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de Visser RO, Nwamba C, Brearley E, Shafiei V, Hart L. Remote consultations in primary care: Patient experiences and suggestions for improvement. J Health Psychol 2024:13591053241240383. [PMID: 38581309 DOI: 10.1177/13591053241240383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024] Open
Abstract
The use of Remote Consultations (RCs) in primary care expanded rapidly during the Covid-19 pandemic: their ongoing use highlights a need to improve experiences of them. We interviewed 17 adults in the UK, including a sub-sample of five people with a First Language other than English (FLotE). Interpretative Phenomenological Analysis identified five major themes: (1) RCs are convenient, but they require appropriate technology and appropriate conditions of use; (2) even those with good general eHealth literacy and connectivity may struggle with systems that are not user-friendly; (3) greater reliance on verbal communication was experience as limiting empathy, and also made RCs more difficult for people with a FLotE; (4) RCs are considered inappropriate for complex conditions, or those with major psychological components; (5) continuity of care is important, but is often lacking. Overall, interviewees emphasised the need for more user-friendly processes, and greater attention to patients' preferences for consultation type.
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Affiliation(s)
| | | | | | | | - Lia Hart
- Brighton & Sussex Medical School, UK
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2
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Vreijling SR, Chin Fatt CR, Williams LM, Schatzberg AF, Usherwood T, Nemeroff CB, Rush AJ, Uher R, Aitchison KJ, Köhler-Forsberg O, Rietschel M, Trivedi MH, Jha MK, Penninx BWJH, Beekman ATF, Jansen R, Lamers F. Features of immunometabolic depression as predictors of antidepressant treatment outcomes: pooled analysis of four clinical trials. Br J Psychiatry 2024; 224:89-97. [PMID: 38130122 PMCID: PMC10884825 DOI: 10.1192/bjp.2023.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Profiling patients on a proposed 'immunometabolic depression' (IMD) dimension, described as a cluster of atypical depressive symptoms related to energy regulation and immunometabolic dysregulations, may optimise personalised treatment. AIMS To test the hypothesis that baseline IMD features predict poorer treatment outcomes with antidepressants. METHOD Data on 2551 individuals with depression across the iSPOT-D (n = 967), CO-MED (n = 665), GENDEP (n = 773) and EMBARC (n = 146) clinical trials were used. Predictors included baseline severity of atypical energy-related symptoms (AES), body mass index (BMI) and C-reactive protein levels (CRP, three trials only) separately and aggregated into an IMD index. Mixed models on the primary outcome (change in depressive symptom severity) and logistic regressions on secondary outcomes (response and remission) were conducted for the individual trial data-sets and pooled using random-effects meta-analyses. RESULTS Although AES severity and BMI did not predict changes in depressive symptom severity, higher baseline CRP predicted smaller reductions in depressive symptoms (n = 376, βpooled = 0.06, P = 0.049, 95% CI 0.0001-0.12, I2 = 3.61%); this was also found for an IMD index combining these features (n = 372, βpooled = 0.12, s.e. = 0.12, P = 0.031, 95% CI 0.01-0.22, I2= 23.91%), with a higher - but still small - effect size compared with CRP. Confining analyses to selective serotonin reuptake inhibitor users indicated larger effects of CRP (βpooled = 0.16) and the IMD index (βpooled = 0.20). Baseline IMD features, both separately and combined, did not predict response or remission. CONCLUSIONS Depressive symptoms of people with more IMD features improved less when treated with antidepressants. However, clinical relevance is limited owing to small effect sizes in inconsistent associations. Whether these patients would benefit more from treatments targeting immunometabolic pathways remains to be investigated.
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Affiliation(s)
- Sarah R. Vreijling
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; and Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Cherise R. Chin Fatt
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Leanne M. Williams
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Alan F. Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Tim Usherwood
- Department of General Practice, Westmead Clinical School, University of Sydney, Sydney, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; and George Institute for Global Health, Sydney, Australia
| | - Charles B. Nemeroff
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, Texas, USA
| | - A. John Rush
- Department of Psychiatry and Behavioral Health, Duke School of Medicine, Durham, North Carolina, USA; and Duke-National University of Singapore, Singapore, Singapore
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Katherine J. Aitchison
- Departments of Psychiatry & Medical Genetics, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada; and Women and Children's Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark; and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Madhukar H. Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Manish K. Jha
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brenda W. J. H. Penninx
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands; and Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Aartjan T. F. Beekman
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands; and Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Rick Jansen
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; and Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Femke Lamers
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; and Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands
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George C, Wargo Aikins J. Developing a secure base in family intervention: using the adult attachment projective system to assess attachment in family relationships. Front Psychol 2023; 14:1291661. [PMID: 38022914 PMCID: PMC10654737 DOI: 10.3389/fpsyg.2023.1291661] [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: 09/09/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Families are core to human well-being. Therapeutic intervention may be needed in the context of family disruptions. Attachment theory conceptualizes parents as the secure base and safe haven that support children's optimal development. Parents who have experienced their own attachment difficulties or traumas may not provide quality caregiving necessary for balanced secure parent-child attachment relationships. Following Bowlby's original thinking (1988), an attachment approach to family intervention views the therapist as a secure base that enables families to explore individual and system problems to restore equilibrium. Attachment informed therapy uses attachment theory to understand family functioning. However, the unavailability of valid economical assessment for examining attachment representations has constricted the practical utility of attachment theory in family therapy beyond applications of general concepts. This chapter describes the Adult Attachment Projective Pictures System (AAP) and explores its use as an efficient manner for assessing attachment representations within families that allows therapists to understand problematic interactions, disabling defensive processes, make predictions concerning negative patterns, and create targets for change and restorative intervention. Consolidating three decades of attachment and caregiving system research, we describe how distinct patterns of AAP responses for each adult attachment group map onto expected parenting and family system expectations and behaviors to provide a concise and informative framework. In addition to the traditional adult attachment patterns (Secure, Dismissing, Preoccupied, Unresolved), we describe for the first time expectations for two additional forms of incomplete pathological mourning (Failed Mourning and Preoccupied with Personal Suffering) that have been overlooked in the field.
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Affiliation(s)
- Carol George
- Mills College at Northeastern University, Oakland, CA, United States
| | - Julie Wargo Aikins
- Merill Palmer Skillman Institute and The Department of Psychiatry and Behavioral Neuroscience, Wayne State University, Detroit, MI, United States
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Conneely M, Packer KC, Bicknell S, Janković J, Sihre HK, McCabe R, Copello A, Bains K, Priebe S, Spruce A, Jovanović N. Exploring Black and South Asian women's experiences of help-seeking and engagement in perinatal mental health services in the UK. Front Psychiatry 2023; 14:1119998. [PMID: 37077277 PMCID: PMC10109459 DOI: 10.3389/fpsyt.2023.1119998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/06/2023] [Indexed: 04/21/2023] Open
Abstract
Background and aims In the United Kingdom (UK), Black and South Asian women are less likely than White British women to access support from perinatal mental health services, despite experiencing similar, or higher, levels of distress. This inequality needs to be understood and remedied. The aim of this study was to answer two questions: how do Black and South Asian women experience (1) access to perinatal mental health services and (2) care received from perinatal mental health services? Method Semi-structured interviews were conducted with Black and South Asian women (n = 37), including four women who were interviewed with an interpreter. Interviews were recorded and transcribed line-by-line. Data were analyzed using framework analysis, by an ethnically diverse multidisciplinary team of clinicians, researchers and people with lived experience of perinatal mental illness. Results Participants described a complex interplay of factors that impacted on seeking, and receiving help, and benefiting from services. Four themes emerged that captured the highly varied experiences of individuals: (1) Self-identity, social expectations and different attributions of distress deter help-seeking; (2) Hidden and disorganized services impede getting support; (3) The role of curiosity, kindness and flexibility in making women feel heard, accepted and supported by clinicians; (4) A shared cultural background may support or hinder trust and rapport. Conclusion Women described a wide range of experiences and a complex interplay of factors impacting access to, and experience of, services. Women described services as giving them strength and also leaving them disappointed and confused about where to get help. The main barriers to access were attributions related to mental distress, stigma, mistrust and lack of visibility of services, and organizational gaps in the referral process. These findings describe that many women feel heard, and supported by services, reporting that services provide a high quality of care that was inclusive of diverse experiences and understandings of mental health problems. Transparency around what PMHS are, and what support is available would improve the accessibility of PMHS.
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Affiliation(s)
- Maev Conneely
- Unit for Social and Community Psychiatry, WHO Collaborating Centre, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Katy C. Packer
- Camden and Islington NHS Foundation Trust, London, United Kingdom
- North East London NHS Foundation Trust, London, United Kingdom
| | - Sarah Bicknell
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
| | - Jelena Janković
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Harpreet Kaur Sihre
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Rosemarie McCabe
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Alex Copello
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Kiren Bains
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Amy Spruce
- Action on Postpartum Psychosis, London, United Kingdom
| | - Nikolina Jovanović
- Unit for Social and Community Psychiatry, WHO Collaborating Centre, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
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Read J. How important are informed consent, informed choice, and patient-doctor relationships, when prescribing antipsychotic medication? J Ment Health 2022:1-9. [PMID: 35536145 DOI: 10.1080/09638237.2022.2069708] [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: 06/25/2021] [Revised: 02/25/2022] [Accepted: 03/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Antipsychotic medications (APs) are used for people with psychosis diagnoses and, increasingly for other problems and groups. AIMS This study examines how APs are prescribed, from the perspective of recipients. METHODS 757 people, from 30 countries, responded to questions about their experiences with APs, in an online survey. RESULTS Most (70%) were told nothing about adverse effects. Fewer than 2% recalled being told about the risks of diabetes, suicidality, sexual dysfunction, or reduced life span. None recalled being told about reduced brain volume or withdrawal effects. Only 28% recalled being offered other treatments; with only 14% offered talking therapies. 46% were not told how long to take the APs; and, of those who were told something, 48% were told to take them forever. Most respondents (76%) were not told how APs work. Only 19% were satisfied with the prescribing process, and only 25% reported a good, or very good, relationship with the prescriber. Information, satisfaction with the process, and the prescriber relationship were all positively related to three self-reported outcomes: reduction of problems the drugs were prescribed for, general helpfulness, and quality of life. CONCLUSIONS Steps need to be taken to ensure people prescribed antipsychotics are fully informed, especially about adverse effects and alternatives.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London, UK
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McCoyd JLM, Curran L, Candelario E, Findley P. "There is Just a Different Energy": Changes in the Therapeutic Relationship with the Telehealth Transition. CLINICAL SOCIAL WORK JOURNAL 2022; 50:325-336. [PMID: 35493775 PMCID: PMC9035977 DOI: 10.1007/s10615-022-00844-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 06/14/2023]
Abstract
The therapeutic relationship (TR), including its therapeutic frame, is the foundation of the therapeutic endeavor. In response to the COVID-19 pandemic and the rapid transition to videoconferencing for therapeutic encounters, we employed a cross-sectional exploratory survey with 1490 respondents to understand how practitioners adapted to the changes. In this secondary analysis focused on the TR, we analyze the clinicians' (N = 448) spontaneous narratives about facets of the TR. Temporally, we focused on how these adaptations occurred during the initial part of the pandemic before vaccination was available and while the TR was still adapting to teletherapy videoconferencing under the duress of pandemic crises. We find three broad themes: (1) It is a "much more remote relationship"; (2) The "connection…remains surprisingly strong"; and (3) It is "energetically taxing." Each reflects clinicians' views of the TR as altered, but surprisingly resilient. Although grateful for the safety of virtual therapeutic encounters, clinicians mourned the loss of an embodied encounter, experienced depletion of energy beyond Zoom fatigue, and nonetheless recognized their clients' and their own abilities to adapt.
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Affiliation(s)
- Judith L. M. McCoyd
- School of Social Work, Rutgers University, 120 Albany St., Tower 1, Suite 200, New Brunswick, NJ 08901 USA
| | - Laura Curran
- School of Social Work, Rutgers University, 120 Albany St., Tower 1, Suite 200, New Brunswick, NJ 08901 USA
| | - Elsa Candelario
- School of Social Work, Rutgers University, 120 Albany St., Tower 1, Suite 200, New Brunswick, NJ 08901 USA
| | - Patricia Findley
- School of Social Work, Rutgers University, 120 Albany St., Tower 1, Suite 200, New Brunswick, NJ 08901 USA
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Lee KC, Silvia RJ, Payne GH, Moore TD, Ansara ED, Ross CA. Best practice model for outpatient psychiatric pharmacy practice, part 2: Confirmation of the attribute statements. Ment Health Clin 2022; 12:65-76. [PMID: 35582319 PMCID: PMC9009822 DOI: 10.9740/mhc.2022.04.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/21/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction The American Association of Psychiatric Pharmacists (AAPP) used multiple modalities to develop and refine 28 attribute statements to describe a best practice model for outpatient psychiatric pharmacists. Before addressing implementation, assessment, and field testing, it was necessary to finalize and confirm the statements and their supporting narratives among stakeholders. The objective of this project was to confirm the attribute statements and supporting justifications for a best practice model for outpatient psychiatric pharmacists providing direct patient care. Methods The 4 phases that resulted in the 28 attribute statements and supporting narratives have been described and published elsewhere. As part of phase 5, the confirmation survey was distributed to pharmacists and resident members of AAPP in November 2021 for 3 weeks. Results The survey respondents (n = 74; 6.1%) were licensed pharmacists for an average of 15.6 years (SD = 12.0) and had been practicing as psychiatric pharmacists for an average of 11.3 years (SD = 10.4). Slightly more than half (54.2%) of the respondents reported practicing in the outpatient setting and three-fourths (74.3%) were Board Certified Psychiatric Pharmacists. For each of the 28 statements, more than 90% of respondents either agreed or agreed with minimal reservations. Discussion Given the high degree of agreement on the proposed practice model statements, they will be used as the basis for the outpatient psychiatric pharmacist best practice model. Next steps in developing this model include establishing implementation guidance, determining appropriate metrics for evaluation of these statements in practice, and establishing appropriate field-testing methods.
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Affiliation(s)
| | - Richard J. Silvia
- Professor of Pharmacy Practice, School of Pharmacy-Boston, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts
| | - Gregory H. Payne
- Director of Strategic Initiatives, American Association of Psychiatric Pharmacists, Lincoln, Nebraska
| | - Tera D. Moore
- Pharmacy Benefits Management Services, Clinical Pharmacy Practice Office, US Department of Veterans Affairs, Washington, DC
| | - Elayne D. Ansara
- Clinical Pharmacy Practitioner–Mental Health, Veteran Health Indiana, Indianapolis, Indiana
| | - Clint A. Ross
- Pharmacy Coordinator, Institute of Psychiatry, MUSC Health, Charleston, South Carolina
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Lattie EG, Stiles-Shields C, Graham AK. An overview of and recommendations for more accessible digital mental health services. NATURE REVIEWS PSYCHOLOGY 2022; 1:87-100. [PMID: 38515434 PMCID: PMC10956902 DOI: 10.1038/s44159-021-00003-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 03/23/2024]
Abstract
Mental health concerns are common, and various evidence-based interventions for mental health conditions have been developed. However, many people have difficulty accessing appropriate mental health care and this has been exacerbated by the COVID-19 pandemic. Digital mental health services, such as those delivered by mobile phone or web-based platforms, offer the possibility of expanding the reach and accessibility of mental health care. To achieve this goal, digital mental health interventions and plans for their implementation must be designed with the end users in mind. In this Review, we describe the evidence base for digital mental health interventions across various diagnoses and treatment targets. Then, we explain the different formats for digital mental health intervention delivery, and offer considerations for their use across key age groups. We discuss the role that the COVID-19 pandemic has played in emphasizing the value of these interventions, and offer considerations for ensuring equity in access to digital mental health interventions among diverse populations. As healthcare providers continue to embrace the role that technology can play in broadening access to care, the design and implementation of digital mental healthcare solutions must be carefully considered to maximize their effectiveness and accessibility.
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Affiliation(s)
- Emily G. Lattie
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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Matos DOD, Medeiros-Souza P, Melo RPD, Menezes RAD, Tavares NUL. Satisfação dos responsáveis por adolescentes com as informações recebidas para o uso dos psicotrópicos em Unidade de Saúde Mental. REVISTA PAULISTA DE PEDIATRIA 2022. [DOI: 10.1590/1984-0462/2022/40/2021012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Resumo Objetivo: Analisar a satisfação dos responsáveis por adolescentes com as informações recebidas para o uso dos medicamentos psicofármacos. Métodos: Estudo transversal realizado em ambulatório de referência entre 2017 e 2019, em Brasília, com 173 responsáveis por adolescentes diagnosticados com transtornos mentais e comportamentais em uso de psicofármacos. O questionário Satisfaction with Information about Medicines Scale (SIMS) foi utilizado para identificar o grau de satisfação em relação às informações recebidas sobre os medicamentos. Resultados: A maioria dos responsáveis estava insatisfeita quanto às informações recebidas sobre psicofármacos (n=112; 64,7%). Destacou-se a insatisfação com as informações sobre potenciais problemas do medicamento (n=127; 73,4%), quando comparada à ação e ao uso (n=89; 51,5%). As informações sobre o impacto do medicamento na vida sexual do adolescente foram consideradas insatisfatórias ou inexistentes. Conclusões: A satisfação dos responsáveis com as informações recebidas sobre psicofármacos foi baixa. Os participantes demonstraram insatisfação com as informações sobre potenciais problemas, especialmente às relacionadas ao impacto na vida sexual dos adolescentes.
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Matos DOD, Medeiros-Souza P, Melo RPD, Menezes RAD, Tavares NUL. Parents’ satisfaction with information received on psychotropic drugs used by adolescents in a Mental Health Unit. REVISTA PAULISTA DE PEDIATRIA 2022; 40:e2021012. [PMID: 35584415 PMCID: PMC9113626 DOI: 10.1590/1984-0462/2022/40/2021012in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/23/2021] [Indexed: 11/22/2022]
Abstract
Abstract Objective: To analyze the satisfaction of those responsible for adolescents with information received for the use of psychotropic drugs. Methods: Cross-sectional study carried out in a reference outpatient clinic in Brasília between 2017 and 2019. It involved 173 legal representatives of adolescents diagnosed with Mental and Behavioral Disorders using psychotropic drugs. In order to identify the level of satisfaction about the information received on psychotropic drugs, the Satisfaction with Information about Medicines Scale (SIMS) was used. Results: Most guardians were dissatisfied with the information received on psychotropic drugs (n=112; 64.7%). The dissatisfaction with information about potential problems of medication was the one that stood out the most (n=127; 73.4%) when compared to information about action and usage (n=89; 51.5%). Participants considered information on the impact of medication on the adolescent’s sexual life unsatisfactory or nonexistent. Conclusions: The parents’ satisfaction with the information received about psychotropic drugs was low. Participants showed dissatisfaction with the information about potential problems, especially related to the impact on the sexual life of their tutored.
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Millard E, Medlicott E, Cardona J, Priebe S, Carr C. Preferences for group arts therapies: a cross-sectional survey of mental health patients and the general population. BMJ Open 2021; 11:e051173. [PMID: 34373313 PMCID: PMC8354273 DOI: 10.1136/bmjopen-2021-051173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The arts therapies include music therapy, dance movement therapy, art therapy and dramatherapy. Preferences for art forms may play an important role in engagement with treatment. This survey was an initial exploration of who is interested in group arts therapies, what they would choose and why. DESIGN An online cross-sectional survey of demographics, interest in and preferences for the arts therapies was designed in collaboration with patients. The survey took 10 min to complete, including informed consent and 14 main questions. Summary statistics, multinomial logistic regression and thematic analysis were used to analyse the data. SETTING Thirteen National Health Service mental health trusts in the UK asked mental health patients and members of the general population to participate. PARTICIPANTS A total of 1541 participants completed the survey; 685 mental health patients and 856 members of the general population. All participants were over 18 years old, had capacity to give informed consent and sufficient understanding of English. Mental health patients had to be using secondary mental health services. RESULTS Approximately 60% of participants would be interested in taking part in group arts therapies. Music therapy was the most frequent choice among mental health patients (41%) and art therapy was the most frequent choice in the general population (43%). Past experience of arts therapies was the most important predictor of preference for that same modality. Expectations of enjoyment, helpfulness, feeling capable, impact on mood and social interaction were most often reported as reasons for preferring one form of arts therapy. CONCLUSIONS Large proportions of the participants expressed an interest in group arts therapies. This may justify the wide provision of arts therapies and the offer of more than one modality to interested patients. It also highlights key considerations for assessment of preferences in the arts therapies as part of shared decision-making.
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Affiliation(s)
- Emma Millard
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | | | | | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Catherine Carr
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
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McGranahan R, Jakaite Z, Edwards A, Rennick-Egglestone S, Slade M, Priebe S. Living with Psychosis without Mental Health Services: A Narrative Interview Study. BMJ Open 2021; 11:e045661. [PMID: 34281919 PMCID: PMC8291296 DOI: 10.1136/bmjopen-2020-045661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Little research has looked at how people who do not use mental health services experience psychosis. Thus, the present study aimed to explore the experiences and views of people with psychosis who have neither sought nor received support from mental health services for at least 5 years. DESIGN A narrative interview study. Thematic analysis was used to analyse the data. SETTING England. PARTICIPANTS Twenty-eight participants with self-defined psychotic experiences were asked to provide a free narrative about their experiences. RESULTS Five themes were identified: (1) Perceiving psychosis as positive; (2) Making sense of psychotic experiences as a more active psychological process to find explanations and meaning; (3) Finding sources of strength, mainly in relationships and the environment, but outside of services; (4) Negative past experiences of mental health services, leading to disengagement and (5) Positive past experiences with individual clinicians, as an appreciation of individuals despite negative views of services as a whole. CONCLUSIONS Perceiving psychosis as something positive, a process of making sense of psychotic experiences and the ability to find external sources of strength all underpin-in addition to negative experiences with services-a choice to live with psychosis outside of services. Future research may explore to what extent these perceptions, psychological processes and abilities can be facilitated and strengthened, in order to support those people with psychosis who do not seek treatment and possibly also some of those who are in treatment.
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Affiliation(s)
- Rose McGranahan
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
| | - Zivile Jakaite
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
| | - Alice Edwards
- Newham Centre for Mental Health, East London NHS Foundation Trust, London, UK
| | | | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
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Xanthopoulou P, Ryan M, Lomas M, McCabe R. Psychosocial Assessment in the Emergency Department. CRISIS 2021; 43:299-306. [PMID: 34042493 DOI: 10.1027/0227-5910/a000786] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: In the United Kingdom, suicide risk is assessed in the emergency department (ED) in a face-to-face assessment with psychiatric liaison practitioners. This study aimed to explore patient experiences of psychosocial assessment after presenting with self-harm/suicidality. Method: A total of 28 patients were interviewed within 2 weeks of ED attendance for self-harm/suicidality. Interviews were transcribed and analyzed using inductive thematic analysis. Results: People described two different experiences. A therapeutic interaction was about the "person" and made people feel their life mattered and instilled hope for the future. This was characterized by: unscripted conversation; warmth promoting disclosure; psychological exploration of feelings; validation of distress; and a coproduced care plan. A formulaic assessment was about the "risk" and made people feel their life did not matter and hopeless about the future. This was characterized by: feeling judged and not worthy of help; a focus on risk and form filling; a trivial treatment plan; and loss of trust in services. Limitations: Our study comprised a single ED and used a non-diverse sample. Conclusion: Psychosocial assessment in the ED impacts on hope for people in crisis. A focus on therapeutic communication that is about the person, as well as the risk, improves patient experience, decreases distress, and instills hope that life is worth living.
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Affiliation(s)
| | | | - Matthew Lomas
- College of Medicine and Health, University of Exeter, UK
| | - Rose McCabe
- School of Health Sciences, City University of London, UK
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Galasiński D. No mental health research without qualitative research. Lancet Psychiatry 2021; 8:266-267. [PMID: 33220778 DOI: 10.1016/s2215-0366(20)30399-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Dariusz Galasiński
- Institute of Journalism and Social Communication, University of Wrocław, Wrocław 50-383, Poland.
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15
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Zangrilli A, Conneely M, McCabe R, Catalfio F, Priebe S. Categorizing what patients with psychosis say in clinical interactions: the development of a framework informed by theory of mind, metacognition and cognitive behavioral theory. J Ment Health 2021; 31:673-682. [PMID: 33612060 DOI: 10.1080/09638237.2021.1875408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Many patients with psychosis are socially isolated and struggle to maintain or establish satisfying social relationships. This has been explained as resulting from a reduced ability to understand one's own mind, others' minds, and how these interact. This understanding of one's own and others' minds is the foundation of many different theories and models from developmental to cognitive psychiatry. Increasing this ability is the goal of many therapeutic approaches and may facilitate establishing a positive therapeutic relationship. Although much interest has focused on what clinicians say in clinical encounters, few scales exist to categorize the content of patients' communication. AIM Theoretically founded in literature on metacognition, theory of mind and cognitive theory, the aim of this study was to create a framework to capture and quantify how patients with psychosis talk about their own and others' thoughts, feelings and behaviors in clinical interactions. METHOD A two-stage iterative process of analysis, refinement and reliability testing was undertaken. In the first stage, thematic analysis, using a combined inductive and deductive approach, was carried out on 14 Italian transcripts of real clinical encounters in acute setting. An initial framework was developed from Italian transcripts, refined, translated and then applied to a sample of 15 English transcripts of real clinical encounters. The framework was further refined, finalized and concordance between independent raters was calculated. RESULTS A framework comprised of 8 categories was developed to categorize verbal displays in which patients recognize and communicate their own emotions, mental states, desires and plans, relevant narratives of their own life and experiences as expressed in routine clinical interactions. Good reliability was obtained in both English (k = 0.87) and Italian transcripts (k = 0.90). CONCLUSION Patients' thoughts about their thoughts, feelings and behaviors, and others' can be reliably assessed in routine clinical encounters using this newly developed framework. Future research should broaden the scope of this research to explore how the questions asked by psychiatrists may influence how patients talk about their thoughts, feelings and actions, and if/how they are correlated with the therapeutic relationship and clinical outcomes.
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Affiliation(s)
| | - Maev Conneely
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom of Great Britain and Northern Ireland
| | - Rosemarie McCabe
- School of Health Sciences, Division of Health Services Research and Management, City University, London, United Kingdom of Great Britain and Northern Ireland
| | | | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom of Great Britain and Northern Ireland
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Rosenfield MN, Bernstein MH. The Importance of Patient Expectations: A Mixed-Methods Study of U.S. Psychiatrists. Front Psychiatry 2021; 12:781494. [PMID: 34925105 PMCID: PMC8678457 DOI: 10.3389/fpsyt.2021.781494] [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: 09/22/2021] [Accepted: 11/03/2021] [Indexed: 11/20/2022] Open
Abstract
Objective: To examine how psychiatrists think about and modulate non-specific factors (e.g., hope, expectations) in clinical practice. Methods: U.S. psychiatrists were recruited for two studies assessing attitudes and behaviors related to non-specific factors. Study 1 entailed remote qualitative focus groups (k = 7) with n = 26 participants (36.0% female). Study 2 was a quantitative survey with n = 346 respondents (34.0% female) designed to assess the generalizability of focus group findings. Results: Four themes were identified in Study 1 that were used to inform the survey (Study 2): (1) Expectations (2) Hope, (3) Placebo Effect, and (4) Aesthetic Features. Nearly all surveyed psychiatrists (92.2%) considered patient expectations at least "most of the time" when interacting with a patient. Focus groups revealed that psychiatrists often attempt to balance optimism and realism to improve outcomes. A majority of survey respondents believed office design and physician attire could at least somewhat influence expectations (72.5 and 77.3%, respectively) and even outcomes (51.5 and 58.7%, respectively). Focus group psychiatrists described how physical features may be used as therapeutic tools. Conclusions: Psychiatrists are highly mindful of patient expectations. Although there is variability in the perceived importance of expectations, hope, the placebo effect, and aesthetic features, many utilize these factors in clinical practice.
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Affiliation(s)
- Maayan N Rosenfield
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, United States
| | - Michael H Bernstein
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, United States
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Banks C, Priebe S. Scales for assessing the therapeutic milieu in psychiatric inpatient settings: A systematic review. Gen Hosp Psychiatry 2020; 66:44-50. [PMID: 32659464 DOI: 10.1016/j.genhosppsych.2020.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The therapeutic milieu is widely regarded as an important factor influencing experiences and outcomes of psychiatric inpatient treatment. Appropriate scales are needed to assess the milieu. The aim of this review is to identify and describe scales established for that purpose. METHOD A systematic search of electronic databases was carried out. Scales used in two or more studies were identified, and data was extracted on key characteristics. RESULTS Scales for assessing the therapeutic milieu were used in 78 studies. Five scales were identified that were used more than once. Four scales originate from 1964 to 1986, one was originally published in 2008. The Ward Atmosphere Scale (WAS) is the most frequently used scale and its psychometric properties have been reported as good. When tested alongside each other, the scales are weakly to moderately correlated. CONCLUSIONS Few scales have been established to assess the therapeutic milieu. All scales capture aspects of relationships on the wards. The most commonly used scale (WAS) has 100 items and was developed more than 50 years ago. Given the changes in the practice of inpatient care over the last 50 years, new, briefer and psychometrically robust scales should be developed.
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Affiliation(s)
- Ciara Banks
- Acute Psychology Department, Newham Centre for Mental Health, East London NHS Foundation Trust, Glen Road, London, UK.
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Service Development, Queen Mary University of London, London, UK
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