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Hancq ES, Munetz M, Silver SC, Parker HA, Bonfine N. Critical Gaps in Assisted Outpatient Treatment Research in the United States. Adm Policy Ment Health 2024:10.1007/s10488-024-01377-z. [PMID: 38687427 DOI: 10.1007/s10488-024-01377-z] [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] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 05/02/2024]
Abstract
In 2023, the White House included the implementation and improvement of assisted outpatient treatment in a list of under-researched strategies to support recovery and long-term treatment engagement for people with serious mental illness. Assisted outpatient treatment is a community-based, court-ordered, mental health treatment program for a subset of individuals with serious mental illness who have a history of difficulty adhering to treatment and staying well while living in the community. There is research supporting the use of assisted outpatient treatment for this specific population, however, the majority focuses on limited geographic regions, specific program organizations, and is outdated. Meanwhile, assisted outpatient treatment programs have increasingly been adopted by counties and states across the country. More research is needed to ensure that assisted outpatient treatment programs are being implemented in the most effective and equitable way possible. In this paper, the authors identify several key gaps in the current literature base relating to the effectiveness and implementation of assisted outpatient treatment.
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Affiliation(s)
| | - Mark Munetz
- Northeast Ohio Medical University, Rootstown, OH, USA
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Dulek EB, Stein CH. The Way I See It: Older Adults with Mental Illness Share Their Views of Community Life Using Photovoice. Community Ment Health J 2024; 60:457-469. [PMID: 37874437 DOI: 10.1007/s10597-023-01192-0] [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: 04/16/2023] [Accepted: 09/15/2023] [Indexed: 10/25/2023]
Abstract
The importance of community involvement for both older adults and individuals coping with mental illness is well documented. Yet, barriers to community integration for adults with mental illness such as social stigma, discrimination, and economic marginalization are often exacerbated by increased health and mobility challenges among older adults. Using photovoice, nine older adults with mental illness represented their views of community in photographs and group discussions over a six-week period. Participant themes of community life included physical spaces, valued social roles, and access to resources in the community. Themes were anchored by older adults' perceptions of historical and cultural time comparisons between 'how things used to be' and 'how things are now.' Barriers to community integration were often related to factors such as age, mobility, and resources rather than to mental health status. Program evaluation results suggest photovoice can promote self-reflection, learning, and collaboration among older adults with mental illness.
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Affiliation(s)
- Erin B Dulek
- Milwaukee VA Medical Center, 5000 W. National Ave, Milwaukee, WI, 53295, USA.
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Nishith P, Huang J, Tsai J, Morse GA, Dell NA, Murphy A, Mueser KT. The Relationship Between Serious Mental Illness and Criminal Offending in Persons Experiencing Homelessness: The Role of Substance Use Disorder. Psychiatr Q 2023; 94:645-653. [PMID: 37750980 DOI: 10.1007/s11126-023-10054-7] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 09/27/2023]
Abstract
Individuals who live with mental illness are encumbered by related risk factors that increase the probability of legal involvement. The goal was to determine how homelessness and substance use disorder are intervening factors in the relationship between symptoms of serious mental illness (SMI) and criminal offending. A sample of 210 chronically homeless adults receiving SAMHSA-funded outreach and psychiatric rehabilitation services between 2014 and 2016 was recruited in a study of interventions to address housing in homeless persons with a SMI. Participants were interviewed and data collected were analyzed using structural equation modeling. Statistical analysis showed that homelessness severity mediated the relationship between SMI symptom severity and criminal offenses committed in the past 30 days in participants with a substance use disorder but not in those with no substance use diagnosis. Results show that homelessness and substance use are important to address to possibly alter trajectories for criminal justice involvement.
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Affiliation(s)
- Pallavi Nishith
- Places for People, Inc, 1001 Lynch Street, St. Louis, MO, 63118, USA.
| | - Jin Huang
- School of Social Work, Saint Louis University, St. Louis, United States
| | - Jack Tsai
- School of Public Health, UTHealth Science Center at Houston, Houston, USA
| | - Gary A Morse
- Places for People, Inc, 1001 Lynch Street, St. Louis, MO, 63118, USA
| | - Nathaniel A Dell
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, United States
| | - Allison Murphy
- Places for People, Inc, 1001 Lynch Street, St. Louis, MO, 63118, USA
| | - Kim T Mueser
- Department of Community Psychiatry Rehabilitation, Boston University, Boston, USA
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Abraham KM, Merrill SL, Patterson SM, Aysta SL. Care Retention Among Veterans with Serious Mental Illness who were once lost-to-Veterans Health Administration care. Psychiatr Q 2023; 94:633-644. [PMID: 37676451 DOI: 10.1007/s11126-023-10049-4] [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] [Accepted: 08/27/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To evaluate care retention among Veterans with serious mental illness (SMI) who were lost to Veterans Health Administration (VHA) care for at least one year and subsequently returned to VHA care via the SMI Re-Engagement program, an outreach program for Veterans with SMI who are lost-to-care. METHODS For the 410 Veterans with SMI who returned to care via SMI Re-Engagement between April 4th, 2016 and January 31, 2018, we assessed VHA in-person and telehealth utilization (overall, primary care, mental health care) for two years following the date of return to care. RESULTS Care retention was common: 70.2% of Veterans had at least one encounter in each year of the two-year follow-up period and an additional 22.7% had at least one encounter during one of the two years. During the two-year follow-up period, 72.4% of Veterans had at least one primary care encounter and 70.7% of Veterans had at least one mental health care encounter. Adjusted binomial logistic regression analyses found a return-to-care encounter in primary care (OR = 2.70; 95% CI: 1.34, 5.42) predicted primary care retention, and a return-to-care encounter in mental health care (OR = 4.01; 95% CI: 2.38, 6.75) predicted mental health care retention. CONCLUSION Most Veterans who return to care via the SMI Re-Engagement program remain in VHA care for the subsequent two years.
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Affiliation(s)
- Kristen M Abraham
- Serious Mental Illness Treatment Resource and Evaluation Center, VA Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, University of Michigan North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA.
- Department of Psychology, University of Detroit Mercy, 4001 W. McNichols Road, Detroit, MI, 48221, USA.
| | - Stephanie L Merrill
- Serious Mental Illness Treatment Resource and Evaluation Center, VA Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, University of Michigan North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA
| | - Scott M Patterson
- Richard L. Roudebush VA Medical Center, 1481 W. 10th Street, Indianapolis, IN, 46202, USA
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th Street, Ste 4800, Indianapolis, IN, 46202, USA
| | - Shanyn L Aysta
- W.G. (Bill) Hefner VA Medical Center, 1601 Brenner Ave, Salisbury, NC, 28144, USA
- Department of Psychiatry, Wake Forest School of Medicine, 791 Jonestown Road, Winston- Salem, NC, 27103, USA
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Karlow SL, Levano SR, von Esenwein SA, Ward MC, McCool-Myers M, Lawley ME. Chlamydia and Gonorrhea Testing Patterns Among Women with and Without Serious Mental Illness. Community Ment Health J 2023; 59:1490-1497. [PMID: 37382860 DOI: 10.1007/s10597-023-01134-w] [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: 11/09/2022] [Accepted: 04/28/2023] [Indexed: 06/30/2023]
Abstract
Rates of the sexually transmitted infections (STIs) Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) have risen in women by 13% and 40%, respectively, since 2015. Women with Serious Mental Illness (SMI) are at disproportionate risk for STIs. A retrospective chart review was performed at a safety-net healthcare system in the Southeastern United States (US) from 2014 to 2017. CT/GC positivity rates did not differ between the general and SMI populations (6.6% vs. 6.5% for CT and 1.8% vs. 2.2% for GC, respectively). Emergency Medicine accounted for more positive STI test results in SMI patients than the general population (25.2% vs. 19.1% for CT, 47.8% vs. 35.5% for GC, respectively). SMI patients received large portions of STI care in emergency settings, where follow-up is poor. Point of Care (POC) testing could improve care in this setting, and mental healthcare providers must address sexual health with patients who otherwise may not receive this care.
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Affiliation(s)
- Samantha L Karlow
- Emory University School of Medicine, Atlanta, GA, USA.
- University of Missouri - Kansas City, 2301 Holmes Street, Kansas City, MO, 64108, USA.
| | | | - Silke A von Esenwein
- Center for Public Partnerships and Research, University of Kansas, Lawrence, KS, USA
| | - Martha C Ward
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Megan McCool-Myers
- Jane Fonda Center, Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Megan E Lawley
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
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Shaffer CW, Wyka K, Ewing J, Russ MJ, Kanellopoulos D, Brody BD. Low COVID-19 Vaccination Rates Among Psychiatric Inpatients: Implications for Institutional Settings and Outreach Efforts. Psychiatr Serv 2023; 74:320-323. [PMID: 36065578 DOI: 10.1176/appi.ps.20220222] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study sought to determine COVID-19 vaccination rates for individuals with serious mental illness admitted to a large health system in New York State. METHODS Vaccination rates among 12,714 patients admitted to psychiatric units and to medical and surgical units were compared between April 6, 2021, and September 30, 2021. RESULTS Only 40% (N=416 of 1,029) of patients admitted to psychiatric services had at least one COVID-19 vaccination, whereas 64.4% (7,523 of 11,685) of patients admitted to medical and surgical services had at least one vaccination. After adjustment for differences in key demographic and clinical characteristics, patients admitted to psychiatric services had a significantly lower likelihood of vaccination during the study period (risk ratio=0.78, 95% confidence interval=0.73-0.85, p<0.001). Black psychiatric patients had the lowest vaccination rate (28%). CONCLUSIONS Psychiatric patients with acute illness had low COVID-19 vaccination rates. Targeted outreach for COVID-19 vaccination is necessary to reach this population.
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Affiliation(s)
- Charles W Shaffer
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Katarzyna Wyka
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Julie Ewing
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Mark J Russ
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Dora Kanellopoulos
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Benjamin D Brody
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
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Starks SL, Kelly EL, Castillo EG, Meldrum ML, Bourgois P, Braslow JT. Client Outreach in Los Angeles County's Assisted Outpatient Treatment Program: Strategies and Barriers to Engagement. Res Soc Work Pract 2022; 32:839-854. [PMID: 36081900 PMCID: PMC9447859 DOI: 10.1177/1049731520949918] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose Assisted Outpatient Treatment (AOT) programs can compel treatment-refusing individuals to participate in mental health treatment via civil court order. In California's AOT programs, individuals first must be offered 30 days of outreach services and can accept services voluntarily. This study examines the use of outreach strategies in an AOT program with the potential for voluntary or involuntary enrollment. Methods Outreach staff completed a survey in which they reported and rated outreach strategies and barriers to treatment for 487 AOT-referred individuals. Results Outreach staff reported using a broad array of strategies to persuade and engage clients. Supportive and persuasive strategies were most common. More coercive strategies, including court order, were used when needed. More clients enrolled voluntarily (39.4%) than involuntarily (7.2%). Conclusions Outreach, coupled with the strategic used of potential court involvement, can lead to voluntary enrollment of treatment-refusing individuals with many, often severe, barriers to engaging in outpatient treatment.
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Affiliation(s)
- Sarah L. Starks
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
| | - Erin L. Kelly
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Enrico G. Castillo
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
- Los Angeles County Department of Mental Health
| | - Marcia L. Meldrum
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
| | - Philippe Bourgois
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
| | - Joel T. Braslow
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA David Geffen School of Medicine and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
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Spivak A, Mojtabai R, Strain EC, Cullen BA, Eaton WW, Spivak S. Symptom severity and medication-assisted treatment for individuals with serious mental illness and a history of heroin use. Psychiatry Res 2021; 296:113671. [PMID: 33387753 DOI: 10.1016/j.psychres.2020.113671] [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: 12/31/2019] [Accepted: 12/19/2020] [Indexed: 11/18/2022]
Abstract
The study examined associations between medication assisted treatment (MAT) and psychiatric symptom severity, measured by Positive and Negative Symptom Scale (PANSS), among individuals with serious mental illness and a history of heroin use. Of 271 participants, 32% (n=87) reported a history of heroin use and, of those, 14.9% (n=13) reported MAT. Higher scores in PANSS Total, Negative, and Disordered subscales were associated with lower odds, while being on an antipsychotic with higher odds, of receiving MAT. This supports the greater need for clinician attention to different symptom clusters and targeted multidimensional interventions as a way to increase MAT participation.
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Affiliation(s)
- Amethyst Spivak
- National Trafficking Shelter Alliance, Millersville, MD, USA.
| | - Ramin Mojtabai
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric C Strain
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bernadette A Cullen
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - William W Eaton
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Drapalski AL, Lucksted A, Brown CH, Fang LJ. Outcomes of Ending Self-Stigma, a Group Intervention to Reduce Internalized Stigma, Among Individuals With Serious Mental Illness. Psychiatr Serv 2021; 72:136-142. [PMID: 33234053 DOI: 10.1176/appi.ps.201900296] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 11/30/2022]
Abstract
OBJECTIVE Ending Self-Stigma is a nine-session group intervention designed to teach individuals experiencing mental illness a set of tools and strategies to effectively deal with self-stigma and its effects. The authors examined the efficacy of Ending Self-Stigma with an active comparison group focused on general health and wellness education (the Health and Wellness intervention) in a cohort of veterans. METHODS Veterans with serious mental illness (N=248) were randomly assigned to either the Ending Self-Stigma or the Health and Wellness intervention. Participants completed assessments of symptoms, internalized stigma, recovery, sense of belonging, and other aspects of psychosocial functioning at baseline, posttreatment, and 6-month follow-up. Repeated-measures, mixed-effects models were used to examine the effects of group × time interactions on outcomes. RESULTS Individuals in both groups experienced significant but modest reductions in self-stigma and increases in psychological sense of belonging after the treatments. The Ending Self-Stigma and Health and Wellness interventions did not significantly differ in primary (self-stigma) or secondary (self-efficacy, sense of belonging, or recovery) outcomes at posttreatment. Significant psychotic symptoms moderated treatment effects on self-stigma, such that among individuals with significant psychotic symptoms at baseline, those who participated in Ending Self-Stigma had a significantly greater reduction in internalized stigma than those in the Health and Wellness intervention. CONCLUSIONS Interventions directly targeting self-stigma and those that may address it more indirectly may be helpful in reducing internalized stigma. Individuals experiencing psychotic symptoms may be more likely to benefit from interventions that specifically target self-stigma.
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Affiliation(s)
- Amy L Drapalski
- U.S. Department of Veterans Affairs (VA) Capitol Health Care Network, Veterans Integrated Service Network 5 (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Drapalski, Lucksted, Brown); Department of Psychiatry (Drapalski, Lucksted, Fang) and Department of Epidemiology and Public Health (Brown), University of Maryland School of Medicine, Baltimore
| | - Alicia Lucksted
- U.S. Department of Veterans Affairs (VA) Capitol Health Care Network, Veterans Integrated Service Network 5 (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Drapalski, Lucksted, Brown); Department of Psychiatry (Drapalski, Lucksted, Fang) and Department of Epidemiology and Public Health (Brown), University of Maryland School of Medicine, Baltimore
| | - Clayton H Brown
- U.S. Department of Veterans Affairs (VA) Capitol Health Care Network, Veterans Integrated Service Network 5 (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Drapalski, Lucksted, Brown); Department of Psychiatry (Drapalski, Lucksted, Fang) and Department of Epidemiology and Public Health (Brown), University of Maryland School of Medicine, Baltimore
| | - Li Juan Fang
- U.S. Department of Veterans Affairs (VA) Capitol Health Care Network, Veterans Integrated Service Network 5 (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore (Drapalski, Lucksted, Brown); Department of Psychiatry (Drapalski, Lucksted, Fang) and Department of Epidemiology and Public Health (Brown), University of Maryland School of Medicine, Baltimore
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Snethen G, Brusilovskiy E, McCormick BP, Hiremath SV, Salzer MS. The Relationship between Community Participation and Physical Activity among Individuals with Serious Mental Illnesses. Ment Health Phys Act 2021; 20:10.1016/j.mhpa.2021.100381. [PMID: 34745346 PMCID: PMC8564502 DOI: 10.1016/j.mhpa.2021.100381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The importance of physical activity (PA) and health outcomes for individuals with serious mental illnesses (SMI) has been well documented. It is also established that individuals with SMI engage in high amounts of sedentary behavior and low amounts of physical activity, which contributes to poor health outcomes. This study explores the relationship between community participation, physical activity, and sedentary behavior among individuals with SMI. METHODS This study used a sample of individuals with SMI who were receiving community mental health services in a large urban area of the United States. Of the 526 individuals approached, 308 were interested in the study; 173 consented and completed data collection. This study reports on 152 participants who had complete data. Using the Temple University Community Participation Scale, participants reported on community-based activities completed independently in the previous 30 days. Additionally, participants were asked to wear a tri-axial accelerometer (ActiGraph GT3X) on the non-dominant wrist for seven days. The total number of community participation days was correlated with PA variables including steps, sedentary, light, and moderate-vigorous PA. Two groups of step data were analyzed using t-tests: ≥7500 steps, and ≥ 10,000 steps. Logistic regressions were run to examine the relationship between amount, breadth and sufficiency of community participation and having +/- 7,500 steps and +/- 10,000 daily steps, controlling for age, gender, and income. RESULTS Amount of community participation was inversely associated with the % of time in sedentary activity and positively associated with the % of time in moderate to vigorous PA. Those with at or more than 7500 steps and 10,000 steps reported significantly more days of community participation. CONCLUSION This study highlights the contribution of everyday activities for increased physical activity and reduced time spent in sedentary activity. Practitioners should consider recommendations for engagement in the community to increase opportunities for walking.
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Affiliation(s)
| | | | | | | | - Mark S Salzer
- Temple University Collaborative on Community Inclusion
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Wu S, Li Z, Li Z, Xiang W, Yuan Y, Liu Y, Xiong Z. The mental state and risk factors of Chinese medical staff and medical students in early stages of the COVID-19 epidemic. Compr Psychiatry 2020; 102:152202. [PMID: 32866693 PMCID: PMC7437442 DOI: 10.1016/j.comppsych.2020.152202] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/25/2020] [Accepted: 08/16/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the mental state of medical staff and medical students in the early stages of the SARS-CoV-2 outbreak, as well as analyze the risk factors of serious mental illness (SMI), so as to provide a scientific basis for further psychological intervention and management. METHOD A cross-sectional survey was conducted from February 2-7, 2020. The Kessler 6 Psychological Distress Scale and a general information questionnaire were administered on-line to a convenience sample of 548 medical staff and medical students in China. Multivariate binary logistic regression analysis was used to screen the risk factors of SMI in medical staff and medical students. RESULTS Of the 505 respondents in the final analysis, 188 (37.23%) were at high risk of SMI. Respondents were at significantly higher risk of SMI if they had been suspected of being infected with the SARS-CoV-2 (OR = 7.00, 95% CI: 1.19-41.14), had relatives suspected of being infected with the SARS-CoV-2 (OR = 23.60, 95% CI: 1.11-501.30), felt concerned towards media coverage of outbreak-related information (OR = 11.95, 95% CI: 3.07-46.57), recently dreamed related to SARS-CoV-2 (OR = 4.21, 95% CI: 2.22-8.01), experienced difficulty in controlling emotions during SARS-CoV-2 epidemic (OR = 3.25, 95% CI: 1.66-6.37), or spent hours watching outbreaks per day (OR = 1.29, 95% CI: 1.13-1.46). CONCLUSION Our findings highlight that medical staff and medical students were vulnerable to SMI during the early stages of the SARS-CoV-2 outbreak and identify the factors associated with SMI which can be used to formulate psychological interventions to improve the mental health. The independent risk factors for SMI among them are suspicion that they or relatives were infected with the SARS-CoV-2, greater interest in media reports about the epidemic, frequency of recent dreams related to SARS-CoV-2, difficulty in controlling emotions during the epidemic, and hours spent watching outbreaks per day.
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Affiliation(s)
- Shuang Wu
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan 610083, China
| | - Zhe Li
- Mental Health Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zhixiong Li
- The Third Department of Clinical Psychology, Karamay Municipal People's Hospital, Karamay, Xinjiang 830054, China
| | - Weiyi Xiang
- The West China College of Medicine, Sichuan University, Chengdu 610041, China
| | - Yiwen Yuan
- Mental Health Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yaya Liu
- Mental Health Center and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China,Zun Yi Psychiatric Hospital, Zunyi, Guizhou 563000, China
| | - Zhenzhen Xiong
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan 610083, China.
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Abstract
OBJECTIVE The study examined change in availability of assertive community treatment (ACT) and associated services over time. METHODS Change over time in the availability of facilities in the United States offering ACT and its associated services was examined by using 2010 and 2016 data from the National Mental Health Services Survey. RESULTS The proportion of facilities that self-reported provision of ACT and its associated services declined between 2010 and 2016 (odds ratio [OR]=0.73, 95% confidence interval [CI]=0.63-0.86, p<0.001). Although a higher proportion of facilities that provided ACT reported offering all the required services in 2016 (OR=1.31, 95% CI=1.04-1.66, p=0.026) compared with 2010, this proportion accounted for less than 20% of the programs. Compared with 2010, in 2016 increases were observed in peer (OR=1.72, 95% CI=1.38-2.13, p<0.001) and co-occurring disorders services (OR=1.23, 95% CI=1.08-1.42, p=0.004) as well as in secondary services, such as tobacco cessation (OR=4.53, 95% CI=3.51-5.84, p<0.001) and telemedicine (OR=2.08, 95% CI=1.67-2.57, p<0.001). Continuous education for staff was required at more facilities with ACT in 2016 compared with 2010. CONCLUSIONS Although the proportion of facilities with ACT that offer all the required core services has increased in recent years, such programs remain a minority, and the overall number of facilities with ACT has declined.
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Affiliation(s)
- Stanislav Spivak
- Johns Hopkins University School of Medicine (Spivak, Cullen, Mojtabai); Johns Hopkins University Bloomberg School of Public Health (Cullen, Mojtabai); Johns Hopkins Medical Systems (Green, Firth, Sater)
| | - Bernadette A Cullen
- Johns Hopkins University School of Medicine (Spivak, Cullen, Mojtabai); Johns Hopkins University Bloomberg School of Public Health (Cullen, Mojtabai); Johns Hopkins Medical Systems (Green, Firth, Sater)
| | - Charee Green
- Johns Hopkins University School of Medicine (Spivak, Cullen, Mojtabai); Johns Hopkins University Bloomberg School of Public Health (Cullen, Mojtabai); Johns Hopkins Medical Systems (Green, Firth, Sater)
| | - Tyler Firth
- Johns Hopkins University School of Medicine (Spivak, Cullen, Mojtabai); Johns Hopkins University Bloomberg School of Public Health (Cullen, Mojtabai); Johns Hopkins Medical Systems (Green, Firth, Sater)
| | - Holly Sater
- Johns Hopkins University School of Medicine (Spivak, Cullen, Mojtabai); Johns Hopkins University Bloomberg School of Public Health (Cullen, Mojtabai); Johns Hopkins Medical Systems (Green, Firth, Sater)
| | - Ramin Mojtabai
- Johns Hopkins University School of Medicine (Spivak, Cullen, Mojtabai); Johns Hopkins University Bloomberg School of Public Health (Cullen, Mojtabai); Johns Hopkins Medical Systems (Green, Firth, Sater)
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Abstract
Transgender people who experience serious mental illness represent a uniquely vulnerable population. Because of limited research, however, recommendations for treating this population are scarce. In this article, the authors describe the challenge of recognizing gender dysphoria in people with serious mental illness. They then discuss why existing evidence and clinical experience support provision of gender-affirming medical and surgical treatments for transgender people who have serious mental illness and also demonstrate capacity to make informed medical decisions. More research is needed to develop evidence-based treatments and programs for transgender people with serious mental illness.
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Affiliation(s)
- William B Smith
- Department of Psychiatry, University of California, San Francisco (Smith); National LGBT Health Education Center, Fenway Institute, Boston (Goldhammer, Keuroghlian); Department of Psychiatry, Massachusetts General Hospital, Boston (Keuroghlian)
| | - Hilary Goldhammer
- Department of Psychiatry, University of California, San Francisco (Smith); National LGBT Health Education Center, Fenway Institute, Boston (Goldhammer, Keuroghlian); Department of Psychiatry, Massachusetts General Hospital, Boston (Keuroghlian)
| | - Alex S Keuroghlian
- Department of Psychiatry, University of California, San Francisco (Smith); National LGBT Health Education Center, Fenway Institute, Boston (Goldhammer, Keuroghlian); Department of Psychiatry, Massachusetts General Hospital, Boston (Keuroghlian)
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Monroe-DeVita M, Morse G, Mueser KT, McHugo GJ, Xie H, Hallgren KA, Peterson R, Miller J, Akiba C, York M, Gingerich S, Stiles B. Implementing Illness Management and Recovery Within Assertive Community Treatment: A Pilot Trial of Feasibility and Effectiveness. Psychiatr Serv 2018; 69:562-571. [PMID: 29446335 PMCID: PMC6433370 DOI: 10.1176/appi.ps.201700124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 11/30/2022]
Abstract
OBJECTIVE In a pilot feasibility and effectiveness study, illness management and recovery (IMR), a curriculum-based program to help people with serious mental illness pursue personal recovery goals, was integrated into assertive community treatment (ACT) to improve participants' recovery and functioning. METHODS A small-scale cluster randomized controlled design was used to test implementation of IMR within ACT teams in two states. Eight high-fidelity ACT teams were assigned to provide IMR (ACT+IMR; four teams) or standard ACT services (ACT only; four teams). Clinical outcomes from 101 individuals with schizophrenia-spectrum or bipolar disorders were assessed at baseline, six months, and one year. RESULTS Exposure to IMR (session attendance and module completion) varied between the ACT+IMR teams, with participants on one team having significantly less exposure. Results from intent-to-treat analyses showed that participants in ACT+IMR demonstrated significantly better outcomes with a medium effect size at follow-up on clinician-rated illness self-management. A nonsignificant, medium effect size was found for one measure of functioning, and small effect sizes were observed for client-rated illness self-management and community integration. Session and module completion predicted better outcomes on four of the 12-month outcome measures. CONCLUSIONS Findings support the feasibility of implementing IMR within ACT teams. Although there were few significant findings, effect sizes on some variables in this small-scale study and the dose-response relationships within ACT+IMR teams suggest this novel approach could be promising for improving recovery for people with serious mental illness. Further large-scale studies utilizing a hybrid effectiveness-implementation design could provide a promising direction in this area.
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Affiliation(s)
- Maria Monroe-DeVita
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Gary Morse
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Kim T Mueser
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Gregory J McHugo
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Haiyi Xie
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Kevin A Hallgren
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Roselyn Peterson
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Joris Miller
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Christopher Akiba
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Mary York
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Susan Gingerich
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
| | - Bryan Stiles
- Dr. Monroe-DeVita, Dr. Hallgren, and Mr. Stiles are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Morse and Mr. Miller are with Places for People, St. Louis. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. McHugo and Dr. Xie are with the Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire. Ms. Peterson is with the Department of Psychology, University of Central Florida, Orlando. Mr. Akiba is with the Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ms. York is with the Department of Psychology, Southern Illinois University, Carbondale, Illinois. Ms. Gingerich is an independent consultant and trainer in Narberth, Pennsylvania
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15
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Hassamal S, Trutia A, Dalkilic A, Pandurangi AK. A pilot study of body image perceptions, and attitudes toward obesity in hospitalized psychotic and non-psychotic patients. Asian J Psychiatr 2017; 26:8-12. [PMID: 28483098 DOI: 10.1016/j.ajp.2016.12.014] [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: 05/19/2016] [Revised: 12/16/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Body image perceptions, and attitudes toward obesity were examined and compared between psychotic and non-psychotic patients with a mood disorder. METHODS 80 psychotic patients and 36 non-psychotic patients with a mood disorder admitted to an acute inpatient psychiatric unit participated in the study. On admission, each patient completed a visual silhouettes scale of actual self and ideal self, as well as the Attitudes Toward Obese Persons (ATOP) scale. RESULTS Analogous to the general population, psychotic and non-psychotic patients had similar body image perceptions, and experienced discrepancy between actual and ideal body image. Female patients with serious mental illness (SMI) picked a heavier actual self body image, and experienced greater discrepancy between actual and ideal body image compared to male patients with SMI. Psychotic and non-psychotic patients experienced similar mostly neutral attitudes toward obese persons, however there was a trend for depressed patients to have more negative attitudes toward obese persons compared to non-depressed patients. DISCUSSION The presence of an acute psychotic episode did not affect body perceptions, or obesity attitudes; however depressed patients had more negative obesity attitudes. Similar to the general population, females with SMI overassessed their body size, and experienced more body dissatisfaction compared to males with SMI.
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Affiliation(s)
- Sameer Hassamal
- Department of Addiction Psychiatry, UCLA-Kern Medical Center, Bakersfield, CA 93306, USA; Los Angeles County Department of Mental Health, Los Angeles, CA 90020, USA.
| | - Alexandru Trutia
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA 23298, USA.
| | - Alican Dalkilic
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA 23298, USA.
| | - Ananda K Pandurangi
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Jackson RG, Patel R, Jayatilleke N, Kolliakou A, Ball M, Gorrell G, Roberts A, Dobson RJ, Stewart R. Natural language processing to extract symptoms of severe mental illness from clinical text: the Clinical Record Interactive Search Comprehensive Data Extraction (CRIS-CODE) project. BMJ Open 2017; 7:e012012. [PMID: 28096249 PMCID: PMC5253558 DOI: 10.1136/bmjopen-2016-012012] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES We sought to use natural language processing to develop a suite of language models to capture key symptoms of severe mental illness (SMI) from clinical text, to facilitate the secondary use of mental healthcare data in research. DESIGN Development and validation of information extraction applications for ascertaining symptoms of SMI in routine mental health records using the Clinical Record Interactive Search (CRIS) data resource; description of their distribution in a corpus of discharge summaries. SETTING Electronic records from a large mental healthcare provider serving a geographic catchment of 1.2 million residents in four boroughs of south London, UK. PARTICIPANTS The distribution of derived symptoms was described in 23 128 discharge summaries from 7962 patients who had received an SMI diagnosis, and 13 496 discharge summaries from 7575 patients who had received a non-SMI diagnosis. OUTCOME MEASURES Fifty SMI symptoms were identified by a team of psychiatrists for extraction based on salience and linguistic consistency in records, broadly categorised under positive, negative, disorganisation, manic and catatonic subgroups. Text models for each symptom were generated using the TextHunter tool and the CRIS database. RESULTS We extracted data for 46 symptoms with a median F1 score of 0.88. Four symptom models performed poorly and were excluded. From the corpus of discharge summaries, it was possible to extract symptomatology in 87% of patients with SMI and 60% of patients with non-SMI diagnosis. CONCLUSIONS This work demonstrates the possibility of automatically extracting a broad range of SMI symptoms from English text discharge summaries for patients with an SMI diagnosis. Descriptive data also indicated that most symptoms cut across diagnoses, rather than being restricted to particular groups.
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Affiliation(s)
- Richard G Jackson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rashmi Patel
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nishamali Jayatilleke
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Anna Kolliakou
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Michael Ball
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Genevieve Gorrell
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Angus Roberts
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Richard J Dobson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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17
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Nash K, Ghinassi F, Brar JS, Alam A, Bohan MC, Gopalan K, Carter A, Chengappa KNR. The Development and Implementation of an Electronic Health Record Tool for Monitoring Metabolic Syndrome Indices in Patients with Serious Mental Illness. ACTA ACUST UNITED AC 2017; 10:145-153. [PMID: 27732099 DOI: 10.3371/1935-1232.10.3.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES 1. A quality performance improvement (QI) project to implement an electronic screening and monitoring tool to record components of the metabolic syndrome (e-MSD) during clinic visits by persons with serious mental illness (SMI). 2. To encourage psychiatrists to use this tool in their documentation. METHODS Working with the information technology staff, five psychiatrists developed, tested, revised and embedded the e-MSD tool into the medication management document within the electronic health record. A continuing medical education program on metabolic syndrome was developed and released to psychiatrists and mental health clinicians. Psychiatrist offices at one clinic were equipped with weighing scales, sphygmomanometers, waist circumference tapes, and a QI project was initiated. RESULTS At one month, 9 to 12% of the anthropometric measures (height, weight, body mass index, waist circumference, and blood pressure) were recorded in 974 unique patient encounters, and one year later the numbers moved upward from 15 to 41%. Toward the end of Year 1, a Patient Care Associate was hired to measure the anthropometric measures and, one year later, the documented rates increased to 75-80%. Laboratory recordings (glucose and lipids) remained ≤8% throughout the first year, but moved upward to 25% in Year 2. DISCUSSION Notwithstanding significant administrative and technical support for this QI project, changing clinician practice to screen, monitor and document metabolic indices in persons with SMI in the ambulatory setting changed significantly after the hiring of a Patient Care Associate. Efforts to obtain laboratory measures in real time remain a challenge. Next steps include interventions to promote weight loss and smoking cessation in SMI patients, and effective communication with their primary care doctors.
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18
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Abstract
Most serious mental illnesses (SMI) have onset by emerging adulthood and SMI can impair adolescents' transitions into healthy, productive adults. Emerging adults (EAs) with SMI are at high risk for justice involvement, and rates of recidivism are greater for offenders with SMI than without. These EAs are frequently multi-system involved (e.g., aging out of foster care; both juvenile and adult arrests; prison reentry). Few interventions, however, have focused specifically on EAs, and no interventions have focused on reducing recidivism in EAs with or without SMI. Multisystemic Therapy for Emerging Adults (MST-EA) is an adaptation of standard MST (for adolescent antisocial behavior) that was specifically designed for EAs with SMI and justice involvement. This paper provides the first description of MST-EA, including clinical outcome data on pilot cases and an extensive case example. To date, 57 cases have been treated with MST-EA. Success at discharge was demonstrated on main outcomes (rearrest and mental health) and other functional outcomes. Clinical data on pilot cases is promising and supports further research to assess long-term outcomes and effectiveness.
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Helu-Brown P, Aranda M. Psychosocial Approaches for Sexual Health and Intimate Relationships Among Patients With Serious Mental Illness. Sex Med Rev 2016; 4:26-35. [PMID: 27872001 DOI: 10.1016/j.sxmr.2015.10.010] [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] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/01/2015] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The sexual health and behavior and the intimate relationships of patients diagnosed with a serious mental illness (SMI) have been described as ongoing and often ignored concerns in mental health treatment. Evidence-based psychosocial interventions have emerged as effective complimentary approaches to address symptoms of SMI in conjunction with psychopharmacology, yet rarely do they address sexual concerns in a targeted manner. AIM This systematic review explores the scope and efficacy of psychosocial interventions designed to address sexual health and behavior and intimate relationship concerns in patients with SMI. METHODS The search was conducted in four targeted databases and identified 967 articles with four of those meeting inclusion criteria for this review. MAIN OUTCOME MEASURES The data extracted included setting, study sample, study design, outcome measures, data analysis, and results. The measures utilized in the studies assess mental and sexual health-related outcomes. RESULTS All four studies reported an improvement in sexual and mental health outcomes. CONCLUSION Given the lack of psychosocial approaches and culturally sensitive adaptations, this review highlights a gap in literature that should be addressed, particularly emphasizing their combined treatment with psychotropic medication and efficacy testing with diverse populations.
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Affiliation(s)
- Paula Helu-Brown
- Social Work, University of Southern California, Los Angeles, CA, USA.
| | - Maria Aranda
- Social Work, University of Southern California, Los Angeles, CA, USA
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Abstract
In this article, we describe the properties and consider the outcome dimensions of a collection of self-administered questionnaires that assess caregivers of offspring with mental illness. To this end, we searched the MEDLINE, Web of Science, and PsycINFO databases, as well as reference lists of studies published between 1980 and 2012. We reviewed 43 instruments, and found multiple outcome domains, associated with either objective burden or subjective burden, or both. A number of tools captured additional negative aspects of caregiving (e.g., strain, stress, and worrying) as well as positive aspects (e.g., personal growth, strength, support, rewards, and satisfaction), supplemented by measures assessing caregivers' perceptions and attitudes toward their offspring with SMI (e.g., insight, stigma, and efficacy). This current review of existing measures and their specific domains contributes to a more comprehensive understanding of the caregiving experience and allows both clinicians and researchers to select the most appropriate measurement tools for their purposes.
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Affiliation(s)
- Marc Gelkopf
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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21
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Nash K, Ghinassi F, Brar JS, Alam A, Bohan MC, Gopalan K, Carter A, Chengappa KNR. The Development and Implementation of an Electronic Health Record Tool for Monitoring Metabolic Syndrome Indices in Patients with Serious Mental Illness. Clin Schizophr Relat Psychoses 2013:1-25. [PMID: 24275635 DOI: 10.3371/csrp.nagh.112013] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives1. A quality performance improvement (QI) project to implement an electronic screening and monitoring tool to record components of the metabolic syndrome (e-MSD) during clinic visits by persons with serious mental illness (SMI). 2. To encourage psychiatrists to use this tool in their documentation.MethodsWorking with the information technology staff; five psychiatrists developed, tested, revised and embedded the e-MSD tool into the medication management document within the electronic health record. A continuing medical education program on metabolic syndrome was developed, and released to psychiatrists and mental health clinicians. Psychiatrist offices at one clinic were equipped with weighing scales, sphygmomanometers, waist circumference tapes and a QI project was initiated.ResultsAt one month, 9 to 12% of the anthropometric measures (height, weight, body mass index, waist circumference, and blood pressure) were recorded in 974 unique patient encounters, and 1 year later the numbers moved upwards - 15 to 41%. Towards the end of Year 1, a patient care associate was hired to measure the anthropometric measures, and one year later, the documented rates increased to 75-80%. Laboratory recordings (glucose and lipids) remained ≤ 8% throughout the first year, but moved upwards to 25% in Year 2.DiscussionNotwithstanding significant administrative and technical support for this QI project, changing clinician practice to screen, monitor and document metabolic indices in persons with SMI in the ambulatory setting changed significantly after the hiring of a patient care associate. Efforts to obtain laboratory measures in real-time remain a challenge. Next steps include interventions to promote weight loss and smoking cessation in SMI patients, and effective communication with their primary care doctors.
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Affiliation(s)
- Ken Nash
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center. University of Pittsburgh School of Medicine
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