-aggregation methodology of the Joanna Briggs Institute (JBI) was adopted to aggregate existing qualitative findings about caregivers' experiences. Twenty-eight qualitative studies on 635 caregivers and family members were included in the review. Six inter-related categories-'stigma', 'help-seeking', 'service encounter', 'emotional challenges', 'on becoming a caregiver' and 'making sense of experience'-were aggregated from 129 themes from the sub-acute stage, the acute stage and the recovery or residual stage. Three statements about caregivers' experiences of their relative's first episode of psychosis were synthesized from the findings. Results highlighted the need of incorporating caregiver intervention into the existing services to support the emotional challenges, uncertainty, and stigma-related burden along the caregiving journey.
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Affiliation(s)
- Esther Yee Wai Mui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China
| | - Sherry K W Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong SAR , China
| | - Pik Ying Chan
- Department of Social Work and Social Administration, The University of Hong Kong , Hong Kong SAR , China
| | - Christy L M Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China
| | - Wing C Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong SAR , China
| | - Edwin H M Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China
| | - Eric Y H Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong SAR , China
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17
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McCombe G, Harrold A, Brown K, Hennessy L, Clarke M, Hanlon D, O'Brien S, Lyne J, Corcoran C, McGorry P, Cullen W. Key Worker-Mediated Enhancement of Physical Health in First Episode Psychosis: Protocol For a Feasibility Study in Primary Care. JMIR Res Protoc 2019; 8:e13115. [PMID: 31293240 PMCID: PMC6652125 DOI: 10.2196/13115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/27/2019] [Accepted: 03/30/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Studies have demonstrated that, for patients with psychosis, a majority of the decline in health status and functioning emerges during the first few years after the onset of illness. This knowledge led to the development of specialized early intervention services (EISs) targeting patients experiencing their first episode of psychosis. The central component of EISs is often assertive case management delivered by a multidisciplinary team, where an appointed key worker is responsible for coordinating treatment and delivering various psychosocial interventions to service users. OBJECTIVE This paper outlines the protocol for a feasibility study examining how key workers may enhance physical health by supporting integration between primary and secondary care. METHODS Semistructured interviews were conducted with key stakeholder groups (General Practitioners and health care professionals working in mental health services). The interviews informed the development of the complex intervention involving a longitudinal pre-post intervention in 8 general practices in 2 regions in Ireland (one urban and one rural). Patients with first episode psychosis (FEP) will be identified from clinical records at general practices and mental health services. RESULTS Baseline and follow-up data (at 6 months) will be collected, examining measures of feasibility, acceptability, and intervention effect size. CONCLUSIONS Study findings will inform future practice by examining feasibility of key workers enhancing physical health through improved interaction between primary and secondary care. By identifying issues involved in enhancing recruitment and retention, as well as the likely effect size, the study will inform a future definitive intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13115.
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Affiliation(s)
- Geoff McCombe
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Aine Harrold
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Katherine Brown
- Dr Steeven's Hospital, Health Service Executive, Dublin, Ireland
| | | | | | | | | | - John Lyne
- Royal College of Surgeons Ireland, Dublin, Ireland.,North Dublin Mental Health Services, Dublin, Ireland
| | | | - Patrick McGorry
- University of Melbourne, Melbourne, Australia.,The National Centre of Excellence in Youth Mental Health, Orygen, Melbourne, Australia
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18
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McCann TV, Polacsek M, Lubman DI. Experiences of family members supporting a relative with substance use problems: a qualitative study. Scand J Caring Sci 2019; 33:902-911. [DOI: 10.1111/scs.12688] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 03/12/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Terence V. McCann
- Institute of Health and Sport Victoria University Melbourne Vic. Australia
| | - Meg Polacsek
- National Ageing Research Institute Melbourne Vic. Australia
| | - Dan I. Lubman
- Turning Point Eastern Health Clinical School Monash University Melbourne Vic. Australia
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19
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Tindall RM, Allott K, Simmons M, Roberts W, Hamilton BE. Engagement at entry to an early intervention service for first episode psychosis: an exploratory study of young people and caregivers. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2018. [DOI: 10.1080/17522439.2018.1502341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Rachel M Tindall
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Department of Nursing, The University of Melbourne, Melbourne, Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Magenta Simmons
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Winsome Roberts
- Department of Social Work, The University of Melbourne, Melbourne, Australia
| | - Bridget E Hamilton
- Department of Nursing, The University of Melbourne, Melbourne, Australia
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20
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Onwumere J, Sirykaite S, Schulz J, Man E, James G, Afsharzadegan R, Khan S, Harvey R, Souray J, Raune D. Understanding the experience of "burnout" in first-episode psychosis carers. Compr Psychiatry 2018; 83:19-24. [PMID: 29505884 DOI: 10.1016/j.comppsych.2018.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 01/23/2018] [Accepted: 02/05/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The first onset of psychosis can exert a significant negative impact on the functioning and positive wellbeing of family carers. Carer reports of "burnout" have recently been recorded in early psychosis carers, though the literature is scarce detailing our understanding of how burnout relates to the primary experience of caregiving. The current study investigated reports of burnout and its relationship with beliefs about caregiving and wellbeing in a large group of early psychosis carers who were routinely assessed within an early intervention team. METHODS AND MATERIALS Using a cross-sectional design, 169 early psychosis carers completed the Maslach Burnout Inventory alongside measures of caregiving experiences, affect and wellbeing. RESULTS The mean illness length for patients with psychosis was 18 months. Their mean age was 24.4 years and most was male (65%). The majority of carer participants were parental caregivers and living with their relative with psychosis. Across the three key burnout dimensions, 58% of the sample reported high levels of emotional exhaustion; 31% endorsed high levels of depersonalization; and 43% reported low levels personal accomplishment. The most severe level of burnout, reflecting elevated rates across all three dimensions, was observed in 16% of the sample. Carer burnout was positively associated with negative caregiving experiences (i.e. burden), poor affect, and reduced levels of positive wellbeing and perception of being in good health. CONCLUSIONS Reports by early psychosis carers of exhaustion, feeling inadequate and expressing negativity towards the relative they care for is not uncommon and are closely associated with their overall negative appraisals of caregiving. The results underscore the importance of developing targeted interventions during the early phase, which are designed to reduce the development and entrenchment of burnout responses in carers, but to also mitigate its negative sequelae.
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Affiliation(s)
- Juliana Onwumere
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
| | | | - Joerg Schulz
- Department of Psychology, University of Hertfordshire, UK
| | - Emma Man
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
| | - Gareth James
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
| | - Roya Afsharzadegan
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
| | - Sanna Khan
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
| | - Raythe Harvey
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
| | - Jonathan Souray
- Early Intervention in Psychosis Service, West London Mental Health NHS Trust, UK
| | - David Raune
- Early Intervention in Psychosis Service, Central and Northwest London NHS Foundation Trust, UK
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