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Koetsier T, Apeldoorn J, Nugter A. Working mechanisms of imagery rescripting (ImRs) in adult patients with childhood-related PTSD: a pilot study. Eur J Psychotraumatol 2024; 15:2339702. [PMID: 38629412 PMCID: PMC11025401 DOI: 10.1080/20008066.2024.2339702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Background: Imagery rescripting (ImRs) has shown to be an effective treatment for posttraumatic stress disorders (PTSD) resulting from childhood-related trauma. The current theory is that the change of meaning of the trauma memory is central to the treatment. Several authors have suggested that the expression of needs, feelings and actions may act as potential healing factors, but little specific research aimed at (in)validating this hypothesis has been done so far.Objective: In this study we investigated to what extent the expression of inhibited action tendencies and the fulfilling of needs lead to the reduction of PTSD symptoms in clients with early childhood trauma.Method: Recordings of 249 therapy sessions of 24 ImRs treatments were rated with an observation instrument developed for this purpose, after which the scores were related to pre and posttreatment symptoms, assessed with the Impact of Events Scale-Revised (IES-R).Results: Scores on the IES-R decreased from pretreatment to posttreatment. The two subscales of the NATS (At-scale and N-scale)significantly predicted the posttreatment scores on the IES-R after controlling for the influence of pretreatment IES-R scores: the better the expression of inhibited action tendencies and the better the fulfilling of needs, the lower the symptoms after treatment.Conclusions: This pilot study on the underlying mechanisms of ImRs in PTSD treatment has shown that the expression of action tendencies and fulfilling basic needs during ImRs are associated with a decrease in PTSD symptoms after treatment, and that actions and basic needs cannot be viewed separately. Follow-up research could focus on which of the six domains of the Needs and Action tendencies Scale (NATS) has the greatest effect on the reduction of PTSD symptoms. With this information we can further improve the ImRs protocol.
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Affiliation(s)
| | | | - Annet Nugter
- GGZ Noord-Holland-Noord, NP Hoorn, the Netherlands
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Engelsbel F, Waterhout N, Dijkstra M, Keet R, Nugter A. Experiences of Clients and Professionals with the Recovery Oriented Intake. Community Ment Health J 2024:10.1007/s10597-024-01250-1. [PMID: 38401011 DOI: 10.1007/s10597-024-01250-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/12/2024] [Indexed: 02/26/2024]
Abstract
The Recovery Oriented Intake (ROI) integrates recovery principles from the start of treatment, and involves peer experts, unlike the intake as usual (IAU). This study compared experiences with ROI and IAU among 127 clients and 391 professionals, consisting of practitioners and peer experts. Intake's quality, measured with questionnaires, showed no differences in experiences between ROI and IAU clients. However, practitioners experienced ROI as more recovery-oriented than IAU. The ROI Fidelity Check (RFC) revealed that clients' RFC-scores, but not practitioners', predicted their valuation of intake's quality. This underscores the need for (re)training and peer supervision for professionals to ensure adherence to ROI's principles. Discrepancies between clients' and professionals' experiences at the start of treatment are consistent with literature on working alliance and Shared Decision Making (SDM). Differences between ROI and IAU professionals may stem from heightened awareness of recovery principles due to training and the presence of peer experts during intake.
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Affiliation(s)
- Fabiana Engelsbel
- GGZ Noord-Holland-Noord Research Department, Heerhugowaard, The Netherlands.
| | - Nanette Waterhout
- GGZ Noord-Holland-Noord Department of Community mental Health, Heerhugowaard, The Netherlands
| | - Marty Dijkstra
- GGZ Noord-Holland-Noord Department of Community mental Health, Heerhugowaard, The Netherlands
| | - René Keet
- GGZ Noord-Holland-Noord FIT-Academy, Heerhugowaard, The Netherlands
| | - Annet Nugter
- GGZ Noord-Holland-Noord Research Department, Heerhugowaard, The Netherlands
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Rusu VA, van der Lans RM, Vermeiren RRJM, Hauber K, de Lijster JM, Lindauer RJL, Nugter A, Hoekstra PJ, Nooteboom LA. Training is not enough: child and adolescent psychiatry clinicians' impressions of telepsychiatry during the first COVID-19 related lockdown. Eur Child Adolesc Psychiatry 2022; 32:987-993. [PMID: 35986802 PMCID: PMC9391644 DOI: 10.1007/s00787-022-02042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 06/25/2022] [Indexed: 11/03/2022]
Abstract
To ensure the continuity of care during the COVID-19 pandemic, clinicians in Child and Adolescent Psychiatry (CAP) were forced to immediately adapt in-person treatment into remote treatment. This study aimed to examine the effects of pre-COVID-19 training in- and use of telepsychiatry on CAP clinicians' impressions of telepsychiatry during the first two weeks of the Dutch COVID-19 related lockdown, providing a first insight into the preparations necessary for the implementation and provision of telepsychiatry during emergency situations. All clinicians employed by five specialized CAP centres across the Netherlands were invited to fill in a questionnaire that was specifically developed to study CAP clinicians' impressions of telepsychiatry during the COVID-19 pandemic. A total of 1065 clinicians gave informed consent and participated in the study. A significant association was found between pre-COVID-19 training and/or use of telepsychiatry and CAP clinicians' impressions of telepsychiatry. By far, the most favourable impressions were reported by participants that were both trained and made use of telepsychiatry before the pandemic. Participants with either training or use separately reported only slightly more favourable impressions than participants without any previous training or use. The expertise required to provide telepsychiatry is not one-and-the-same as the expertise that is honed through face-to-face consultation. The findings of this study strongly suggest that, separately, both training and (clinical) practice fail to sufficiently support CAP clinicians in the implementation and provision of telepsychiatry. It is therefore recommended that training and (clinical) practice are provided in conjunction.
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Affiliation(s)
- Vlad-Alexandru Rusu
- Curium LUMC, Oegstgeest, The Netherlands. .,Karakter, Wageningen, The Netherlands. .,de Bascule, Duivendrecht, The Netherlands. .,GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands. .,Accare, Assen, The Netherlands.
| | - R. M. van der Lans
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - R. R. J. M. Vermeiren
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - K. Hauber
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - J. M. de Lijster
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - R. J. L. Lindauer
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - A. Nugter
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - P. J. Hoekstra
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - L. A. Nooteboom
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
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de Jager J, Topper M, Nugter A, van Os J. The impact of childhood sexual trauma on intimacy and sexuality needs among people with non-affective psychosis. Schizophr Res 2021; 236:97-103. [PMID: 34455357 DOI: 10.1016/j.schres.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Childhood trauma, in particular childhood sexual abuse (CSA), and unmet sexuality and intimacy needs are prevalent among people with psychosis spectrum disorders. The association between CSA and sexuality and intimacy needs over time in adults with psychosis spectrum disorders were examined. METHOD Patients (n = 1119) were recruited as part of the Genetic Risk and OUtcome of Psychosis (GROUP) study, a representative cohort of patients with non-affective psychotic disorder. At baseline, three-year and six-year follow-up, sexuality and intimacy needs were assessed with the Camberwell Assessment of Needs. CSA was assessed with the Childhood Trauma Questionnaire. RESULTS At baseline, sexuality (26%) and intimacy (40%) needs were prevalent; 90% of these needs remained unmet. Cross-sectionally, CSA was associated with sexuality needs (OR = 1.68, 95% CI: 1.13-2.04) and intimacy needs (OR = 1.75, 95% CI: 1.04- 1.77). Childhood emotional abuse (CEA) was also cross-sectionally associated with sexuality and intimacy needs. Others forms of trauma were not. Prospectively, CSA predicted incidence of a sexuality need (HR = 2.1, 95% CI: 1.23-3.74) as well as an intimacy need (HR = 1.7, 95% CI: 1.11-2.66), as did CEA (sexuality: HR = 1.8, 95% CI: 1.11-2.89; intimacy: HR = 1.4, 95% CI: 1.03-1.96). CSA and CEA were not associated with persistence of sexuality or intimacy. CONCLUSION CSA and CEA are associated with a higher prevalence and incidence of sexuality and intimacy needs in patients with psychotic disorders. High rates of unmet sexuality and intimacy needs may indicate an underlying need for trauma-related treatment as well as a need for novel interventions targeting these needs.
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Affiliation(s)
- Jose de Jager
- Mental health care institution GGZ Noord-Holland Noord, Postbus 18, 1850 BA Heiloo, the Netherlands; Brain Centre Rudolf Magnus University Medical Centre, Utrecht, the Netherlands.
| | - Maurice Topper
- Mental health care institution GGZ Noord-Holland Noord, Postbus 18, 1850 BA Heiloo, the Netherlands.
| | - Annet Nugter
- Mental health care institution GGZ Noord-Holland Noord, Postbus 18, 1850 BA Heiloo, the Netherlands.
| | - Jim van Os
- Brain Centre Rudolf Magnus University Medical Centre, Utrecht, the Netherlands; King's College, Institute of Psychiatry, London, UK.
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Swagemakers O, Nugter A, Engelsbel F, Schulte P. Feasibility of group cognitive behavioural therapy for insomnia (CBT-I) in bipolar disorder. Eur Psychiatry 2021. [PMCID: PMC9471893 DOI: 10.1192/j.eurpsy.2021.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Euthymic patients with bipolar I and II disorder (BD) often have comorbid insomnia, which is associated with worse outcome. Cognitive behavioral therapy for insomnia (CBT-I) is rarely offered to this population, though preliminary research indicates CBT-I to be safe and helpful to improve sleep and mood stability. Objectives The present study investigates if CBT-I for euthymic BD patients is feasible and acceptable when offered in a group format. Methods 14 euthymic bipolar disorder I or II participants participated in a 7-session group CBT-I with BD-specific modifications (CBT-I-BD), preceded by one individual session. Feasibility and acceptability were assessed by recruitment, treatment drop-out and participants’ and therapists’ evaluations, while sleep quality, mood and sleep medication were assessed at baseline, end of treatment, 3 and 6 months later. Results
31 of 539 patients with bipolar disorder were referred, 14 were included and one dropped out of treatment. Group CBT-I-BD was acceptable as shown by high session attendance and good homework compliance. Participants highly appreciated the treatment, the group format and learning effect. Insomnia severity decreased significantly between baseline and post-treatment. Group CBT-I-BD did not cause mood episodes during treatment and although not requested, the total number of nights with sleep medication decreased. Conclusions
Group CBT-I-BD seems to be a feasible, acceptable and therefore viable treatment for euthymic patients with bipolar disorder suffering from persistent insomnia. The small sample size, resulting in small CBT-I-BD groups was a main limitation of the study.
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McCann E, Donohue G, de Jager J, Nugter A, Stewart J, Eustace-Cook J. Sexuality and intimacy among people with serious mental illness: a qualitative systematic review. ACTA ACUST UNITED AC 2020; 17:74-125. [PMID: 30629043 DOI: 10.11124/jbisrir-2017-003824] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of this systematic review was to synthesize the best available qualitative evidence on the experiences and support needs of people with serious mental illness (SMI) regarding sexuality and intimacy within hospital and community settings. The objectives were to explore intimate relationship experiences of people with SMI, to uncover potential obstacles to the expression of sexuality and to present recommendations for mental health policy, education, research and practice. INTRODUCTION Mental health services worldwide have seen major transformations in recent years through deinstitutionalization programs and more enlightened ways of organizing and providing mental health care. However, in terms of social and emotional wellbeing, issues persist for people with SMI, particularly relating to intimacy and the expression of sexuality. This systematic review may assist service providers to determine ways that they may better support people in establishing and maintaining satisfying intimate relationships and the full expression of their sexuality. INCLUSION CRITERIA This review explored the intimacy and sexuality experiences, perceptions and concerns of people over the age of 18 years who were living with a SMI in hospital or community settings. This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. METHODS The databases MEDLINE, CINAHL, PsycINFO, Embase and Web of Science were utilised in the review. The search included studies published from 1995 up to and including February 6, 2018 and were limited to those in the English language. Each paper was assessed by two independent reviewers for methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Any disagreements that arose between the reviewers were resolved through discussion. Data extraction was conducted by two independent reviewers using the standardized qualitative data extraction tool from JBI. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings. RESULTS Based on the thematic findings from the 21 studies, three synthesized findings were extracted from 10 categories and 83 findings: 1) the complexity of individual sexual experiences, 2) the clinical constructs of sexuality and 3) family and partner involvement. CONCLUSIONS Having fulfilling and satisfying sexual and relationship experiences is a fundamental human right that can enhance an individual's quality of life. Being aware of the potential stresses and challenges that having a SMI can have on a relationship and involving partners in the treatment, may help to promote intimacy and recovery. Practitioners can use these findings to guide future policy, education and developments in practice. Further research is required to develop and evaluate interventions that target the identified barriers and help people with SMI to fulfil their unmet sexuality and intimacy needs.
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Affiliation(s)
- Edward McCann
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: a Joanna Briggs Institute Affiliated Group
| | - Grainne Donohue
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: a Joanna Briggs Institute Affiliated Group
| | - Jose de Jager
- Maastricht University, Medical Centre, Maastricht, The Netherlands
| | - Annet Nugter
- Mental Health Service Organization, GGZ Noord-Holland-Noord, The Netherlands
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Keet R, Miedema AG, de Ruijter E, Blom A, Bottelier MA, Nugter A. [Reaction on 'The time is ripe for inclusive specialized psychiatry for patients with complex problems']. Tijdschr Psychiatr 2020; 62:600-601. [PMID: 32700306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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McCann E, Donohue G, de Jager J, Nugter A, Stewart J, Eustace-Cook J. Sexuality and intimacy among people with serious mental illness: a qualitative systematic review. JBI Database System Rev Implement Rep 2019. [PMID: 30629043 DOI: 10.11124/jbisrir-2017–003824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The aim of this systematic review was to synthesize the best available qualitative evidence on the experiences and support needs of people with serious mental illness (SMI) regarding sexuality and intimacy within hospital and community settings. The objectives were to explore intimate relationship experiences of people with SMI, to uncover potential obstacles to the expression of sexuality and to present recommendations for mental health policy, education, research and practice. INTRODUCTION Mental health services worldwide have seen major transformations in recent years through deinstitutionalization programs and more enlightened ways of organizing and providing mental health care. However, in terms of social and emotional wellbeing, issues persist for people with SMI, particularly relating to intimacy and the expression of sexuality. This systematic review may assist service providers to determine ways that they may better support people in establishing and maintaining satisfying intimate relationships and the full expression of their sexuality. INCLUSION CRITERIA This review explored the intimacy and sexuality experiences, perceptions and concerns of people over the age of 18 years who were living with a SMI in hospital or community settings. This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. METHODS The databases MEDLINE, CINAHL, PsycINFO, Embase and Web of Science were utilised in the review. The search included studies published from 1995 up to and including February 6, 2018 and were limited to those in the English language. Each paper was assessed by two independent reviewers for methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Any disagreements that arose between the reviewers were resolved through discussion. Data extraction was conducted by two independent reviewers using the standardized qualitative data extraction tool from JBI. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings. RESULTS Based on the thematic findings from the 21 studies, three synthesized findings were extracted from 10 categories and 83 findings: 1) the complexity of individual sexual experiences, 2) the clinical constructs of sexuality and 3) family and partner involvement. CONCLUSIONS Having fulfilling and satisfying sexual and relationship experiences is a fundamental human right that can enhance an individual's quality of life. Being aware of the potential stresses and challenges that having a SMI can have on a relationship and involving partners in the treatment, may help to promote intimacy and recovery. Practitioners can use these findings to guide future policy, education and developments in practice. Further research is required to develop and evaluate interventions that target the identified barriers and help people with SMI to fulfil their unmet sexuality and intimacy needs.
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Affiliation(s)
- Edward McCann
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: a Joanna Briggs Institute Affiliated Group
| | - Grainne Donohue
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: a Joanna Briggs Institute Affiliated Group
| | - Jose de Jager
- Maastricht University, Medical Centre, Maastricht, The Netherlands
| | - Annet Nugter
- Mental Health Service Organization, GGZ Noord-Holland-Noord, The Netherlands
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de Beurs E, Blankers M, Delespaul P, van Duijn E, Mulder N, Nugter A, Swildens W, Tiemens BG, Theunissen J, van Voorst AFA, van Weeghel J. Treatment results for severe psychiatric illness: which method is best suited to denote the outcome of mental health care? BMC Psychiatry 2018; 18:225. [PMID: 30005594 PMCID: PMC6044073 DOI: 10.1186/s12888-018-1798-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 06/25/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The present study investigates the suitability of various treatment outcome indicators to evaluate performance of mental health institutions that provide care to patients with severe mental illness. Several categorical approaches are compared to a reference indicator (continuous outcome) using pretest-posttest data of the Health of Nation Outcome Scales (HoNOS). METHODS Data from 10 institutions and 3189 patients were used, comprising outcomes of the first year of treatment by teams providing long-term care. RESULTS Findings revealed differences between continuous indicators (standardized pre-post difference score ES and ΔT) and categorical indicators (SEM, JTRCI, JTCS, JTRCI&CS, JTrevised) on their ranking of institutions, as well as substantial differences among categorical indicators; the outcome according to the traditional JT approach was most concordant with the continuous outcome indicators. CONCLUSIONS For research comparing group averages, a continuous outcome indicator such as ES or ΔT is preferred, as this best preserves information from the original variable. Categorical outcomes can be used to illustrate what is accomplished in clinical terms. For categorical outcome, the classical Jacobson-Truax approach is preferred over the more complex method of Parabiaghi et al. with eight outcome categories. The latter may be valuable in clinical practice as it allows for a more detailed characterization of individual patients.
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Affiliation(s)
- Edwin de Beurs
- Stichting Benchmark GGZ, Rembrandtlaan 46, 3723 BK Bilthoven, Netherlands
- Leiden University, Wassenaarseweg 52, 2333 Leiden, AK Netherlands
| | - Matthijs Blankers
- Arkin, Klaprozenweg 111, 1033 Amsterdam, NN Netherlands
- Trimbos Institute, Da Costakade 45, 3521 Utrecht, VS Netherlands
| | - Philippe Delespaul
- Maastricht University, Minderbroedersberg 4-6, 6211 Maastricht, LK Netherlands
| | - Erik van Duijn
- GGZ Delfland, Sint Jorisweg 2, 2612 Delft, GA Netherlands
| | - Niels Mulder
- Parnassia Bavo GGZ Zorgholding BV, Monsterseweg 93, 2553 Den Haag, RJ Netherlands
- Erasmus University, Burgemeester Oudlaan 50, 3062 Rotterdam, PA Netherlands
| | - Annet Nugter
- GGZ Noord-Holland Noord, Postbus 18, 1850 Heilo, BA Netherlands
| | - Wilma Swildens
- Altrecht Mental Health Care, Lange Nieuwstraat 119, 3512 Utrecht, PG Netherlands
| | - Bea G. Tiemens
- Pro Persona Mental health Services ProCES, Indigo, Wolfheze 2, 6874 Wolfheze, BE Netherlands
- Radboud University, Comeniuslaan 4, 6525 Nijmegen, HP Netherlands
| | - Jan Theunissen
- GGZ Ingeest, VU University Medical Center Amsterdam, De Boelelaan 1117, 1081 Amsterdam, HV Netherlands
| | | | - Jaap van Weeghel
- Parnassia Bavo GGZ Zorgholding BV, Monsterseweg 93, 2553 Den Haag, RJ Netherlands
- Phrenos, Trimbos Institute, Da Costakade 45, 3521 Utrecht, VS Netherlands
- Tilburg University, Warandelaan 2, 5037 Tilburg, AB Netherlands
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McCann E, Donohue G, de Jager J, van Os J, Nugter A, Stewart J, Eustace-Cook J. Sexuality and intimacy among people with serious mental illness in hospital and community settings. ACTA ACUST UNITED AC 2018; 16:324-327. [DOI: 10.11124/jbisrir-2017-003450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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de Jager J, Cirakoglu B, Nugter A, van Os J. Intimacy and its barriers: A qualitative exploration of intimacy and related struggles among people diagnosed with psychosis. Psychosis 2017. [DOI: 10.1080/17522439.2017.1330895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- José de Jager
- Mental health service organization, GGZ Noord-Holland-Noord, Heilloo, The Netherlands
- Maastricht University, Medical Centre, Maastricht, The Netherlands
| | - Bahar Cirakoglu
- Mental health service organization, GGZ Noord-Holland-Noord, Heilloo, The Netherlands
| | - Annet Nugter
- Mental health service organization, GGZ Noord-Holland-Noord, Heilloo, The Netherlands
| | - Jim van Os
- Maastricht University, Medical Centre, Maastricht, The Netherlands
- Brain Centre Rudolf Magnus, University Medical Centre, Utrecht, The Netherlands
- Institute of Psychiatry, King’s College London, London, UK
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Voogt LA, Nugter A, Goossens PJJ, van Achterberg T. An Interview Study on "Providing Structure" as an Intervention in Psychiatric Inpatient Care: The Nursing Perspective. Perspect Psychiatr Care 2016; 52:208-16. [PMID: 25944548 DOI: 10.1111/ppc.12119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/20/2015] [Accepted: 03/26/2015] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To gain insight into nurses' perceptions and use of providing structure (PS) as an intervention during psychiatric inpatient care. DESIGN AND METHODS Interviews were conducted with nurses (n = 18) from two inpatient wards in psychiatry immediately following the occurrence of a PS event. This was done immediately following the occurrence of a PS event. Transcripts were analyzed using a qualitative coding process. FINDINGS Four general and 14 specific PS activities were described associated with the nursing intervention PS. PRACTICE IMPLICATIONS Nurses can now refer to specific activities of PS. An elaborated definition of PS is provided to facilitate a better understanding and using of PS as a psychiatric nursing intervention.
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Affiliation(s)
- L Amar Voogt
- Philadelphia Zorg regio Noordwest, Organization for People with a Mental Disability, Mental Health Care Hospital GGZ Noord-Holland Noord, Heiloo, The Netherlands.,Department of Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annet Nugter
- Mental Health Care Hospital GGZ Noord-Holland Noord, Heerhugowaard, The Netherlands
| | - Peter J J Goossens
- Department of Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.,Center for Bipolar Disorder, Dimence Mental Health Care, Deventer, The Netherlands.,GGZ-VS Institute for the Education of Clinical Nurse Specialist in Mental Health, Utrecht, The Netherlands.,Department of Nursing Sciences, Ghent University, Ghent, Belgium
| | - Theo van Achterberg
- Department of Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.,Centre for Health Services and Nursing Research, KU Leuven, Leuven, Belgium
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13
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Voogt LA, Nugter A, van Achterberg T, Goossens PJJ. Development of the Psychiatric Nursing Intervention Providing Structure: An International Delphi Study. J Am Psychiatr Nurses Assoc 2016; 22:100-11. [PMID: 26944935 DOI: 10.1177/1078390316637049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Psychiatric nurses commonly refer to "providing structure" (PS) as a key intervention. But no consensus exists about what PS entails. PS can be understood as a complex intervention. In four previous studies, a definition, activities, and context variables were described that were presented to experts in a Delphi study. OBJECTIVE To reach consensus about the definition of PS, its activities, and context variables. DESIGN In a qualitative study, a Delphi study is used to gather the opinions of experts. The Delphi study consisted of three rounds with statements to score in each round. RESULTS Experts reached consensus about a definition of PS, its activities, and context variables. Eleven statements related to the definition were accepted. Fourteen statements of a total of 17 statements related to the specific activities reached sufficient agreement, and 4 statements related to context variables were accepted. CONCLUSIONS A definition could be given of PS with 4 general PS activities, 15 specific activities, and 3 context variables. Psychiatric nurses can use the information about PS to reflect on the use of PS activities within their own working environment, and these insights can help nurses develop their professional growth.
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Affiliation(s)
- L Amar Voogt
- L. Amar Voogt, MSc, APRN, RN, GGD Zaanstreek-Waterland, Zaandam, Netherlands; Mental Health Care Hospital GGZ Noord-Holland Noord, Heerhugowaard, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands
| | - Annet Nugter
- Annet Nugter, PhD, Mental Health Care Hospital GGZ Noord-Holland Noord, Heerhugowaard, Netherlands
| | - Theo van Achterberg
- Theo van Achterberg, PhD, RN, FEANS, KU Leuven, Leuven, Belgium; Radboud University Medical Center, Nijmegen, Netherlands; Uppsala University, Uppsala, Sweden
| | - Peter J J Goossens
- Peter J. J. Goossens, PhD, APRN, RN, FEANS, Dimence Mental Health Care, Deventer, Netherlands; Radboud University Medical Center, Nijmegen, Netherlands; GGZ-VS Institute for the Education of Clinical Nurse Specialist in Mental Health, Utrecht, Netherlands; Ghent University, Ghent, Belgium
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Voogt LA, Goossens PJJ, Nugter A, van Achterberg T. The patient's perspective on "providing structure" in psychiatric inpatient care: an interview study. Perspect Psychiatr Care 2015; 51:136-47. [PMID: 25040334 DOI: 10.1111/ppc.12076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/22/2014] [Accepted: 05/29/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To gain insight into the patients' experiences on providing structure (PS) as a nursing intervention during psychiatric inpatient care. DESIGN AND METHOD Interviews were conducted with patients (n = 17) from two inpatient wards within a mental healthcare organization. For data analysis, a qualitative coding process was followed. FINDINGS The patients' expectations for PS were described. One expectation seemed to reflect key concern: the need to maintain autonomy. PRACTICAL IMPLICATIONS The study reveals the patients' views about PS. When the importance of PS is mentioned, nurses can refer to our description of PS. We were able to further stipulate the required activities of PS and provide for an adapted definition of PS.
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Affiliation(s)
- L Amar Voogt
- Care and Support Regio Noordwest Philadelphia Zorg, Organization for People with a Mental Disability, Mental Health Care Hospital GGZ Noord-Holland Noord, Heiloo, The Netherlands; Quality of Care/Nursing Science, Radboud University, Nijmegen, The Netherlands
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15
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Voogt LA, Goossens PJJ, Nugter A, van Achterberg T. An observational study of providing structure as a psychiatric nursing intervention. Perspect Psychiatr Care 2014; 50:7-18. [PMID: 24387611 DOI: 10.1111/ppc.12018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 02/01/2013] [Accepted: 02/04/2013] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To observe the actions of psychiatric nurses when providing structure and identify results in order to better understand providing structure as a complex nursing intervention. DESIGN AND METHOD Participant observation data were collected on a dual diagnosis ward and a crisis intervention ward in a mental healthcare organization. A total of 52 events were selected that involved providing structure. FINDINGS Three phases in the processing of providing structure were identified: the start of the interaction, the interaction phase, and the end of the interaction. For each phase in the intervention, both critical nurse and patient responses were coded. PRACTICAL IMPLICATIONS The results of this observational study contribute to a formalization of the nursing intervention "providing structure" in the Nursing Interventions Classification.
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Affiliation(s)
- L Amar Voogt
- Regio Noordwest Philadelphia Zorg, Organisation for People with a Mental Disability; Mental Health Care Hospital GGZ Noord-Holland Noord, Heiloo; Quality of Care/Nursing Science, Radboud University, Nijmegen, The Netherlands
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Voogt LA, Nugter A, Goossens PJJ, van Achterberg T. "Providing structure" as a psychiatric nursing intervention: a review of the literature. Perspect Psychiatr Care 2013; 49:278-87. [PMID: 25187449 DOI: 10.1111/ppc.12014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 11/23/2012] [Accepted: 12/21/2012] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The focus is on a nursing intervention called "providing structure" (PS). This label does not exist in the Nursing Interventions Classification. The following three questions were asked: (a) How is PS defined? (b) What are the goals of PS? and (c) What is the evidence regarding the effectiveness of PS? DESIGN AND METHOD A systematic literature review. Forty articles, predominantly qualitative studies of PS, were selected for review. FINDINGS Regarding PS, three elements were mentioned: to impose and maintain rules and limits; to assess the condition of the patient; and to interact with the patient. The goals for PS related to patient security, making expectations explicit, and recovering from illness. Major findings were reviewed, but little was found about the effectiveness of PS.
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Affiliation(s)
- L Amar Voogt
- Regio Noordwest, Philadelphia Zorg, Heerhugowaard, Netherlands; Mental Health Care Hospital GGZ Noord-Holland Noord, Heiloo, Netherlands; Quality of Care/Nursing Science, Radboud University, Nijmegen, Netherlands
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17
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Nugter A, Keet R, Dhondt T. [Reaction on 'Behavioural standard or coercive measure? Some considerations regarding the special issue on ROM']. Tijdschr Psychiatr 2013; 55:307-308. [PMID: 23595846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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van Vugt MD, Kroon H, Delespaul PAEG, Dreef FG, Nugter A, Roosenschoon BJ, van Weeghel J, Zoeteman JB, Mulder CL. Assertive community treatment in the Netherlands: outcome and model fidelity. Can J Psychiatry 2011; 56:154-60. [PMID: 21443822 DOI: 10.1177/070674371105600305] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The implementation of assertive community treatment (ACT) varies widely. To date, the association between model fidelity and effect has not been investigated in Europe. We investigated the association between model fidelity and outcome in the Dutch mental health system. METHOD In a prospective longitudinal study, ACT model fidelity and patient outcomes were assessed in 20 outpatient treatment teams. Patients with severe mental illness (n = 530) participated in the study. Outcomes were assessed 3 times using the Health of the Nation Outcome Scales (HoNOS), the Camberwell Assessment of Need Short Assessment Schedule (CANSAS), and the number of hospital days and homeless days during a 2-year follow-up period. Data were analyzed using multilevel statistics. RESULTS High ACT model fidelity was associated with better outcomes on the HoNOS and less homeless days. Among all of the ACT ingredients, team structure was associated with better outcomes. No associations were found between ACT model fidelity, number of hospital days, and CANSAS scores. CONCLUSIONS Our evidence supports the importance of model fidelity for improving patient outcomes.
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Affiliation(s)
- Maaike D van Vugt
- Department of Reintegration, Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
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Cohen D, Nugter A. PW01-198 - Metabolic screening ijn fact population. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71605-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
A controlled longitudinal treatment study was carried out to investigate the effect of a behavioral family treatment on Expressed Emotion (EE) and to examine the correspondence between EE changes and relapse rates. Subjects were 52 patients with recent onset schizophrenia or related disorders and their parents. After completion of inpatient treatment they were randomly allocated to individual treatment or individual treatment plus family treatment. The family treatment consisted of education and training in communication and problem-solving skills. Expressed Emotion was measured with the Five-Minute Speech Sample (FMSS). The findings show that family treatment did not have a significant positive effect on EE level. The dichotomous FMSS/EE did not systematically change and these findings were comparable with the results of prior EE research. A scoring system that included all subscores of the FMSS was somewhat more sensitive to changes. In the individual treatment condition relapse rates tended to co-occur with a change in FMSS/EE level, irrespective of the direction of this change.
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Affiliation(s)
- A Nugter
- Psychiatric Centre Willibrord, Department of Psychotherapy De Oosthoek, Limmen, The Netherlands
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Linszen D, Dingemans P, Van der Does JW, Nugter A, Scholte P, Lenior R, Goldstein MJ. Treatment, expressed emotion and relapse in recent onset schizophrenic disorders. Psychol Med 1996; 26:333-342. [PMID: 8685289 DOI: 10.1017/s0033291700034723] [Citation(s) in RCA: 145] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The effect of in-patient and individual orientated psychosocial intervention (IPI) and in-patient and individual and family orientated intervention (IPFI) across levels of expressed emotion (EE) on relapse was compared in a group of patients with recent onset schizophrenic disorders. Patients were randomly assigned to an individual orientated psychosocial intervention programme or to an identical psychosocial programme plus a behavioural family intervention. Seventy-six patients were studied during a 12 month out-patient treatment period after an in-patient treatment programme in which parents followed a psychoeducational programme. Overall relapse rates during the out-patient interventions were low (16%). Adding family intervention to the psychosocial intervention did not affect the relapse rate. Patients in low EE families relapsed slightly more often during the psychosocial plus family intervention. In-patient treatment with psychoeducation for parents, followed by an out-patient psychosocial intervention programme, has a favourable impact on relapse. Additional family intervention may increase stress in low EE families, thus affecting relapse in their children.
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Affiliation(s)
- D Linszen
- Academic Medical Centre, University of Amsterdam, Department of Psychiatry, The Netherlands
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