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Happell B, Furness T, Jacob A, Stimson A, Curtis J, Watkins A, Platania-Phung C, Scholz B, Stanton R. Nurse-Led Physical Health Interventions for People with Mental Illness: A Scoping Review of International Literature. Issues Ment Health Nurs 2023:1-16. [PMID: 37294933 DOI: 10.1080/01612840.2023.2212772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
People with mental illness have a higher prevalence of co-occurring physical health conditions and poor health behaviors, leading a mortality gap of up to 16 years, compared with the general population. Nurses working in mental health settings play an important role in addressing factors influencing sub-optimal physical health. Therefore, this scoping review aimed to identify nurse-led physical health interventions and align interventions to eight recognized physical healthcare priority areas (i.e. Equally Well in Victoria Framework). A systematic search strategy was used to identify relevant literature. Data extraction included alignment to the Equally Well priority areas, research design, and indication of co-design (meaningful and collaborative involvement of consumers and significant others) and recovery-oriented practice (focusing on needs and goals of a consumer's recovery journey). All included papers (n = 74) were aligned to at least one of eight Equally Well priority areas. Papers were predominately quantitative (n = 64, 86%), with the remainder mixed methods (n = 9, 9%) or qualitative (n = 4, 5%). Most papers were aligned to improving metabolic health and support to quit smoking. One study focused on nurse-led intervention designed to reduce falls. Recovery-oriented practice was evident in six papers. No paper described evidence of co-design. A research gap was identified for nurse-led intervention to reduce falls and improve dental/oral care. Relative to mental healthcare policy, there is a need for future nurse-led physical health research to be co-designed and include recovery-oriented practice. Evaluation and description of future nurse-led physical interventions should seek to report perspectives of key stakeholders as these remain relatively unknown.
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Affiliation(s)
- Brenda Happell
- Mental Health and Psychosocial Well-being Theme, Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Alycia Jacob
- School of Nursing and Midwifery, Australian Catholic University, Fitzroy, Australia
| | - Alisa Stimson
- School of Nursing, Midwifery and Social Sciences, CQUniversity, Rockhampton, Queensland, Australia
| | - Jackie Curtis
- Mindgardens Neuroscience Network, South East Sydney Local Health District, University of New South Wales - Cliffbrook Campus, Coogee, Australia
| | - Andrew Watkins
- Mindgardens Neuroscience Network, South East Sydney Local Health District, University of New South Wales - Cliffbrook Campus, Coogee, Australia
| | | | - Brett Scholz
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Robert Stanton
- Cluster for Resilience and Wellbeing, Appleton Institute, Rockhampton, South Australia, Australia
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Queensland, Australia
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Strunz M, Jiménez NP, Gregorius L, Hewer W, Pollmanns J, Viehmann K, Jacobi F. Interventions to Promote the Utilization of Physical Health Care for People with Severe Mental Illness: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:126. [PMID: 36612457 PMCID: PMC9819522 DOI: 10.3390/ijerph20010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The main contributor to excess mortality in severe mental illness (SMI) is poor physical health. Causes include unfavorable health behaviors among people with SMI, stigmatization phenomena, as well as limited access to and utilization of physical health care. Patient centered interventions to promote the utilization of and access to existing physical health care facilities may be a pragmatic and cost-effective approach to improve health equity in this vulnerable and often neglected patient population. OBJECTIVE/METHODS In this study, we systematically reviewed the international literature on such studies (sources: literature databases, trial-registries, grey literature). Empirical studies (quantitative, qualitative, and mixed methods) of interventions to improve the utilization of and access to medical health care for people with a SMI, were included. RESULTS We identified 38 studies, described in 51 study publications, and summarized them in terms of type, theoretical rationale, outcome measures, and study author's interpretation of the intervention success. CONCLUSIONS Useful interventions to promote the utilization of physical health care for people with a SMI exist, but still appear to be rare, or at least not supplemented by evaluation studies. The present review provides a map of the evidence and may serve as a starting point for further quantitative effectiveness evaluations of this promising type of behavioral intervention.
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Affiliation(s)
| | | | - Lisa Gregorius
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Walter Hewer
- Klinikum Christophsbad, 73035 Göppingen, Germany
| | | | - Kerstin Viehmann
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Frank Jacobi
- Psychologische Hochschule Berlin, 10179 Berlin, Germany
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Fortuna KL, Myers AL, Ferron J, Kadakia A, Bianco C, Bruce ML, Bartels SJ. Assessing a digital peer support self-management intervention for adults with serious mental illness: feasibility, acceptability, and preliminary effectiveness. J Ment Health 2022; 31:833-841. [PMID: 35088619 PMCID: PMC9329481 DOI: 10.1080/09638237.2021.2022619] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To assess the feasibility, acceptability, and preliminary effectiveness of digital peer support integrated medical and psychiatric self-management intervention ("PeerTECH") for adults with a serious mental illness. METHODS Twenty-one adults with a chart diagnosis of a serious mental illness (i.e., schizophrenia, schizoaffective disorder, bipolar disorder, or treatment-refractory major depressive disorder) and at least one medical comorbidity (i.e., cardiovascular disease, obesity, diabetes, chronic obstructive pulmonary disease, hypertension, and/or high cholesterol) aged 18 years and older received the PeerTECH intervention in the community. Nine peer support specialists were trained to deliver PeerTECH. Data were collected at baseline and 12-weeks. RESULTS This pilot study demonstrated that a 12-week, digital peer support integrated medical and psychiatric self-management intervention for adults with serious mental illness was feasible and acceptable among peer support specialists and patients and was associated with statistically significant improvements in self-efficacy to manage chronic disease and personal empowerment. In addition, pre/post non-statistically significant improvements were observed in psychiatric self-management, medical self-management skills, and feelings of loneliness. CONCLUSIONS This single-arm pre/post pilot study demonstrated preliminary evidence peer support specialists could offer a fidelity-adherent digital peer support self-management intervention to adults with serious mental illness. These findings build on the evidence that a digital peer support self-management intervention for adults with serious mental illness designed to improve medical and psychiatric self-management is feasible, acceptable, and shows promising evidence of improvements in clinical outcomes. The use of technology among peer support specialists may be a promising tool to facilitate the delivery of peer support and guided evidence-based self-management support.People with serious mental illness (SMI; defined as individuals diagnosed with schizophrenia spectrum disorder, bipolar disorder, or treatment-refractory major depressive disorder) are increasingly utilizing peer support services to support their health and recovery. Peer support is defined as shared knowledge, experience, emotional, social, and/or practical assistance to support others with similar lived experiences (Solomon, 2004). Most recently the definition also includes the provision of evidence-based peer-supported self-management services (Fortuna et al., 2020). Mental health peer support can augment the traditional mental health treatment system through providing support services to maintain recovery between clinical encounters (Solomon, 2004) and is classified by the World Health Organization as an essential element of recovery (World, Health, and Organization, About social determinants of health, 2017).
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Affiliation(s)
- Karen L. Fortuna
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Joelle Ferron
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Arya Kadakia
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover NH, USA
| | - Cynthia Bianco
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Martha L. Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Takase A, Matoba Y, Taga T, Ito K, Okamura T. Middle-aged and older people with urgent, unaware, and unmet mental health care needs: Practitioners' viewpoints from outside the formal mental health care system. BMC Health Serv Res 2022; 22:1400. [PMID: 36419047 PMCID: PMC9685835 DOI: 10.1186/s12913-022-08838-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Mental health challenges are highly significant among older individuals. However, the non-utilization of mental health services increases with age. Although universal health coverage (UHC) was reported to reduce unmet health care needs, it might not be sufficient to reduce unmet mental health care needs from a clinical perspective. Despite the existence of UHC in Japan, this study aimed to explore the factors related to the non-utilization of formal mental health care systems among middle-aged and older people with urgent, unaware, and unmet mental health care needs. METHODS Purposeful sampling was used as the sampling method in this study by combining snowball sampling and a specific criterion. The interviewees were nine practitioners from four sectors outside the mental health care system, including long-term care, the public and private sector, as well as general hospitals in one area of Tokyo, where we had conducted community-based participatory research for five years. The interviews were conducted by an interdisciplinary team, which comprised a psychiatrist, a public health nurse from a non-profit organization, and a Buddhist priest as well as a social researcher to cover the broader unmet health care needs, such as physical, psychosocial, and spiritual needs. The basic characteristics of the interviewees were enquired, followed by whether the interviewees had case of middle-aged or older individuals with urgent, unaware, and unmet mental health care needs. If the answer was yes, we asked the interviewees to describe the details. The interviews pertinent to this study were conducted between October 2021 and November 2021. In this study, we adopted a qualitative descriptive approach. First, we created a summary of each case. Next, we explored the factors related to the non-utilization of formal mental health care systems by conducting a thematic analysis to identify the themes in the data collected. RESULTS The over-arching category involving "the factors related to an individual person" included two categories, as follows: 1) "Individual intrinsic factors," which comprised two sub-categories, including "difficulty in seeking help" and "delusional disorders," and 2) "family factors," which comprised "discord between family members," "denial of service engagement," "multiple cases in one family," and "families' difficulty in seeking help." The over-arching category "the factors related to the systems" included four categories, as follows: 1) "Physical health system-related factors," which comprised "the indifference of physical healthcare providers regarding mental health" and "the discontinuation of physical health conditions," 2) "mental health system-related factors," which comprised "irresponsive mental health care systems" and "uncomfortable experiences in previous visits to clinics," and 3) "social service system-related factors," which comprised "the lack of time to provide care," "social service not allowed without diagnosis," and "no appropriate service in the community," as well as 4) " the lack of integration between the systems." Apart from the aforementioned factors, "the community people-related factor" and "factors related to inter-regional movements" also emerged in this study. CONCLUSIONS The results of this study suggest a specific intervention target, and they provide further directions for research and policy implementation. The suggested solutions to the issues pertinent to this study are as follows: the recognition of the ways in which older people may inadequately understand their health or be unaware of available services, the building of a therapeutic alliance for "the individual intrinsic factors." Regarding the "family factors," the solutions include the provision of particularly intensive care for families with family discords, families with multiple cases, and families who find it difficult to seek help, as well as making intensive efforts for ensuring early involvement after contact with health care services. Regarding the "the factors related to the systems," the solutions include the implementation of mental health education campaigns aimed at enhancing mental health knowledge among non-mental health professionals, as well as formulating and implementing reforms ensuring that such professionals are increasingly responsible especially with regard to emergency inpatient care. It also include listening without ageism in clinical practice, the expansion of social services regarding human resources and the flexibility of use which increases the breadth of the types of care, as well as facilitating the integration between the associated health care systems. Further suggestions include encouraging community residents to join social security systems as well as the provision of particularly intensive care for people who have just moved in.
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Affiliation(s)
- Akinori Takase
- grid.442973.f0000 0001 1464 9781Department of Public Policy, Faculty of Socio-Symbiosis, Taisho University, Toshima, Tokyo, Japan
| | | | - Tsutomu Taga
- grid.420122.70000 0000 9337 2516Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Itabashi, Tokyo, Japan
| | - Kae Ito
- grid.420122.70000 0000 9337 2516Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, Itabashi, Tokyo, Japan
| | - Tsuyoshi Okamura
- grid.420122.70000 0000 9337 2516Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Itabashi, Tokyo, Japan
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Reynolds CF, Jeste DV, Sachdev PS, Blazer DG. Mental health care for older adults: recent advances and new directions in clinical practice and research. World Psychiatry 2022; 21:336-363. [PMID: 36073714 PMCID: PMC9453913 DOI: 10.1002/wps.20996] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The world's population is aging, bringing about an ever-greater burden of mental disorders in older adults. Given multimorbidities, the mental health care of these people and their family caregivers is labor-intensive. At the same time, ageism is a big problem for older people, with and without mental disorders. Positive elements of aging, such as resilience, wisdom and prosocial behaviors, need to be highlighted and promoted, both to combat stigma and to help protect and improve mental health in older adults. The positive psychiatry of aging is not an oxymoron, but a scientific construct strongly informed by research evidence. We champion a broader concept of geriatric psychiatry - one that encompasses health as well as illness. In the present paper, we address these issues in the context of four disorders that are the greatest source of years lived with disability: neurocognitive disorders, major depression, schizophrenia, and substance use disorders. We emphasize the need for implementation of multidisciplinary team care, with comprehensive assessment, clinical management, intensive outreach, and coordination of mental, physical and social health services. We also underscore the need for further research into moderators and mediators of treatment response variability. Because optimal care of older adults with mental disorders is both patient-focused and family-centered, we call for further research into enhancing the well-being of family caregivers. To optimize both the safety and efficacy of pharmacotherapy, further attention to metabolic, cardiovascular and neurological tolerability is much needed, together with further development and testing of medications that reduce the risk for suicide. At the same time, we also address positive aging and normal cognitive aging, both as an antidote to ageism and as a catalyst for change in the way we think about aging per se and late-life mental disorders more specifically. It is in this context that we provide directions for future clinical care and research.
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Affiliation(s)
| | - Dilip V. Jeste
- Department of PsychiatryUniversity of California San DiegoLa JollaCAUSA
| | | | - Dan G. Blazer
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNCUSA
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Schutt RK, Xi H, Mueser KT, Killam MA, Delman J, Eack SM, Mesholam-Gately R, Pratt SI, Sandoval L, Santos MM, Golden LR, Keshavan MS. Cognitive Enhancement Therapy vs social skills training in schizophrenia: a cluster randomized comparative effectiveness evaluation. BMC Psychiatry 2022; 22:583. [PMID: 36050663 PMCID: PMC9434502 DOI: 10.1186/s12888-022-04149-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/19/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Schizophrenia and related disorders are highly disabling and create substantial burdens for families, communities, and health care systems. Although pharmacological treatments can often lessen the psychotic symptoms that are a hallmark of schizophrenia, they do not lessen the social and cognitive deficits that create the greatest impediments to community engagement and functional recovery. This study builds on prior research on psychosocial rehabilitation by comparing the effectiveness of two treatments demonstrated as efficacious in improving social and community functioning, Cognitive Enhancement Therapy (CET) and a version of Social Skills Training (HOPES/SST). METHODS The study uses a randomized cluster design in which a pair of clinicians at community- and hospital-based mental service centers deliver either CET or HOPES to at least one group of 6-8 eligible clients for 12 months. Clinicians are trained and then supervised weekly, with ongoing process measurement of treatment fidelity, attendance, satisfaction, and retention, and use of other services. Measures administered at baseline and at 6 and 12 months while in treatment, and then at 18 and 24 months after treatment include social adjustment, quality of life, social skills, positive and negative symptoms, and neuro- and social cognition. We hypothesize that CET will be associated with greater improvements than SST in both the primary outcome of community functioning and the secondary outcomes of neuro- and social cognition and social skills. Secondarily, we hypothesize that more cognitive impairment at baseline and younger age will predict more benefit from CET compared to HOPES. DISCUSSION Resource shortages endemic in mental health services and exacerbated by the pandemic highlight the importance of identifying the most effective approach to improving social and community functioning. We aim to improve understanding of the impact of two efficacious psychosocial treatments and to improve clinicians' ability to refer to both treatments the individuals who are most likely to benefit from them. We expect the result to be programmatic improvements that improve the magnitude and durability of gains in community functioning. TRIAL REGISTRATION ClinicalTrial.gov NCT04321759 , registered March 25, 2020.
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Affiliation(s)
- Russell K. Schutt
- grid.239395.70000 0000 9011 8547Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA ,grid.266685.90000 0004 0386 3207University of Massachusetts Boston, Boston, USA
| | - Haiyi Xi
- grid.254880.30000 0001 2179 2404Dartmouth College, Hanover, USA
| | - Kim T. Mueser
- grid.189504.10000 0004 1936 7558Boston University, Boston, USA
| | - Matthew A. Killam
- grid.239395.70000 0000 9011 8547Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Jonathan Delman
- grid.168645.80000 0001 0742 0364University of Massachusetts Medical School, Worcester, USA
| | - Shaun M. Eack
- grid.21925.3d0000 0004 1936 9000University of Pittsburgh, Pittsburgh, USA
| | - Raquelle Mesholam-Gately
- grid.239395.70000 0000 9011 8547Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Sarah I. Pratt
- grid.254880.30000 0001 2179 2404Geisel School of Medicine at Dartmouth, Hanover, USA
| | - Luis Sandoval
- grid.239395.70000 0000 9011 8547Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Meghan M. Santos
- grid.254880.30000 0001 2179 2404Geisel School of Medicine at Dartmouth, Hanover, USA
| | - Laura R. Golden
- grid.239395.70000 0000 9011 8547Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA ,grid.266685.90000 0004 0386 3207University of Massachusetts Boston, Boston, USA
| | - Matcheri S. Keshavan
- grid.239395.70000 0000 9011 8547Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
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Effectiveness of personal recovery facilitators in adults with schizophrenia and other psychoses: A systematic review of reviews and narrative synthesis. Schizophr Res 2022; 246:132-147. [PMID: 35777151 DOI: 10.1016/j.schres.2022.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 01/12/2023]
Abstract
This review aimed to examine the evidence base for the use of personal recovery facilitators [non-psychopharmacological approaches] for adults with a diagnosis of schizophrenia and other psychoses. A systematic review (umbrella review) was conducted of reviews published in English between January 2010 and February 2022, which examined the effectiveness of personal recovery facilitators to support aspects of personal recovery as defined by the CHIME framework (connectedness, hope and optimism, identity, meaning and purpose, and empowerment). Twenty-one systematic reviews on thirteen different types of personal recovery facilitators [PRFs] were included in this umbrella review. Only one review sought to directly measure personal recovery processes according to the CHIME framework. Outcome measures mostly aligned with the processes of hope (21 reviews) and connectedness (19 reviews). Those related to empowerment (2 reviews), identity (5 reviews) and meaning and purpose (1 review) were less frequently the focus of PRFs. Yoga and music therapy showed the most promise as PRFs. Vocational treatments and integrated supported employment show good potential as personal recovery facilitators. However, together with narrative photovoice, art making and exhibition, they require further robust research to fully examine their impact. Personal recovery is only beginning to be considered as an intended outcome of interventions for persons with schizophrenia and other psychoses. This may be due in part to the continued predominance of the biomedical model approach to recovery within statutory services. Future evaluations of PRFs should include outcome measures that directly assess personal recovery according to the CHIME framework or other measures developed in consultation with recipients of these approaches. Review registration number and date: PROSPERO 2020 CRD42020215471: 10/11/20.
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Dell NA, Murphy AM, Stewart M, Sasaki N, Klier M. Promoting Recovery among Older Adults with Serious Mental Illness. SOCIAL WORK 2022; 67:184-190. [PMID: 35079825 DOI: 10.1093/sw/swac003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/11/2020] [Accepted: 10/14/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Nathaniel A Dell
- is vice president of knowledge translation and impact, Places for People, Inc., 1001 Lynch Street, St. Louis, MO 63118, USA
| | - Allison M Murphy
- is team leader, Research and Evaluation, Places for People, Inc., St. Louis, MO, USA
| | - Madeline Stewart
- is a medical student, School of Medicine, Boston University, Boston, MA, USA
| | - Natsuki Sasaki
- is a practicum student, Places for People, Inc., St. Louis, MO, USA
| | - Marina Klier
- is a therapist, Terrace House, St. Louis, MO, USA
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McDonagh MS, Dana T, Kopelovich SL, Monroe-DeVita M, Blazina I, Bougatsos C, Grusing S, Selph SS. Psychosocial Interventions for Adults With Schizophrenia: An Overview and Update of Systematic Reviews. Psychiatr Serv 2022; 73:299-312. [PMID: 34384230 DOI: 10.1176/appi.ps.202000649] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The authors of this systematic review (SR) sought to provide evidence for effects of commonly used psychosocial interventions on several outcomes among adults with schizophrenia. METHODS MEDLINE, the Cochrane Library, and PsycINFO databases were searched through July 2020. Eligible studies were SRs and trials of at least 12 weeks duration and with ≥50 participants that compared psychosocial interventions with treatment as usual among adults with schizophrenia. Study design, year, setting, country, sample size, eligibility criteria, population, clinical and intervention characteristics, results, and funding source were extracted, along with quality criteria. The evidence was evaluated on quality and strength of evidence stratified by intervention area and outcome, according to the Evidence-Based Practice Centers Methods Guide of the Agency for Healthcare Research and Quality. RESULTS Nine SRs and 30 trials (N=23,921 patients) in 11 intervention areas were included. Trials were mostly of fair quality and had low-to-moderate strength of evidence. Compared with treatment as usual, most psychosocial interventions were more effective in improving intervention-targeted outcomes, including core illness symptoms. Compared with treatment as usual, assertive community treatment, cognitive-behavioral therapy (CBT), family interventions, psychoeducation, social skills training, supported employment, and early interventions for first-episode psychosis (FEP) improved various functional outcomes. CBT and early interventions for FEP improved quality of life. Family interventions, psychoeducation, illness self-management, and early interventions for FEP reduced relapse. CONCLUSIONS Compared with treatment as usual, most psychosocial interventions improved functional outcomes, quality of life, and core illness symptoms, and several reduced relapse frequency among adults with schizophrenia.
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Affiliation(s)
- Marian S McDonagh
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Tracy Dana
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Sarah L Kopelovich
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Maria Monroe-DeVita
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Ian Blazina
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Christina Bougatsos
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Sara Grusing
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Shelley S Selph
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
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10
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Muhammad T, Rashid M. Prevalence and correlates of pain and associated depression among community-dwelling older adults: Cross-sectional findings from LASI, 2017-2018. Depress Anxiety 2022; 39:163-174. [PMID: 34970825 DOI: 10.1002/da.23239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Health practitioners often meet older persons suffering both from pain and depression. The study aimed to examine the factors associated with pain among older individuals and its association with major depression. In addition, the interaction between self-rated health (SRH), wealth status, and pain that is associated with depression are explored. METHODS We used data from the Longitudinal Aging Study in India (LASI). Participants included 15,098 male and 16,366 female adults aged 60 years or older. Univariate and bivariate analyses along with χ2 tests were conducted in the initial stage. Binary logistic regression analyses were performed to fulfill the objectives. Major depression was calculated using Short Form Composite International Diagnostic Interview. RESULTS A proportion of 39.6% older individuals (n = 12,686) reported pain and 8.7% older adults (n = 2657) suffered from depression. Older adults who suffered from pain frequently were more likely to be depressed than those who never suffered from pain (adjusted odds ratio [AOR]: 1.70; confidence interval [CI]: 1.38-2.09). The interaction of pain, SRH, and household wealth status on depression found that older adults with pain who reported poor SRH (AOR: 4.18; CI: 3.50-5.00) or belonged to rich households (AOR: 2.27; CI: 1.84-2.80) had higher odds of suffering from depression, compared to older adults with no pain and good SRH or no pain and belonged to poor households. CONCLUSION It is highlighted that pain is quite common in older people, and is linked to depression especially among older people with poor SRH. Thus, routine evaluation of pain and associated symptoms of mental illnesses should be performed for ensuring healthy aging.
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Affiliation(s)
- Thalil Muhammad
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Muhammed Rashid
- Department of Rehabilitation Research, JSS College of Physiotherapy, Mysore, India
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11
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Rajji TK, Mamo DC, Holden J, Granholm E, Mulsant BH. Cognitive-Behavioral Social Skills Training for patients with late-life schizophrenia and the moderating effect of executive dysfunction. Schizophr Res 2022; 239:160-167. [PMID: 34896870 DOI: 10.1016/j.schres.2021.11.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
The objectives of this study are to test the efficacy of Cognitive-Behavioral Social Skills Training (CBSST) in enhancing social function in a sample of older patients with schizophrenia, and to assess whether baseline cognition moderates response to CBSST. To address these objectives, we conducted a randomized controlled trial of 63 participants, randomized 1:1 into CBSST or Treatment-As-Usual (TAU). The setting was a community-based geriatric mental health outpatient clinic in Toronto, Ontario, Canada. Data were collected at baseline, and week 18, 36 and 52, between June 2008 and May 2014. Participants were outpatients, aged 60 or older, with a diagnosis of schizophrenia or schizoaffective disorder and no evidence of dementia or other conditions associated with cognitive or functional impairment. The intervention was a weekly group CBSST for 36 weeks. Cognition, including executive function, was assessed at baseline. Modified total score on the Independent Living Skills Survey (ILSS) at 18, 36, and 52 weeks was the primary outcome measure. In a linear mixed model analysis, the ILSS trajectory was better in the CBSST group than the TAU group, with significantly better function at 36 (Cohen's d = 0.75) and 52 weeks (Cohen's d = 0.92). Baseline executive dysfunction moderated CBSST response, whereby participants with more severe executive dysfunction experienced the most improvement in ILSS. CBSST was efficacious in patients with late-life schizophrenia and prevented decline in social function over a one-year period. CBSST was most beneficial for patients with more severe executive dysfunction, i.e., those who needed skills training the most.
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Affiliation(s)
- Tarek K Rajji
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada.
| | - David C Mamo
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jason Holden
- University of California, San Diego, San Diego, CA, USA
| | - Eric Granholm
- University of California, San Diego, San Diego, CA, USA
| | - Benoit H Mulsant
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
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12
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Ociskova M, Prasko J, Kantor K, Hodny F, Kasyanik P, Holubova M, Vanek J, Slepecky M, Nesnidal V, Minarikova Belohradova K. Schema Therapy for Patients with Bipolar Disorder: Theoretical Framework and Application. Neuropsychiatr Dis Treat 2022; 18:29-46. [PMID: 35023920 PMCID: PMC8747790 DOI: 10.2147/ndt.s344356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022] Open
Abstract
Bipolar disorder (BD) is a severe mood disorder characterized by episodes of depression and hypomania or mania. Despite its primarily biological roots, the onset and course of the disorder have also been related to psychosocial factors such as early adverse experiences and related maladaptive schemas. Several researchers proposed a schema therapeutic model to treat patients with BD. In this paper, we further develop the theoretical model and elaborate on seven elements that were found effective in the psychosocial interventions with individuals with BD: monitoring mood and early symptoms of relapse, recognizing and management of stressful situations and interpersonal conflicts, creating a relapse prevention plan, stabilizing the sleep/wake cycle and daily routine, encouraging the use of medication, and reducing self-stigma and substance use. Apart from that, we describe the elements of the schema work with patients who suffer from BD. Illustrative clinical cases accompany the theoretical framework. The research of the schema therapy with patients with severe mental illnesses has only recently started developing. The presented paper also aims to encourage further research in this area and highlight potentially beneficial research goals.
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Affiliation(s)
- Marie Ociskova
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic.,Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic.,Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, The Czech Republic
| | - Krystof Kantor
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | - Frantisek Hodny
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | | | - Michaela Holubova
- Department of Pedagogy and Psychology, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, The Czech Republic.,Department of Psychiatry, Regional Hospital Liberec, Liberec, The Czech Republic
| | - Jakub Vanek
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic
| | - Vlastimil Nesnidal
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | - Kamila Minarikova Belohradova
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
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13
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Abstract
OBJECTIVE While there is considerable current emphasis on youth and early psychosis, relatively little is known about the lives of people who live with psychotic disorders into middle age and beyond. We investigated social functioning, physical health status, substance use and psychiatric symptom profile in people with psychotic disorders aged between 50 and 65 years. METHODS Data were collected as part of the Survey of High Impact Psychosis, a population-based survey of Australians aged 18-65 years with a psychotic disorder. We compared those aged 50-65 years (N = 347) with those aged 18-49 years (N = 1478) across a range of measures. RESULTS The older group contained more women and more people with affective psychoses compared to the younger group. They were also more likely to have had a later onset and a chronic course of illness. The older group were more likely to have negative symptoms but less likely to exhibit positive symptoms; they also had lower current cognition, compared to the younger group. Compared to the younger group, the older group were more likely to be divorced/separated, to be living alone and to be unemployed. They had substantially lower lifetime use of alcohol and illicit substances, but rates of obesity, metabolic syndrome and diabetes mellitus were higher. CONCLUSION Our findings suggest that the characteristics of people with psychosis change significantly as they progress into the middle age and beyond. A better understanding of these differences is important in informing targeted treatment strategies for older people living with psychosis.
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Affiliation(s)
- Cherrie Galletly
- Interim Dean and Discipline of Psychiatry, Department of Medical Specialties, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network (NALHN), Lyell McEwin Hospital, Adelaide, SA, Australia
- Ramsay Health Care (SA) Mental Health Services, The Adelaide Clinic, Gilberton, Australia
| | - Shuichi Suetani
- Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
- Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia
- Department of Medicine, Griffith University, Nathan, QLD, Australia
| | - Lisa Hahn
- Ramsay Health Care (SA) Mental Health Services, The Adelaide Clinic, Gilberton, Australia
| | - Duncan McKellar
- Northern Adelaide Local Health Network (NALHN), Lyell McEwin Hospital, Adelaide, SA, Australia
- Office of the Chief Psychiatrist, SA Department of Health and Wellbeing, Adelaide, SA, Australia
| | - David Castle
- The University of Melbourne, Department of Psychiatry Melbourne, VIC, Australia
- St Vincent's Health Australia, Melbourne, VIC, Australia
- Scientific Director, Centre for Complex Interventions, Centre for Addictions and Mental Health; and Professor, Department of Psychiatry, University of Toronto, Toronto, Canada
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14
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Holthoff-Detto V, Seifert K. [Importance of psychotherapeutically oriented treatment procedures in geriatric psychiatry and psychotherapy]. Z Gerontol Geriatr 2021; 54:747-752. [PMID: 34825955 DOI: 10.1007/s00391-021-01992-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/13/2021] [Indexed: 10/19/2022]
Abstract
There is an increasing body of evidence for occupational and art therapies for treatment of severe mental illness in old age, such as geriatric depression, dementia and delirium. The individualized intervention strategies activate the patients' skills and activities in various ways and enhance psychological processes such as awareness of thoughts and activities, experiences and feelings of self-determination and autonomy. They may also encourage the patients' willingness to participate in multimodal treatment and to agree to pharmacotherapy and psychotherapy.
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Affiliation(s)
- Vjera Holthoff-Detto
- Medizinische Fakultät, Technische Universität Dresden, Dresden, Deutschland. .,Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Alexianer Krankenhaus Hedwigshöhe, Höhensteig 1, 12526, Berlin, Deutschland.
| | - Kathrin Seifert
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland. .,Hochschule für Künste im Sozialen, Ottersberg, Deutschland.
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15
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Kelly EL, Hong B, Duan L, Pancake L, Cohen H, Brekke JS. Service Use by Medicaid Recipients With Serious Mental Illness During an RCT of the Bridge Peer Health Navigator Intervention. Psychiatr Serv 2021; 72:1145-1150. [PMID: 33887952 DOI: 10.1176/appi.ps.201900615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Integration of general medical care and mental health care is a high priority for individuals with serious mental illnesses because of their high risk of morbidity and early mortality. The Bridge is a peer-led, health navigator intervention designed to improve access to and use of health care and self-management of medical services by individuals with serious mental illnesses. This study expands on a previous study in which the authors examined participants' self-reported outcomes from a 12-month randomized controlled trial of the Bridge. In the study reported here, Medicaid data were used to assess the impact of the intervention on service use during that trial. METHODS Medicaid data on use of general medical services (emergency room, outpatient, and inpatient) for 6 months were compared for 144 individuals with serious mental illnesses-Bridge participants (N=72) and a waitlist control group (N=72). An intent-to-treat approach was used, with regression models controlling for general medical services in the 6 months before baseline. RESULTS Zero-inflated negative binomial analyses, controlling for service use 6 months before baseline, found that the intervention group used the emergency room significantly less frequently, compared with the control group (adjusted mean±SD number of visits, 0.72±0.19 versus 1.59±0.42). No between-group differences were found in use of general medical inpatient or outpatient services. CONCLUSIONS The Bridge was effective in decreasing emergency room use among individuals with serious mental illnesses.
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Affiliation(s)
- Erin L Kelly
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
| | - Benjamin Hong
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
| | - Lei Duan
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
| | - Laura Pancake
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
| | - Heather Cohen
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
| | - John S Brekke
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
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16
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Brooks JM, Umucu E, Storm M, Chiu C, Wu JR, Fortuna KL. Preliminary Outcomes of an Older Peer and Clinician co-Facilitated Pain Rehabilitation Intervention among Adults Aged 50 Years and Older with Comorbid Chronic Pain and Mental Health Conditions. Psychiatr Q 2021; 92:561-571. [PMID: 32827098 PMCID: PMC7897749 DOI: 10.1007/s11126-020-09831-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The present study aimed to examine the acceptability, feasibility, and preliminary effectiveness of an older peer and clinician co-facilitated Behavioral Activation for Pain Rehabilitation (BA-PR) intervention among adults aged 50 years and older with comorbid chronic pain and mental health conditions. This was a mixed-methods research design with eight participants aged 55 to 62 years old with mental health conditions including schizophrenia spectrum disorder, bipolar disorder, major depressive disorder, personality disorder, and adjustment disorder. The quantitative data were assessed from observational methods, a pain rating scale and related measures. We used semi-structured interviews for qualitative feedback on experiences with the BA-PR intervention after participation. Overall, the participants had positive experiences following receipt of the BA-PR intervention. The recruitment and adherence rates for participants were 72.7% and 100%, respectively. Approximately 75% of the participants remained enrolled in the study. Findings from a paired t-test showed the BA-PR intervention was linked to significantly reduced prescription opioid misuse risk, t (7) = 2.42, p < 0.05. There were also non-significant reductions in pain intensity and depression severity, in addition to improvements in active and passive pain coping strategies and behavioral activation.The BA-PR intervention is the first pain rehabilitation intervention specifically designed for middle-aged and older adults with comorbid chronic pain and mental health conditions. Our findings indicate promise for the BA-PR intervention to potentially reduce prescription opioid misuse risk, pain, and depressive symptoms. However, a quasi-experimental study is needed before rigorous effectiveness testing.
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Affiliation(s)
- Jessica M Brooks
- Columbia University School of Nursing, 560 West 168th Street, New York, NY, 10032, USA.
| | - Emre Umucu
- Department of Rehabilitation Sciences, University of Texas at El Paso, El Paso, TX, 79902, USA
| | - Marianne Storm
- Faculty of Health Sciences, Department of Public Health, University of Stavanger, 4036, Stavanger, Norway
| | - Chungyi Chiu
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, 61820, USA
| | - Jia-Rung Wu
- Department of Counselor Education, Daniel L. Goodwin College of Education, Northeastern Illinois University, 5500 North St. Louis Avenue, Chicago, IL, 60625, USA
| | - Karen L Fortuna
- Geisel School of Medicine, Department of Mental Health, Dartmouth College, Lebanon, NH, 03766, USA.,CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, 03766, USA
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17
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Lee MS, Peart JR, Armin JS, Williamson HJ. A Scoping Review of Barriers and Facilitators to Pap Testing in Women with Disabilities and Serious Mental Illnesses: Thirty Years After the Americans with Disabilities Act. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2021; 14:25-56. [PMID: 38550304 PMCID: PMC10978025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/01/2024]
Abstract
Background Thirty years after the Americans with Disabilities Act (ADA) was passed, promising equal access to health services for people with disabilities and serious mental illness, research on Pap testing continues to uncover health disparities among women with disabilities and women with serious mental illnesses, including those that identify as an ethnic/racial minority. Aim The purpose of this paper is to describe and present the literature on the barriers and facilitators women with disabilities and women with serious mental illnesses face with receiving a Pap test using the social ecological model. We also examined the degree to which racial/ethnic minority women were included in these articles. Method A scoping review was conducted where the research team searched United States academic literature from 1990 through February 2020 in PubMed, Medline, and CINAHL using general subject headings for disability, mental illness, and Pap testing. Results Thirty-two articles met inclusion criteria. More barriers than facilitators were mentioned in articles. Barriers and facilitators are organized into three groups according to social ecological model and include individual (e.g., socioeconomic status, anxiety, education), interpersonal (e.g., family, living environment), and organizational factors (health care provider training, health care system). Participant's race/ethnicity were often reported but minoritized populations were often not the focus of articles. Conclusions More articles discussed the difficulties that women with disabilities and women with serious mental illnesses face with receiving a Pap test than facilitators to Pap testing. Additional research should focus on the intersectionality race/ethnicity and women with disabilities and women with serious mental illnesses in relation to Pap testing.
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Affiliation(s)
- Michele Sky Lee
- The Institute for Human Development, Northern Arizona University
| | | | - Julie S Armin
- Department of Family and Community Medicine, College of Medicine-Tucson, The University of Arizona
| | - Heather J Williamson
- Center for Health Equity Research and Department of Occupational Therapy, Northern Arizona University
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18
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Does Self-Efficacy Predict Functioning in Older Adults with Schizophrenia? A Cross-Sectional and Longitudinal Mediation Analysis. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Richardson A, Richard L, Gunter K, Cunningham R, Hamer H, Lockett H, Wyeth E, Stokes T, Burke M, Green M, Cox A, Derrett S. A systematic scoping review of interventions to integrate physical and mental healthcare for people with serious mental illness and substance use disorders. J Psychiatr Res 2020; 128:52-67. [PMID: 32521251 DOI: 10.1016/j.jpsychires.2020.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 02/07/2023]
Abstract
Integrated care approaches have been recommended to remove barriers to healthcare and improve the physical health outcomes of people living with serious mental illness (SMI) and/or substance use disorders (SUDs). The aim of this systematic scoping review was to describe empirical investigations of interventions designed to integrate physical, mental, and addiction healthcare for this population. An iterative and systematic search of five electronic databases (Medline (Ovid), PsycINFO, CINAHL, Embase (Ovid) and Scopus) was conducted to identify peer-reviewed articles published between January 2000 and April 2019. Two reviewers independently screened publications in two successive stages of title and abstract screening, followed by full-text screening of eligible publications. Data from each included publication were extracted independently by two reviewers using a standardised spreadsheet. A total of 28 eligible publications were identified, representing 25 unique studies. Over half of the included studies investigated the use of case managers to provide self-management skills or to coordinate mental and physical healthcare (n = 14). Other interventions examined the co-location of services (n = 9) and the implementation of screening and referral pathways to specialist treatment (n = 2). Less than half of the included studies described a framework, theory or model that was underpinning the intervention tested. While some aspects of integrated care have been identified and addressed by interventions, other key dimensions have not been considered, such as shared decision-making. Identification of a comprehensive model of integrated care is recommended to inform the development and evaluation of future interventions for people with SMI/SUDs.
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Affiliation(s)
- Amy Richardson
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Lauralie Richard
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Kathryn Gunter
- Chicago Center for Diabetes Translation Research, The University of Chicago Department of Medicine, Chicago, IL, 60637, USA.
| | - Ruth Cunningham
- Department of Public Health, University of Otago, Wellington, PO Box 7343, Wellington, 6242, New Zealand.
| | - Helen Hamer
- Helen Hamer & Associates Ltd, Auckland, New Zealand.
| | - Helen Lockett
- Department of Public Health, University of Otago, Wellington, PO Box 7343, Wellington, 6242, New Zealand.
| | - Emma Wyeth
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Martin Burke
- Addictions, Supportive Accommodation, Reintegration and Palliative Care Services, Salvation Army, PO Box 6015, Wellington, 6141, New Zealand.
| | - Mel Green
- South Community Mental Health Team, Southern District Health Board, Private Bag 1921, Dunedin, 9054, New Zealand.
| | - Adell Cox
- Southern District Health Board, New Zealand.
| | - Sarah Derrett
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
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20
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Storm M, Fortuna KL, Gill EA, Pincus HA, Bruce ML, Bartels SJ. Coordination of services for people with serious mental illness and general medical conditions: Perspectives from rural northeastern United States. Psychiatr Rehabil J 2020; 43:234-243. [PMID: 31985242 PMCID: PMC7382986 DOI: 10.1037/prj0000404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The objective of the study was to investigate providers' perspectives on how medical, mental health, and social services are coordinated for people with serious mental illnesses and general medical conditions in 2 predominantly rural states. METHOD To achieve multiple perspectives on service coordination, this study includes perspectives from providers employed in community mental health centers, social service agencies, and primary care settings in 2 northern rural New England states with contrasting approaches to financing and organizing services. We conducted 29 individual semistructured interviews and 1 focus group, which included administrative leaders, team leaders, primary care providers, social workers, and case managers who provide services for people with serious mental illness. Data were analyzed using qualitative thematic content analysis. RESULTS We identified key themes at 3 levels: (a) provider-level coordination: bridging across services; managing interprofessional communications; and contrasting perspectives on the locus of responsibility for coordination; (b) individual-level coordination: support for self-management and care navigation; trusting and continuous relationships; and the right to individual choice and autonomy; (c) system-level coordination: linking appropriate residential and care provision services, funding, recruiting and retaining staff, policy enablers, and integration solutions. CONCLUSIONS Three levels of provider-reported coordination themes are described for the 2 states, reflecting efforts to coordinate and integrate service delivery across medical, mental health, and social services. IMPLICATIONS Improvements in patient outcomes will need additional actions that target key social determinants of health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Marianne Storm
- Faculty of Health Sciences, Department of Public Health, University of Stavanger
| | | | - Emily A Gill
- General Practice and Primary Healthcare, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland
| | - Harold A Pincus
- Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University
| | | | - Stephen J Bartels
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School
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21
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Smart EL, Brown L, Palmier-Claus J, Raphael J, Berry K. A systematic review of the effects of psychosocial interventions on social functioning for middle-aged and older-aged adults with severe mental illness. Int J Geriatr Psychiatry 2020; 35:449-462. [PMID: 31919890 DOI: 10.1002/gps.5264] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 12/21/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The number of older adults with severe mental health problems such as schizophrenia is likely to double in the next 20 years. The needs of this patient group change across the life course, but difficulties with social functioning persist into older age. Poorer social functioning is associated with poorer outcomes and has been identified as a priority for intervention by patients themselves. This paper systematically reviews studies examining the effectiveness of psychosocial interventions on social functioning for people with severe mental health problems in later life. METHODS A systematic review of peer-reviewed journal articles was conducted and databases were searched from inception to December 2017. The review was limited to psychosocial interventions, for mid to older aged adults (≥40 years of age) with severe mental illness that included a validated measure of social functioning. RESULTS Fifteen studies (17 papers) met inclusion criteria. There was evidence to support skills training interventions that primarily focused on social skills training or integrated mental and physical health interventions. There was not sufficient evidence to recommend any other interventions. CONCLUSIONS The results highlight the limited nature of interventions designed specifically for older people with severe mental health problems that target social functioning and the need for more robust, large-scale studies in the area. Current evidence suggests that cognitive behaviour therapy can be effective in targeting social functioning in younger age groups, but, as yet, there is insufficient evidence to recommend this intervention for an older population.
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Affiliation(s)
- Emily L Smart
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Laura Brown
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jasper Palmier-Claus
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Jessica Raphael
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Greater Manchester Mental Health, NHS Foundation Trust, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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22
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Advances in the Conceptualization and Study of Schizophrenia in Later Life: 2020 Update. Clin Geriatr Med 2020; 36:221-236. [DOI: 10.1016/j.cger.2019.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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23
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Bartels SJ, DiMilia PR, Fortuna KL, Naslund JA. Integrated Care for Older Adults with Serious Mental Illness and Medical Comorbidity: Evidence-Based Models and Future Research Directions. Clin Geriatr Med 2020; 36:341-352. [PMID: 32222306 DOI: 10.1016/j.cger.2019.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The excess risk of early mortality, medical comorbidity, early institutionalization, and high costs among older adults with serious mental illness necessitates development and dissemination of effective and sustainable integrated care models that simultaneously address mental and physical health needs. This overview highlights current, evidence-based integrated care models, which predominantly adopt the following approaches: (1) psychosocial skills training, (2) integrated illness self-management, and (3) collaborative care and behavioral health homes. Finally, innovative models that build on these approaches by incorporating novel uses of telehealth, mobile health technology and peer support, and strategies from developing economies are discussed.
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Affiliation(s)
- Stephen J Bartels
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Box 201, Lebanon, NH 03766, USA.
| | - Peter R DiMilia
- The Dartmouth Institute for Health Policy and Clinical Practice, 46 Centerra Parkway, Box 201, Lebanon, NH 03766, USA
| | - Karen L Fortuna
- Psychiatry, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Box 201, Lebanon, NH 03766, USA
| | - John A Naslund
- Dartmouth Center for Technology and Behavioral Health, 46 Centerra Parkway, Box 201, Lebanon, NH 03766, USA
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Effects of depression and cognitive impairment on quality of life in older adults with schizophrenia spectrum disorder: Results from a multicenter study. J Affect Disord 2019; 256:164-175. [PMID: 31176189 DOI: 10.1016/j.jad.2019.05.063] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/14/2019] [Accepted: 05/27/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little is known about the respective effects of depression and cognitive impairment on quality of life among older adults with schizophrenia spectrum disorder. METHODS We used data from the Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia or schizoaffective disorder (N = 353). Quality of life (QoL), depression and cognitive impairment were assessed using the Quality of Life Scale (QLS), the Center of Epidemiologic Studies Depression scale and the Mini-Mental State Examination, respectively. We used structural equation modeling to examine the shared and specific effects of depression and cognitive impairment on QoL, while adjusting for sociodemographic characteristics, general medical conditions, psychotropic medications and the duration of the disorder. RESULTS Depression and cognitive impairment were positively associated (r = 0.24, p < 0.01) and both independently and negatively impacted on QoL (standardized β = -0.41 and β = -0.32, both p < 0.01) and on each QLS quality-of-life domains, except for depression on instrumental role and cognitive impairment on interpersonal relations in the sensitivity analyses excluding respondents with any missing data. Effects of depression and cognitive impairment on QoL were not due to specific depressive symptoms or specific cognitive domains, but rather mediated through two broad dimensions representing the shared effects across all depressive symptoms and all cognitive deficits, respectively. LIMITATIONS Because of the cross-sectional design of this study, measures of association do not imply causal associations. CONCLUSIONS Mechanisms underlying these two broad dimensions should be considered as important potential targets to improve quality of life of this vulnerable population.
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Brooks JM, Polenick CA, Bryson W, Naslund JA, Renn BN, Orzechowski NM, Almeida M, Bartels SJ. Pain intensity, depressive symptoms, and functional limitations among older adults with serious mental illness. Aging Ment Health 2019; 23:470-474. [PMID: 29356566 PMCID: PMC6054897 DOI: 10.1080/13607863.2017.1423025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine pain-related activity interference as a mediator for the relationship between pain intensity and depressive symptoms among older adults with serious mental illness (SMI). METHOD Ordinary least-squares regressions were used to investigate the mediation analysis among older adults with SMI (n = 183) from community mental health centers. Analyses used secondary data from the HOPES intervention study. RESULTS Higher pain intensity was associated with greater pain-related activity interference. Higher pain intensity and pain-related activity interference were also associated with elevated depressive symptoms. Finally, greater pain-related activity interference significantly mediated the association between higher pain intensity and elevated depressive symptoms. CONCLUSIONS These findings demonstrate that pain and depressive symptoms may be linked to functional limitations. Clinicians and researchers in the mental health field should better address pain-related activity interference among older adults with SMI, especially among those with higher pain intensity and elevated depressive symptoms.
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Affiliation(s)
- Jessica M. Brooks
- Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College, Lebanon, NH, USA,Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, USA
| | | | - William Bryson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - John A. Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Brenna N. Renn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Nicole M. Orzechowski
- Section of Rheumatology, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Margaret Almeida
- Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College, Lebanon, NH, USA
| | - Stephen J. Bartels
- Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College, Lebanon, NH, USA,The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
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Tampi RR, Young J, Hoq R, Resnick K, Tampi DJ. Psychotic disorders in late life: a narrative review. Ther Adv Psychopharmacol 2019; 9:2045125319882798. [PMID: 31662846 PMCID: PMC6796200 DOI: 10.1177/2045125319882798] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 09/25/2019] [Indexed: 11/25/2022] Open
Abstract
Psychotic disorders are not uncommon in late life. These disorders often have varied etiologies, different clinical presentations, and are associated with significant morbidity and mortality among the older adult population. Psychotic disorders in late life develop due to the complex interaction between various biological, psychological, social, and environmental factors. Given the significant morbidity and mortality associated with psychotic disorders in late life, a comprehensive work-up should be conducted when they are encountered. The assessment should not only identify the potential etiologies for the psychotic disorders, but also recognize factors that predicts possible outcomes for these disorders. Treatment approaches for psychotic disorders in late life should include a combination of nonpharmacological management strategies with the judicious use of psychotropic medications. When antipsychotic medications are necessary, they should be used cautiously with the goal of optimizing outcomes with regular monitoring of their efficacy and adverse effects.
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Affiliation(s)
- Rajesh R Tampi
- Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH 44307, USA
| | - Juan Young
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rakin Hoq
- NeoMed/Summa Psychiatry Residency Program, Akron, OH, USA
| | - Kyle Resnick
- NeoMed/Summa Psychiatry Residency Program, Akron, OH, USA
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D'Amico ML, Jaffe LE, Gardner JA. Evidence for Interventions to Improve and Maintain Occupational Performance and Participation for People With Serious Mental Illness: A Systematic Review. Am J Occup Ther 2018; 72:7205190020p1-7205190020p11. [PMID: 30157006 DOI: 10.5014/ajot.2018.033332] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This systematic review evaluates the evidence for the effectiveness of interventions within the scope of occupational therapy to improve and maintain performance and participation for people with serious mental illness. Areas included in this review are activities of daily living, instrumental activities of daily living, leisure, social participation, and rest and sleep. METHOD Databases searched included MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews. Reviewers read and assessed citations, abstracts, and full-text articles for inclusion and analysis. RESULTS Sixty-one articles were selected for inclusion. The review yielded strong evidence for psychoeducation and occupation- and cognitive-based interventions, moderate evidence for skills-based interventions, and limited evidence for technology-supported interventions. CONCLUSION Results of this review support use of evidence-based practice within the scope of occupational therapy, inclusion of occupational therapy practitioners as mental health service providers, and continued research.
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Affiliation(s)
- Mariana L D'Amico
- Mariana L. D'Amico, EdD, OTR/L, FAOTA, is Associate Professor, Nova Southeastern University-Tampa, FL;
| | - Lynn E Jaffe
- Lynn E. Jaffe, ScD, OTR/L, FAOTA, is Professor and Program Director, Florida Gulf State University, Fort Myers
| | - Jennifer A Gardner
- Jennifer A. Gardner, OTD, OTR, is Associate Professor, Kean University, Union, NJ
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Brooks JM, Umucu E, Huck GE, Fortuna K, Sánchez J, Chiu CY, Bartels SJ. Sociodemographic characteristics, health conditions, and functional impairment among older adults with serious mental illness reporting moderate-to-severe pain. Psychiatr Rehabil J 2018; 41:224-233. [PMID: 30160508 PMCID: PMC6123826 DOI: 10.1037/prj0000316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare adults aged ≥50 years with serious mental illness reporting moderate-to-severe pain to older adults with serious mental illness without pain with respect to sociodemographic characteristics, health conditions, and functional impairment. METHOD Secondary data analyses were conducted using baseline assessments of 183 participants recruited for the Helping Older People Experience Success (HOPES) study from three community mental health centers. The primary outcome was self-reported, nonexperimentally induced, moderate-to-severe pain (referent = no-to-mild pain). Predictor variables consisted of sociodemographic characteristics, health conditions, and functional impairment. We conducted univariable and multivariable logistic regression analyses to examine the associations between these variables. RESULTS Sixty-one participants (33.3%) from our sample reported pain. Pain was associated with all of the sociodemographic and health-related factors in univariable analyses. In the multivariable model, only older age, pain-related activity interference, and physical and emotional health-related social limitations were significantly associated with pain. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The presence of moderate-to-severe pain in older adults with serious mental illness is associated with pain-attributable impairment of activities and social problems above and beyond the substantial functional limitations routinely experienced by this high-risk, high-need group. Given the high rates of preexisting conditions and persistent social impairment among these older adults, our findings suggest that pain may contribute to worse overall functional outcomes. Future research and clinical interventions focused on improving outcomes should include an evaluation of pain as a contributor to decreased functioning and assess the need for early intervention, nonpharmacological pain management, or other health promotion services in psychiatric rehabilitation. (PsycINFO Database Record
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Affiliation(s)
- Jessica M. Brooks
- Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College, Lebanon, NH
- University of North Texas, Denton, TX
| | - Emre Umucu
- Department of Rehabilitation Sciences, The University of Texas at El Paso, El Paso, Texas
| | - Garrett E. Huck
- Department of Rehabilitation and Human Services, Pennsylvania State University- Penn State Hazleton, Hazleton, PA
| | - Karen Fortuna
- Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College, Lebanon, NH
| | - Jennifer Sánchez
- Department of Rehabilitation and Counselor Education, The University of Iowa, Iowa City, IA
| | - Chung-Yi Chiu
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Urbana, IL
| | - Stephen J. Bartels
- Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College, Lebanon, NH
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH
- Centers for Health and Aging, Lebanon, NH
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Fortuna KL, DiMilia PR, Lohman MC, Bruce ML, Zubritsky CD, Halaby MR, Walker RM, Brooks JM, Bartels SJ. Feasibility, Acceptability, and Preliminary Effectiveness of a Peer-Delivered and Technology Supported Self-Management Intervention for Older Adults with Serious Mental Illness. Psychiatr Q 2018; 89:293-305. [PMID: 28948424 PMCID: PMC5874159 DOI: 10.1007/s11126-017-9534-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To assess the feasibility, acceptability, and preliminary effectiveness of a peer-delivered and technology supported integrated medical and psychiatric self-management intervention for older adults with serious mental illness. Ten older adults with serious mental illness (i.e., schizophrenia, schizoaffective disorder, bipolar disorder, or major depressive disorder) and medical comorbidity (i.e., cardiovascular disease, obesity, diabetes, chronic obstructive pulmonary disease, hypertension, and/or high cholesterol) aged 60 years and older received the PeerTECH intervention in their homes. Three certified peer specialists were trained to deliver PeerTECH. Data were collected at baseline, one-month, and three-month. The pilot study demonstrated that a three-month, peer-delivered and technology-supported integrated medical and psychiatric self-management intervention ("PeerTECH") was experienced by peer specialists and participants as feasible and acceptable. PeerTECH was associated with statistically significant improvements in psychiatric self-management. In addition, pre/post, non-statistically significant improvements were observed in self-efficacy for managing chronic health conditions, hope, quality of life, medical self-management skills, and empowerment. This pre/post pilot study demonstrated it is possible to train peers to use technology to deliver an integrated psychiatric and medical self-management intervention in a home-based setting to older adults with serious mental illness with fidelity. These findings provide preliminary evidence that a peer-delivered and technology-supported intervention designed to improve medical and psychiatric self-management is feasible, acceptable, and is potentially associated with improvements in psychiatric self-management, self-efficacy for managing chronic health conditions, hope, quality of life, medical self-management skills, and empowerment with older adults with serious mental illness and chronic health conditions.
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Affiliation(s)
- Karen L Fortuna
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA.
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Peter R DiMilia
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Matthew C Lohman
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Cynthia D Zubritsky
- Center for Mental Health Policy and Services Research, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Jessica M Brooks
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Stephen J Bartels
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
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Rej S, Quayle W, Forester BP, Dols A, Gatchel J, Chen P, Gough S, Fox R, Sajatovic M, Strejilevich SA, Eyler LT. Measurement tools for assessment of older age bipolar disorder: A systematic review of the recent global literature. Bipolar Disord 2018; 20:359-369. [PMID: 29108106 DOI: 10.1111/bdi.12566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/04/2017] [Accepted: 09/15/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES More than 50% of people with bipolar disorder will be age 60 years or older by 2030. There is a need for more data to guide assessment and treatment in older age bipolar disorder (OABD); however, interpretation of findings from small, single-site studies may not be generalizable and there are few large trials. As a step in the direction of coordinated large-scale OABD data collection, it is critical to identify which measurements are currently used and identify potential gaps in domains typically assessed. METHODS An international group of OABD experts performed a systematic literature review to identify studies examining OABD in the past 6 years. Relevant articles were assessed to categorize the types of clinical, cognitive, biomarker, and neuroimaging OABD tools routinely used in OABD studies. RESULTS A total of 53 papers were identified, with a broad range of assessments. Most studies evaluated demographic and clinical domains, with fewer studies assessing cognition. There are relatively few biomarker and neuroimaging data, and data collection methods were less comprehensively covered. CONCLUSION Assessment tools used in the recent OABD literature may help to identify both a minimum and a comprehensive dataset that should be evaluated in OABD. Our review also highlights gaps where key clinical outcomes have not been routinely assessed. Biomarker and neuroimaging assessment could be further developed and standardized. Clinical data could be combined with neuroimaging, genetic, and other biomarkers in large-scale coordinated data collection to further improve our understanding of OABD phenomenology and biology, thereby contributing to research that advances care.
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Affiliation(s)
- Soham Rej
- GeriPARTy Group, Division of Geriatric Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada
| | - William Quayle
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZ inGeest, EMGO Institute of Care and Health Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Jennifer Gatchel
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Peijun Chen
- Departments of Psychiatry& Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Centre, Cleveland, OH, USA.,Psychiatry Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Sarah Gough
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Rebecca Fox
- GeriPARTy Group, Division of Geriatric Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada
| | - Martha Sajatovic
- Departments of Psychiatry& Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Centre, Cleveland, OH, USA
| | - Sergio A Strejilevich
- Bipolar Disorder Program, Institute of Neurosciences, Favaloro University, Buenos Aires, Argentina
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Desert-Pacific Mental Illness Research Education and Clinical Center, VA San Diego Healthcare System, San Diego, CA, USA
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Abstract
A crisis looms as research and clinical programs have not kept pace with dramatic increases in the number of older adults with schizophrenia. This article provides an overview of the advances in the conceptualization and study of schizophrenia in later life. Theoretic and clinical models in psychiatry and gerontology are integrated. Specifically, recovery is examined in the context of aging, how clinical dimensionality affects diagnoses in older adults, how various features of schizophrenia are implicated in models of accelerated and paradoxic aging, and how outcome in later life is a more dynamic and heterogeneous than assumed previously.
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Bartels SJ, DiMilia PR, Fortuna KL, Naslund JA. Integrated Care for Older Adults with Serious Mental Illness and Medical Comorbidity: Evidence-Based Models and Future Research Directions. Psychiatr Clin North Am 2018; 41:153-164. [PMID: 29412843 PMCID: PMC5806142 DOI: 10.1016/j.psc.2017.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The excess risk of early mortality, medical comorbidity, early institutionalization, and high costs among older adults with serious mental illness necessitates development and dissemination of effective and sustainable integrated care models that simultaneously address mental and physical health needs. This overview highlights current, evidence-based integrated care models, which predominantly adopt the following approaches: (1) psychosocial skills training, (2) integrated illness self-management, and (3) collaborative care and behavioral health homes. Finally, innovative models that build on these approaches by incorporating novel uses of telehealth, mobile health technology and peer support, and strategies from developing economies are discussed.
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Affiliation(s)
| | - Peter R. DiMilia
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Karen L. Fortuna
- Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - John A. Naslund
- Dartmouth Center for Technology and Behavioral Health, Lebanon, NH, USA
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Choi KH, Kang J, Kim SM, Lee SH, Park SC, Lee WH, Choi S, Park K, Hwang TY. Cognitive Remediation in Middle-Aged or Older Inpatients with Chronic Schizophrenia: A Randomized Controlled Trial in Korea. Front Psychol 2018; 8:2364. [PMID: 29467684 PMCID: PMC5807907 DOI: 10.3389/fpsyg.2017.02364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/27/2017] [Indexed: 02/05/2023] Open
Abstract
Background: Accumulating evidence indicates that cognitive remediation (CR) is effective for improving various cognitive deficits in adult patients with schizophrenia. Although reports of brain plasticity in older adults and the service needs for chronic patients with schizophrenia are increasing, very few randomized controlled trials of CR have been conducted in middle-aged or older inpatients with chronic schizophrenia. We investigated the efficacy of individualized CR on the cognitive impairments of middle-aged or older inpatients with chronic schizophrenia within the context of comprehensive psychiatric rehabilitation (PR) by comparing the results obtained with PR only and treatment as usual (TAU). Method: Fifty-seven middle-aged and older individuals with chronic schizophrenia and mild to moderate cognitive deficits were enrolled. Thirty-eight who were undergoing PR were randomly assigned to CR + PR (N = 19) or PR-only (N = 19) groups. Nineteen participants who were undergoing TAU without CR or PR were evaluated pre- and post-treatment. Results: CR was easily provided and well received (drop-out rates = 5.3%) by middle-aged or older psychiatric inpatients. Compared to the PR-Only or TAU patients, patients in the CR + PR group showed greater improvement in executive functioning. Compared to TAU patients, CR + PR and PR-only patients showed greater improvement in logical memory. More patients in the CR + PR group improved clinically significantly in executive functioning and logical memory, compared with the PR-only and TAU patients. Conclusions: These results suggested that CR improved some cognitive deficits in middle-aged or older inpatients with chronic schizophrenia and that it was effective as an adjunctive treatment to the usual PR services provided in inpatient settings. Clinical Registration: KCT0002609.
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Affiliation(s)
- Kee-Hong Choi
- Department of Psychology, Korea University, Seoul, South Korea
| | - Jinsook Kang
- Department of Psychology, Korea University, Seoul, South Korea
| | - Sun-Min Kim
- Department of Psychology, Korea University, Seoul, South Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Inje University College of Medicine and Ilsan Paik Hospital, Goyang, South Korea
| | - Seon-Cheol Park
- Department of Psychiatry, Inje University College of Medicine and Haeundae Paik Hospital, Busan, South Korea
| | - Won-Hye Lee
- Department of Clinical Psychology, National Center for Mental Health, Seoul, South Korea
| | - Sun Choi
- Department of Clinical Psychology, Yongin Mental Hospital, Yongin, South Korea
| | - Kiho Park
- Department of Psychology, Korea University, Seoul, South Korea
| | - Tae-Yeon Hwang
- Division of Mental Health Service and Planning, National Center for Mental Health and Yongin WHO Collaborating Center for Psychosocial Rehabilitation and Community Mental Health, Seoul, South Korea
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Fortuna KL, Lohman MC, Bruce ML, Bartels SJ. Utility of functioning measures in the prediction of independent living status in older adults with serious mental illness. Int J Geriatr Psychiatry 2018; 33:423-431. [PMID: 28776766 PMCID: PMC5872810 DOI: 10.1002/gps.4764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 06/17/2017] [Accepted: 06/27/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The objective of the study was to compare the predictive utility of three commonly used functioning measures for people with serious mental illness in the prediction of independent living status. METHODS We conducted a secondary data analysis from the Helping Older People Experience Success study with adults aged 50 years and older with a diagnosis of bipolar disorder, schizoaffective disorder, schizophrenia, or major depressive disorder (N = 183). RESULTS Total scores for the Independent Living Skills Survey, Multnomah Community Ability Scale, and UCSD Performance-Based Skills Assessment were modestly inter-correlated. For the overall sample, greater independent living status at baseline and 1-year follow-up was predicted by higher baseline functioning scores on both the self-reported Independent Living Skills Survey and the UCSD Performance-Based Skills Assessment. However, by diagnostic subgroup, independent living status at 1-year follow-up was only predicted by the Independent Living Skills Survey for affective disorders and by the UCSD Performance-Based Skills Assessment for schizophrenia-spectrum disorders. For the total sample, the Independent Living Skills Survey was associated with self-efficacy and employment status. Neither the Independent Living Skills Survey nor UCSD Performance-Based Skills Assessment was associated with medical or psychiatric hospitalizations or with subjective physical or mental health status. CONCLUSIONS These commonly used functioning measures for people with serious mental illness examine different aspects of functioning. The choice of functional measurement should be based on the population under study and intervention goals. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Karen L Fortuna
- Dartmouth Centers for Health and Aging, Lebanon, NH, USA
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Matthew C Lohman
- Dartmouth Centers for Health and Aging, Lebanon, NH, USA
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Martha L Bruce
- Dartmouth Centers for Health and Aging, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Stephen J Bartels
- Dartmouth Centers for Health and Aging, Lebanon, NH, USA
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
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35
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Pratt SI, Mueser KT, Wolfe R, Santos MM, Bartels SJ. One size doesn't fit all: A trial of individually tailored skills training. Psychiatr Rehabil J 2017; 40:380-386. [PMID: 28604015 PMCID: PMC5726946 DOI: 10.1037/prj0000261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This article describes a pilot test of an individually tailored program to improve community living and health self-management skills in older adults with serious mental illness. METHOD This study provided the Helping Older People Experience Success-Individually Tailored (HOPES-I) intervention, an adaptation of an empirically supported, manualized, group-based skills training program shown to improve community functioning, psychiatric symptoms, self-efficacy, and receipt of preventive health. HOPES-I targets 5 skill areas: leisure time, communication, independent living, friendships, and health self-management. We enrolled 47 adults age 50 and older (mean age = 62) with serious mental illness (38% schizophrenia spectrum, 62% mood disorders). Trained HOPES-I coaches evaluated participants' skills and functioning and engaged them in shared decision-making to select which curricular areas to receive. Participants received 1 HOPES-I session per week for 9-12 months, with assessments of overall psychosocial functioning and the 5 skill areas targeted by the program at baseline, postintervention, and at 3 and 6 months. RESULTS Participants with baseline impairments in overall functioning and in each of the skill areas targeted by the program demonstrated significant improvements on related outcome measures. Selection of specific HOPES-I curriculum was not associated with level of impairment in associated skill areas at baseline, but participants with more impairment overall chose and completed more curriculum modules. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The results of this study support the feasibility and potential benefits of an individually tailored skills training program for the rapidly growing and vulnerable group of older people with serious mental illness. (PsycINFO Database Record
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Affiliation(s)
- Sarah I Pratt
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth
| | - Kim T Mueser
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth
| | - Rosemarie Wolfe
- Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth
| | - Meghan M Santos
- Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth
| | - Stephen J Bartels
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth
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Mueller DR, Khalesi Z, Benzing V, Castiglione CI, Roder V. Does Integrated Neurocognitive Therapy (INT) reduce severe negative symptoms in schizophrenia outpatients? Schizophr Res 2017; 188:92-97. [PMID: 28185784 DOI: 10.1016/j.schres.2017.01.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/20/2017] [Accepted: 01/22/2017] [Indexed: 12/16/2022]
Abstract
Negative symptoms often inhibit the social integration of people suffering from schizophrenia. Reducing severe negative symptoms (SNS) in a clinically relevant way is a major unmet need. The aim of this study was to investigate whether Integrated Neurocognitive Therapy (INT), a group cognitive remediation therapy (CRT), reduces SNS in schizophrenia outpatients. INT was compared with Treatment As Usual (TAU) in a randomized-controlled trial (RCT). A total of 61 SNS outpatients participated in the study, 28 were allocated to the INT group and 33 to the TAU group. A test-battery was used at baseline, post-treatment at 15weeks, and 1-year-follow-up. Remission rates of SNS after therapy were significantly higher for INT compared to TAU. A trend favoring INT was obtained at follow-up. Furthermore, INT showed significantly higher functional outcome during follow-up compared to TAU. Regarding cognition, the strongest significant effect was found in attention post-treatment. No effects between groups on more complex neurocognition and social cognition were evident. SNS outpatients seem to accept INT group intervention as suggested by the high attendance rate.
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Affiliation(s)
- Daniel R Mueller
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.
| | - Zahra Khalesi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Valentin Benzing
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland; Institute of Sport Science, University of Bern, Switzerland
| | - Clelia I Castiglione
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Volker Roder
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.
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Characteristics and Service Use of Older Adults with Schizoaffective Disorder Versus Older Adults with Schizophrenia and Bipolar Disorder. Am J Geriatr Psychiatry 2017; 25:941-950. [PMID: 28478998 PMCID: PMC6013831 DOI: 10.1016/j.jagp.2017.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/23/2017] [Accepted: 03/21/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if schizoaffective disorder in older adults is differentiated from schizophrenia and bipolar disorder with respect to community functioning, cognitive functioning, psychiatric symptoms, and service use. DESIGN Secondary analysis of baseline data collected from the Helping Older People Experience Success psychosocial skills training and health management study. SETTING Three community mental health centers in New Hampshire and Massachusetts. PARTICIPANTS Adults over the age of 50 (N = 139, mean age: 59.7 years, SD: 7.4 years) with persistent functional impairment and a diagnosis of schizoaffective disorder (N = 52), schizophrenia (N = 51), or bipolar disorder (N = 36). MEASUREMENTS Health status (36-Item Short Form Health Survey [SF-36]), performance-based community living skills (UCSD Performance-Based Skills Assessment), neuropsychological functioning (Delis-Kaplan Executive Functioning subtests), psychiatric symptoms (Brief Psychiatric Rating Scale, Center for Epidemiologic Studies Depression Scale, Scale for the Assessment of Negative Symptoms), medical severity (Charlson comorbidity index), and acute service use. RESULTS Older adults with schizoaffective disorder had depressive symptoms of similar severity to bipolar disorder, and thought disorder symptoms of similar severity to schizophrenia. Schizoaffective disorder compared with schizophrenia was associated with better community functioning, but poorer subjective physical and mental health functioning as measured by the SF-36. Older adults with schizoaffective disorder had greater acute hospitalization compared with adults with schizophrenia, though their use of acute care services was comparable to individuals with bipolar disorder. CONCLUSIONS Findings from this study suggest that schizoaffective disorder in older adults occupies a distinct profile from either schizophrenia or bipolar disorder with respect to community functional status, symptom profile, and acute services utilization.
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Sajatovic M, Gunzler DD, Kanuch SW, Cassidy KA, Tatsuoka C, McCormick R, Blixen CE, Perzynski AT, Einstadter D, Thomas CL, Lawless ME, Martin S, Falck-Ytter C, Seeholzer EL, McKibben CL, Bauer MS, Dawson NV. A 60-Week Prospective RCT of a Self-Management Intervention for Individuals With Serious Mental Illness and Diabetes Mellitus. Psychiatr Serv 2017; 68:883-890. [PMID: 28502243 PMCID: PMC5675044 DOI: 10.1176/appi.ps.201600377] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES A 60-week randomized controlled trial assessed the effects of targeted training in illness management (TTIM) versus treatment as usual among 200 individuals with serious mental illness and diabetes mellitus. METHODS The study used the Clinical Global Impression (CGI), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Brief Psychiatric Rating Scale (BPRS) to assess psychiatric symptoms; the Global Assessment of Functioning (GAF) and the Sheehan Disability Scale (SDS) to assess functioning; the 36-Item Short-Form Health Survey (SF-36) to assess general health, and serum glycosylated hemoglobin (HbA1c) to assess diabetes control. RESULTS Participants' mean±SD age was 52.7±9.5 years, and 54% were African American. They were diagnosed as having depression (48%), schizophrenia (25%), and bipolar disorder (28%). At baseline, depression severity was substantial but psychosis severity was modest. At 60 weeks, there was greater improvement among TTIM participants versus treatment-as-usual recipients on the CGI (p<.001), the MADRS (p=.016), and the GAF (p=.003). Diabetes knowledge was significantly improved among TTIM participants but not in the treatment-as-usual group. In post hoc analyses among participants whose HbA1c levels at baseline met recommendations set by the American Diabetes Association for persons with high comorbidity (53%), TTIM participants had minimal change in HbA1c over the 60-week follow-up, whereas HbA1c levels worsened in the treatment-as-usual group. CONCLUSIONS TTIM was associated with improved psychiatric symptoms, functioning, and diabetes knowledge compared with treatment as usual. Among participants with better diabetes control at baseline, TTIM participants had better diabetes control at 60 weeks compared with recipients of treatment as usual.
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Affiliation(s)
- Martha Sajatovic
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Douglas D Gunzler
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Stephanie W Kanuch
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Kristin A Cassidy
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Curtis Tatsuoka
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Richard McCormick
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Carol E Blixen
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Adam T Perzynski
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Douglas Einstadter
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Charles L Thomas
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Mary E Lawless
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Siobhan Martin
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Corinna Falck-Ytter
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Eileen L Seeholzer
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Christine L McKibben
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Mark S Bauer
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Neal V Dawson
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
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Abstract
PURPOSE OF REVIEW The population over age 60 is growing more rapidly than the general population. Given the projected increase and need for data that can inform treatment, this review provides a brief description of newer publications focused on mania in older-age bipolar disorder (OABD), including epidemiology, diagnosis, and treatments. RECENT FINDINGS Age cutoffs to define OABD range from 50 to 65 years. OABD clinical presentation and course of illness is highly variable, often characterized by mood episode recurrence, medical comorbidity, cognitive deficits, and impaired functioning. There is little pharmacotherapy data on mania in OABD. Lithium and valproate have been tested in a single randomized controlled trial and there is data of more limited quality with other compounds. Treating OABD is challenging due to medical complexity, comorbidity, diminished tolerance to treatment, and a limited evidence base. More data is needed to keep pace with clinical demand.
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Vermunt NPCA, Harmsen M, Westert GP, Olde Rikkert MGM, Faber MJ. Collaborative goal setting with elderly patients with chronic disease or multimorbidity: a systematic review. BMC Geriatr 2017; 17:167. [PMID: 28760149 PMCID: PMC5537926 DOI: 10.1186/s12877-017-0534-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 07/04/2017] [Indexed: 11/29/2022] Open
Abstract
Background It is challenging to use shared decision-making with patients who have a chronic health condition or, especially, multimorbidity. A patient-goal-oriented approach can thus be beneficial. This study aims to identify and evaluate studies on the effects of interventions that support collaborative goal setting or health priority setting compared to usual care for elderly people with a chronic health condition or multimorbidity. Methods This systematic review was based on EPOC, PRISMA and MOOSE guidelines. Pubmed, PsychInfo, CINAHL, Web of Science, Embase and the Cochrane Central Register of Controlled Trials were searched systematically. The following eligibility criteria were applied: 1. Randomised (cluster) controlled trials, non-randomised controlled trials, controlled before-after studies, interrupted time series or repeated measures study design; 2. Single intervention directed specifically at collaborative goal setting or health priority setting or a multifactorial intervention including these elements; 3. Study population of patients with multimorbidity or at least one chronic disease (mean age ± standard deviation (SD) incl. age 65). 4. Studies reporting on outcome measures reducible to outcomes for collaborative goal setting or health priority setting. Results A narrative analysis was performed. Eight articles describing five unique interventions, including four cluster randomised controlled trials and one randomised controlled trial, were identified. Four intervention studies, representing 904, 183, 387 and 1921 patients respectively, were multifactorial and showed statistically significant effects on the application of goal setting (Patient Assessment of Chronic Illness Care (PACIC) goal setting subscale), the number of advance directives or the inclusion of goals in care plans. Explicit attention for goal setting or priority setting by a professional was a common element in these multifactorial interventions. One study, which implemented a single-factor intervention on 322 patients, did not have significant effects on doctor-patient agreement. All the studies had methodological concerns in varying degrees. Conclusions Collaborative goal setting and/or priority setting can probably best be integrated in complex care interventions. Further research should determine the mix of essential elements in a multifactorial intervention to provide recommendations for daily practice. In addition, the necessity of methodological innovation and the application of mixed evaluation models must be highlighted to deal with the complexity of goal setting and/or priority setting intervention studies. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0534-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Neeltje P C A Vermunt
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), PO Box 9101, NL-6500 HB, Nijmegen, Netherlands. .,The Dutch Council for Health and Society (Raad voor Volksgezondheid en Samenleving, RVS), PO Box 19404, NL-2500 CK, The Hague, Netherlands.
| | - Mirjam Harmsen
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), PO Box 9101, NL-6500 HB, Nijmegen, Netherlands
| | - Gert P Westert
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), PO Box 9101, NL-6500 HB, Nijmegen, Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatrics, Radboud university medical center/Radboud Alzheimer Center, PO Box 9101, NL-6500 HB, Nijmegen, Netherlands
| | - Marjan J Faber
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), PO Box 9101, NL-6500 HB, Nijmegen, Netherlands
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Lutgens D, Gariepy G, Malla A. Psychological and psychosocial interventions for negative symptoms in psychosis: systematic review and meta-analysis. Br J Psychiatry 2017; 210:324-332. [PMID: 28302699 DOI: 10.1192/bjp.bp.116.197103] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/10/2016] [Accepted: 01/27/2017] [Indexed: 01/15/2023]
Abstract
BackgroundNegative symptoms observed in patients with psychotic disorders undermine quality of life and functioning. Antipsychotic medications have a limited impact. Psychological and psychosocial interventions, with medication, are recommended. However, evidence for the effectiveness of specific non-biological interventions warrants detailed examination.AimsTo conduct a meta-analytic and systematic review of the literature on the effectiveness of non-biological treatments for negative symptoms in psychotic disorders.MethodWe searched for randomised controlled studies of psychological and psychosocial interventions in psychotic disorders that reported outcome on negative symptoms. Standardised mean differences (SMDs) in values of negative symptoms at the end of treatment were calculated across study domains as the main outcome measure.ResultsA total of 95 studies met our criteria and 72 had complete quantitative data. Compared with treatment as usual cognitive-behavioural therapy (pooled SMD -0.34, 95% CI -0.55 to -0.12), skills-based training (pooled SMD -0.44, 95% CI -0.77 to -0.10), exercise (pooled SMD -0.36, 95% CI -0.71 to -0.01), and music treatments (pooled SMD -0.58, 95% CI -0.82 to -0.33) provide significant benefit. Integrated treatment models are effective for early psychosis (SMD -0.38, 95% CI -0.53 to -0.22) as long as the patients remain in treatment. Overall quality of evidence was moderate with a high level of heterogeneity.ConclusionsSpecific psychological and psychosocial interventions have utility in ameliorating negative symptoms in psychosis and should be included in the treatment of negative symptoms. However, more effective treatments for negative symptoms need to be developed.
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Affiliation(s)
- Danyael Lutgens
- Danyael Lutgens, MSc, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montréal, Quebec; Genevieve Gariepy, PhD, McGill University, Institute for Health and Social Policy, Montréal, Quebec; Ashok Malla, MD, FRCPC, McGill University, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Genevieve Gariepy
- Danyael Lutgens, MSc, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montréal, Quebec; Genevieve Gariepy, PhD, McGill University, Institute for Health and Social Policy, Montréal, Quebec; Ashok Malla, MD, FRCPC, McGill University, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Ashok Malla
- Danyael Lutgens, MSc, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montréal, Quebec; Genevieve Gariepy, PhD, McGill University, Institute for Health and Social Policy, Montréal, Quebec; Ashok Malla, MD, FRCPC, McGill University, Douglas Mental Health University Institute, Montréal, Quebec, Canada
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van Liempt S, Dols A, Schouws S, Stek ML, Meesters PD. Comparison of social functioning in community-living older individuals with schizophrenia and bipolar disorder: a catchment area-based study. Int J Geriatr Psychiatry 2017; 32:532-538. [PMID: 27121916 DOI: 10.1002/gps.4490] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 03/10/2016] [Accepted: 03/17/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Preserved social functioning is of utmost importance for older individuals living in the community to maintain independency. However, in patients with schizophrenia or bipolar disorder, it remains unclear which factors influence social functioning in later life. METHODS In a catchment area-based study in Amsterdam, The Netherlands, 120 older (>60 years) community-living patients with schizophrenia (n = 73) and with bipolar disorder (n = 47) were included. Clinical interviews on social functioning and psychometric measurements were applied. RESULTS Patients with schizophrenia scored lower on all social measures (social functioning, social participation, network size, availability of confidants) compared with their peers with bipolar disorder. In patients with schizophrenia, lower social functioning was associated with having more negative symptoms and depressive symptoms. Age of onset was also associated with social functioning in schizophrenia, with higher scores in very late-onset schizophrenia-like psychosis. Unfavourable social functioning in patients with bipolar disorder was associated with lower cognitive functioning. Furthermore, in both groups, social functioning was not related to age, having offspring or the presence of a partner. CONCLUSIONS In community-living older patients, schizophrenia has a more disruptive effect on social functioning than bipolar disorder, except in those with a very late-onset schizophrenia-like psychosis. Minimizing residual depressive symptoms and optimizing cognitive functioning may be targets for improving social functioning and independent-living in older patients with severe mental illness. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Annemiek Dols
- GGZ inGeest, Amsterdam, The Netherlands.,Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Sigfried Schouws
- GGZ inGeest, Amsterdam, The Netherlands.,Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Max L Stek
- GGZ inGeest, Amsterdam, The Netherlands.,Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Paul D Meesters
- GGZ inGeest, Amsterdam, The Netherlands.,Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Murante T, Cohen CI. Cognitive Functioning in Older Adults With Schizophrenia. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2017; 15:26-34. [PMID: 31975837 DOI: 10.1176/appi.focus.20160032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cognitive deficits are thought to be a core feature in schizophrenia and have been found to be strongly associated with impairments in functioning. It is estimated that more than 70% of patients with schizophrenia have cognitive impairment. The aim of this article is to critically review the emerging literature on cognition in older adults with schizophrenia. Specifically, we address the following questions: Are there differences in cognitive functioning between older adults with schizophrenia and their healthy age peers as well as with younger people with schizophrenia? What are the factors associated with cognitive deficits and their interaction over time? What are the life course trajectories of cognitive deficits, especially in later life? Are older adults with schizophrenia more likely to develop dementia, and, if so, does it differ from other dementias? Are there pharmacological and psychosocial interventions that can successfully treat cognitive deficits in older adults with schizophrenia?
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Affiliation(s)
- Tessa Murante
- Dr. Murante is with the Psychiatric Residency Training Program and Dr. Cohen is with the Division of Geriatric Psychiatry, SUNY Downstate Medical College, Brooklyn, New York. Send correspondence to Dr. Cohen (e-mail: )
| | - Carl I Cohen
- Dr. Murante is with the Psychiatric Residency Training Program and Dr. Cohen is with the Division of Geriatric Psychiatry, SUNY Downstate Medical College, Brooklyn, New York. Send correspondence to Dr. Cohen (e-mail: )
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Whiteman KL, Naslund JA, DiNapoli EA, Bruce ML, Bartels SJ. Systematic Review of Integrated General Medical and Psychiatric Self-Management Interventions for Adults With Serious Mental Illness. Psychiatr Serv 2016; 67:1213-1225. [PMID: 27301767 PMCID: PMC5089924 DOI: 10.1176/appi.ps.201500521] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Adults with serious mental illness are disproportionately affected by general medical comorbidity, earlier onset of disease, and premature mortality. Integrated self-management interventions have been developed to address both general medical and psychiatric illnesses. This systematic review examined evidence about the effect of self-management interventions that target both general medical and psychiatric illnesses and evaluated the potential for implementation. METHODS Databases, including CINAHL, Cochrane Central, Ovid MEDLINE, PsycINFO, and Web of Science, were searched for articles published between 1946 and July 2015. Studies evaluating integrated general medical and psychiatric self-management interventions for adults with schizophrenia spectrum or mood disorders and general medical comorbidity were included. RESULTS Fifteen studies (nine randomized controlled trials and six pre-post designs) reported on nine interventions: automated telehealth, Health and Recovery Peer program, Helping Older People Experience Success, Integrated Illness Management and Recovery, Life Goals Collaborative Care, Living Well, Norlunga Chronic Disease Self-Management program, Paxton House, and Targeted Training in Illness Management. Most studies demonstrated feasibility, acceptability, and preliminary effectiveness; however, clinical effectiveness could not be established in most studies because of methodological limitations. Factors identified that may deter implementation included operating costs, impractical length, and workforce requirements. CONCLUSIONS Integrated general medical and psychiatric illness self-management interventions appear feasible and acceptable, with high potential for clinical effectiveness. However, implementation factors were rarely considered in intervention development, which may contribute to limited uptake and reach in real-world settings.
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Affiliation(s)
- Karen L Whiteman
- Dr. Whiteman and Dr. Bartels are with the Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Mr. Naslund is with the CDC Health Promotion Research Center at Dartmouth and the Dartmouth Institute, Lebanon, New Hampshire. Dr. DiNapoli is with the Mental Illness Research, Education and Clinical Center, VISN 4, Department of Veterans Affairs Pittsburgh Healthcare System, and with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Bruce is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - John A Naslund
- Dr. Whiteman and Dr. Bartels are with the Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Mr. Naslund is with the CDC Health Promotion Research Center at Dartmouth and the Dartmouth Institute, Lebanon, New Hampshire. Dr. DiNapoli is with the Mental Illness Research, Education and Clinical Center, VISN 4, Department of Veterans Affairs Pittsburgh Healthcare System, and with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Bruce is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Elizabeth A DiNapoli
- Dr. Whiteman and Dr. Bartels are with the Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Mr. Naslund is with the CDC Health Promotion Research Center at Dartmouth and the Dartmouth Institute, Lebanon, New Hampshire. Dr. DiNapoli is with the Mental Illness Research, Education and Clinical Center, VISN 4, Department of Veterans Affairs Pittsburgh Healthcare System, and with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Bruce is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Martha L Bruce
- Dr. Whiteman and Dr. Bartels are with the Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Mr. Naslund is with the CDC Health Promotion Research Center at Dartmouth and the Dartmouth Institute, Lebanon, New Hampshire. Dr. DiNapoli is with the Mental Illness Research, Education and Clinical Center, VISN 4, Department of Veterans Affairs Pittsburgh Healthcare System, and with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Bruce is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Stephen J Bartels
- Dr. Whiteman and Dr. Bartels are with the Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Mr. Naslund is with the CDC Health Promotion Research Center at Dartmouth and the Dartmouth Institute, Lebanon, New Hampshire. Dr. DiNapoli is with the Mental Illness Research, Education and Clinical Center, VISN 4, Department of Veterans Affairs Pittsburgh Healthcare System, and with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Bruce is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
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Sajatovic M, Strejilevich SA, Gildengers AG, Dols A, Al Jurdi RK, Forester BP, Kessing LV, Beyer J, Manes F, Rej S, Rosa AR, Schouws SNTM, Tsai SY, Young RC, Shulman KI. A report on older-age bipolar disorder from the International Society for Bipolar Disorders Task Force. Bipolar Disord 2015; 17:689-704. [PMID: 26384588 PMCID: PMC4623878 DOI: 10.1111/bdi.12331] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 07/24/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES In the coming generation, older adults with bipolar disorder (BD) will increase in absolute numbers as well as proportion of the general population. This is the first report of the International Society for Bipolar Disorder (ISBD) Task Force on Older-Age Bipolar Disorder (OABD). METHODS This task force report addresses the unique aspects of OABD including epidemiology and clinical features, neuropathology and biomarkers, physical health, cognition, and care approaches. RESULTS The report describes an expert consensus summary on OABD that is intended to advance the care of patients, and shed light on issues of relevance to BD research across the lifespan. Although there is still a dearth of research and health efforts focused on older adults with BD, emerging data have brought some answers, innovative questions, and novel perspectives related to the notion of late onset, medical comorbidity, and the vexing issue of cognitive impairment and decline. CONCLUSIONS Improving our understanding of the biological, clinical, and social underpinnings relevant to OABD is an indispensable step in building a complete map of BD across the lifespan.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Sergio A Strejilevich
- Bipolar Disorder Program, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina
| | - Ariel G Gildengers
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Annemiek Dols
- GGZinGeest, VU Medical Center, Amsterdam, the Netherlands
| | - Rayan K Al Jurdi
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Brent P Forester
- Geriatric Psychiatry Research Program, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Lars Vedel Kessing
- Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John Beyer
- Duke University Medical Center, Durham, NC, USA
| | - Facundo Manes
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Argentina
- UPD-INECO Foundation Core on Neuroscience (UNIFCoN), Chile
- National Scientific and Technical Rsearch Council (CONICET), Argentina
- Australian Research Council Centre of Excellence in Cognition and its Disorders, Australia
| | - Soham Rej
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Geri PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
| | - Adriane R Rosa
- Federal University of Rio Grande do Sul, Brazil
- Department of Pharmacology, Laboratory of Molecular Psychiatry, INCT for Translational Medicine–CNPq, Hospital de Clínicas de Porto Alegre, Brazil
| | - Sigfried NTM Schouws
- GGZ inGeest, Department of Psychiatry, EMGO Institute of Care and Health Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Shang-Ying Tsai
- Department of Psychiatry, Taipei Medical University Hospital
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Robert C Young
- Weill Cornell Medical College and New York Presbyterian Hospital, White Plains, NY, USA
| | - Kenneth I Shulman
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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46
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Jang J, Futeran S, Large M, Curtis J. An audit of general practitioner involvement in public community mental health care. Australas Psychiatry 2015; 23:571-4. [PMID: 26139704 DOI: 10.1177/1039856215592479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Existing guidelines suggest that collaboration between general practitioners and mental health services may improve the physical health of people with serious mental illness. This study investigated the extent of general practitioner involvement in a community mental health centre and examined whether the presence of a documented general practitioner in the patient's medical records was associated with markers of better health outcomes. METHODS The medical records of current patients were audited, including those receiving medical care and case management and those only receiving medical care. The demographic and diagnostic information, evidence of metabolic screening, blood test results, and medications of patients with a recorded general practitioner were compared with those of patients with no recorded general practitioner. RESULTS Ninety-eight of 191 (51%) of patients had details of a general practitioner documented in their medical records. There were no significant differences in rates of metabolic screening between the two groups. Those with a general practitioner had more medical diagnoses and were taking a greater number of psychiatric medications. CONCLUSION Although the medical comorbidities of serious mental illness are becoming increasingly recognised, our findings suggest the need for ongoing and coordinated efforts by policymakers, general practitioners, mental health services and patients to ensure the health and longevity of people with serious mental illness.
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Affiliation(s)
- Jae Jang
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Shuli Futeran
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, and; Eastern Suburbs Mental Health Service, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Matthew Large
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, and; Eastern Suburbs Mental Health Service, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Jackie Curtis
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, and; Eastern Suburbs Mental Health Service, South Eastern Sydney Local Health District, Sydney, NSW, Australia
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Happell B, Galletly C, Castle D, Platania-Phung C, Stanton R, Scott D, McKenna B, Millar F, Liu D, Browne M, Furness T. Scoping review of research in Australia on the co-occurrence of physical and serious mental illness and integrated care. Int J Ment Health Nurs 2015. [PMID: 26220151 DOI: 10.1111/inm.12142] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The physical health of people with serious mental illness (SMI) has become a focal area of research. The aim of the present study was to ascertain the attention and distribution of research from within Australia on physical illness and SMI co-occurrence, and to identify gaps. A scoping review of peer-reviewed research literature from Australia, published between January 2000 and March 2014, was undertaken through an electronic literature search and coding of papers to chart trends. Four trends are highlighted: (i) an almost threefold increase in publications per year from 2000-2006 to 2007-2013; (ii) a steady release of literature reviews, especially from 2010; (iii) health-related behaviours, smoking, integrated-care programmes, and antipsychotic side-effects as the most common topics presented; and (iv) paucity of randomized, controlled trials on integrated-care models. Despite a marked increase in research attention to poorer physical health, there remains a large gap between research and the scale of the problem previously identified. More papers were descriptive or reviews, rather than evaluations of interventions. To foster more research, 12 research gaps are outlined. Addressing these gaps will facilitate the reduction of inequalities in physical health for people with SMI. Mental health nurses are well placed to lead multidisciplinary, consumer-informed research in this area.
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Affiliation(s)
- Brenda Happell
- Synergy, Nursing and Midwifery Research Centre, University of Canberra and ACT Health, Canberra Hospital, ACT, Canberra, Australia
| | - Cherrie Galletly
- The Adelaide Clinic, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - David Castle
- St Vincent's Hospital, Melbourne, Victoria, Australia.,School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Chris Platania-Phung
- Synergy, Nursing and Midwifery Research Centre, University of Canberra and ACT Health, Canberra Hospital, ACT, Canberra, Australia
| | - Robert Stanton
- Central Queensland University, Central Queensland University, School of Human Health and Social Sciences, Bundaberg, Queensland, Australia
| | - David Scott
- Central Queensland University, School of Medical and Applied Sciences, Melbourne, Victoria, Australia
| | - Brian McKenna
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia.,NorthWestern Mental Health, Melbourne, Victoria, Australia
| | | | - Dennis Liu
- Northern Mental Health Service, Salisbury, South Australia, Australia
| | - Matthew Browne
- Central Queensland University, Central Queensland University, School of Human Health and Social Sciences, Bundaberg, Queensland, Australia
| | - Trentham Furness
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia.,NorthWestern Mental Health, Melbourne, Victoria, Australia
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The Affordable Care Act, Accountable Care Organizations, and Mental Health Care for Older Adults: Implications and Opportunities. Harv Rev Psychiatry 2015; 23:304-19. [PMID: 25811340 PMCID: PMC4894763 DOI: 10.1097/hrp.0000000000000086] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Patient Protection and Affordable Care Act (ACA) represents the most significant legislative change in the United States health care system in nearly half a century. Key elements of the ACA include reforms aimed at addressing high-cost, complex, vulnerable patient populations. Older adults with mental health disorders are a rapidly growing segment of the population and are among the most challenging subgroups within health care, and they account for a disproportionate amount of costs. What does the ACA mean for geriatric mental health? We address this question by highlighting opportunities for reaching older adults with mental health disorders by leveraging the diverse elements of the ACA. We describe nine relevant initiatives: (1) accountable care organizations, (2) patient-centered medical homes, (3) Medicaid-financed specialty health homes, (4) hospital readmission and health care transitions initiatives, (5) Medicare annual wellness visit, (6) quality standards and associated incentives, (7) support for health information technology and telehealth, (8) Independence at Home and 1915(i) State Plan Home and Community-Based Services program, and (9) Medicare-Medicaid Coordination Office, Center for Medicare and Medicaid Innovation, and the Patient-Centered Outcomes Research Institute. We also consider potential challenges to full implementation of the ACA and discuss novel solutions for advancing geriatric mental health in the context of projected workforce shortages and the opportunities afforded by the ACA.
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Cohen CI, Meesters PD, Zhao J. New perspectives on schizophrenia in later life: implications for treatment, policy, and research. Lancet Psychiatry 2015; 2:340-50. [PMID: 26360087 DOI: 10.1016/s2215-0366(15)00003-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/06/2015] [Indexed: 11/17/2022]
Abstract
Worldwide, in the past few decades, the demographics of older people (ie, people 55 years and over) with schizophrenia have changed completely with respect to absolute numbers of people affected, the proportion of all people with the disorder, life expectancy, and residential status. The ageing schizophrenia population has created vast health-care needs and their medical comorbidity contributes to higher mortality than in the general population. Proposals to classify schizophrenia into early-onset, late-onset, and very-late-onset subtypes now should be tempered by the recognition that comorbid medical and neurological disorders can contribute to psychotic symptoms in later life. The concept of outcome has become more nuanced with an appreciation that various outcomes can occur, largely independent of each other, that need different treatment approaches. Data show that schizophrenia in later life is not a stable end-state but one of fluctuation in symptoms and level of functioning, and show that pathways to improvement and recovery exist. Several novel non-pharmacological treatment strategies have been devised that can augment the clinical options used to address the specific needs of older adults with schizophrenia.
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Affiliation(s)
- Carl I Cohen
- SUNY Downstate Medical Center, Brooklyn, NY, USA.
| | - Paul D Meesters
- Department of Psychiatry, VU University Medical Center, GGZ inGeest and EMGO+, Institute for Health and Care Research, Amsterdam, Netherlands
| | - Jingna Zhao
- SUNY Downstate Medical Center, Brooklyn, NY, USA
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50
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Kelly EL, Fenwick KM, Barr N, Cohen H, Brekke JS. A systematic review of self-management health care models for individuals with serious mental illnesses. Psychiatr Serv 2014; 65:1300-10. [PMID: 25023057 PMCID: PMC4433309 DOI: 10.1176/appi.ps.201300502] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The general medical health of individuals with serious mental illnesses is compromised relative to those without serious mental illnesses. To address this health disparity, numerous integrated care strategies are being employed from the system level to the level of individual patients. However, self-management of health care, a strategy considered an integral aspect of typical care, has been infrequently included in interventions for this population. Despite reservations about the capacity of those with serious mental illnesses to self-manage health care, a subset of new interventions focused on general medical health in this population has tested whether models including self-management strategies have empirical support. To understand whether these models are supported, the authors reviewed the evidence for self-management models. METHODS This systematic review examined collaborative and integrated care models that include self-management components for individuals with serious mental illnesses. RESULTS Across the 14 studies identified in this review, promising evidence was found that individuals with serious mental health issues can collaborate with health professionals or be trained to self-manage their health and health care. The evidence supports the use of mental health peers or professional staff to implement health care interventions. However, the substantial heterogeneity in study design, types of training, and examined outcomes limited conclusions about the comparative effectiveness of existing studies. CONCLUSIONS This review found preliminary support that self-management interventions targeting the general medical health of those with serious mental illnesses are efficacious, but future work is needed to determine what elements of training or skills lead to the most salient changes.
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Affiliation(s)
- Erin L Kelly
- The authors are with the School of Social Work, University of Southern California, Los Angeles (e-mail: ). Dr. Kelly is also with the Semel Institute, University of California, Los Angeles
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