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Davies K, Lappin JM, Gott C, Steel Z. Experiencing Psychosis and Shame: A Systematic Review and Meta-analysis of the Strength and Patterns of Association. Schizophr Bull 2024:sbae139. [PMID: 39175117 DOI: 10.1093/schbul/sbae139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
BACKGROUND AND HYPOTHESIS Shame has been linked to the experience of psychosis, with implications for clinical outcomes, however, a meta-analysis of the relationship has not yet been conducted. This systematic review and meta-analysis aimed to examine the strength of the association between shame and psychosis, and any variations between clinical and non-clinical populations and shame type (internal vs external shame). STUDY DESIGN Searches were conducted in CINAHL, EMBASE, PsycInfo, PubMed, Scopus, and Web of Science from the inception of the e-databases until July 2023. For inclusion, studies reported a quantitative association between psychosis and shame, or data that could be used to identify a relationship. From 11 372 unique retrieved records, 40 articles met the inclusion criteria and 38 were included in the meta-analyses. STUDY RESULTS A significant large pooled estimate of the psychosis-shame association was identified (Zr = 0.36, [95% CI: 0.28, 0.44], P < .001), indicating that higher levels of shame were associated with greater severity of psychotic symptoms. The strength of the association was similar across clinical and non-clinical populations, however, differed by type of shame and psychosis symptom measured. External shame was strongly associated with paranoia suggesting possible confounding. Only a minority of studies met the highest quality criteria. CONCLUSIONS Shame is strongly associated with the severity of psychotic symptoms in clinical and non-clinical populations. Given the overlap with paranoia, measurement of external shame alone is not advised. Larger studies in clinical populations, with measures of a range of psychosis symptoms, are needed to better understand the relationship between shame and specific symptoms.
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Affiliation(s)
- Kimberley Davies
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
- The Tertiary Referral Service for Psychosis, Prince of Wales Hospital, Randwick 2031, NSW, Australia
| | - Julia M Lappin
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
- The Tertiary Referral Service for Psychosis, Prince of Wales Hospital, Randwick 2031, NSW, Australia
| | - Chloe Gott
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
- The Tertiary Referral Service for Psychosis, Prince of Wales Hospital, Randwick 2031, NSW, Australia
| | - Zachary Steel
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia
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Powell T, Glozier N, Conn K, Einboden R, Buus N, Caldwell P, Milton A. The impact of early intervention psychosis services on hospitalisation experiences: a qualitative study with young people and their carers. BMC Psychiatry 2024; 24:350. [PMID: 38730333 PMCID: PMC11088060 DOI: 10.1186/s12888-024-05758-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND While a core aim of early intervention psychosis services (EIPS) is to prevent hospitalisation, many with a first episode of psychosis (FEP) will require inpatient care. We explored young people's (YP) and their carers' hospitalisation experiences prior to and during EIPS engagement and how factors across these services influenced these experiences. METHODS Using purposive sampling, we recruited twenty-seven YP, all of whom had been involved with the hospital system at some stage, and twelve support persons (parents and partners of YP) from state and federally funded EIPS in Australia with different models of care and integration with secondary mental health care. Audio-recorded interviews were conducted face-to-face or via phone. A diverse research team (including lived experience, clinician, and academic researchers) used an inductive thematic analysis process. RESULTS Four key themes were identified as influential in shaping participant's hospital experiences and provide ideas for an approach to care that is improved by the effective coordination of that care, and includes this care being delivered in a trauma informed manner: (1) A two-way street: EIPS affected how participants experienced hospitalisation, and vice versa; (2) It's about people: the quality and continuity of relationships participants had with staff, in hospital and at their EIPS, was central to their experience; (3) A gradual feeling of agency: participants viewed EIPS as both reducing involuntary care and supporting their self-management; and (4) Care coordination as navigation for the healthcare system: great when it works; frustrating when it breaks down. CONCLUSIONS Hospitalisation was viewed as a stressful and frequently traumatic event, but a approach to care founded on trust, transparency, and collaboration that is trauma-informed ameliorated this negative experience. Consistent EIPS care coordination was reported as essential in assisting YP and carers navigate the hospital system; conversely, discontinuity in EIPS staff and lack of integration of EIPS with hospital care undermined the positive impact of the EIPS care coordinator during hospitalisation. Care coordinator involvement as a facilitator, information provider, and collaborator in inpatient treatment decisions may improve the usefulness and meaningfulness of hospital interventions.
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Affiliation(s)
- Tacita Powell
- Adolescent Mental Health, Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Nicholas Glozier
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
- The University of Sydney and Australian Research Council (ARC) Centre of Excellence for, Camperdown, Australia
| | - Katrina Conn
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
- Department of Education, NSW, Sydney, Australia
| | - Rochelle Einboden
- School of Nursing, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario (CHEO) & CHEO Research Institute, Ottawa, Canada
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- School of Nursing, Western Sydney University, Camperdown, Australia
| | - Niels Buus
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Patrick Caldwell
- School of Rural Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Alyssa Milton
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
- The University of Sydney and Australian Research Council (ARC) Centre of Excellence for, Camperdown, Australia.
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Chalker SA, Sicotte R, Bornheimer LA, Parrish EM, Wastler H, Ehret B, DeVylder J, Depp CA. A call to action: informing research and practice in suicide prevention among individuals with psychosis. Front Psychiatry 2024; 15:1378600. [PMID: 38711871 PMCID: PMC11073495 DOI: 10.3389/fpsyt.2024.1378600] [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: 01/29/2024] [Accepted: 03/22/2024] [Indexed: 05/08/2024] Open
Abstract
Although it is well established that individuals living with psychosis are at increased risk for suicidal ideation, attempts, and death by suicide, several gaps in the literature need to be addressed to advance research and improve clinical practice. This Call-to-Action highlights three major gaps in our understanding of the intersection of psychosis and suicide as determined by expert consensus. The three gaps include research methods, suicide risk screening and assessment tools used with persons with psychosis, and psychosocial interventions and therapies. Specific action steps to address these gaps are outlined to inform research and practice, and thus, improve care and prognoses among persons with psychosis at risk for suicide.
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Affiliation(s)
- Samantha A. Chalker
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Roxanne Sicotte
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Lindsay A. Bornheimer
- University of Michigan, School of Social Work, Ann Arbor, MI, United States
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Emma M. Parrish
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Heather Wastler
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - Jordan DeVylder
- Silver School of Social Work, New York University, New York, NY, United States
| | - Colin A. Depp
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, CA, United States
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van Sambeek N, Franssen G, van Geelen S, Scheepers F. Making meaning of trauma in psychosis. Front Psychiatry 2023; 14:1272683. [PMID: 38025479 PMCID: PMC10656619 DOI: 10.3389/fpsyt.2023.1272683] [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: 08/04/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Finding new meaning and identity in the aftermath of trauma has been identified as a key process of mental health recovery. However, research indicates that this meaning-making process is compromised in people with psychosis. Considering the high prevalence, yet under-treatment of trauma in people with psychosis, it is urgent to gain insight into how their meaning-making process can be supported. Aim To gain insight into how people with psychosis make meaning of trauma and identify barriers and facilitators in their meaning-making process. Methods Qualitative inquiry of N = 21 interviews transcripts from the Dutch Psychiatry Storybank. We included interviews of people who (a) lived through multiple psychotic episodes, and (b) spontaneously addressed traumatic experiences in a low-structured interview. Storyline analysis was performed to gain insight into the meaning-making of trauma within their self-stories. Psychosocial conceptualizations of narrative identity were used to inform the analysis. A data-validation session with four experts-by-experience was organized to check and improve the quality of our analysis. Results We identified four different story types: (1) Psychiatry as the wrong setting to find meaning; (2) The ongoing struggle to get trauma-therapy; (3) Exposure to trauma as a threat to a stable life, and (4) Disclosure as the key to resolving alienation. Each story type comprises a different plot, meaning of trauma withing the self-story, (lack of) integration and barriers and facilitators in the meaning-making process. Overall, barriers in the meaning-making process were mostly situated within mental healthcare and stigma-related. People felt particularly hindered by pessimistic ideas on their capacity to develop self-insight and cope with distress, resulting in limited treatment options. Their process of adaptive meaning-making often started with supportive, non-judgmental relationships with individuals or communities that offered them the safety to disclose trauma and motivated them to engage in a process of self-inquiry and growth. Conclusion The outcomes illuminate the social context of the meaning-making challenges that people with psychosis face and illustrate the devastating influence of stigma. Our outcomes offer guidance to remove barriers to adaptive meaning-making in people with psychosis, and can help clinicians to attune to differences in the meaning-making of trauma.
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Affiliation(s)
- Nienke van Sambeek
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gaston Franssen
- Faculty of Humanities, University of Amsterdam, Amsterdam, Netherlands
| | | | - Floortje Scheepers
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
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Bremler R, Katati N, Shergill P, Erritzoe D, Carhart-Harris RL. Case analysis of long-term negative psychological responses to psychedelics. Sci Rep 2023; 13:15998. [PMID: 37749109 PMCID: PMC10519946 DOI: 10.1038/s41598-023-41145-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/22/2023] [Indexed: 09/27/2023] Open
Abstract
Recent controversies have arisen regarding claims of uncritical positive regard and hype surrounding psychedelic drugs and their therapeutic potential. Criticisms have included that study designs and reporting styles bias positive over negative outcomes. The present study was motivated by a desire to address this alleged bias by intentionally focusing exclusively on negative outcomes, defined as self-perceived 'negative' psychological responses lasting for at least 72 h after psychedelic use. A strong justification for this selective focus was that it might improve our ability to capture otherwise missed cases of negative response, enabling us to validate their existence and better examine their nature, as well as possible causes, which could inspire risk-mitigation strategies. Via advertisements posted on social media, individuals were recruited who reported experiencing negative psychological responses to psychedelics (defined as classic psychedelics plus MDMA) lasting for greater than 72 h since using. Volunteers were directed to an online questionnaire requiring quantitative and qualitative input. A key second phase of this study involved reviewing all of the submitted cases, identifying the most severe-e.g., where new psychiatric diagnoses were made or pre-existing symptoms made worse post psychedelic-use-and inviting these individuals to participate in a semi-structured interview with two members of our research team, during which participant experiences and backgrounds were examined in greater depth. Based on the content of these interviews, a brief summary of each case was compiled, and an explorative thematic analysis was used to identify salient and consistent themes and infer common causes. 32 individuals fully completed an onboarding questionnaire (56% male, 53% < age 25); 37.5% of completers had a psychiatric diagnosis that emerged after their psychedelic experience, and anxiety symptoms arose or worsened in 87%. Twenty of the seemingly severer cases were invited to be interviewed; of these, 15 accepted an in-depth interview that lasted on average 60 min. This sample was 40% male, mean age = 31 ± 7. Five of the 15 (i.e., 33%) reported receiving new psychiatric diagnoses after psychedelic-use and all fifteen reported the occurrence or worsening of psychiatric symptoms post use, with a predominance of anxiety symptoms (93%). Distilling the content of the interviews suggested the following potential causal factors: unsafe or complex environments during or surrounding the experience, unpleasant acute experiences (classic psychedelics), prior psychological vulnerabilities, high- or unknown drug quantities and young age. The current exploratory findings corroborate the reality of mental health iatrogenesis via psychedelic-use but due to design limitations and sample size, cannot be used to infer on its prevalence. Based on interview reports, we can infer a common, albeit multifaceted, causal mechanism, namely the combining of a pro-plasticity drug-that was often 'over-dosed'-with adverse contextual conditions and/or special psychological vulnerability-either by young age or significant psychiatric history. Results should be interpreted with caution due to the small sample size and selective sample and study focus.
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Affiliation(s)
- Rebecka Bremler
- Centre for Psychedelic Research, Imperial College London, London, UK.
| | - Nancy Katati
- Centre for Psychedelic Research, Imperial College London, London, UK
| | | | - David Erritzoe
- Centre for Psychedelic Research, Imperial College London, London, UK
| | - Robin L Carhart-Harris
- Centre for Psychedelic Research, Imperial College London, London, UK
- Psychedelics Division, Neuroscape, University of California San Francisco, San Francisco, USA
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Ma M, Shi Z, Chen Y, Ma X. Recovery journey of people with a lived experience of schizophrenia: a qualitative study of experiences. BMC Psychiatry 2023; 23:468. [PMID: 37369995 DOI: 10.1186/s12888-023-04862-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 05/11/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Mental health recovery involves an integration of clinical and psychosocial frameworks. The recovery journey of individuals diagnosed with schizophrenia and the factors that influence it have been extensively studied. Because the recovery journey is culturally influenced, we examined the recovery process expriences of individuals diagnosed with schizophrenia in China, focusing on the influence of a Confucian-dominated collectivist and family-centred culture. METHODS An Interpretive Phenomenological Analysis (IPA) study was conducted; data were gathered through in-depth interviews with 11 individuals with lived experience of schizophrenia. RESULTS Four themes were identified in this study: traumatic illness experiences, influence of the family, motives for recovery, and posttraumatic growth, comprising ten subthemes. "For the family" and "relying on oneself" are the main drivers of recovery for individuals with a Chinese cultural background. Some people believe that taking care of themselves is an important way to ease the burden on their families and treat them well. There is a link between 'for the family' and 'relying on oneself. CONCLUSIONS Individuals living with schizophrenia in China have undergone significant traumatic experiences and have profound interactions with their families. Post-traumatic growth reflects an increase in the individual's connection to others and individual agency. It also suggests that the individual is not receiving enough support outside of the family. The impact of individual agency and family relationships should be considered in services that promote recovery, and clinic staff should enhance support outside the home to the individuals.
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Affiliation(s)
- Min Ma
- Wuhan Mental Health center, Wuhan Hospital for Psychotherapy, Rehabilitation Department, Wuhan, China
| | - Zhidao Shi
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Yanhong Chen
- China University of Geosciences Wuhan, Wuhan, China
| | - Xiquan Ma
- Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Sikstrom L, Maslej MM, Findlay Z, Strudwick G, Hui K, Zaheer J, Hill SL, Buchman DZ. Predictive care: a protocol for a computational ethnographic approach to building fair models of inpatient violence in emergency psychiatry. BMJ Open 2023; 13:e069255. [PMID: 37185650 PMCID: PMC10151964 DOI: 10.1136/bmjopen-2022-069255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Managing violence or aggression is an ongoing challenge in emergency psychiatry. Many patients identified as being at risk do not go on to become violent or aggressive. Efforts to automate the assessment of risk involve training machine learning (ML) models on data from electronic health records (EHRs) to predict these behaviours. However, no studies to date have examined which patient groups may be over-represented in false positive predictions, despite evidence of social and clinical biases that may lead to higher perceptions of risk in patients defined by intersecting features (eg, race, gender). Because risk assessment can impact psychiatric care (eg, via coercive measures, such as restraints), it is unclear which patients might be underserved or harmed by the application of ML. METHODS AND ANALYSIS We pilot a computational ethnography to study how the integration of ML into risk assessment might impact acute psychiatric care, with a focus on how EHR data is compiled and used to predict a risk of violence or aggression. Our objectives include: (1) evaluating an ML model trained on psychiatric EHRs to predict violent or aggressive incidents for intersectional bias; and (2) completing participant observation and qualitative interviews in an emergency psychiatric setting to explore how social, clinical and structural biases are encoded in the training data. Our overall aim is to study the impact of ML applications in acute psychiatry on marginalised and underserved patient groups. ETHICS AND DISSEMINATION The project was approved by the research ethics board at The Centre for Addiction and Mental Health (053/2021). Study findings will be presented in peer-reviewed journals, conferences and shared with service users and providers.
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Affiliation(s)
- Laura Sikstrom
- The Krembil Centre for Neuroinformatics, The Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Anthropology, University of Toronto, Toronto, Ontario, Canada
| | - Marta M Maslej
- The Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Zoe Findlay
- The Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Gillian Strudwick
- Information Management Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Katrina Hui
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Juveria Zaheer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Gerald Sheff and Shanitha Kachan Emergency Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sean L Hill
- The Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Z Buchman
- Office of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Airey ND, Taylor CDJ, Vikram A, Berry K. Trauma measures for use with psychosis populations: A systematic review of psychometric properties using COSMIN. Psychiatry Res 2023; 323:115163. [PMID: 36948019 DOI: 10.1016/j.psychres.2023.115163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
Traumatic events play a key role in the development and course of psychosis. Psychotic symptoms themselves and coercive treatment practices can be inherently traumatic. Hence, reliable and valid methods of assessing trauma and its impact (i.e., Post-Traumatic Stress Disorder (PTSD) symptomology) are essential for use with people with psychosis. Many measures are available to select from, but this is the first review to appraise the psychometric properties of trauma measures to guide decision making regarding instrument use. The review was prospectively registered on Prospero (CRD42022306100). Evaluation of methodological and psychometric quality followed Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidance. Twenty-four articles were eligible, with sixteen trauma measures evaluated. Childhood Trauma Questionnaire- Short Form demonstrated the most robust evidence for assessing experience of trauma. The Trauma and Life Experience (TALE) checklist was the only measure to include specific psychosis and iatrogenic harm items. For PTSD measures, the Symptoms of Trauma Scale and PTSD Symptom Scale- Self Report had the highest quality evidence. Psychometric strengths and weaknesses of various trauma measures are comprehensively evaluated, highlighting future research directions to strengthen the evidence base with emphasis on further evaluation of the TALE, which integrates trauma specific to psychosis.
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Affiliation(s)
- Nicola D Airey
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, 2(nd) Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester M25 3BL, UK.
| | - Christopher D J Taylor
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, 2(nd) Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; Community Mental Health Team, Pennine Care NHS Foundation Trust, Humphrey House, Angouleme Way, Bury BL9 0EQ, UK
| | - Anvita Vikram
- Community Mental Health Team, Pennine Care NHS Foundation Trust, Humphrey House, Angouleme Way, Bury BL9 0EQ, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, 2(nd) Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester M25 3BL, UK
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Hennessy B, Hunter A, Grealish A. A qualitative synthesis of patients' experiences of re-traumatization in acute mental health inpatient settings. J Psychiatr Ment Health Nurs 2022; 30:398-434. [PMID: 36519519 DOI: 10.1111/jpm.12889] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/28/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Research indicates many people accessing mental healthcare have trauma history and often experience re-traumatization in acute mental health inpatient settings. Treatment for trauma is not routinely explored as a treatment option in mental health inpatient settings and consequently mental health professionals do not draw connections between the person with trauma history and their presenting mental health problems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: People in acute mental health inpatient units are not asked about their previous trauma histories on admission and their trauma history is not taken into consideration during interventions in particular coercive practices such as seclusion, restraint, forced medication, and involuntary admission. This paper provides an understanding on how to address trauma-related issues within in-patient settings and identifies practical examples of how to reduce the risk of re-traumatization. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Staff induction and training development needs can be used to help mental health professionals to be more confident and competent in assessing and identifying the history of trauma so that they can improve recognition, provide post-disclosure support, and avoid the potential for re-traumatization for inpatients. Physical environments need to be welcoming, homely, and have comfortable furnishing. They also require adequate space for inpatients to move around freely and have a quiet space to go to de-escalate themselves when required. ABSTRACT INTRODUCTION: Rates of re-traumatization among mentally ill-health patients have risen significantly over the past decade and clinical guidelines place mental health nurses at the heart of their care. AIM To gather, analyse, and synthesize the evidence on people's experiences on re-traumatization in acute mental health inpatient settings. METHOD A systematic search for qualitative studies (CINAHL, MEDLINE, ASSIA, PsycINFO, and EMBASE) was conducted. Two authors independently assessed eligibility and appraised methodological quality using Joanna Briggs's quality appraisal tool and extracted data. The analysis followed the principles of interpretative synthesis. RESULTS Fourteen papers were included for thematic synthesis. Three themes emerged: (1) Quality of staff interaction; (2) Specific interventions, (Sub-theme nature of symptoms); and (3) Nature of the environment. DISCUSSION Our findings demonstrate that patients are experiencing re-traumatization in acute mental health inpatient settings and that there is little being done to prevent it from occurring. IMPLICATIONS FOR PRACTICE This study is the first to analyse the factors that contribute to re-traumatization and make recommendations to mental healthcare professionals to reduce the harmful practices in place in inpatient settings. It is suggested that training staff in trauma-informed care and allowing patients to be experts in their own care can reduce the rates of re-traumatization.
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Affiliation(s)
- Brid Hennessy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Andrew Hunter
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Annmarie Grealish
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Penninx Quevedo R, de Jongh A, Bouwmeester S, Didden R. EMDR therapy for PTSD symptoms in patients with mild intellectual disability or borderline intellectual functioning and comorbid psychotic disorder: A case series. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 117:104044. [PMID: 34438220 DOI: 10.1016/j.ridd.2021.104044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Little is known about the effectiveness of EMDR therapy for PTSD symptoms in persons with mild intellectual disability or borderline intellectual functioning (MID-BIF, IQ 50-85) and psychosis. AIMS To examine effectiveness, feasibility, and safety of eye movement desensitization and reprocessing (EMDR) therapy in six patients with MID-BIF, PTSD and psychotic disorder. METHODS AND PROCEDURES Data were collected in a multiple baseline across-subjects design. Before, during and after treatment, weekly assessments on PTSD symptoms and adverse events were carried out. PTSD classification was assessed, and severity of hallucinations, delusions, and general psychopathology were measured at pretreatment, posttreatment and three-month follow-up. OUTCOMES AND RESULTS There were no dropouts and five of the six participants completed treatment early. They showed a decrease in PTSD symptom severity and did no longer meet DSM-5 PTSD criteria at posttreatment. Results were maintained at follow-up. Symptoms did not exacerbate as indicated by a significant decrease in general psychopathology (in five participants) and an improvement in general functioning. In five participants severity of psychotic symptoms decreased. CONCLUSIONS AND IMPLICATIONS EMDR therapy is safe and feasible and the results suggest that it can be an effective treatment for PTSD in patients with triple mental health problems in a tertiary mental health treatment setting.
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Affiliation(s)
| | - Ad de Jongh
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, the Netherlands; Research Department PSYTREC, Bilthoven, the Netherlands; School of Health Sciences, Salford University, Manchester, United Kingdom; Institute of Health and Society, University of Worcester, United Kingdom; School of Psychology, Queen's University, Belfast, Northern Ireland, United Kingdom
| | | | - Robert Didden
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands; Trajectum, Zwolle, the Netherlands; GGZ Oost-Brabant, Centre for Mild Intellectual Disability and Psychiatry, Boekel, The Netherlands
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Fares-Otero NE, Trautmann S, Pfaltz MC, Rodriguez-Jimenez R. Letter to the Editor: Targeting adverse stress-related consequences of the COVID-19 crisis in individuals with psychotic disorders and childhood maltreatment. J Psychiatr Res 2021; 138:453-455. [PMID: 33964683 PMCID: PMC9750188 DOI: 10.1016/j.jpsychires.2021.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/01/2021] [Accepted: 04/20/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Natalia E. Fares-Otero
- Corresponding author. Department of Psychiatry, Biomedical Research Institute, University Hospital 12 de Octubre (imas12), Avda. de Córdoba s/n, 28041, Madrid, Spain
| | | | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Faculty of Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Roberto Rodriguez-Jimenez
- Department of Psychiatry, Biomedical Research Institute, University Hospital 12 de Octubre (imas12), Faculty of Medicine, Complutense University of Madrid (UCM), Madrid, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain
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Baumgardt J, Schwarz J, Bechdolf A, Nikolaidis K, Heinze M, Hamann J, Holzke M, Längle G, Richter J, Brieger P, Kilian R, Timm J, Hirschmeier C, Von Peter S, Weinmann S. Implementation, efficacy, costs and processes of inpatient equivalent home-treatment in German mental health care (AKtiV): protocol of a mixed-method, participatory, quasi-experimental trial. BMC Psychiatry 2021; 21:173. [PMID: 33781237 PMCID: PMC8008509 DOI: 10.1186/s12888-021-03163-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Over the last decades, many high-income countries have successfully implemented assertive outreach mental health services for acute care. Despite evidence that these services entail several benefits for service users, Germany has lagged behind and has been slow in implementing outreach services. In 2018, a new law enabled national mental health care providers to implement team-based crisis intervention services on a regular basis, allowing for different forms of Inpatient Equivalent Home Treatment (IEHT). IEHT is similar to the internationally known Home Treatment or Crisis Resolution Teams. It provides acute psychiatric treatment at the user's home, similar to inpatient hospital treatment in terms of content, flexibility, and complexity. METHODS/DESIGN The presented naturalistic, quasi-experimental cohort study will evaluate IEHT in ten hospitals running IEHT services in different German regions. Within a multi-method research approach, it will evaluate stakeholders' experiences of care, service use, efficacy, costs, treatment processes and implementation processes of IEHT from different perspectives. Quantitative surveys will be used to recruit 360 service users. Subsequently, 180 service users receiving IEHT will be compared with 180 matched statistical 'twins' receiving standard inpatient treatment. Assessments will take place at baseline as well as after 6 and 12 months. The primary outcome is the hospital re-admission rate within 12 months. Secondary outcomes include the combined readmission rate, total number of inpatient hospital days, treatment discontinuation rate, quality of life, psycho-social functioning, job integration, recovery, satisfaction with care, shared decision-making, and treatment costs. Additionally, the study will assess the burden of care and satisfaction with care among relatives or informal caregivers. A collaborative research team made up of researchers with and without lived experience of mental distress will conduct qualitative investigations with service users, caregivers and IEHT staff teams to explore critical ingredients and interactions between implementation processes, treatment processes, and outcomes from a stakeholder perspective. DISCUSSION By integrating outcome, process and implementation research as well as different stakeholder perspectives and experiences in one study, this trial captures the various facets of IEHT as a special form of home treatment. Therefore, it allows for an adequate, comprehensive evaluation on different levels of this complex intervention. TRIAL REGISTRATION Trial registrations: 1) German Clinical Trials Register (DRKS), DRKS000224769. Registered December 3rd 2020, https://www.drks.de/drks_web/setLocale_EN.do ; 2) ClinicalTrials.gov, Identifier: NCT0474550 . Registered February 9th 2021.
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Affiliation(s)
- Johanna Baumgardt
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Vivantes Klinikum Am Urban, Berlin, Germany.
| | - Julian Schwarz
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Vivantes Klinikum Am Urban, Berlin, Germany
- ORYGEN, National Center of Excellence of Youth Mental Health, University of Melbourne, Melbourne, Australia
- Department for Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Konstantinos Nikolaidis
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Johannes Hamann
- kbo-Isar Amper Klinikum, Region München, Munich, Germany
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Martin Holzke
- Center for Psychiatry Suedwuerttemberg, Department of Psychiatry I, Ulm University, Ravensburg, Weissenau, Germany
| | - Gerhard Längle
- Center for Psychiatry Suedwuerttemberg, Zwiefalten, Germany
- Gemeinnützige GmbH für Psychiatrie Reutlingen (PP.rt), Academic Hospital of Tuebingen University, Reutlingen, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Department of Medicine of the Tuebingen University, Tuebingen, Germany
| | - Janina Richter
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Department of Medicine of the Tuebingen University, Tuebingen, Germany
| | - Peter Brieger
- kbo-Isar Amper Klinikum, Region München, Munich, Germany
| | - Reinhold Kilian
- Department of Psychiatry II, Ulm University, Günzburg, Germany
| | | | - Constance Hirschmeier
- Department for Psychiatry and Psychotherapy, Charité University Hospital Berlin, Berlin, Germany
| | - Sebastian Von Peter
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Stefan Weinmann
- Psychiatric Hospital and Rehabilitation Unit, Rudolf-Sophien-Stift, Stuttgart, Germany
- University Psychiatric Hospital Basel, Basel, Switzerland
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Pathways to aggression and violence in psychosis without longstanding antisocial behavior: A review and proposed psychosocial model for integrative clinical interventions. Psychiatry Res 2020; 293:113427. [PMID: 32866792 DOI: 10.1016/j.psychres.2020.113427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/19/2020] [Accepted: 08/23/2020] [Indexed: 11/22/2022]
Abstract
There is a need for a clearer understanding of the factors associated with increased risk of aggression and violence (AV) among people with psychosis and other severe mental illness (SMI) to guide effective prevention and intervention. The current article (1) reviews the literature regarding psychosocial factors associated with AV among individuals with psychosis and other SMI who do not have longstanding antisocial behaviors, (2) proposes an integrative psychosocial model of AV that can be practically applied, and (3) proposes appropriate evidence-based clinical interventions to reduce AV and facilitate recovery. We propose that increased risk for AV among people with psychosis is driven by anger, which is affected by a range of factors including victimization and situational stressors, social rejection or experiences of discrimination, anxious arousal, and hostile attribution bias related to psychosis. The cumulative effect of these systems is exacerbated by co-occurring substance misuse and increased impulsivity, particularly negative urgency. In consideration of the current psychosocial model and existing evidence-based interventions for AV in individuals with psychosis, we propose that trauma-informed interventions that integrate skills training in emotion regulation, social and interpersonal situations, cognitive restructuring and remediation, and modified prolonged exposure may demonstrate the most promise for this population.
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Bacha K, Hanley T, Winter LA. 'Like a human being, I was an equal, I wasn't just a patient': Service users' perspectives on their experiences of relationships with staff in mental health services. Psychol Psychother 2020; 93:367-386. [PMID: 30720230 PMCID: PMC7217193 DOI: 10.1111/papt.12218] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/10/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The quality of therapeutic relationships in psychiatric services has a significant impact upon the therapeutic outcomes for people diagnosed with a severe mental illness. As previous work has not explicitly explored service users' in-depth views about the emotional impact of these relationships, the objective of this work was to bring this perspective to the fore and to gain a greater understanding about which relational components can lead to psychological change. DESIGN The project was conducted alongside a service user organization. An interview design was used to qualitatively explore service users' experiences and perceptions of their relationships with mental health practitioners. METHODS Eight individuals who had experience of the mental health system in the United Kingdom were interviewed. Interpretative phenomenological analysis was used to analyse the data. FINDINGS Three superordinate themes emerged from the analysis. These were (1) Trying to survive: am I a person or just an object in the system?; (2) Traumatic experiences within relationships; and (3) Helpful and transformative relationships. Further, the key transformative components of these relationships were power, safety, and identity. CONCLUSIONS Mental health services should be more focused upon care, rather than control. The Power Safety Identity (PSI) model, a reflexive model based upon key relational components highlighted by participants, is proposed for services and professionals to consider their work. The components of this model are managed by mental health practitioners and can determine whether these relationships maintain, increase, or alleviate psychological distress. PRACTITIONER POINTS Awareness of the relational components of power, safety, and identity has the potential to help practitioners reflect upon the tensions they experience in their relationships with service users. Mental health services and professionals that are sensitive to issues related to power, safety, and identity when responding to the needs of the service users can improve how individuals perceive the quality of care provided by them. Relationships between service users and mental health practitioners can encourage recovery if they are consistent, safe, trusting, provide protective power, and mirror a positive sense of self.
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Affiliation(s)
- Karin Bacha
- Manchester Institute of EducationUniversity of ManchesterUK
| | - Terry Hanley
- Manchester Institute of EducationUniversity of ManchesterUK
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Dijkhuizen LGM, Kubat B, Duijst WLJM. Sudden death during physical restraint by the Dutch police. J Forensic Leg Med 2020; 72:101966. [PMID: 32452456 DOI: 10.1016/j.jflm.2020.101966] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND and goal: The Police is sometimes confronted with the death of a subject during physical restraint. In most of these cases a clear Cause of Death (COD) cannot be determined by the Pathologist. The goal of this research is to find and clarify a pattern and pinpoint a clearer COD. METHOD The research group is compiled of 38 closed police case files from the NPIID (National Police Internal Investigation Department) between 2005 and 2016. The control group is compiled of cases involving excitation and restraint, without leading to death. 148 cases were included from the NPIID between 2005 and 2016 and the Violence Registration Database of the Dutch National Police between 2014 and 2015. Case files of both the research and the control group were systematically analyzed and compared. RESULTS AND CONCLUSION The observed patter shows that subjects dying during Physical Restraint are mostly males between 30 and 40 years old with a BMI above 30 kg/m2. Both BMI and age are remarkably lower in the control group. Subjects were encountered in a state of excitation mostly attributed to (multiple) drugs (cocaine, MDMA or cannabis). The physical restraint portrayed a pattern of escalation with restraint being mostly face-down, hands cuffed to the back, receiving thoracic pressure, resulting in a high total amount of force used. In the research group 44.7% (17/38) of subjects were encountered (partially) unclothed versus 4.1% (6/148) in the control group. Cause of death in these cases seems to be multifactorial and is comprised of both personal factors and factors during and after the struggle. The different factors are comingled and augment each other. The end effect is that the subjects end up in a fatal spiral.
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Affiliation(s)
- L G M Dijkhuizen
- GGD IJsselland, Zeven Alleetjes 1, 8011 CV, Zwolle, the Netherlands; Faculty of Law, Maastricht University, Minderbroedersberg 4-6, 6211 LK, Maastricht, the Netherlands.
| | - Bela Kubat
- Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands; NFI (Netherlands Forensic Institute), Laan van Ypenburg 6, 2497 GB, The Hague, the Netherlands.
| | - W L J M Duijst
- GGD IJsselland, Zeven Alleetjes 1, 8011 CV, Zwolle, the Netherlands; Faculty of Law, Maastricht University, Minderbroedersberg 4-6, 6211 LK, Maastricht, the Netherlands.
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Rodrigues R, Beswick A, Anderson KK. Psychiatric hospitalization following psychosis onset: A retrospective cohort study using health administrative data. Early Interv Psychiatry 2020; 14:235-240. [PMID: 31696672 DOI: 10.1111/eip.12893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/18/2019] [Accepted: 10/19/2019] [Indexed: 11/28/2022]
Abstract
AIM There is limited evidence examining admissions in early psychosis. We sought to estimate the proportion of people with a psychiatric admission within 2 years of the first diagnosis of psychosis, and to identify associated risk factors. METHOD We constructed a cohort of incident non-affective psychosis cases using health administrative data and identified the first psychiatric hospitalization after psychosis onset. We compared hospitalization rates across sociodemographic, clinical and service-use factors. RESULTS One in three patients had an admission within 2 years of first diagnosis. Younger age, migrant status, diagnosis of psychosis not otherwise specified, and prior substance use were associated with increased hospitalization rates, whereas family physician involvement in diagnosis was protective. CONCLUSIONS Adolescents, immigrants and people presenting with diagnostic instability or prior substance use issues may benefit from interventions aimed at reducing hospitalization risk. Increasing primary care access and utilization among youth with early psychosis may also reduce hospitalization rates.
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Affiliation(s)
- Rebecca Rodrigues
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Adam Beswick
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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McKenna G, Jackson N, Browne C. Trauma history in a high secure male forensic inpatient population. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 66:101475. [PMID: 31706394 DOI: 10.1016/j.ijlp.2019.101475] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/03/2019] [Accepted: 07/17/2019] [Indexed: 06/10/2023]
Abstract
There is an increasing focus on trauma within forensic services. This study aimed to investigate exposure to trauma among a high secure male forensic population. Based on the Childhood Trauma Questionnaire (CTQ) and the Trauma History Questionnaire (THQ) data capture sheets were developed. Patients' own offending behaviour was included as a source of potential trauma. Records for all patients placed within the hospital (n = 194) were reviewed. All patients had been exposed to a traumatic event over the lifespan, with 75% having been exposed to trauma during childhood. Sixty-five percent of patients had experienced more than one type of trauma during childhood; the mean number of trauma types experienced during this period being 2.31. In adulthood 63% had been exposed to one trauma type while 29% had been exposed to two or more trauma types. No significant difference was found between those with and those without childhood trauma histories on hospital variables including admission length, seclusion and incidents. The implications of these results in the context of adopting a trauma informed care approach to treatment in forensic settings are discussed, and recommendations for future clinical and research directions are made.
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Affiliation(s)
- Gráinne McKenna
- High Secure Psychological Services Ashworth Hospital, Mersey Care NHS Foundation Trust, Parkbourn, Maghull, Merseyside L31 1HW, UK.
| | - Neil Jackson
- High Secure Psychological Services Ashworth Hospital, Mersey Care NHS Foundation Trust, Parkbourn, Maghull, Merseyside L31 1HW, UK
| | - Claire Browne
- High Secure Psychological Services Ashworth Hospital, Mersey Care NHS Foundation Trust, Parkbourn, Maghull, Merseyside L31 1HW, UK
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Rodrigues R, MacDougall AG, Zou G, Lebenbaum M, Kurdyak P, Li L, Shariff SZ, Anderson KK. Involuntary hospitalization among young people with early psychosis: A population-based study using health administrative data. Schizophr Res 2019; 208:276-284. [PMID: 30728106 DOI: 10.1016/j.schres.2019.01.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Early psychosis is an important window for establishing long-term trajectories. Involuntary hospitalization during this period may impact subsequent service engagement in people with newly diagnosed psychotic disorder. However, population-based studies of involuntary hospitalization in early psychosis are lacking. We sought to estimate the proportion of people aged 16 to 35 years with early psychosis in Ontario who are hospitalized involuntarily at first admission, and to identify the associated risk factors and outcomes. METHODS Using linked population-based health administrative data, we identified incident cases of non-affective psychosis over a five-year period (2009-2013) and followed cases for two years to ascertain the first psychiatric hospitalization. We used modified Poisson regression to model sociodemographic, clinical, and service-related risk factors, and compared service-related outcomes for cases admitted on an involuntary versus voluntary basis. RESULTS Among 17,725 incident cases of non-affective psychosis, 38% were hospitalized within two years, and 81% of these admissions occurred on an involuntary basis (26% of cohort). Sociodemographic factors associated with an increased risk of involuntary admission included younger age (16-20), and first-generation migrant status. The strongest risk factors were poor illness insight, recent police involvement, and admission to a general (versus psychiatric) hospital. Outcomes associated with involuntary admission included increased likelihood of control intervention use and a shorter length of stay. CONCLUSIONS One in four young people with first-episode psychosis will have an involuntary admission early in the course of their illness. Our findings highlight areas for intervention to improve pathways to care for people with psychotic disorder.
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Affiliation(s)
- Rebecca Rodrigues
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Arlene G MacDougall
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Guangyong Zou
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Paul Kurdyak
- Institute for Clinical Evaluate Sciences, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lihua Li
- Institute for Clinical Evaluate Sciences, Toronto, ON, Canada
| | | | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Institute for Clinical Evaluate Sciences, Toronto, ON, Canada.
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Jaeger S, Hüther F, Steinert T. Refusing Medication Therapy in Involuntary Inpatient Treatment-A Multiperspective Qualitative Study. Front Psychiatry 2019; 10:295. [PMID: 31139098 PMCID: PMC6520436 DOI: 10.3389/fpsyt.2019.00295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/16/2019] [Indexed: 11/20/2022] Open
Abstract
Objective: Between June 2012 and February 2013, two decisions by the German Federal Constitutional Court restricted the so-far common practice to use involuntary medication in inpatients who were involuntarily hospitalized. Up to then, involuntary medication was justified by a judge's decision on involuntary hospitalization. It could be applied according to clinical judgment even against the declared will of a patient. Since then, all domestic laws related to involuntary treatment had to be revised. For several months, involuntary medication was allowed only in an emergency. We were interested in the impact of the changed legal framework on the experiences of inpatients, their relatives, and clinical professionals during that time. Methods: Thirty-two interviews were analyzed qualitatively using a grounded theory methodology framework. Results: As a consequence of the restrictions to involuntary medication, special efforts by nursing and medical staff were required concerning de-escalation, ward management, and the promotion of treatment commitment in inpatients who refused medication. Family caregivers were also under strong pressure. They wanted to help and to protect their relatives, but some also welcomed the use of coercion if the patient refused treatment. Most of the interviewed patients had not even noticed that their rights to refuse medication had been strengthened. They complained primarily about the involuntary hospital stay and the associated limitations of their everyday lives. While patients and family members evaluated the refusal of medication from a biographical perspective, the mental health care professionals' focus was on the patients' symptoms, and they understood the situation from a professional perspective. It was obvious that, in any of the four perspectives, the problem of feeling restricted was crucial and that all groups strived to gain back their scope of action. Conclusion: The temporary ban on involuntary medication questioned the hitherto common routines in inpatient treatment, in particular when patients refused to take medication. Each of the different groups did not feel good about the situation, for different reasons, however. As a consequence, it might be indispensable to increase awareness of the different perspectives and to focus the efforts on the establishment of nonviolent treatment structures and practices.
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Affiliation(s)
- Susanne Jaeger
- Department of Psychiatry I, Ulm University, Centre for Psychiatry Suedwuerttemberg, Health Services Research Weissenau, Ravensburg, Germany
| | - Franziska Hüther
- Department of Psychiatry I, Ulm University, Centre for Psychiatry Suedwuerttemberg, Health Services Research Weissenau, Ravensburg, Germany
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Tilman Steinert
- Department of Psychiatry I, Ulm University, Centre for Psychiatry Suedwuerttemberg, Health Services Research Weissenau, Ravensburg, Germany
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Ladois-Do Pilar Rei A, Chraïbi S. [Patients assaulted in psychiatric institutions: Literature review and clinical implications]. Rev Epidemiol Sante Publique 2017; 66:53-62. [PMID: 29223515 DOI: 10.1016/j.respe.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/30/2017] [Accepted: 10/20/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The psychiatric ward is a place where all forms of violence are treated. Occasionally, this violence involves acts of aggression between patients in emergency psychiatric units or hospital wards. Such events can lead to the development or worsening of posttraumatic stress disorder. METHODS To establish the context, we first examined the epidemiology data concerning posttraumatic stress disorder in psychiatric patients who were frequently exposed to assaults. Secondly, we examined the issue of sexual and physical assaults between patients receiving treatment in a psychiatric ward. In this context, we studied possible occurrence of posttraumatic stress disorder associated with exposure to assaults of this kind. RESULTS In certain cases, potentially traumatic exposure to violence was unknown to the medical staff or not taken into consideration. This would induce a risk of later development of posttraumatic stress disorder that would not be treated during the stay in psychiatry. CONCLUSION To date, few scientific studies have focused on the proportion of patients assaulted by other patients during treatment in a psychiatric ward and the subsequent development of peritraumatic reactions and/or posttraumatic stress disorder associated with these assaults. We know that an insufficient number of public and private health institutions report the existence of such facts to the competent authorities. Also, a minority of clinicians and caregivers are trained in screening and management of trauma victims. Yet, these issues are particularly relevant in the scope of public health and health promotion.
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Affiliation(s)
- A Ladois-Do Pilar Rei
- Centre hospitalier de Lannemezan, CMP Théophile-Gautier, 1, rue Théophile-Gautier, 65000 Tarbes, France.
| | - S Chraïbi
- Laboratoire cliniques pathologique et interculturelle (LCPI), université Toulouse Jean-Jaurès, 5, allées Antonio-Machado, 31058 Toulouse, France
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