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Herinckx H, Gubrud P, Kerlinger A, Cellarius K. Identifying Competencies of the ACT Program Nurse Using the DACUM Method. Issues Ment Health Nurs 2024; 45:607-616. [PMID: 38593458 DOI: 10.1080/01612840.2024.2328255] [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: 04/11/2024]
Abstract
The nurse role on an Assertive Community Treatment (ACT) team requires a specialized set of skills in psychiatric community-based care. While the ACT model has existed for fifty years, no nationally recognized standard curriculum to train ACT nurses has been developed. The ACT Nursing Project described in this paper aimed to create a competency-based on-board training program using the Developing a Curriculum (DACUM) method. Eight ACT nurses from three states served as the expert panel to create a DACUM chart detailing the full set of nine duties and 127 tasks required of ACT nurses. To verify the DACUM results, 57 ACT nurses from four states completed a survey and confirmed that 80% of the tasks identified by the expert panel were also performed by the validation sample of ACT nurses. This paper describes how the DACUM duties and tasks provided the framework to develop onboard training curriculum for ACT program nurses. The next step is to pilot the onboard training curriculum to newly hired ACT nurses to ensure they are equipped to meet the complex needs of people living with serious mental illness, and to increase their competency, job satisfaction and decrease the high annual turnover rate among ACT nurses.
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Affiliation(s)
- Heidi Herinckx
- Oregon Centers of Excellence, Options for Southern Oregon, Grants Pass, Oregon, USA
| | - Paula Gubrud
- Nursing Education Connections and OHSU School of Nursing, Portland, Oregon, USA
| | - Alyssa Kerlinger
- Oregon Center of Excellence for Assertive Community Treatment, Options for Southern Oregon, Grants Pass, Oregon, USA
| | - Karen Cellarius
- School of Social Work, Human Services Implementation Lab at the Portland State University Regional Research Institute, Portland, Oregon, USA
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Herizchi S, Shafiee-Kandjani AR, Farahbakhsh M, Jahangiri Z, Ghanbarzadeh Javid S, Azizi H. Efficacy of Rivastigmine Augmentation on Positive and Negative Symptoms, General Psychopathology, and Quality of Life in Patients with Chronic Schizophrenia: A Randomized Controlled Trial. PSYCHOPHARMACOLOGY BULLETIN 2024; 54:15-27. [PMID: 38601834 PMCID: PMC11003261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
The study aimed to assess Rivastigmine augmentation on positive and negative symptoms (PNSs), general psychopathology, and quality of life in patients with chronic Schizophrenia. A double-blind, parallel-design, randomized, placebo-controlled trial of 60 schizophrenia patients was conducted. Intervention group received rivastigmine 3 mg/day + Treatment as Usual (TAU) and the control group: TAU + placebo. Negative and positive symptoms, general psychopathology; and quality of life were measured using Positive and Negative Symptom Scale (PANSS) and Manchester Short Assessment of Quality of Life (MANSA). T-test, ANOVA, and the general univariate linear model tests were used for the analyses. Out of 60 participants, 52 (86.6%) were male. At baseline, no significant relationship was found for demographic and clinical characteristics between intervention and control groups. Between-group analysis indicated that all outcome measures PNSs, general psychopathology symptoms, and QoL score in rivastigmine group was significantly improved (p = 0.001). According to within-group analysis, a significant association was found between Rivastigmine and placebo groups in PNSs (p < 0.05). Rivastigmine augmentation improved PNSs and psychopathology in schizophrenia patients. However, no significant association found for improving the life quality after 8 weeks treatment.
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Affiliation(s)
- Sepideh Herizchi
- Herizchi, Associate Professor of Psychiatry, Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Science, Tabriz, Iran, ORCID: 0000-0002-0299-1122
| | - Ali Reza Shafiee-Kandjani
- Shafiee-Kandjani, Professor of Psychiatry, Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Mostafa Farahbakhsh
- Farahbakhsh, Assistant Professor of Psychiatry, Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Zahra Jahangiri
- Jahangiri, MD, Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Shahriyar Ghanbarzadeh Javid
- Ghanbarzadeh Javid, MD, Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hosein Azizi
- Azizi, Assistant Professor of Epidemiology, Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Evans M, Cuddeback GS, Golin C, Muessig K, Bellamy C, Costa M, O'Connell M, Fisher EB. Diverse elements comprising studies of peer support complicate evidence synthesis. J Ment Health 2024:1-15. [PMID: 38556804 DOI: 10.1080/09638237.2024.2332798] [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: 02/24/2023] [Accepted: 01/20/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Innovative approaches to care, such as peer support, are needed to address the substantial and frequently unmet needs of people with serious mental illnesses such as schizophrenia. Although peer support services continue to expand in mental healthcare, findings of effectiveness from systematic reviews are mixed. However, the studies evaluated in these reviews consisted of diverse elements which the review methods neglected to consider. AIMS This review aims to demonstrate the substantial diversity in intervention components and measured outcomes among studies of peer support and lay the groundwork for more focused reviews of individual intervention components. METHODS As part of a realist review of the literature, here we synthesize evidence in a way that examines the substantial diversity in intervention components and measured outcomes comprising studies of peer support. RESULTS Seven categories of outcomes were represented, including recovery, symptoms and functioning, and care utilization. Importantly, seven distinct intervention components were represented in 26 studies: "being there," assistance in self-management, linkage to clinical care and community resources, social and emotional support, ongoing support, explicit utilization of shared lived experience or peer support values, and systems advocacy. Reflecting diversity in approaches, no study reported all intervention components, and no component was found among all studies. IMPLICATIONS Peer support services constitute a category of intervention approaches far too varied to evaluate as a single entity. Results suggest intervention components deserving more focused research, including assistance in self-management, "being there," and explicit utilization of shared lived experience or peer support values. PRISMA/PROSPERO As this article reports results from a realist review of the literature, we did not follow the PRISMA guidance which is suitable for systematic reviews. We did follow the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines.This review was not registered on PROSPERO as it is not a systematic review.
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Affiliation(s)
- Megan Evans
- Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Gary S Cuddeback
- School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Carol Golin
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kathryn Muessig
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Chyrell Bellamy
- Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Mark Costa
- Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Maria O'Connell
- Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Edwin B Fisher
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Kent J, Pinkham A. Cerebral and cerebellar correlates of social cognitive impairment in schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2024; 128:110850. [PMID: 37657639 DOI: 10.1016/j.pnpbp.2023.110850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/26/2023] [Accepted: 08/28/2023] [Indexed: 09/03/2023]
Abstract
Social cognition is a broad construct encompassing the ways in which individuals perceive, process, and use information about other people. Social cognition involves both lower- and higher-level processes such as emotion recognition and theory of mind, respectively. Social cognitive impairments have been repeatedly demonstrated in schizophrenia spectrum illnesses and, crucially, are related to functional outcomes. In this review, we summarize the literature investigating the brain networks implicated in social cognitive impairments in schizophrenia spectrum illnesses. In addition to cortical and limbic loci and networks, we also discuss evidence for cerebellar contributions to social cognitive impairment in this population. We conclude by synthesizing these two literatures, with an emphasis on current knowledge gaps, particularly in regard to cerebellar influences, and future directions.
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Affiliation(s)
- Jerillyn Kent
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Amy Pinkham
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States.
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Moon KJ, Stephenson S, Hasenstab KA, Sridhar S, Seiber EE, Breitborde NJK, Nawaz S. Policy Complexities in Financing First Episode Psychosis Services: Implementation Realities from a Home Rule State. J Behav Health Serv Res 2024; 51:132-145. [PMID: 38017296 DOI: 10.1007/s11414-023-09865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/30/2023]
Abstract
Over the past decade, significant investments have been made in coordinated specialty care (CSC) models for first episode psychosis (FEP), with the goal of promoting recovery and preventing disability. CSC programs have proliferated as a result, but financing challenges imperil their growth and sustainability. In this commentary, the authors discuss (1) entrenched and emergent challenges in behavioral health policy of consequence for CSC financing; (2) implementation realities in the home rule context of Ohio, where significant variability exists across counties; and (3) recommendations to improve both care quality and access for individuals with FEP. The authors aim to provoke careful thought about policy interventions to bridge science-to-service gaps, and in this way, advance behavioral health equity.
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Affiliation(s)
- Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kathryn A Hasenstab
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Srinivasan Sridhar
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Eric E Seiber
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA.
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA.
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Moureau L, Verhofstadt M, Liégeois A. Mapping the ethical aspects in end-of-life care for persons with a severe and persistent mental illness: A scoping review of the literature. Front Psychiatry 2023; 14:1094038. [PMID: 37009126 PMCID: PMC10062453 DOI: 10.3389/fpsyt.2023.1094038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
Persons with severe and persistent mental illness (SPMI) make up a vulnerable group within mental healthcare and society. Not only do they suffer from long-term, serious psychiatric disorders; they often also experience considerable problems in their psychosocial functioning. Research has disclosed that the care needs of this target group are complex, and that the life expectancy of these persons is significantly lower than in the general population. Given (1) the lower life expectancy of persons with SPMI, (2) the higher suicide risk related to mental disorders, and (3) the legalization and practice of medical assistance in dying in an increasing number of countries, it is of utmost importance to map the ethical aspects and challenges of end-of-life care needs in persons with SPMI. Therefore, we charted the way end-of-life care is provided for them by means of a scoping review of the scientific literature, with an emphasis on the ethical aspects surrounding it. We explore existing ethical dilemmas; the underlying ethical values, principles and attitudes; and the locus and stakeholders of ethical dialog regarding end-of-life care in persons with SPMI. The results indicate that the four guiding principles of biomedical ethics can well be identified in the literature, and are each addressed in their own specific way: Autonomy in relation to questions regarding the decision-making capacity of persons with SPMI; Justice in relation to access to quality care and the presence of stigma; and Non-maleficence and Beneficence in relation to the ongoing debate regarding the benefits and obstacles in applying palliative care approaches in the context of psychiatry, and the status of the futility-concept therein. Personal virtues and attitudes in care professionals, like compassion, non-abandonment and upholding dignity are key, as care professionals are the main advocates of persons with SPMI, which often lack an extensive social network. Further, we find that the ethical dialog is mainly focused on care professionals and relatives, rather than the persons with SPMI themselves. This is reflected in the existing research that often had the voices of the latter missing. Future research may benefit from the inclusion of persons with SMPI’s first-hand accounts. End-of-life care for persons with SPMI may benefit from identifying and integrating (locally developed) good practices like cross-sectoral education, specific care models, and ethics support.
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Affiliation(s)
- Loïc Moureau
- Faculty of Theology and Religious Studies, KU Leuven, Leuven, Belgium
- *Correspondence: Loïc Moureau,
| | - Monica Verhofstadt
- Medical and Health Sciences, Ghent University, Ghent, East Flanders, Belgium
| | - Axel Liégeois
- Faculty of Theology and Religious Studies, KU Leuven, Leuven, Belgium
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Cogley C, Carswell C, Bramham K, Chilcot J. Chronic Kidney Disease and Severe Mental Illness: Addressing Disparities in Access to Health Care and Health Outcomes. Clin J Am Soc Nephrol 2022; 17:1413-1417. [PMID: 35361628 PMCID: PMC9625106 DOI: 10.2215/cjn.15691221] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Individuals with severe mental illness, including conditions such as schizophrenia and bipolar disorder, are at a higher risk of developing CKD. Higher incidences of CKD in this population can be partially explained by known risk factors, such as the use of lithium treatment and higher rates of cardiovascular disease. However, this does not fully explain the higher proportion of CKD in individuals with severe mental illness, and further research investigating the factors influencing disease onset and progression is needed. Similarly, although it is well documented that mental health difficulties, such as depression and anxiety, are highly prevalent among individuals with CKD, there is a lack of published data regarding the rates of severe mental illness in individuals with CKD. Furthermore, for individuals with CKD, having severe mental illness is associated with poor health outcomes, including higher mortality rates and higher rates of hospitalizations. Evidence also suggests that individuals with severe mental illness receive suboptimal kidney care, have fewer appointments with nephrologists, and are less likely to receive a kidney transplant. Limited research suggests that care might be improved through educating kidney health care staff regarding the needs of patients with severe mental illness and by facilitating closer collaboration with psychiatry. Further research investigating the rates of severe mental illness in patients with CKD, as well as the barriers and facilitators to effective care for this population, is clearly required to inform the provision of appropriate supports and to improve health outcomes for individuals with CKD and co-occurring severe mental illness.
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Affiliation(s)
- Clodagh Cogley
- Department of Psychology, University College Dublin, Dublin, Ireland
| | - Claire Carswell
- Department of Health Sciences, University of York, Heslington, York, United Kingdom
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Kate Bramham
- Department of Women and Children’s Health, King’s College London, London, United Kingdom
| | - Joseph Chilcot
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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Ma F, Anto MM. Importance of mental health awareness among school teachers in bridging mental health treatment gap in India. Int J Soc Psychiatry 2022; 68:233-236. [PMID: 33525932 DOI: 10.1177/0020764021991889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fathima Ma
- Department of Psychology, Prajyoti Niketan College, Research Center under University of Calicut, Pudukkad, Kerala, India
| | - Milu Maria Anto
- Department of Psychology, Prajyoti Niketan College, Research Center under University of Calicut, Pudukkad, Kerala, India
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AshaRani PV, Tan YWB, Samari E, Wang P, Cetty L, Satghare P, Ho J, Koh SA, Zhong Yi L, Tang C, Verma S, Subramaniam M. Needs of patients with early psychosis: A comparison of patient's and mental health care provider's perception. Front Psychiatry 2022; 13:952666. [PMID: 36203834 PMCID: PMC9531114 DOI: 10.3389/fpsyt.2022.952666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/26/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Needs define the capacity of a patient to benefit from health care services and a systematic assessment of needs allows planning and delivery of effective treatment to suit patients. This study aimed to understand the (a) needs felt by patients and those perceived by the care providers (CPs), (b) agreement between patients and CPs in the identified needs and (c) factors associated with unmet needs. METHODS Participants (N = 215) were recruited through convenience sampling from the Early Psychosis Intervention Programme (EPIP). Data was captured from patients and CPs using the Camberwell Assessment of Needs Short Appraisal Schedule (CANSAS). RESULTS Patients and CPs identified an average of 4.06 and 3.84 needs, respectively. The highest number of unmet needs were identified for the social (50% of patients and CPs) and health domains (31.13% of patients' vs. 28.30% of CPs). Company, intimate relationships, psychotic symptoms, money, sexual expression and psychological distress, information and benefits were the unmet needs identified by patients, whereas company, intimate relationships, physical health, and daytime activities were identified by CPs. The concordance between patients and CPs was low with majority of the items scoring slight to fair agreement (Cohen's kappa = 0-0.4). Older age, depression, severe anxiety and having Obsessive-Compulsive Disorder (OCD) were positively associated with unmet needs in patients. CONCLUSION While there was an overall consensus on the total needs and met needs between patients and CPs, the level of agreement between the two groups on various items were low. Different perceptions regarding unmet needs were noted between the groups. A holistic approach that takes into account different facets of the needs of patients together with strategic planning to address unmet needs might improve treatment outcomes and satisfaction.
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Affiliation(s)
- P V AshaRani
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Ellaisha Samari
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Peizhi Wang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Laxman Cetty
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Pratika Satghare
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Jayne Ho
- Early Psychosis Intervention Programme, Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Shiyun Astelle Koh
- Early Psychosis Intervention Programme, Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Lee Zhong Yi
- Early Psychosis Intervention Programme, Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Charmaine Tang
- Early Psychosis Intervention Programme, Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Swapna Verma
- Early Psychosis Intervention Programme, Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Morozov P, Bekker R, Bykov Y. Cariprazine's Potential in Improving Social Dysfunction in Patients With Schizophrenia: A Perspective. Front Psychiatry 2022; 13:868751. [PMID: 35573354 PMCID: PMC9091654 DOI: 10.3389/fpsyt.2022.868751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
Social dysfunction is one of the most debilitating aspects of schizophrenia. Treatment of this complex phenomenon, constituted by negative, cognitive, and affective symptoms, has been difficult with the available pharmacological agents, hence it represents an unmet medical need. Cariprazine, a novel, third-generation antipsychotic with a unique mechanism of action has been proven to sufficiently alleviate negative, cognitive, and affective symptoms of schizophrenia. These characteristics make this compound a valid candidate for addressing social dysfunction too. In this perspective, we argue that cariprazine can be viewed as a "socializing drug" that has the ability to improve the patient's functionality and ultimately their quality of life. Data from animal research, clinical trials, an observational study, and patient cases are provided.
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Affiliation(s)
- Petr Morozov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Roman Bekker
- Ben-Gurion University of the Negev, Beersheba, Israel
| | - Youri Bykov
- Stavropol State Medical University, Stavropol, Russia
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Dellazizzo L, Potvin S, Phraxayavong K, Giguère S, Hamidi LN, Dumais A. L’amélioration de la qualité de vie chez les patients atteints d’une schizophrénie réfractaire ayant suivi la Thérapie assistée par la Réalité Virtuelle : une analyse de contenu. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1081514ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectifs La schizophrénie, en particulier la schizophrénie résistante aux traitements (SRT), est considérée comme l’un des troubles psychiatriques les plus invalidants en termes d’effets indésirables sur la qualité de vie (QV) des patients. La QV subjective est devenue une cible particulièrement cruciale qui devrait être améliorée avec le traitement, car une QV améliorée peut entraîner le rétablissement chez les patients atteints de schizophrénie. Il existe cependant peu de preuves des effets des interventions psychosociales recommandées sur les mesures non symptomatiques comme la QV. À cet égard, le traitement de la schizophrénie peut être renforcé si, en plus du traitement des symptômes, l’accent thérapeutique est mis sur d’autres sphères importantes pour les patients. Avec les progrès technologiques, la Thérapie assistée par la Réalité Virtuelle (TRV) permet aux entendeurs de voix d’entrer en dialogue direct avec un avatar, animé entièrement par le thérapeute, qui représente leur voix la plus persécutrice. Ceci dans le but de leur permettre d’acquérir un meilleur contrôle sur leurs voix et de travailler sur leur estime de soi. Au-delà de la symptomatologie, les résultats des projets pilotes sur cette thérapie innovante ont montré des résultats significatifs sur la QV.
Méthode Afin de peaufiner les résultats quantitatifs trouvés, cet article a exploré les thèmes émergents d’une analyse de contenu découlant du discours spontané de 10 patients ayant bien répondu à la TRV.
Résultats Quatre thèmes généraux ont émergé : 1) impact de la thérapie sur les voix ; 2) relations interpersonnelles ; 3) bien-être psychologique ; et 4) mode de vie. Cette analyse de contenu a permis d’identifier plusieurs sphères de vie qui sont davantage améliorées chez les patients ayant une SRT à l’aide de la TRV.
Conclusion : La TRV met en évidence l’avenir des approches adaptées aux objectifs des patients qui intègrent plusieurs processus pertinents pour potentiellement améliorer leur QV. La TRV peut avoir des implications potentiellement immenses sur la santé et la qualité de vie des patients. Cette étude fut une première étape vers l’exploration des effets subjectifs de la TRV sur la vie des patients au-delà des symptômes.
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Affiliation(s)
- Laura Dellazizzo
- Centre de recherche de l’Institut Universitaire en Santé mentale de Montréal, Montréal, Canada ; Faculté de Médecine, Université de Montréal, Montréal, Canada
| | - Stéphane Potvin
- Centre de recherche de l’Institut Universitaire en Santé mentale de Montréal, Montréal, Canada ; Faculté de Médecine, Université de Montréal, Montréal, Canada
| | | | - Sabrina Giguère
- Centre de recherche de l’Institut Universitaire en Santé mentale de Montréal, Montréal, Canada ; Faculté de Médecine, Université de Montréal, Montréal, Canada
| | - Lyna-Nour Hamidi
- Centre de recherche de l’Institut Universitaire en Santé mentale de Montréal, Montréal, Canada ; Faculté de Médecine, Université de Montréal, Montréal, Canada
| | - Alexandre Dumais
- Centre de recherche de l’Institut Universitaire en Santé mentale de Montréal, Montréal, Canada ; Faculté de Médecine, Université de Montréal, Montréal, Canada ; Services et Recherches Psychiatriques AD, Montréal, Canada ; Institut national de psychiatrie légale Philippe-Pinel, Montréal, Canada
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12
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Dellazizzo L, Potvin S, Phraxayavong K, Dumais A. One-year randomized trial comparing virtual reality-assisted therapy to cognitive-behavioral therapy for patients with treatment-resistant schizophrenia. NPJ SCHIZOPHRENIA 2021; 7:9. [PMID: 33580033 PMCID: PMC7881089 DOI: 10.1038/s41537-021-00139-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/09/2020] [Indexed: 01/16/2023]
Abstract
The gold-standard cognitive-behavioral therapy (CBT) for psychosis offers at best modest effects. With advances in technology, virtual reality (VR) therapies for auditory verbal hallucinations (AVH), such as AVATAR therapy (AT) and VR-assisted therapy (VRT), are amid a new wave of relational approaches that may heighten effects. Prior trials have shown greater effects of these therapies on AVH up to a 24-week follow-up. However, no trial has compared them to a recommended active treatment with a 1-year follow-up. We performed a pilot randomized comparative trial evaluating the short- and long-term efficacy of VRT over CBT for patients with treatment-resistant schizophrenia. Patients were randomized to VRT (n = 37) or CBT (n = 37). Clinical assessments were administered before and after each intervention and at follow-up periods up to 12 months. Between and within-group changes in psychiatric symptoms were assessed using linear mixed-effects models. Short-term findings showed that both interventions produced significant improvements in AVH severity and depressive symptoms. Although results did not show a statistically significant superiority of VRT over CBT for AVH, VRT did achieve larger effects particularly on overall AVH (d = 1.080 for VRT and d = 0.555 for CBT). Furthermore, results suggested a superiority of VRT over CBT on affective symptoms. VRT also showed significant results on persecutory beliefs and quality of life. Effects were maintained up to the 1-year follow-up. VRT highlights the future of patient-tailored approaches that may show benefits over generic CBT for voices. A fully powered single-blind randomized controlled trial comparing VRT to CBT is underway.
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Affiliation(s)
- Laura Dellazizzo
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and addictology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Stéphane Potvin
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and addictology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | | | - Alexandre Dumais
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.
- Department of Psychiatry and addictology, Faculty of Medicine, University of Montreal, Montreal, Canada.
- Services et Recherches Psychiatriques AD, Montreal, Canada.
- Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada.
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13
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Thakkar KN, Ghermezi L, Silverstein SM, Slate R, Yao B, Achtyes ED, Brascamp JW. Stronger tilt aftereffects in persons with schizophrenia. JOURNAL OF ABNORMAL PSYCHOLOGY 2020; 130:186-197. [PMID: 33301337 DOI: 10.1037/abn0000653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Individuals with schizophrenia may fail to appropriately use temporal context and apply past environmental regularities to the interpretation of incoming sensory information. Here we use the visual system as a test bed for investigating how prior experience shapes perception in individuals with schizophrenia. Specifically, we use visual aftereffects, illusory percepts resulting from prior exposure to visual input, to measure the influence of prior events on current processing. At a neural level, visual aftereffects arise due to attenuation in the responses of neurons that code the features of the prior stimulus (neuronal adaptation) and subsequent disinhibition of neurons signaling activity at the opposite end of the feature dimension. In the current study, we measured tilt aftereffects and negative afterimages, 2 types of aftereffects that reflect, respectively, adaptation of cortical orientation-coding neurons and adaptation of subcortical and retinal luminance-coding cells in persons with schizophrenia (PSZ; n = 36) and demographically matched healthy controls (HC; n = 22). We observed stronger tilt aftereffects in PSZ compared to HC, but no difference in negative afterimages. Stronger tilt aftereffects were related to more severe negative symptoms. These data suggest oversensitivity to recent regularities, in the form of stronger visual adaptation, at cortical, but not subcortical, levels in schizophrenia. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Cook JA, Burke-Miller JK, Jonikas JA, Aranda F, Santos A. Factors associated with 30-day readmissions following medical hospitalizations among Medicaid beneficiaries with schizophrenia, bipolar disorder, and major depressive disorder. Psychiatry Res 2020; 291:113168. [PMID: 32619823 DOI: 10.1016/j.psychres.2020.113168] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 01/12/2023]
Abstract
While evidence suggests that adults with serious mental illness have an elevated rate of 30-day readmissions after medical hospitalizations, most studies are of patients who are privately insured or Medicare beneficiaries, and little is known about the differential experiences of people with schizophrenia, bipolar disorder, and major depression. We used the Truven Health Analytics MarketScan® Medicaid Multi-State Database to study 43,817 Medicaid enrollees from 11 states, age 18-64, who were discharged from medical hospitalizations in 2011. Our outcome was unplanned all-cause readmissions within 30 days of discharge. In a multivariable analysis, compared to those with no SMI, people with schizophrenia had the highest odds of 30-day readmission (aOR: 1.46, 95% CI: 1.33-1.59), followed by those with bipolar disorder (aOR: 1.25, 95% CI: 1.14-1.38), and those with major depressive disorder (aOR: 1.18, 95% CI: 1.06-1.30). Readmissions also were more likely among those with substance use disorders, males, those with Medicaid eligibility due to disability, patients with longer index hospitalizations, and those with 2 or more medical co-morbidities. This is the first large-scale study to demonstrate the elevated risk of hospital readmission among low-income, working-age adults with schizophrenia. Given their greater psychological, social, and economic vulnerability, our findings can be used to design transition interventions and service delivery systems that address their complex needs.
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Affiliation(s)
- Judith A Cook
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
| | - Jane K Burke-Miller
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Jessica A Jonikas
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Frances Aranda
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Alberto Santos
- Department of Psychiatry, Fetter Health Care Network, Charleston, SC, USA
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15
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Antonucci LA, Pergola G, Pigoni A, Dwyer D, Kambeitz-Ilankovic L, Penzel N, Romano R, Gelao B, Torretta S, Rampino A, Trojano M, Caforio G, Falkai P, Blasi G, Koutsouleris N, Bertolino A. A Pattern of Cognitive Deficits Stratified for Genetic and Environmental Risk Reliably Classifies Patients With Schizophrenia From Healthy Control Subjects. Biol Psychiatry 2020; 87:697-707. [PMID: 31948640 DOI: 10.1016/j.biopsych.2019.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/23/2019] [Accepted: 11/04/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Schizophrenia risk is associated with both genetic and environmental risk factors. Furthermore, cognitive abnormalities are established core characteristics of schizophrenia. We aim to assess whether a classification approach encompassing risk factors, cognition, and their associations can discriminate patients with schizophrenia (SCZs) from healthy control subjects (HCs). We hypothesized that cognition would demonstrate greater HC-SCZ classification accuracy and that combined gene-environment stratification would improve the discrimination performance of cognition. METHODS Genome-wide association study-based genetic, environmental, and neurocognitive classifiers were trained to separate 337 HCs from 103 SCZs using support vector classification and repeated nested cross-validation. We validated classifiers on independent datasets using within-diagnostic (SCZ) and cross-diagnostic (clinically isolated syndrome for multiple sclerosis, another condition with cognitive abnormalities) approaches. Then, we tested whether gene-environment multivariate stratification modulated the discrimination performance of the cognitive classifier in iterative subsamples. RESULTS The cognitive classifier discriminated SCZs from HCs with a balanced accuracy (BAC) of 88.7%, followed by environmental (BAC = 65.1%) and genetic (BAC = 55.5%) classifiers. Similar classification performance was measured in the within-diagnosis validation sample (HC-SCZ BACs, cognition = 70.5%; environment = 65.8%; genetics = 49.9%). The cognitive classifier was relatively specific to schizophrenia (HC-clinically isolated syndrome for multiple sclerosis BAC = 56.7%). Combined gene-environment stratification allowed cognitive features to classify HCs from SCZs with 89.4% BAC. CONCLUSIONS Consistent with cognitive deficits being core features of the phenotype of SCZs, our results suggest that cognitive features alone bear the greatest amount of information for classification of SCZs. Consistent with genes and environment being risk factors, gene-environment stratification modulates HC-SCZ classification performance of cognition, perhaps providing another target for refining early identification and intervention strategies.
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Affiliation(s)
- Linda A Antonucci
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany; Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy.
| | - Giulio Pergola
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, Maryland
| | - Alessandro Pigoni
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Dominic Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | | | - Nora Penzel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Raffaella Romano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Barbara Gelao
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Silvia Torretta
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Rampino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Bari University Hospital, Bari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Bari University Hospital, Bari, Italy
| | - Grazia Caforio
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Bari University Hospital, Bari, Italy
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Giuseppe Blasi
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Bari University Hospital, Bari, Italy
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Bari University Hospital, Bari, Italy.
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16
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Ferreira RJO, Santos EJF, de Wit M, Marques A, Barbieri-Figueiredo MDC, Marques A, Ventura F, da Silva JAP, Ndosi M. Shared decision-making in people with chronic disease: Integrating the biological, social and lived experiences is a key responsibility of nurses. Musculoskeletal Care 2020; 18:84-91. [PMID: 31837252 DOI: 10.1002/msc.1443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Ricardo J O Ferreira
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Eduardo J F Santos
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Maarten de Wit
- Patient research partner, EULAR Standing Committee of People with Arthritis/Rheumatism in Europe, Zurich, Switzerland
- Department of Medical Humanities, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Andréa Marques
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Nursing School of Coimbra, Coimbra, Portugal
| | - Maria do Céu Barbieri-Figueiredo
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- Nursing School of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - António Marques
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- AGI médica I, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Filipa Ventura
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - José A P da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Mwidimi Ndosi
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
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Das S, Manjunatha N, Kumar CN, Math SB, Thirthalli J. Tele-psychiatric after care clinic for the continuity of care: A pilot study from an academic hospital. Asian J Psychiatr 2020; 48:101886. [PMID: 31835142 DOI: 10.1016/j.ajp.2019.101886] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 11/22/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND There is a need of continuity of care research in psychiatric disorders to deal two important issues such as accessibility of psychiatrists, and travel. AIMS This pilot was designed to evaluate the acceptability, feasibility, possible clinical effectiveness and cost benefit of video based tele-psychiatric aftercare (TAC) clinic from an academic hospital. METHODS Fifty selected patients were recruited to provide direct video-consultations (DVC). RESULTS This study shows higher score on acceptability, satisfaction and respect to privacy on these TAC. DISCUSSION AND CONCLUSIONS This is first pilot study as one of the patient friendly and less expensive continuity of care.
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Affiliation(s)
- Soumitra Das
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Narayana Manjunatha
- Digital Psychiatry Program, Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - C Naveen Kumar
- Digital Psychiatry Program, Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Suresh Bada Math
- Digital Psychiatry Program, Tele Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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18
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Lahera G, Cid J, Gonzalez-Pinto A, Cabrera A, Mariner C, Vieta E, Arango C, Crespo-Facorro B. Needs of people with psychosis and their caregivers: «In their own voice». REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 13:80-89. [PMID: 31937434 DOI: 10.1016/j.rpsm.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/08/2019] [Accepted: 11/13/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Improvement in mental health care services is going through a greater involvement of people with mental disorders and their families. Our aim was to directly ask the opinion of people with psychosis and their caregivers about their needs and preference for treatment. METHODS The authors designed an anonymous survey containing 9questions about their needs or suggestions on different areas such as personal and social dimensions of the illness, medical and psychotherapeutic treatment, psychosocial rehabilitation or help received from professionals. A pilot study was done to ensure the adequacy and intelligibility of the form. The final survey consisted of 5.205 completed surveys were collected, corresponding to 2.840 people diagnosed with psychotic disorder (including schizophrenia) and 1.341 caregivers, from all over Spain. RESULTS The most important need as assessed by participants was emotional support (friendships, partner, family). 91% of patients indicated that this need was «quite» or «very important». Both people with schizophrenia and caregivers perceived their health to be poor (3.29 and 3.30 respectively on an ascending scale from 0 to 5). 43% of males and 39% of females reported having «little» or «no» freedom to make important life decisions. For 35% of participants the psychotherapeutic treatment was instituted too late. Work was «important» or «very important» for 74% of respondents, especially for young people. The most valued anti-stigma initiative was to increase investments in schizophrenia healthcare plans. CONCLUSIONS Designers of mental health care services should consider the importance given by people diagnosed with psychosis to emotional needs, perception of freedom to make choices and early intervention.
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Affiliation(s)
- Guillermo Lahera
- Universidad de Alcalá, IRyCIS, CIBERSAM, Alcalá de Henares, Madrid, España.
| | - Jordi Cid
- Institut d'Assistència Sanitària de Girona, Salt, Girona, España
| | - Ana Gonzalez-Pinto
- Hospital Universitario Araba, BIOARABA, Universidad del País Vasco, CIBERSAM, Vitoria-Gasteiz, España
| | - Ana Cabrera
- Asociación Madrileña de Amigos y Familiares de Personas con Esquizofrenia, Madrid, España
| | | | - Eduard Vieta
- Hospital Clínic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, España
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, CIBERSAM, Madrid, España
| | - Benedicto Crespo-Facorro
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla, CIBERSAM, Sevilla, España
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19
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Fleury MJ, Rochette L, Grenier G, Huỳnh C, Vasiliadis HM, Pelletier É, Lesage A. Factors associated with emergency department use for mental health reasons among low, moderate and high users. Gen Hosp Psychiatry 2019; 60:111-119. [PMID: 31404825 DOI: 10.1016/j.genhosppsych.2019.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study identified factors associated with frequency of emergency department (ED) use for mental health (MH) reasons in Quebec during 2015-2016. METHODS Participants (n = 115,066) were categorized as: 1) low (1 visit/year; 76%); 2) moderate (2 visits/year; 14%); and 3) high (3+ visits/year; 10%) ED users. Independent variables included predisposing, enabling and needs factors based on the Andersen Behavioral Model. Variables significantly associated with frequency of ED use were entered into a multinomial logistic regression. RESULTS Patients with mental illness (MI), especially substance-related disorders (SRD) and schizophrenia spectrum disorders; bipolar, depressive, anxiety or personality disorders; and those with severe chronic physical illness (needs factors) were more likely to use ED for MH reasons, as were male participants 18-64 years old, and those living in metropolitan areas with high social or material deprivation (predisposing factors). Regarding enabling factors, consultations with outpatient psychiatrists and not seeing a general practitioner (GP) in the year prior to ED visit were associated with high ED use. CONCLUSION The severity of MI/SRD contributed most to frequent ED use, while social and material deprivation in metropolitan areas, and intensity of medical care also influenced ED use for MH reasons.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada; Douglas Mental Health University Institute, Montréal, QC, Canada.
| | - Louis Rochette
- Insitut national de santé publique du Québec, Québec, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Christophe Huỳnh
- University Institute on Addictions, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada; Department of Psychiatry, University of Montreal, Montréal, QC, Canada; School of Psychoeducation, University of Montreal, Montréal, QC, Canada
| | - Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, QC, Canada; Centre de recherche Charles LeMoyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Longueuil, QC, Canada
| | - Éric Pelletier
- Insitut national de santé publique du Québec, Québec, QC, Canada
| | - Alain Lesage
- Department of Psychiatry, University of Montreal, Montréal, QC, Canada; Centre de recherche Fernand-Séguin, Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
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20
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Sommerfeld DH, Granholm E, Holden J, Seijo C, Rapoport CS, Mueser KT, Naqvi JB, Aarons GA. Concept mapping study of stakeholder perceptions of implementation of cognitive-behavioral social skills training on assertive community treatment teams. Psychol Serv 2019; 18:33-41. [PMID: 30855157 DOI: 10.1037/ser0000335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study aimed to identify factors associated with implementation of cognitive behavioral social skills training (CBSST) on assertive community treatment (ACT) teams in a large public sector behavioral health system. This study used concept mapping (a mixed-method approach) and involved a sample including diverse stakeholder participants including patients, ACT team members, team leaders, organization leaders, and system leaders. We identified 14 distinct issues related to implementing CBSST on ACT teams: (a) CBSST fit with ACT structure, (b) CBSST fit with ACT process, (c) provider perceptions about CBSST, (d) staff pressures/other demands; (e) CBSST and ACT synergy, (f) client characteristics, (g) benefits of CBSST, (h) coordination/interaction among ACT providers, (i) government/regulatory factors, (j) integration of CBSST into ACT, (k) training support, (l) training resources, (m) multilevel agency leadership, and (n) provider characteristics. Each of these dimensions were rated in regard to importance and changeability with the top 5 rated dimensions including effective training support; alignment of leadership across levels of the community-based organizations delivering services; perceived benefits of CBSST, CBSST and ACT synergy; and provider perceptions of CBSST. The most critical issues for CBSST implementation on ACT teams should be addressed in future studies. Implementation strategies that capitalize on enhancing leadership and organizational climate hold promise to address all of these issues. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego
| | - Jason Holden
- Department of Psychiatry, University of California, San Diego
| | - Chariz Seijo
- Department of Psychiatry, University of California, San Diego
| | | | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University
| | - Jeanean B Naqvi
- Department of Psychiatry, University of California, San Diego
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Liu J, Abdin E, Verma S, Sim K, Chong SA, Subramaniam M. Clarifying pathways to poor psychological health: The mediating role of psychosocial factors in the relationship between general psychopathology and quality of life impairment in patients diagnosed with schizophrenia. J Clin Psychol 2019; 75:1022-1033. [PMID: 30671966 PMCID: PMC6563093 DOI: 10.1002/jclp.22747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objectives The present study examines the latent factor structure of general psychopathology and investigates the mediating role of unmet psychosocial concerns, motivation, and medication side effects in the relationship between general psychopathology and quality of life (QOL) impairment in patients with schizophrenia. Methods A total of 251 patients completed self‐report measures of unmet psychosocial concerns, motivation, medication side effects, and physical/mental QOL impairment. The severity of schizophrenia was assessed on the Positive and Negative Syndrome Scale. Results Exploratory factor analysis revealed one latent factor (emotional distress) of general psychopathology. Mediation path analyses controlling for confounding variables revealed significant indirect effects of unmet psychosocial concerns, motivation, and medication side effects on emotional distress and physical/mental QOL impairment. Conclusions Our findings suggest that identifying optimal methods of managing co‐occurring emotional distress as well as secondary psychosocial factors on psychological health may improve QOL among patients diagnosed with schizophrenia.
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Affiliation(s)
- Jianlin Liu
- Research DivisionInstitute of Mental HealthSingaporeSingapore
| | | | - Swapna Verma
- Department of Early Psychosis InterventionInstitute of Mental HealthSingaporeSingapore
| | - Kang Sim
- Research DivisionInstitute of Mental HealthSingaporeSingapore
- Department of General PsychiatryInstitute of Mental HealthSingaporeSingapore
| | - Siow Ann Chong
- Research DivisionInstitute of Mental HealthSingaporeSingapore
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22
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Grandón P, Saldivia S, Vaccari P, Ramirez-Vielma R, Victoriano V, Zambrano C, Ortiz C, Cova F. An Integrative Program to Reduce Stigma in Primary Healthcare Workers Toward People With Diagnosis of Severe Mental Disorders: A Protocol for a Randomized Controlled Trial. Front Psychiatry 2019; 10:110. [PMID: 30899230 PMCID: PMC6416206 DOI: 10.3389/fpsyt.2019.00110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/13/2019] [Indexed: 01/08/2023] Open
Abstract
Background: People with severe mental disorders (SMDs) have higher disease and death rates than the general population. Stigma (negative attitudes and perceptions) contributes to limited access to health services and a lower quality of medical assistance in this population, and it is manifested as negative attitudes, social distance, and discrimination toward this social group. For these reasons, healthcare workers are a priority group for anti-stigma interventions. This study aims to assess the effectiveness of a program specifically designed to decrease negative attitudes and social distance and increase inclusive behaviors in healthcare workers toward people with SMD. Methods: The study will be a randomized clinical trial. A minimum of 210 healthcare workers from 11 primary care centers in the province of Concepción, Chile, will be randomly chosen to receive the program or be part of the control group. There will be a pre-, post-, and 4-months evaluation of social distance, attitudes, and behaviors of participants toward people with SMD using standardized scales such as the social distance scale, which is a scale of clinician attitude toward mental illness adapted from attitudes of clinicians toward mental illness, and self-reports. The intervention program will consist of education strategies, direct, and indirect contact with people diagnosed with SMD, and skill development. There will be six face-to-face sessions directly with the participants and two additional sessions with the directors of each healthcare center. The program will involve a facilitator who will be a healthcare professional and a co-facilitator who will be a person diagnosed with SMD. Discussion: This study will evaluate an intervention program especially designed to reduce stigma in healthcare workers toward people with SMD, a topic on which there is little background information, particularly in low- and middle-income countries. It is important to have interventions with proven effectiveness for this purpose to ensure equity in healthcare services. Trial Registration: This study was registered under ISRCTN.com (ISRCTN46464036).
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Affiliation(s)
- Pamela Grandón
- Department of Psychology, University of Concepción, Concepción, Chile
| | - Sandra Saldivia
- Department of Psychiatry and Mental Health, University of Concepción, Concepción, Chile
| | - Pamela Vaccari
- Department of Psychology, University of Concepción, Concepción, Chile
| | | | | | | | - Camila Ortiz
- Department of Psychology, University of Concepción, Concepción, Chile
| | - Felix Cova
- Department of Psychology, University of Concepción, Concepción, Chile
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23
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Gorwood P, Mallet J, Lancrenon S. Functional remission in schizophrenia: A FROGS-based definition and its convergent validity. Psychiatry Res 2018; 268:94-101. [PMID: 30015112 DOI: 10.1016/j.psychres.2018.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/28/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
Functional remission concerns only one third of schizophrenia patients who achieved symptomatic remission. We previously developed a scale devoted to functional remission, named the FROGS (Functional Remission Of General Schizophrenia). This instrument encompasses three clinically relevant dimensions. The aim of this study is to provide a threshold for functional remission relying on these three dimensions, and to compare its psychometric properties with other scales devoted to functional remission. We tested the characteristics of functional remission according to the FROGS. The FROGS was used in different European countries and compared to other valid scales (GAF, PSP and PSRS) in a sample of 295 schizophrenia patients. The association with different parameters as external validators was assessed, including clinical remission. A comparison of the classifying properties of each scale compared to the others was made. The four instruments were equally influenced by the PANSS score, the clinical remission according Andreassen's criteria, the number of past hospitalizations and the presence of a paid working activity. These findings provide a simple threshold for the FROGS, tightly linked to the definition of functional remission, with a good convergent validity. This instrument might be easily used to facilitate the assessment of functional remission in schizophrenia.
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Affiliation(s)
- Philip Gorwood
- Sainte-Anne Hospital (CMME), Paris Descartes University, Paris, France; INSERM U894, Institute of Psychiatry and Neuroscience of Paris (IPNP), Paris, France.
| | - Jasmina Mallet
- INSERM U894, Institute of Psychiatry and Neuroscience of Paris (IPNP), Paris, France; CHU Louis Mourier, Department of Psychiatry, Paris Diderot University, AP-HP, Colombes, France
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Ritsner MS, Farkash H, Rauchberger B, Amrami-Weizman A, Zendjidjian XY. Assessment of health needs, satisfaction with care, and quality of life in compulsorily admitted patients with severe mental disorders. Psychiatry Res 2018; 267:541-550. [PMID: 29980135 DOI: 10.1016/j.psychres.2018.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/20/2018] [Accepted: 05/11/2018] [Indexed: 11/17/2022]
Abstract
This cross-sectional study compared the levels of needs, care satisfaction, quality of life, and social support of compulsory admitted patients with severe mental disorders to a comparable group of voluntary admitted patients. One hundred and twenty-five patients with schizophrenia and schizoaffective disorder were admitted to a hospital by district psychiatrist order (DPO), court observation order (COO), or voluntary (VA). Participants were assessed before discharge using questionnaires, and psychiatric rating scales. A linear discriminant analysis revealed eight variables that best differentiated the three groups. COO patients were significantly discriminated from the two other groups (DPO and VA) by severe negative symptoms, better satisfaction with both nursing staff and family support. COO subjects had more non-illness unmet needs, while reported better hedonic capacity for social and interpersonal pleasure - compared to VA patients. DPO patients were significantly indicated by poorer awareness to illness, but better satisfaction with subjective feelings. VA subjects were significantly discriminated from compulsory admitted patients by higher illness severity scores. Assessment of unmet needs, satisfaction with care, quality of life, hedonic capacity, and social support constitute the factors that differentiate compulsory admitted patients and could be targets for interventions aimed to reduce the negative effects of compulsory admissions.
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Affiliation(s)
- Michael S Ritsner
- Shaar Menashe Mental Health Center, Israel; National Insurance Institute in Israel, Haifa, Israel.
| | | | | | | | - Xavier Y Zendjidjian
- Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Marseille, France.
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Menon V, Selvakumar N, Kattimani S, Andrade C. Therapeutic effects of mobile-based text message reminders for medication adherence in bipolar I disorder: Are they maintained after intervention cessation? J Psychiatr Res 2018; 104:163-168. [PMID: 30081390 DOI: 10.1016/j.jpsychires.2018.07.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/01/2018] [Accepted: 07/25/2018] [Indexed: 12/28/2022]
Abstract
Mobile phone short messaging service (SMS) reminders may be a low-cost method for promoting medication adherence. Our objective was to determine whether text SMS reminders improve medication adherence in patients with bipolar I disorder even after discontinuation of the intervention. Participants were stable adult bipolar I disorder outpatients on maintenance medication who were randomized to receive treatment as usual (TAU; n = 70) or TAU plus twice-weekly medication reminders by SMS (n = 62) for 3 months. Rater-blinded assessments of medication adherence, treatment attitudes, and quality of life (QoL) were obtained at baseline, at the 3-month intervention endpoint, and at a 3-month post-intervention follow up during which both groups received TAU. Intent-to-treat analyses were conducted on the full randomized sample. The clinical trial protocol was registered with the Clinical Trials Registry of India (CTRI) (CTRI/2016/07/007101). The SMS intervention improved medication adherence and attitudes towards medication at the end of the treatment phase; these benefits were maintained for medication adherence but not for attitudes towards medication at the end of the follow-up phase. The SMS intervention did not improve QoL outcomes. These findings indicate that biweekly SMS reminders improve medication adherence and the benefits persist for at least 3 months after the SMS reminders are discontinued. The SMS reminders do not affect attitudes towards treatment or QoL.
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Affiliation(s)
- Vikas Menon
- Dept. of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
| | - Nivedhitha Selvakumar
- Dept. of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
| | - Shivanand Kattimani
- Dept. of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
| | - Chittaranjan Andrade
- Dept. of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
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Nuhoho S, Saad A, Saumell G, Ribes D, El Khoury AC. Economic evaluation of paliperidone palmitate once monthly for treating chronic schizophrenia patients in the United Arab Emirates. Curr Med Res Opin 2018; 34:601-611. [PMID: 29292670 DOI: 10.1080/03007995.2017.1417246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Schizophrenia is one of the most debilitating diseases in the United Arab Emirates. Oral antipsychotics (OA) are commonly used in terms of pharmacotherapy; however, these treatments can be rendered ineffective by poor patient adherence. Paliperidone palmitate once monthly (PP1M) is a long acting antipsychotic which can offer an adherence advantage when compared to oral treatments. The study objective is to estimate the cost effectiveness of PP1M in the UAE setting. RESEARCH DESIGN AND METHODS A 1-year validated decision-tree model was adapted to the UAE setting using published literature and expert opinion. Patients on PP1M were compared with or without oral supplementation to patients on any oral antipsychotic. Patient outcomes studied were incremental cost per quality adjusted life years gained, incremental cost per hospitalizations, relapses, and emergency room visits averted. RESULTS After 1 year, patients on PP1M monotherapy when compared to oral antipsychotics had better outcomes (0.840 vs 0.811 QALYs; 31 relapse days averted as well as 9 and 24 percentage points of ER and hospitalizations averted, respectively), and better healthcare savings (AED 1405). PP1M economically dominated oral antipsychotics. The results were stable across a broad range of deterministic and probabilistic sensitivity analyses. PP1M plus oral antipsychotics could not be evaluated due to the absence of clinical data that would provide insight into the clinical value of combination therapy. CONCLUSION PP1M is estimated to save the UAE healthcare system money, while at the same time improving patient outcomes.
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Affiliation(s)
- Solomon Nuhoho
- a Johnson & Johnson Middle East FZ LLC , Dubai , United Arab Emirates
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Caqueo-Urízar A, Boyer L, Gilman SE. Needs of Patients with Schizophrenia Among an Ethnic Minority Group in Latin America. J Immigr Minor Health 2018; 19:606-615. [PMID: 26936764 DOI: 10.1007/s10903-016-0376-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of the study is to describe the need profile of outpatients with schizophrenia belonging to an Aymara ethnic group in Latin-America and to compare that profile to non-Aymara patients. A sample of 253 patients were evaluated with the Two-Way Communication Checklist (2-COM Checklist) measuring the needs and satisfaction of the patient; Positive and Negative Syndrome scale for Schizophrenia (PANSS) and Attitude to the Drugs (DAI-10). No significant differences were found between Aymara and non-Aymara, either in the total number of needs or in the subscales of satisfaction or in the types of needs. After adjustment for socio-demographic and clinical factors, patients with higher severity (PANSS) had higher number of needs and lower level of satisfaction. Higher score on DAI-10 is related to a higher total number of needs and better satisfaction with medication. Age, sex, ethnicity and employment were also associated with specific needs. The profile of the needs of schizophrenic Aymara patients does not differ from that of non-Aymara patients, and that in both groups it is necessary that the treatment primarily address symptom management and the subjective aspects of quality of life.
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Affiliation(s)
- Alejandra Caqueo-Urízar
- Escuela de Psicología y Filosofía, Universidad de Tarapacá, Avenida 18 de Septiembre 2222, Arica, Chile. .,Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115-6018, USA.
| | - Laurent Boyer
- EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, 13005, Marseille, France
| | - Stephen E Gilman
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115-6018, USA.,Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115-6018, USA.,Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.,Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd, Rockville, MD, 20852, USA
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Biringer E, Hartveit M, Sundfør B, Ruud T, Borg M. Continuity of care as experienced by mental health service users - a qualitative study. BMC Health Serv Res 2017; 17:763. [PMID: 29162112 PMCID: PMC5698968 DOI: 10.1186/s12913-017-2719-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 11/09/2017] [Indexed: 12/20/2022] Open
Abstract
Background People who struggle with mental health problems can provide valuable insight into understanding and improving the coordination of mental health and welfare services. The aims of the study were to explore service users’ experiences and perceptions of continuity of care within and across services relevant to personal recovery, to elicit which dimensions of continuity of care are most essential to service users, and to generate ideas for improving service users’ experiences of continuity of care. Methods In the context of a hermeneutic-phenomenological approach, ten service users at a community mental health centre were interviewed about their experiences of continuity of care in and across services. Eight of these were re-interviewed two years later. A collaborative research approach was adopted. Data were analysed by means of a data-driven stepwise approach in line with thematic analysis. Results Following the analysis five themes representing experiences of continuity of care were developed. Each theme ranged from poor to good experiences of continuity of care: Relationship – from experiencing frequent setbacks and anxiety due to breaks in relationships, to feeling safe in an ongoing personal relationship; Timeliness – from experiencing frustrating waiting times with worsening of problems, to getting help when needed; Mutuality – from having a one-sided struggle, to a situation in which both professionals and service users take initiatives; Choice – from not having the opportunity to make practical arrangements within the context of one’s everyday life, to having an array of support options to choose from; Knowledge – from feeling confused and insecure because one does not know what is happening, to feeling safe because one is informed about what is going to happen. Participants provided a range of suggestions for improving experiences of continuity of care. Conclusions A discrepancy between aspects of continuity that are essential for service users and their experiences of actual practice was revealed. The valid evidence generated in the present collaborative study therefore offers knowledge to policy makers, professionals and service users that may be of help in their future efforts in orienting primary care, mental health, addiction and welfare services towards recovery. Electronic supplementary material The online version of this article (10.1186/s12913-017-2719-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eva Biringer
- Helse Fonna Local Health Authority, P.O. Box 2170, N-5504, Haugesund, Norway.
| | - Miriam Hartveit
- Helse Fonna Local Health Authority, P.O. Box 2170, N-5504, Haugesund, Norway
| | - Bengt Sundfør
- Regional Research Network on Mood Disorders (MoodNet), Haukeland University Hospital, Division of Mental Health, P.O. Box 1400, N-5021, Bergen, Norway
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, P.O. Box 1000, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, Blindern, N-0318, Oslo, Norway
| | - Marit Borg
- Faculty of Health Sciences, University College of Southeast Norway, Papirbredden, Drammen kunnskapspark, Grønland 58, 3045, Drammen, Norway
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Rodrigues-Silva N, Ribeiro L. Impact of medical comorbidity in psychiatric inpatient length of stay. J Ment Health 2017; 29:701-705. [PMID: 28686478 DOI: 10.1080/09638237.2017.1340605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Medical comorbidity is associated with worse psychiatric outcomes, reduced functioning and higher services use, including inpatient psychiatric care.Aim: We explored the relation between medical comorbidity and length of stay, adjusting for potential confounders.Methods: We retrospectively analyzed an administrative database comprising all inpatient admissions between 2005 and 2014 at the Department of Psychiatry and Mental Health at Vila Nova de Gaia/Espinho Healthcare Center, Vila Nova de Gaia - Portugal. Psychiatric diagnosis and medical comorbidity were coded according to single-level and multi-level classification schemes, respectively, as proposed by the Clinical Classification Software.Results: We included a total of 4613 psychiatric inpatient admissions. The prevalence of medical comorbidity was 25.4% and it was associated with an average increase of 3.5 days (p < 0.001) in length of stay, comparing to patients without medical comorbidity. After adjusting for potential confounders, such as age, sex and year of discharge, medical comorbidity was associated with a 13% increase in length of stay.Conclusions: Medical comorbidity has measurable effects in inpatient outcomes, such as the length of stay and should be a major focus for intervention, in ambulatory care but also during psychiatric hospitalization.
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Affiliation(s)
- Nuno Rodrigues-Silva
- Department of Psychiatry and Mental Health, Vila Nova de Gaia/Espinho Healthcare Center, Vila Nova de Gaia, Portugal
| | - Lúcia Ribeiro
- Department of Psychiatry and Mental Health, Vila Nova de Gaia/Espinho Healthcare Center, Vila Nova de Gaia, Portugal
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Frost BG, Tirupati S, Johnston S, Turrell M, Lewin TJ, Sly KA, Conrad AM. An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges. BMC Psychiatry 2017; 17:22. [PMID: 28095811 PMCID: PMC5240195 DOI: 10.1186/s12888-016-1164-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over past decades, improvements in longer-term clinical and personal outcomes for individuals experiencing serious mental illness (SMI) have been moderate, although recovery has clearly been shown to be possible. Recovery experiences are inherently personal, and recovery can be complex and non-linear; however, there are a broad range of potential recovery contexts and contributors, both non-professional and professional. Ongoing refinement of recovery-oriented models for mental health (MH) services needs to be fostered. DISCUSSION This descriptive paper outlines a service-wide Integrated Recovery-oriented Model (IRM) for MH services, designed to enhance personally valued health, wellbeing and social inclusion outcomes by increasing access to evidenced-based psychosocial interventions (EBIs) within a service context that supports recovery as both a process and an outcome. Evolution of the IRM is characterised as a series of five broad challenges, which draw together: relevant recovery perspectives; overall service delivery frameworks; psychiatric and psychosocial rehabilitation approaches and literature; our own clinical and service delivery experience; and implementation, evaluation and review strategies. The model revolves around the person's changing recovery needs, focusing on underlying processes and the service frameworks to support and reinforce hope as a primary catalyst for symptomatic and functional recovery. Within the IRM, clinical rehabilitation (CR) practices, processes and partnerships facilitate access to psychosocial EBIs to promote hope, recovery, self-agency and social inclusion. Core IRM components are detailed (remediation of functioning; collaborative restoration of skills and competencies; and active community reconnection), together with associated phases, processes, evaluation strategies, and an illustrative IRM scenario. The achievement of these goals requires ongoing collaboration with community organisations. CONCLUSIONS Improved outcomes are achievable for people with a SMI. It is anticipated that the IRM will afford MH services an opportunity to validate hope, as a critical element for people with SMI in assuming responsibility and developing skills in self-agency and advocacy. Strengthening recovery-oriented practices and policies within MH services needs to occur in tandem with wide-ranging service evaluation strategies.
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Affiliation(s)
- Barry G. Frost
- School of Psychology, Faculty of Science and Technology, University of Newcastle, Callaghan, NSW 2308 Australia ,Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia
| | - Srinivasan Tirupati
- Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | | | - Megan Turrell
- Hunter New England Mental Health, Newcastle, NSW 2300 Australia
| | - Terry J. Lewin
- Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia ,Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Ketrina A. Sly
- Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia ,Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Agatha M. Conrad
- Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia ,Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
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Neogi R, Chakrabarti S, Grover S. Health-care needs of remitted patients with bipolar disorder: A comparison with schizophrenia. World J Psychiatry 2016; 6:431-441. [PMID: 28078207 PMCID: PMC5183995 DOI: 10.5498/wjp.v6.i4.431] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/18/2016] [Accepted: 10/18/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate health-care needs and their correlates among patients with remitted bipolar disorder (BD) compared to patients with remitted schizophrenia.
METHODS Outpatients with BD (n = 150) and schizophrenia (n = 75) meeting clearly defined remission criteria were included in the study along with their relatives. Diagnostic ascertainment was carried out using the Mini International Neuropsychiatric Interview. Demographic and clinical details were recorded using structured formats. Residual symptoms were assessed using standardized scales. Health-care needs were assessed on two separate scales. The principal instrument employed to assess health-care needs was the Camberwell Assessment of Need-Research version (CAN-R). To further evaluate health-care needs we felt that an additional instrument, which was more relevant for Indian patients and treatment-settings and designed to cover those areas of needs not specifically covered by the CAN-R was required. This instrument with a structure and scoring pattern similar to the CAN-R was used for additional evaluation of needs. Patients’ level of functioning was assessed using the Global Assessment of Functioning Scale and their quality of life (QOL) using the World Health Organization Quality Of Life-BREF version in Hindi.
RESULTS An average of 6-7 needs was reported by patients with BD as well as their relatives. Commonly reported needs were in the areas of economic and welfare needs, informational needs, social needs and the need for treatment. According to the CAN-R, both patients and relatives reported that more than 60% of the total needs were being met. However, over 90% of the needs covered by the additional evaluation were unmet according to patients and relatives. Needs in the areas of economic and welfare-benefits, information, company, daytime activities and physical health-care were largely unmet according to patients and relatives. Total, met and unmet needs were significantly higher for schizophrenia, but the most common types of needs were quite similar to BD. Relatives reported more needs than patients with certain differences in the types of needs reported. Level of patients’ functioning was the principal correlate of greater total and unmet needs in both groups. Significant associations were also obtained with residual symptoms and QOL.
CONCLUSION The presence of unmet needs in remitted patients with BD was an additional marker of the enduring psychosocial impairment characteristic of the remitted phase of BD.
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Medeiros-Ferreira L, Navarro-Pastor JB, Zúñiga-Lagares A, Romaní R, Muray E, Obiols JE. Perceived needs and health-related quality of life in people with schizophrenia and metabolic syndrome: a "real-world" study. BMC Psychiatry 2016; 16:414. [PMID: 27871263 PMCID: PMC5117524 DOI: 10.1186/s12888-016-1005-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 08/16/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The complexity of schizophrenia lies in the combination of psychiatric, somatic and social needs requiring care. The aim of the study was to compare perceived needs between groups with absence/presence of metabolic syndrome (MetS) and to analyze the relationship between needs, health-related quality of life (HRQoL) and MetS in people with schizophrenia or schizoaffective disorder. METHODS A "real-world" cross-sectional study was set up with a comprehensive framework including the following, needs for care (Camberwell Assessment of Need Interview [CAN]), HRQoL (Euro Qol-5D Questionnaire), sociodemographic data, lifestyle habits, psychopathology (Positive And Negative Syndrome Scale [PANSS]), global functioning (Global Assessment of Functioning Scale [GAF]), anthropometric measurements and blood test results were assessed for an outpatient sample (n = 60). RESULTS The mean number of needs (given by CAN) was identified for both groups. Patients with MetS rated a higher number of needs compared to the group without this condition. Mobility problems (given by EQ-5D) were negatively associated with the number of total and unmet needs. For participants with MetS, HRQoL was related to the number of needs and unmet needs. For people with MetS, positive symptomatology score (given by PANSS) was related to the number of needs and met needs and general symptomatology was associated with total, met and unmet needs. For individuals without MetS, the global functioning score (given by GAF) was significantly inversely related with total, met and unmet needs. CONCLUSIONS Needs and HRQoL, as well as general symptomatology, were related only in patients with MetS. This has implications for treatment planning at the individual and organizational levels. An analysis of both physical and mental needs could provide a starting point for the extension of facilities in the health care system in order to reach the goal of improving quality of life.
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Affiliation(s)
- Leticia Medeiros-Ferreira
- Department of Clinical and Health Psychology, Faculty of Psychology, Universitat Autònoma de Barcelona/Nou Barris Nord Mental Health Center, Paseo Valldaura 214- bajos, 08042, Barcelona, Spain. .,Nou Barris Nord Mental Health Center, Paseo Valldaura 214- bajos, 08042, Barcelona, Spain.
| | - José Blas Navarro-Pastor
- Department of Psychobiology and Methodology of Health Sciences, Faculty of Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Zúñiga-Lagares
- Nou Barris Nord Mental Health Center, Paseo Valldaura 214- bajos, 08042 Barcelona, Spain
| | - Rosanna Romaní
- Nou Barris Nord Mental Health Center, Paseo Valldaura 214- bajos, 08042 Barcelona, Spain
| | - Elisenda Muray
- Nou Barris Nord Mental Health Center, Paseo Valldaura 214- bajos, 08042 Barcelona, Spain
| | - Jordi E. Obiols
- Department of Clinical and Health Psychology, Faculty of Psychology, Universitat Autònoma de Barcelona/Nou Barris Nord Mental Health Center, Paseo Valldaura 214- bajos, 08042 Barcelona, Spain
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Li JB, Liu WI, Huang MW. Integrating Evidence-Based Community-Care Services to Improve Schizophrenia Outcomes: A Preliminary Trial. Arch Psychiatr Nurs 2016; 30:102-8. [PMID: 26804510 DOI: 10.1016/j.apnu.2015.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/21/2015] [Accepted: 08/25/2015] [Indexed: 01/19/2023]
Abstract
This aim of this preliminary experimental study was to integrate effective evidence-based community-care services that are subjected to heavy caseloads, and to then examine the effects on individuals with schizophrenia. Using a cluster sampling method, four homecare nurses were randomly assigned to either the experimental group or the comparison group. The nurses in the experimental group applied the following six identified effective elements: (1) established an alliance with their patients; (2) assessed patient-care needs; (3) considered both medical and social-care practices; (4) addressed patients' self-management of medication and their daily tasks; (5) provided crisis intervention; and (6) coordinated resources. The patients comprised 85 individuals with schizophrenia. In the experimental group, psychiatric homecare nurses were randomly assigned to implement integrated, evidence-based community-care services during a six-month follow-up period. Patients in the comparison group continued to receive their customary community care. In the experimental group, patient satisfaction scores, medication attitudes, and general functioning levels were significantly higher than in the comparison group. These preliminary findings indicate a potentially effective model for community care in areas where intensive case management cannot be provided.
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Affiliation(s)
- Jin-Biau Li
- National Yang Ming University School of Nursing, Taipei, Taiwan; Bali Psychiatric center, New Taipei City, Taiwan.
| | - Wen-I Liu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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Hajda M, Prasko J, Latalova K, Hruby R, Ociskova M, Holubova M, Kamaradova D, Mainerova B. Unmet needs of bipolar disorder patients. Neuropsychiatr Dis Treat 2016; 12:1561-70. [PMID: 27445475 PMCID: PMC4928671 DOI: 10.2147/ndt.s105728] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a serious mental illness with adverse impact on the lives of the patients and their caregivers. BD is associated with many limitations in personal and interpersonal functioning and restricts the patients' ability to use their potential capabilities fully. Bipolar patients long to live meaningful lives, but this goal is hard to achieve for those with poor insight. With progress and humanization of society, the issue of patients' needs became an important topic. The objective of the paper is to provide the up-to-date data on the unmet needs of BD patients and their caregivers. METHODS A systematic computerized examination of MEDLINE publications from 1970 to 2015, via the keywords "bipolar disorder", "mania", "bipolar depression", and "unmet needs", was performed. RESULTS Patients' needs may differ in various stages of the disorder and may have different origin and goals. Thus, we divided them into five groups relating to their nature: those connected with symptoms, treatment, quality of life, family, and pharmacotherapy. We suggested several implications of these needs for pharmacotherapy and psychotherapy. CONCLUSION Trying to follow patients' needs may be a crucial point in the treatment of BD patients. However, many needs remain unmet due to both medical and social factors.
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Affiliation(s)
- Miroslav Hajda
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Klara Latalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Radovan Hruby
- Outpatient Psychiatric Department, Martin, Slovak Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Michaela Holubova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic; Department of Psychiatry, Regional Hospital Liberec, Liberec, Czech Republic
| | - Dana Kamaradova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Barbora Mainerova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
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Taborda Zapata EM, Montoya González LE, Gómez Sierra NM, Arteaga Morales LM, Correa Rico OA. [Intervention of Schizophrenia From the Community Model]. REVISTA COLOMBIANA DE PSIQUIATRIA 2016; 45:46-50. [PMID: 26896404 DOI: 10.1016/j.rcp.2015.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 06/26/2015] [Accepted: 09/01/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Schizophrenia is a complex disease for which pharmacological management is an insufficient therapeutic measure to ensure adaptation to the community and restoring the quality of life of the patient, with a multidimensional management and community interventions being necessary. METHODOLOGY Case report. RESULTS This case report illustrates a multidisciplinary treatment response, based on a community care model for mental health from Envigado, Colombia. DISCUSSION The management of schizophrenia requires multimodal interventions that include community screening, psychoeducation of individuals, their families and society, addressing different areas of operation that allow adaptation of the subject to his social environment. CONCLUSIONS A integrated intervention that can be provided on a Community scale, with the implementation of policies that allow it to be applied.
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Bruijnzeel D, Yazdanpanah M, Suryadevara U, Tandon R. Lurasidone in the treatment of schizophrenia: a critical evaluation. Expert Opin Pharmacother 2015; 16:1559-65. [PMID: 26111577 DOI: 10.1517/14656566.2015.1058780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Antipsychotic medications are the foundation of the pharmacological treatment of schizophrenia and lurasidone is the most recent of the 65 agents around the world to become available. In order to use it optimally, it is important to understand its pharmacological and clinical nature and its comparative effectiveness to other antipsychotic agents in the treatment of schizophrenia. AREAS COVERED Following a comprehensive review of the literature, this article summarizes current information about the pharmacology of lurasidone, data about its short- and long-term efficacy and safety/tolerability in the treatment of schizophrenia, its comparative effectiveness to other antipsychotic agents, and guidance about its optimal use in the treatment of individuals with schizophrenia. EXPERT OPINION Lurasidone is a benzoisothiazole with potent dopamine D2 and serotonin 5HT2A antagonist and serotonin 5HT1A partial agonist properties (like other second-generation antipsychotic agents) with additional potent 5HT7 and alpha2C noradrenergic antagonism. It has little or no activity at the alpha1 and alpha2A noradrenergic, 5HT2C serotonergic, histaminergic and cholinergic receptors. Available only in an oral formulation, it is effective in once-daily dosing (40 - 160 mg/day) and its absorption is affected by food. There is an extensive clinical trial database with short-term and long-term placebo- and antipsychotic-controlled clinical trials evaluating the efficacy and safety/tolerability of lurasidone in the treatment of schizophrenia. It has been found to be efficacious with comparable efficacy to other agents in the treatment of acute psychosis and prevention of relapse in individuals with schizophrenia. The greater antidepressant and cognitive benefits suggested by its receptor profile need substantiation in robust clinical trials. It is less likely to cause metabolic and cardiac adverse effects than most other second-generation agents and is associated with a modest risk of extrapyramidal side-effects, akathisia, and prolactin elevation.
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Affiliation(s)
- Dawn Bruijnzeel
- University of Florida College of Medicine, Department of Psychiatry , 1149 Newell Drive, L4-100, Gainesville, FL 32611 , USA +1 352 376 1611, ext. 4381 ;
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Hsu YH, Cheng JS, Ouyang WC, Lin CL, Huang CT, Hsu CC. Lower Incidence of End-Stage Renal Disease but Suboptimal Pre-Dialysis Renal Care in Schizophrenia: A 14-Year Nationwide Cohort Study. PLoS One 2015; 10:e0140510. [PMID: 26469976 PMCID: PMC4607300 DOI: 10.1371/journal.pone.0140510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/25/2015] [Indexed: 01/21/2023] Open
Abstract
Schizophrenia is closely associated with cardiovascular risk factors which are consequently attributable to the development of chronic kidney disease and end-stage renal disease (ESRD). However, no study has been conducted to examine ESRD-related epidemiology and quality of care before starting dialysis for patients with schizophrenia. By using nationwide health insurance databases, we identified 54,361 ESRD-free patients with schizophrenia and their age-/gender-matched subjects without schizophrenia for this retrospective cohort study (the schizophrenia cohort). We also identified a cohort of 1,244 adult dialysis patients with and without schizophrenia (1:3) to compare quality of renal care before dialysis and outcomes (the dialysis cohort). Cox proportional hazard models were used to estimate the hazard ratio (HR) for dialysis and death. Odds ratio (OR) derived from logistic regression models were used to delineate quality of pre-dialysis renal care. Compared to general population, patients with schizophrenia were less likely to develop ESRD (HR = 0.6; 95% CI 0.4–0.8), but had a higher risk for death (HR = 1.2; 95% CI, 1.1–1.3). Patients with schizophrenia at the pre-ESRD stage received suboptimal pre-dialysis renal care; for example, they were less likely to visit nephrologists (OR = 0.6; 95% CI, 0.4–0.8) and received fewer erythropoietin prescriptions (OR = 0.7; 95% CI, 0.6–0.9). But they had a higher risk of hospitalization in the first year after starting dialysis (OR = 1.4; 95% CI, 1.0–1.8, P < .05). Patients with schizophrenia undertaking dialysis had higher risk for mortality than the general ESRD patients. A closer collaboration between psychiatrists and nephrologists or internists to minimize the gaps in quality of general care is recommended.
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Affiliation(s)
- Yueh-Han Hsu
- Department of Public Health and Department of Health Services Administration, China Medical University, Taichung City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
- Department of Nursing, Min-Hwei College of Health Care Management, Tainan City, Taiwan
| | - Jur-Shan Cheng
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Wen-Chen Ouyang
- Department of Psychiatry, Changhua Christian Hospital and Changhua Christian Healthcare System, Changhua, Taiwan
- Lutung Christian Hospital, Changhua, Taiwan
- Department of Nursing, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan, Taiwan
- Department of Psychiatry, Kaohsiung Medicine University, Kaohsiung, Taiwan
| | - Chen-Li Lin
- Taipei City Hospital Fuyou Branch; Taipei, Taiwan
| | - Chi-Ting Huang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
- Department of Health Services Administration, China Medical University, Taichung City, Taiwan
- * E-mail:
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Miyamoto Y, Hashimoto-Koichi R, Akiyama M, Takamura S. Mental health and social service needs for mental health service users in Japan: a cross-sectional survey of client- and staff-perceived needs. Int J Ment Health Syst 2015; 9:19. [PMID: 25945122 PMCID: PMC4419408 DOI: 10.1186/s13033-015-0009-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 03/19/2015] [Indexed: 11/20/2022] Open
Abstract
Background The appropriate utilization of community services by people with mental health difficulties is becoming increasingly important in Japan. The aim of the present study was to describe service needs, as perceived by people with mental health difficulties living in the community and their service providers. We analyzed the difference between two necessity ratings using paired data in order to determine implications related to needs assessment for mental health services. Methods This cross-sectional study used two self-reported questionnaires, with one questionnaire administered to mental health service users living in the community and another questionnaire to staff members providing services to those users at community service facilities. The study was conducted in psychiatric social rehabilitation facilities for people with mental health difficulties in Japan. The paired client and staff responses rated needs for each kind of mental health and social service independently. The 19 services listed in the questionnaire included counseling and healthcare, housing, renting, daily living, and employment. Overall, 246 individuals with mental health difficulties were asked to participate in this study, and after excluding invalid responses, 188 client-staff response dyads (76.4% of recruited people, 83.6% of people who gave consent) were analyzed in this study. A Wilcoxon matched-pairs signed rank test was used to compare the perceived needs, and weighted and unweighted Kappa statistics were calculated to assess rating agreement within client-staff dyads. Results Over 75% of participants in our study, who were people with mental health difficulties living in the community, regarded each type of mental health service as “somewhat necessary,” or “absolutely necessary” to live in their community. Most clients and staff rated healthcare facilities with 24/7 crisis consultation services as necessary. Agreement between client and staff ratings of perceived needs for services was low (Kappa = .02 to .26). Services regarding housing, renting a place to live, and advocacy had the same tendency in that clients perceived a higher need when compared to staff perceptions (p < .01). Conclusions It is essential for the service providers to identify the services that each user needs, engage in dialogue, and involve clients in service planning and development. Electronic supplementary material The online version of this article (doi:10.1186/s13033-015-0009-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuki Miyamoto
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033 Japan
| | - Rieko Hashimoto-Koichi
- School of Nursing and Nutrition, Shukutoku University, 673 Nitona, Chuo-ku, Chiba, 260-8703 Japan
| | - Miki Akiyama
- Division of Nursing, Faculty of Healthcare, Tokyo Healthcare University, 4 Chome-1-17 Higashigotanda, Shinagawa, Tokyo 141-0022 Japan
| | - Soichi Takamura
- School of Nursing, Seirei Christopher University, 3453 Mikataharacho, Kita Ward, Hamamatsu, Shizuoka 433-8558 Japan
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Caqueo-Urízar A, Rus-Calafell M, Urzúa A, Escudero J, Gutiérrez-Maldonado J. The role of family therapy in the management of schizophrenia: challenges and solutions. Neuropsychiatr Dis Treat 2015; 11:145-51. [PMID: 25609970 PMCID: PMC4298308 DOI: 10.2147/ndt.s51331] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Family interventions for schizophrenia have been amply demonstrated to be effective and are recommended by most of the international clinical guidelines. However, their implementation in the clinical setting as well as in treatment protocols of patients with psychosis has not been fully achieved yet. With the increasing deinstitutionalization of patients, family has begun to assume the role of care performed by psychiatric hospitals, with a high emotional cost for caregivers as well as the recognition of burden experiences. Families have been the substitute in the face of the scarcity of therapeutic, occupational, and residential resources. For this reason, the viability of patients' care by their families has become a challenge. This article aims to discuss the most important aspects of family interventions, their impact on families, and the most important challenges that need to be overcome in order to achieve well-being and recovery in both patients and caregivers.
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Affiliation(s)
| | - Mar Rus-Calafell
- Department of Social Psychiatry, Institute of Psychiatry, King's College London, London, UK
| | - Alfonso Urzúa
- Alfonso Urzúa Morales, Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
| | - Jorge Escudero
- Departamento de Filosofía y Psicología, Universidad de Tarapacá, Arica, Chile
| | - José Gutiérrez-Maldonado
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad de Barcelona, Barcelona, Spain
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Abstract
The primary objectives in the treatment of schizophrenia are to reduce the frequency and severity of psychotic exacerbation, ameliorate a broad range of symptoms, and improve functional capacity and quality of life. Treatment includes pharmacotherapy and a range of psychosocial interventions. Antipsychotics are the cornerstone of pharmacological treatment for schizophrenia. The sixty-five antipsychotics available in the world are classified into two major groups: first-generation (conventional) agents (FGAs) and second-generation (atypical) agents (SGAs). Whereas clozapine is found to be more efficacious than other agents among otherwise treatment-refractory schizophrenia patients, other differences in efficacy between antipsychotic agents are minor. There are, however, pronounced differences in adverse effect profiles among the 65 antipsychotic medications. Although the 14 SGAs differ "on average" from the 51 FGAs in terms of being associated with a lower risk of EPS and greater risk of metabolic side-effects, substantial variation within the two classes with regard to both risks and other relevant clinical properties undermines the categorical distinction between SGAs and FGAs. Choice of antipsychotic medication should be based on prior treatment response, individual preference, medical history and individual patient vulnerabilities. An individualized treatment approach with ongoing risk-benefit monitoring and collaborative decision-making is outlined. Even as rapid neuroscience advances promise revolutionary improvements in the future, a thoughtful and disciplined approach can provide enhanced outcomes for all schizophrenia patients today.
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Sicras-Mainar A, Maurino J, Ruiz-Beato E, Navarro-Artieda R. Impact of negative symptoms on healthcare resource utilization and associated costs in adult outpatients with schizophrenia: a population-based study. BMC Psychiatry 2014; 14:225. [PMID: 25096022 PMCID: PMC4149268 DOI: 10.1186/s12888-014-0225-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/24/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To evaluate the prevalence and impact of negative symptoms on healthcare resources utilization and costs in patients with schizophrenia. METHODS A retrospective study was conducted using electronic medical records from the health provider BSA (Badalona, Spain). All adult outpatients with a diagnosis of schizophrenia were followed for 12 months. Two study groups were defined by the presence or absence of negative symptoms based on the PANSS Negative Symptoms Factor (N1-N4, N6, G7 and G16). Healthcare (direct cost) and non-healthcare costs (work productivity losses) were described. An ANCOVA model was used for correction, p < 0.05. RESULTS One thousand one hundred and twenty patients were included in the study (mean age: 46.8 ± 13.8 years; male: 58.4%). One or more negative symptoms were present in 52.5% of patients (95% CI: 49.6-55.4%). The most frequent were passive/apathetic social withdrawal and emotional withdrawal (60.5% and 49.8%, respectively). Patients with negative symptoms showed a greater mean number of comorbid conditions and pharmacological treatments. The adjusted unit healthcare cost related to the presence/absence of negative symptoms was €2,190.80 and €1,787.60 and the healthcare cost was €2,085.00 and €1,659.10, respectively; (p < 0.001). Patients with negative symptoms used more healthcare resources, mainly derived from primary care. The presence of negative symptoms was associated with being male, dyslipidemia, obesity and arterial hypertension (OR = 1.7, 1.4, 1.4 and 1.2, respectively). CONCLUSIONS Negative symptoms are highly prevalent in adult outpatients with schizophrenia with a relevant economic impact on the healthcare system.
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Affiliation(s)
| | - Jorge Maurino
- Medical Department, Roche Farma SA, Eucalipto, 33, 28016 Madrid, Spain
| | - Elena Ruiz-Beato
- Health Economics and Outcomes Research Unit, Roche Farma SA, Madrid, Spain
| | - Ruth Navarro-Artieda
- Department of Medical Information, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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