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Maung HH. Externalist argument against medical assistance in dying for psychiatric illness. JOURNAL OF MEDICAL ETHICS 2023; 49:553-557. [PMID: 36175124 PMCID: PMC10423508 DOI: 10.1136/jme-2022-108431] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/23/2022] [Indexed: 05/20/2023]
Abstract
Medical assistance in dying, which includes voluntary euthanasia and assisted suicide, is legally permissible in a number of jurisdictions, including the Netherlands, Belgium, Switzerland and Canada. Although medical assistance in dying is most commonly provided for suffering associated with terminal somatic illness, some jurisdictions have also offered it for severe and irremediable psychiatric illness. Meanwhile, recent work in the philosophy of psychiatry has led to a renewed understanding of psychiatric illness that emphasises the role of the relation between the person and the external environment in the constitution of mental disorder. In this paper, I argue that this externalist approach to mental disorder highlights an ethical challenge to the practice of medical assistance in dying for psychiatric illness. At the level of the clinical assessment, externalism draws attention to potential social and environmental interventions that might have otherwise been overlooked by the standard approach to mental disorder, which may confound the judgement that there is no further reasonable alternative that could alleviate the person's suffering. At the level of the wider society, externalism underscores how social prejudices and structural barriers that contribute to psychiatric illness constrain the affordances available to people and result in them seeking medical assistance in dying when they otherwise might not have had under better social conditions.
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Affiliation(s)
- Hane Htut Maung
- Department of Politics Philosophy and Religion, Lancaster University, Lancaster, UK
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2
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van Veen M, Koekkoek B, Kloos M, Braam AW. Suicidal Behavior and Difficulty of Patients, as Perceived by Community Mental Health Nurses. J Psychiatr Pract 2023; 29:113-121. [PMID: 36928198 DOI: 10.1097/pra.0000000000000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Mental health professionals who work in community mental health services play an important role in treating patients after attempted suicide or deliberate self-injury. When such behaviors are interpreted negatively, patients may be seen as difficult, which may lead to ineffective treatment and mutual misunderstanding. OBJECTIVE The goal of this study was to assess the association between the grading of suicidality and perceived difficulty. We hypothesized that a higher grading of suicidality is associated with increased perceived difficulty. METHODS We analyzed cross-sectional data from 176 patients who participated in 2 cohort studies: 92 patients in the MATCH-cohort study and 84 patients in the Interpersonal Community Psychiatric Treatment (ICPT) study. The dependent variable was perceived difficulty, as measured by the Difficult Doctor-Patient Relationship Questionnaire (DDPRQ) and the Difficulty Single-item (DSI), a single item measuring the difficulty of the patient as perceived by the professional. Grading of suicidality was considered as the independent variable. Multiple linear and logistic regression was performed. RESULTS We found a significant association between perceived difficulty (DDPRQ) and high gradings of suicidality (B: 3.96; SE: 1.44; β: 0.21; P=0.006), increasing age (B: 0.09; SE: 0.03; β: 0.22; P<0.003), sex (female) (B: 2.33; SE: 0.83; β: 0.20; P=0.006), and marital status (being unmarried) (B: 1.92; SE: 0.85; β: 0.17; P=0.025). A significant association was also found between the DSI and moderate (odds ratio: 3.04; 95% CI: 1.355-6.854; P=0.007) and high (odds ratio: 7.11; 95% CI: 1.8.43-24.435; P=0.005) gradings of suicidality. CONCLUSION In this study, we found that perceived difficulty was significantly associated with moderate and high gradings of suicidality, increasing age, female sex, and being unmarried.
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van Veen M, Koekkoek B, Teerenstra S, Adang E, Mulder CL. Effectiveness and cost effectiveness of interpersonal community psychiatric treatment (ICPT) for people with long-term severe non-psychotic mental disorders: a multi-Centre randomized controlled trial. BMC Psychiatry 2021; 21:261. [PMID: 34011328 PMCID: PMC8136177 DOI: 10.1186/s12888-021-03264-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 05/05/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Long-term community mental health treatment for non-psychotic disorder patients with severe mental illness (SMI) who are perceived as difficult by clinicians, is poorly developed and lacks a structured, goal-centred approach. This study compares (cost-)effectiveness of Interpersonal Community Psychiatric Treatment (ICPT) with Care As Usual (CAU) on quality of life and clinician perceived difficulty in the care for non-psychotic disorder SMI-patients. A multi-centre cluster-randomized clinical tria was conducted in which Community Mental Health Nurses (Clinicians) in three large community mental health services in the Netherlands were randomly allocated to providing either ICPT or CAU to included patients. A total of 56 clinicians were randomized, who treated a total of 93 patients (59 in ICPT-group and 34 in CAU-group). METHODS Primary outcome measure is patient-perceived quality of life as measured by the Manchester Short Assessment of Quality of Life (MANSA). Secondary outcome measures include clinician-perceived difficulty, general mental health, treatment outcomes, illness management and recovery, therapeutic relationship, care needs and social network. Patients were assessed at baseline, during treatment (6 months), after treatment (12 months) and at 6 months follow-up (18 months). Linear mixed-effects models for repeated measurements were used to compare mean changes in primary and secondary outcomes between intervention and control group of patients over time on an intention to treat basis. Potential efficiency was investigated from a societal perspective. Economic evaluation was based on general principles of a cost-effectiveness analysis. Outcome measures for health economic evaluation, were costs, and Quality Adjusted Life Years (QALYs). RESULTS Half of the intended number of patients were recruited. There was no statistically significant treatment effect found in the MANSA (0.17, 95%-CI [- 0.058,0.431], p = 0.191). Treatment effects showed significant improvement in the Different Doctor-Patient Relationship Questionnaire-scores and a significant increase in the Illness Management and Recovery-scale Client-version scores). No effects of ICPT on societal and medical costs nor QALYs were found. CONCLUSIONS This is the first RCT to investigate the (cost)-effectiveness of ICPT. Compared with CAU, ICPT did not improve quality of life, but significantly reduced clinician-perceived difficulty, and increased subjective illness management and recovery. No effects on costs or QALY's were found. TRIAL REGISTRATION NTR 3988 , registered 13 May 2013.
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Affiliation(s)
- Mark van Veen
- Institute for Nursing studies, University of Applied Sciences, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands.
| | - Bauke Koekkoek
- grid.491369.00000 0004 0466 1666Research Group for Social Psychiatry and Mental Health Nursing, University of Applied Science, Nijmegen and Pro Persona Mental Health Services, Arnhem, the Netherlands
| | - Steven Teerenstra
- grid.10417.330000 0004 0444 9382Department for Health Evidence, section Biostatistics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Eddy Adang
- grid.10417.330000 0004 0444 9382Department for Health Evidence, section Biostatistics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Cornelis L. Mulder
- grid.5645.2000000040459992XDepartment of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC, Rotterdam, the Netherlands ,Psychiatric Institute, Rotterdam, the Netherlands
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Roughley M, Maguire A, Wood G, Lee T. Referral of patients with emotionally unstable personality disorder for specialist psychological therapy: why, when and how? BJPsych Bull 2021; 45:52-58. [PMID: 33504392 PMCID: PMC8058872 DOI: 10.1192/bjb.2020.48] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although we commonly work with patients with emotionally unstable personality disorder (EUPD) in community mental health teams (CMHTs), only some enter evidence-based psychological therapies. Many patients are not considered ready to engage in specialist treatments and remain in CMHTs without any clear focus or structure to their treatment, which is unsatisfactory for patients, clinicians and services. We present a fictional case and synthesise available literature and lived experience to explore readiness and ways to promote it. We highlight relevant issues for trainees to consider in practice. Patients with EUPD who have not received specialist treatment can be considered in terms of the transtheoretical model's stages of change. Identifying a patient's stage can help guide how to increase readiness for referral and decide when to refer. Interventions available to all healthcare professionals which may promote readiness include: psychoeducation, personal formulations, crisis planning, goal-setting, peer support, distress tolerance skills, motivational interviewing and mindfulness.
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Day C, Briskman J, Crawford MJ, Foote L, Harris L, Boadu J, McCrone P, McMurran M, Michelson D, Moran P, Mosse L, Scott S, Stahl D, Ramchandani P, Weaver T. An intervention for parents with severe personality difficulties whose children have mental health problems: a feasibility RCT. Health Technol Assess 2020; 24:1-188. [PMID: 32174297 PMCID: PMC7103915 DOI: 10.3310/hta24140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The children of parents with severe personality difficulties have greater risk of significant mental health problems. Existing care is poorly co-ordinated, with limited effectiveness. A specialised parenting intervention may improve child and parenting outcomes, reduce family morbidity and lower the service costs. OBJECTIVES To develop a specialised parenting intervention for parents affected by severe personality difficulties who have children with mental health problems and to conduct a feasibility trial. DESIGN A pragmatic, mixed-methods design to develop and pilot a specialised parenting intervention, Helping Families Programme-Modified, and to conduct a randomised feasibility trial with process evaluation. Initial cost-effectiveness was assessed using UK NHS/Personal Social Services and societal perspectives, generating quality-adjusted life-years. Researchers collecting quantitative data were masked to participant allocation. SETTING Two NHS mental health trusts and concomitant children's social care services. PARTICIPANTS Parents who met the following criteria: (1) the primary caregiver of the index child, (2) aged 18-65 years, (3) have severe personality difficulties, (4) proficient in English and (5) capable of providing informed consent. Index children who met the following criteria: (1) aged 3-11 years, (2) living with index parent and (3) have significant emotional/behavioural difficulties. Exclusion criteria were (1) having coexisting psychosis, (2) participating in another parenting intervention, (3) receiving inpatient care, (4) having insufficient language/cognitive abilities, (5) having child developmental disorder, (6) care proceedings and (7) index child not residing with index parent. INTERVENTION The Helping Families Programme-Modified - a 16-session intervention using structured, goal-orientated strategies and collaborative therapeutic methods to improve parenting, and child and parent functioning. Usual care - standard care augmented by a single psychoeducational session. MAIN OUTCOME MEASURES Trial feasibility - rates of recruitment, eligibility, allocation, retention, data completion and experience. Intervention acceptability - rates of acceptance, completion, alliance (Working Alliance Inventory-Short Revised) and experience. Outcomes - child (assessed via Concerns About My Child, Eyberg Child Behaviour Inventory, Child Behaviour Checklist-Internalising Scale), parenting (assessed via the Arnold-O'Leary Parenting Scale, Kansas Parental Satisfaction Scale), parent (assessed via the Symptom Checklist-27), and health economics (assessed via the Client Service Receipt Inventory, EuroQol-5 Dimensions). RESULTS The findings broadly supported trial feasibility using non-diagnostic screening criteria. Parents were mainly referred from one site (75.0%). Site and participant factors delayed recruitment. An estimate of eligible parents was not obtained. Of the 86 parents referred, 60 (69.7%) completed screening and 48 of these (80.0%) were recruited. Participants experienced significant disadvantage and multiple morbidity. The Helping Families Programme-Modified uptake (87.5%) was higher than usual-care uptake (62.5%). Trial retention (66.7%, 95% confidence interval 51.6% to 79.6%) exceeded the a priori rate. Process findings highlighted the impact of random allocation and the negative effects on retention. The Helping Families Programme-Modified was acceptable, with duration of delivery longer than planned, whereas the usual-care condition was less acceptable. At initial follow-up, effects on child and parenting outcomes were detected across both arms, with a potential outcome advantage for the Helping Families Programme-Modified (effect size range 0.0-1.3). For parental quality-adjusted life-years, the Helping Families Programme-Modified dominated usual care, and child quality-adjusted life-years resulted in higher costs and more quality-adjusted life-years. At second follow-up, the Helping Families Programme-Modified was associated with higher costs and more quality-adjusted life-years than usual care. For child quality-adjusted life-years, when controlled for baseline EuroQol-5 Dimensions, three-level version, usual care dominated the Helping Families Programme-Modified. No serious adverse events were reported. CONCLUSION The Helping Families Programme-Modified is an acceptable specialised parenting intervention. Trial methods using non-diagnostic criteria were largely supported. For future work, a definitive efficacy trial should consider site selection, recruitment methods, intervention efficiency and revised comparator condition. TRIAL REGISTRATION Current Controlled Trials ISRCTN14573230. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Crispin Day
- CAMHS Research Unit, Centre for Parent and Child Support, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, London, UK
| | - Jackie Briskman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mike J Crawford
- The Centre for Psychiatry, Department of Medicine, Imperial College London, London, UK
| | | | - Lucy Harris
- CAMHS Research Unit, Centre for Parent and Child Support, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, London, UK
| | - Janet Boadu
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul McCrone
- Institute of Lifecourse Development, University of Greenwich, London, UK
| | - Mary McMurran
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | | | - Paul Moran
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Liberty Mosse
- CAMHS Research Unit, Centre for Parent and Child Support, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, London, UK
| | - Stephen Scott
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Ramchandani
- PEDAL Research Centre, The Faculty of Education, University of Cambridge, Cambridge, UK
| | - Timothy Weaver
- Department of Mental Health, Social Work and Integrative Medicine, School of Health and Education, Middlesex University, London, UK
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Morris C, Smith I, Alwin N. Is contact with adult mental health services helpful for individuals with a diagnosable BPD? A study of service users views in the UK. J Ment Health 2015; 23:251-5. [PMID: 25222368 DOI: 10.3109/09638237.2014.951483] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Previous research in the UK has suggested that individuals with a diagnosable borderline personality disorder (BPD) have often found contact with adult mental health services unhelpful. In 2003, UK government guidance outlined how services might address this issue. Since this guidance, there has been little research that seeks to understand services users' experiences of services and provide information about how services might improve. AIMS To explore the experiences of individuals with a diagnosis of BPD in accessing adult mental health services and to better understand which aspects of contact with services can be helpful or unhelpful. METHODS Nine service users with a diagnosable BPD were recruited through voluntary sector services in England. Semi-structured interviews were used and interview data was analysed using an inductive thematic analysis. RESULTS Three themes were generated including "The diagnostic process influences how service users feel about BPD", "Non-caring care" and "It's all about the relationship". CONCLUSION The participants' accounts identify a number of practical points which services could implement to improve the experiences of service users.
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Affiliation(s)
- Charlotte Morris
- Tameside and Glossop Psychological Therapies Service, Pennine Care NHS Foundation Trust , Greater Manchester , UK
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Stringer B, van Meijel B, Karman P, Koekkoek B, Hoogendoorn AW, Kerkhof AJFM, Beekman ATF. Collaborative Care for Patients With Severe Personality Disorders: Preliminary Results and Active Ingredients From a Pilot Study (Part I). Perspect Psychiatr Care 2015; 51:180-9. [PMID: 25088207 DOI: 10.1111/ppc.12079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/19/2014] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To test if a collaborative care program (CCP) with nurses in a coordinating position is beneficial for patients with severe personality disorders. DESIGN AND METHODS A pilot study with a comparative multiple case study design using mixed methods investigating active ingredients and preliminary results. FINDINGS Most patients, their informal caregivers, and nurses value (parts of) the CCP positively; preliminary results show a significant decrease in severity of borderline symptoms. PRACTICE IMPLICATIONS With the CCP, we may expand the supply of available treatments for patients with (severe) personality disorders, but a larger randomized controlled trial is warranted to confirm our preliminary results.
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Affiliation(s)
- Barbara Stringer
- Department of Psychiatry and the EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam/GGZ inGeest, Amsterdam, The Netherlands.,Research Group Mental Health Nursing/Cluster Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Berno van Meijel
- Research Group Mental Health Nursing/Cluster Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Parnassia Academy, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Pieter Karman
- Psychiatric Centre Children and Adolescents, De Jutters Foundation, The Hague, The Netherlands
| | - Bauke Koekkoek
- ProCES, Pro Persona GGZ, Wolfheze, The Netherlands.,Research Group Social Psychiatry & Mental Health Nursing, HAN University of Applied Science, Nijmegen, The Netherlands
| | - Adriaan W Hoogendoorn
- Department of Psychiatry and the EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam/GGZ inGeest, Amsterdam, The Netherlands
| | - Ad J F M Kerkhof
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry and the EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam/GGZ inGeest, Amsterdam, The Netherlands
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van Veen M, Koekkoek B, Mulder N, Postulart D, Adang E, Teerenstra S, Schoonhoven L, van Achterberg T. Cost effectiveness of interpersonal community psychiatric treatment for people with long-term severe non-psychotic mental disorders: protocol of a multi-centre randomized controlled trial. BMC Psychiatry 2015; 15:100. [PMID: 25934175 PMCID: PMC4422542 DOI: 10.1186/s12888-015-0476-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 04/23/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aims for health gain and cost reduction in the care for people with long-term non-psychotic psychiatric disorders. Present care for this population has a limited evidence base, is often open ended, little effective, and expensive. Recent epidemiological data shows that 43.5% of the Dutch are affected by mental illness during their life. About 80% of all patients receiving mental health services (MHS) have one or more non-psychotic disorders. Particularly for this group, long-term treatment and care is poorly developed. Care As Usual (CAU) currently is a form of low-structured treatment/care. Interpersonal Community Psychiatric Treatment (ICPT) is a structured treatment for people with long-term, non-psychotic disorders, developed together with patients, professionals, and experts. ICPT uses a number of evidence-based techniques and was positively evaluated in a controlled pilot study. METHODS/DESIGN Multi-centre cluster-randomized clinical trial: 36 professionals will be randomly allocated to either ICPT or CAU for an intervention period of 12 months, and a follow-up of 6 months. 180 Patients between 18-65 years of age will be included, who have been diagnosed with a non-psychotic psychiatric disorder (depressive, anxiety, personality or substance abuse disorder), have long-term (>2 years) or high care use (>1 outpatient contact per week or >2 crisis contacts per year or >1 inpatient admission per year), and who receive treatment in a specialized mental health care setting. The primary outcome variable is quality of life; secondary outcomes are costs, recovery, general mental health, therapeutic alliance, professional-perceived difficulty of patient, care needs and social contacts. DISCUSSION No RCT, nor cost-effectiveness study, has been conducted on ICPT so far. The empirical base for current CAU is weak, if not absent. This study will fill this void, and generate data needed to improve daily mental health care. TRIAL REGISTRATION Netherlands Trial Register (NTR): 3988 . Registered 13th of May 2013.
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Affiliation(s)
- Mark van Veen
- Research Group Social Psychiatry & Mental Health Nursing, University of Applied Sciences Arnhem Nijmegen, PO Box 6960, Nijmegen, GL, 6503, The Netherlands.
- Altrecht Mental Health Services, Oude Arnhemseweg 260, Zeist, BK, 3705, The Netherlands.
| | - Bauke Koekkoek
- Research Group Social Psychiatry & Mental Health Nursing, University of Applied Sciences Arnhem Nijmegen, PO Box 6960, Nijmegen, GL, 6503, The Netherlands.
- Pro Persona Mental Health Services, Wolfheze 2 ProCES, Renkum, BE, 6874, The Netherlands.
| | - Niels Mulder
- Department of Psychiatry, Erasmus MC, University Medical Center, PO Box 2040, Rotterdam, CA, 3000, The Netherlands.
| | - Debby Postulart
- Department of Research and Development, GGZ Oost Brabant Mental Health Services, PO Box 3, Boekel, ZG, 5427, The Netherlands.
| | - Eddy Adang
- Epidemiology, Biostatistics & Health Technology Assessment, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, GA, 6525, The Netherlands.
| | - Steven Teerenstra
- Epidemiology, Biostatistics & Health Technology Assessment, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, GA, 6525, The Netherlands.
| | - Lisette Schoonhoven
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center Nursing science, PO Box 9101, Nijmegen, HB, 6500, The Netherlands.
- Faculty of Health Sciences Highfield, Southampton, University of Southampton, SO17 1BJ, Southampton, UK.
| | - Theo van Achterberg
- Centre for Health Services and Nursing Research, Kapucijnenvoer 35 blok d, box 7001, 3000, Leuven, Belgium.
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Bornovalova MA, Gratz KL, Daughters SB, Hunt ED, Lejuez CW. Initial RCT of a distress tolerance treatment for individuals with substance use disorders. Drug Alcohol Depend 2012; 122:70-6. [PMID: 21983476 PMCID: PMC3288895 DOI: 10.1016/j.drugalcdep.2011.09.012] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 09/08/2011] [Accepted: 09/10/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Psychological distress tolerance, the ability to persist in goal directed activity when experiencing psychological distress, is associated with poor substance use treatment outcomes including drug and alcohol treatment dropout and relapse. OBJECTIVE The current study examines if a brief distress tolerance intervention that was specifically developed as an adjunctive treatment for patients in residential substance abuse treatment shows efficacy in improving the patients' distress tolerance. METHODS Seventy-six individuals who were receiving treatment at a residential substance use treatment facility and indexed low distress tolerance on laboratory distress tolerance measures were randomized into three conditions: treatment-as-usual (TAU), six sessions of Supportive Counseling (SC), or six sessions of the novel distress tolerance treatment, Skills for Improving Distress Intolerance (SIDI). MEASURES Patients were assessed at baseline for DSM-IV psychiatric diagnoses, DSM-IV substance use disorders, distress tolerance, and depressive symptoms. Patients were again assessed at posttreatment. Therapeutic alliance and treatment expectancies and credibility were also assessed at posttreatment. RESULTS Patients who received SIDI (n=28) evidenced significantly greater improvements than SC (n=24) and TAU participants (n=24) on the distress tolerance laboratory measures, even when controlling for changes in negative affect (in the form of depression). Additionally, a higher percentage of patients in SIDI reached clinically significant improvement compared to patients in SC and TAU. CONCLUSION This study supports the efficacy of SIDI in improving distress tolerance levels among individuals with drug and alcohol use disorders currently receiving residential substance use treatment. SIDI appears to be a brief and feasible intervention for use within inpatient substance use facilities.
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Affiliation(s)
- Marina A Bornovalova
- Department of Psychology, University of South Florida, 4202 East Fowler Ave, Tampa, FL 33620, United
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10
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Interpersonal community psychiatric treatment for non-psychotic chronic patients and nurses in outpatient mental health care: a controlled pilot study on feasibility and effects. Int J Nurs Stud 2011; 49:549-59. [PMID: 22130506 DOI: 10.1016/j.ijnurstu.2011.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 10/08/2011] [Accepted: 11/04/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND In psychiatric care professionals perceive some patients as 'difficult', especially patients with long-term non-psychotic disorders. For these patients few evidence-based treatments exist. An intervention program, Interpersonal Community Psychiatric Treatment (ICPT), was developed by the authors. It was evaluated with the aim to increase effective behaviours by both patients and community psychiatric nurses (CPNs). OBJECTIVE To assess the feasibility and effectiveness of an intervention program for use by CPNs in the care of 'difficult' patients with non-psychotic chronic disorders, in a controlled pilot study. DESIGN A mixed-methods quasi-experimental study using process and outcome measures across several dimensions. Measurements took place at 0, 3, and 6 months. SETTINGS Three community mental health centres in the centre of The Netherlands. PARTICIPANTS 14 CPNs and 36 long-term non-psychotic patients who were perceived as 'difficult' were selected. Patients were offered either ICPT (20) or care as usual (16). All patients and CPNs could be followed up at all measurements. METHODS Quantitative data included type and severity of psychiatric disorder, psychosocial functioning, needs for care, quality of life and social participation. Also, service use, satisfaction with care, and quality of the therapeutic alliance were measured. Qualitative interviews were conducted with all CPNs and patients in the experimental group. RESULTS ICPT was found feasible by both CPNs and patients. Both the experimental and control condition showed improvement on a number of outcomes. ICPT, however, resulted in significantly better results in some areas. Patients' social network size increased and their care utilization decreased. Also, the quality of the working alliance increased and perceived patient difficulty decreased, both as scored by professionals. CONCLUSIONS ICPT is one of very few intervention programs aimed at 'difficult' non-psychotic chronic patients. In this pilot study was found that it can be successfully carried out by CPNs, is generally experienced as acceptable and useful by patients and CPNs alike, and results in some significantly better effects on both process and outcome measures. In the main study, some alterations will be made to the instruction manual and training program. Also, the diagnostic interview may be briefer, and the characteristics and treatment integrity of CPNs will be included in measurements. Further controlled and randomized research is needed to test the effectiveness of the program in a larger group of patients.
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Stringer B, van Meijel B, Koekkoek B, Kerkhof A, Beekman A. Collaborative Care for patients with severe borderline and NOS personality disorders: a comparative multiple case study on processes and outcomes. BMC Psychiatry 2011; 11:102. [PMID: 21699740 PMCID: PMC3135521 DOI: 10.1186/1471-244x-11-102] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 06/24/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Structured psychotherapy is recommended as the preferred treatment of personality disorders. A substantial group of patients, however, has no access to these therapies or does not benefit. For those patients who have no (longer) access to psychotherapy a Collaborative Care Program (CCP) is developed. Collaborative Care originated in somatic health care to increase shared decision making and to enhance self management skills of chronic patients. Nurses have a prominent position in CCP's as they are responsible for optimal continuity and coordination of care. The aim of the CCP is to improve quality of life and self management skills, and reduce destructive behaviour and other manifestations of the personality disorder. METHODS/DESIGN Quantitative and qualitative data are combined in a comparative multiple case study. This makes it possible to test the feasibility of the CCP, and also provides insight into the preliminary outcomes of CCP. Two treatment conditions will be compared, one in which the CCP is provided, the other in which Care as Usual is offered. In both conditions 16 patients will be included. The perspectives of patients, their informal carers and nurses are integrated in this study. Data (questionnaires, documents, and interviews) will be collected among these three groups of participants. The process of treatment and care within both research conditions is described with qualitative research methods. Additional quantitative data provide insight in the preliminary results of the CCP compared to CAU. With a stepped analysis plan the 'black box' of the application of the program will be revealed in order to understand which characteristics and influencing factors are indicative for positive or negative outcomes. DISCUSSION The present study is, as to the best of our knowledge, the first to examine Collaborative Care for patients with severe personality disorders receiving outpatient mental health care. With the chosen design we want to examine how and which elements of the CC Program could contribute to a better quality of life for the patients. TRIAL REGISTRATION Netherlands Trial Register (NTR): NTR2763.
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Affiliation(s)
- Barbara Stringer
- Department of Psychiatry and EMGO institute, VU University Medical Center/GGZ inGeest, Amsterdam, the Netherlands
- Research Group Mental Health Nursing, Inholland University for Applied Sciences, Amsterdam, the Netherlands
| | - Berno van Meijel
- Research Group Mental Health Nursing, Inholland University for Applied Sciences, Amsterdam, the Netherlands
| | - Bauke Koekkoek
- Propersona, Centre for Education and Science, ProPersona, Wolfheze, the Netherlands
- Research Group Social Psychiatry & Mental Health Nursing, HAN University of Applied Science, Nijmegen, the Netherlands
| | - Ad Kerkhof
- Department of Clinical Psychology and EMGO institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Aartjan Beekman
- Department of Psychiatry and EMGO institute, VU University Medical Center/GGZ inGeest, Amsterdam, the Netherlands
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Koekkoek B, van Meijel B, Schene A, Hutschemaekers G. Development of an intervention program to increase effective behaviours by patients and clinicians in psychiatric services: Intervention Mapping study. BMC Health Serv Res 2010; 10:293. [PMID: 20973985 PMCID: PMC2987792 DOI: 10.1186/1472-6963-10-293] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 10/25/2010] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Health clinicians perceive certain patients as 'difficult' across all settings, including mental health care. In this area, patients with non-psychotic disorders that become long-term care users may be perceived as obstructing their own recovery or seeking secondary gain. This negative perception of patients results in ineffective responses and low-quality care by health clinicians. Using the concept of illness behaviour, this paper describes the development, implementation, and planned evaluation of a structured intervention aimed at prevention and management of ineffective behaviours by long-term non-psychotic patients and their treating clinicians. METHODS The principles of Intervention Mapping were applied to guide the development, implementation, and planned evaluation of the intervention. Qualitative (individual and group interviews), quantitative (survey), and mixed methods (Delphi-procedure) research was used to gain a broad perspective of the problem. Empirical findings, theoretical models, and existing evidence were combined to construct a program tailored to the needs of the target groups. RESULTS A structured program to increase effective illness behaviour in long-term non-psychotic patients and effective professional behaviour in their treating clinicians was developed, consisting of three subsequent stages and four substantial components, that is described in detail. Implementation took place and evaluation of the intervention is being carried out. CONCLUSIONS Intervention Mapping proved to be a suitable method to develop a structured intervention for a multi-faceted problem in mental health care.
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Affiliation(s)
- Bauke Koekkoek
- ProPersona Mental Health Care, Pro Persona Centre for Education and Science, Wolfheze
- Altrecht Mental Health Care, Zeist, The Netherlands
| | - Berno van Meijel
- InHolland University for Applied Sciences, Research Group Mental Health Nursing, Amsterdam, The Netherlands
| | - Aart Schene
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Giel Hutschemaekers
- ProPersona Mental Health Care, Pro Persona Centre for Education and Science, Wolfheze
- Radboud University, Academic Centre of Social Sciences, Nijmegen, The Netherlands
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