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Herrera SN, Sarac C, Phili A, Gorman J, Martin L, Lyallpuri R, Dobbs MF, DeLuca JS, Mueser KT, Wyka KE, Yang LH, Landa Y, Corcoran CM. Psychoeducation for individuals at clinical high risk for psychosis: A scoping review. Schizophr Res 2023; 252:148-158. [PMID: 36652831 PMCID: PMC9974813 DOI: 10.1016/j.schres.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
Psychoeducation is recommended in the treatment of patients with schizophrenia and has been shown to improve satisfaction with mental health service and treatment adherence, reduce relapse and hospital readmission rates, and enhance functioning and quality of life. Youth at clinical high risk for psychosis (CHR) may also benefit from receiving psychoeducation as part of their treatment. The goal of this study was to conduct a scoping review to map out the existing literature on psychoeducation for CHR individuals, including content, utilization, and benefits, in order to identify areas for future research and clinical care. Following PRISMA guidelines, we conducted a systematic search of electronic databases (MEDLINE, Embase, PsycINFO, Scopus, and Web of Science Core Collection) to identify literature through 02/25/2022 that provided data or significant commentary about the provision of psychoeducation to CHR individuals. After screening titles and abstracts, four co-authors assessed full-text articles for eligibility. Thirty-three studies were included in the review. Psychoeducation is recommended in the treatment of CHR individuals, is a preferred treatment option among CHR individuals, and many CHR programs report offering psychoeducation. However, details about the psychoeducational content and method of delivery are notably absent from recommendations and reports on the provision of CHR psychoeducation in real-world settings. We identified two brief and structured CHR psychoeducation interventions and one longer-term psychoeducational multifamily group model for CHR that show feasibility and promise, though they have not yet undergone randomized trials to evaluate effectiveness of the psychoeducation. We also identified several comprehensive CHR interventions that included an explicit psychoeducation module, though the unique role of the psychoeducational component is unknown. Despite being recommended as a critical component of treatment for CHR individuals and preferred by CHR individuals, the ways in which psychoeducation are being delivered to CHR individuals in real-world practice is still largely ambiguous. Rigorous evaluations of psychoeducation treatment models are needed, as well as investment from clinical programs to facilitate the implementation and dissemination of standardized psychoeducation for CHR individuals.
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Affiliation(s)
- Shaynna N Herrera
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Cansu Sarac
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Antigone Phili
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jane Gorman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lily Martin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Romi Lyallpuri
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; School of Nursing, Columbia University, New York, NY, USA
| | - Matthew F Dobbs
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph S DeLuca
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Katarzyna E Wyka
- Department of Psychiatry, Weill Medical College of Cornell University, New York, NY, USA; Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Lawrence H Yang
- School of Global Public Health, New York University, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Yulia Landa
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; U.S. Department of Veterans Affairs, VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Cheryl M Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; U.S. Department of Veterans Affairs, VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
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2
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Zhou W, Ouyang F, Yu Y, Li Y, Bi F, Xiao S, Khoshnood K. Knowledge of mental health diagnosis among patients and their family members: an inpatient survey in China. J Ment Health 2023; 32:234-240. [PMID: 35770867 DOI: 10.1080/09638237.2022.2091753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/03/2022] [Accepted: 05/03/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Patient-oriented information disclosure has been advocated by the National Mental Health Law (NMHL) in China since 2012; however, reporting on diagnostic disclosure to patients with mental disorders after the NMHL is limited. AMIS This study aims to investigate and compare the knowledge of mental health diagnosis among patients and their family members in China. METHODS An inpatient survey was conducted among 205 patients with mental disorders and their family members. Group differences of the correctness of self-reported mental health diagnosis were compared, and logistic regression was performed to investigate correlates among both patients and their family members. RESULTS Overall, 76.7% patients and 80.6% of their family members reported a correct diagnosis. Only 46.2% patients with psychotic disorders correctly knew their diagnosis, significantly lower than their family members and patients with non-psychotic disorders. Multivariate regression analysis found that the diagnosis of psychotic disorders was a risk factor of patients' diagnostic knowledge (AOR = 0.137; 95% CI = 0.044-0.429), while family members' diagnostic knowledge was associated with their employment (AOR = 6.125, 95% CI = 1.942-19.323) and parent-child relationship with patients (AOR = 3.719; 95% CI = 1.057-13.086). CONCLUSIONS The majority of patients with non-psychotic disorders know their diagnosis correctly and informing family members of patients' diagnosis remains a common practice in psychiatric setting after the implementation of China's NMHL.
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Affiliation(s)
- Wei Zhou
- Research Center for Public Health and Social Security, School of Public Administration, Hunan University, Changsha, China
| | - Feiyun Ouyang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yu Yu
- Division of Prevention and Community Research and The Consultation Center, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Yilu Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Fengying Bi
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
- Zibo Central Hospital, Zibo, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Kaveh Khoshnood
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
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3
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Herrera SN, Lyallpuri R, Sarac C, Dobbs MF, Nnaji O, Jespersen R, DeLuca JS, Wyka KE, Yang LH, Corcoran CM, Landa Y. Development of the Brief Educational Guide for Individuals in Need (BEGIN): A psychoeducation intervention for individuals at risk for psychosis. Early Interv Psychiatry 2022; 16:1002-1010. [PMID: 34811878 DOI: 10.1111/eip.13242] [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: 05/07/2021] [Revised: 08/30/2021] [Accepted: 11/07/2021] [Indexed: 11/29/2022]
Abstract
AIM Identification of individuals with psychosis risk (PR) through screening and specialized assessment is becoming more widespread in an effort to promote early intervention and improve recovery outcomes. PR individuals report interest in psychoeducation, though such interventions are currently lacking. Our goal was to develop a structured PR psychoeducation intervention grounded in theory and stakeholder feedback. METHODS By following a step-by-step intervention development model, we identified relevant conceptual frameworks, developed the content and format, and obtained stakeholder feedback. This process resulted in a 5-session PR psychoeducation intervention, Brief Educational Guide for Individuals in Need (BEGIN), with content conveyed visually via a slideshow presentation. PR individuals (n = 5) and parents of PR individuals (n = 5) reviewed BEGIN's content and format, and provided feedback through semi-structured qualitative interviews. Major themes were identified through iterative thematic analysis. RESULTS PR individuals and parents had a positive impression of BEGIN's materials and step-by-step format and psychoeducation about the PR condition. They indicated that the intervention was likely to encourage agency. PR participants emphasized the importance of a patient's decision regarding whether their family member(s) should participate in BEGIN. Parents reported that BEGIN is an important first step in treatment and offers a safe therapeutic environment. Feedback was then utilized to modify the intervention. CONCLUSIONS BEGIN is desired by consumers and may lay the foundation for future engagement with treatment by facilitating agency. A feasibility trial is underway and future studies are needed to measure outcomes (e.g., treatment engagement) and evaluate BEGIN as an evidence-based PR psychoeducation model.
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Affiliation(s)
- Shaynna N Herrera
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Romi Lyallpuri
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Cansu Sarac
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matthew F Dobbs
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,U.S. Department of Veterans Affairs, VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Obiora Nnaji
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rachel Jespersen
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph S DeLuca
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Katarzyna E Wyka
- Department of Psychiatry, Weill Medical College of Cornell University, New York, New York, USA.,Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Lawrence H Yang
- School of Global Public Health, New York University, New York, New York, USA.,Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Cheryl M Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,U.S. Department of Veterans Affairs, VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Yulia Landa
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,U.S. Department of Veterans Affairs, VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
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Ditton-Phare P, Sandhu H, Kelly B, Loughland C. ComPsych communication skills training: Applicability of simulated patients in psychiatry communication skills training. Australas Psychiatry 2022; 30:552-555. [PMID: 35138955 DOI: 10.1177/10398562211067199] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Communication skills training (CST) programs within postgraduate psychiatry training are rare. ComPsych CST utilises simulated patients (SPs) for trainees to practice communication skills for discussing severe mental illness with patients and their families/carers. This study examined the applicability of using SPs in a psychiatry-specific CST. METHODS A total of 41 postgraduate psychiatry trainees attended at least one of four modules of training in their cohort year and completed a questionnaire after each module presenting eight questions rating the use of SPs and ratings of course deliverables. RESULTS Overall, trainees rated contact with SPs very highly across all modules, with a mean rating of 9.11 out of 10 (SD = 0.97). Trainees agreed that SPs appeared authentic, that their reactions showed they listened to the trainee. CONCLUSIONS Trainees valued training with SPs, providing evidence that using SPs for psychiatry-specific CST is feasible. Despite subjectivity, this is valuable to course providers as it highlights benefits perceived by trainees to be useful and provides further evidence for the program's feasibility and utility.
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Affiliation(s)
- Philippa Ditton-Phare
- 278707Hunter New England Mental Health, Newcastle, NSW, Australia.,School of Medicine and Public Health, 64834Faculty of Health University of Newcastle, Callaghan, Newcastle NSW, Australia.,Centre for Brain and Mental Health Research, Mater Hospital Campus, Newcastle, NSW, Australia.,Hunter Medical Research Institute, John Hunter Hospital Campus, Newcastle, NSW, Australia
| | - Harsimrat Sandhu
- 278707Hunter New England Mental Health, Newcastle, NSW, Australia.,School of Medicine and Public Health, 64834Faculty of Health University of Newcastle, Callaghan, Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, Mater Hospital Campus, Newcastle, NSW, Australia
| | - Brian Kelly
- 278707Hunter New England Mental Health, Newcastle, NSW, Australia.,School of Medicine and Public Health, 64834Faculty of Health University of Newcastle, Callaghan, Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, Mater Hospital Campus, Newcastle, NSW, Australia.,Hunter Medical Research Institute, John Hunter Hospital Campus, Newcastle, NSW, Australia
| | - Carmel Loughland
- 278707Hunter New England Mental Health, Newcastle, NSW, Australia.,School of Medicine and Public Health, 64834Faculty of Health University of Newcastle, Callaghan, Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, Mater Hospital Campus, Newcastle, NSW, Australia.,Hunter Medical Research Institute, John Hunter Hospital Campus, Newcastle, NSW, Australia
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Viduani A, Benetti S, Petresco S, Piccin J, Velazquez B, Fisher HL, Mondelli V, Kohrt BA, Kieling C. The experience of receiving a diagnosis of depression in adolescence: A pilot qualitative study in Brazil. Clin Child Psychol Psychiatry 2022; 27:598-612. [PMID: 35156863 PMCID: PMC7612913 DOI: 10.1177/13591045211063494] [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] [Indexed: 01/03/2023]
Abstract
Receiving a diagnosis of depression can have an important impact on the lives of adolescents. However, there is limited information about how youth tackle, attribute meaning to and understand mental health diagnoses. The aim of this study was to explore adolescents' initial reactions after receiving a clinical diagnosis of Major Depressive Disorder in the context of a neurobiological study of depression in Brazil. Using a qualitative design, eight Brazilian adolescents were interviewed twice: immediately after a psychiatric assessment and neuroimaging study, in which they were given a diagnosis of depression, and in a follow-up visit 2 weeks later. Interviews were designed to explore the subjective experience of receiving the diagnosis and the impacts of depression on adolescents' lives. Framework Analysis was used to analyze the accounts. Diagnosis was perceived as a reification of an abnormal status, highlighting the role of stigma and the process of disclosing the diagnosis to others. Adolescents reported the multiple sensemaking processes that occurred when they received a diagnosis of depression, and most struggled with the idea that negative emotions would equate their experience with a disorder. The results show that future efforts could enhance clinical assessment processes with adolescents by exploring adolescents' reactions to diagnosis, as well as the support networks available to them, resulting in increased help-seeking behaviors, and diminished social and personal stigma.
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Affiliation(s)
- Anna Viduani
- Department of Psychiatry, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Silvia Benetti
- Department of Psychiatry, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sandra Petresco
- Department of Psychiatry, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jader Piccin
- Department of Psychiatry, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruna Velazquez
- Department of Psychiatry, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Helen L Fisher
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, 4616King's College London, UK.,ESRC Centre for Society and Mental Health, 4616King's College London, UK
| | - Valeria Mondelli
- Department of Psychological Medicine, 34426King's College London Institute of Psychiatry Psychology & Neuroscience, UK
| | - Brandon A Kohrt
- Division of Global Mental Health, George Washington University, DC, USA
| | - Christian Kieling
- Department of Psychiatry, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Brazil
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Ditton-Phare P, Sandhu H, Kelly B, Loughland C. Does ComPsych Communication Skills Training Alter Trainee Self-Efficacy? ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:303-310. [PMID: 34553322 DOI: 10.1007/s40596-021-01517-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE ComPsych communication skills training is designed to teach psychiatry trainees effective skills and strategies for undertaking key communication tasks relating to mental illness, such as schizophrenia, with patients and their families/carers. This study examined the program's feasibility, utility, and trainees' self-efficacy. METHODS Trainee cohorts attending their first year formal education course were recruited annually over 4 years between 2015 and 2018. Each trainee attended at least one session of training in their cohort year. Trainees completed a questionnaire presenting questions about personal demographics, their perceived confidence in communication, and the effectiveness of elements of training delivery. A total of 41 trainee psychiatrists (15 male) completed the questionnaires presented at four time points (two pre-training and two post-training). RESULTS Participants reported a significant increase in confidence in their own communication skills post-training (d = 1.12) and rated elements of training delivery (video feedback, feedback from peers in small groups, small group facilitation, and use of simulated patients) as significantly more helpful or effective post-training (d = 0.42). Trainees also reported a significantly increased ability to critically evaluate their own communication skills post-training (d = 0.59), suggesting an increased ability to recognize their own communication skill competence. CONCLUSIONS Following ComPsych training, trainees were more confident discussing information about schizophrenia with patients and their families/carers and were more able to critically evaluate their own communication skills: an important feature of good clinical acumen. These subjective ratings provide important self-efficacy information, including the benefits perceived and evidence of the program's feasibility and utility.
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Affiliation(s)
| | | | - Brian Kelly
- University of Newcastle, Callaghan, Newcastle, NSW, Australia
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7
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GPs' and patients' views on the value of diagnosing anxiety disorders in primary care: a qualitative interview study. Br J Gen Pract 2021; 71:e450-e457. [PMID: 33824158 PMCID: PMC8049220 DOI: 10.3399/bjgp.2020.0959] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background In the UK between 1998 and 2008, GPs’ recording of anxiety symptoms increased, but their recording of anxiety disorders decreased. The reason for this decline is not clear, nor are the treatment implications for primary care patients. Aim To understand GPs’ and patients’ views on the value of diagnosing anxiety disorders in primary care. Design and setting In-depth interviews were conducted with 15 GPs and 20 patients, purposively sampled from GP practices in Bristol and the surrounding areas. Method Interviews were held either in person or by telephone. A topic guide was used to ensure consistency across the interviews. The interviews were audio-recorded, transcribed verbatim, and analysed thematically. Results GPs reported preferring to use symptom rather than diagnostic codes in order to avoid assigning potentially stigmatising labels, and because they felt diagnostic codes could encourage some patients to adopt a ‘sick role’. In addition, their decision to use a diagnostic code depended on symptom severity and chronicity, and these were hard to establish in a time-limited clinical consultation. In contrast, patients commented that receiving a diagnosis helped them to understand their symptoms, and encouraged them to engage with treatment. Conclusion GPs may be reluctant to diagnose an anxiety disorder, but patients can find a diagnosis helpful in terms of understanding their symptoms and the need for treatment. As limited consultation time can discourage discussions between GPs and patients, followup appointments and continuity of care may be particularly important for the management of anxiety in primary care.
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Deleva VN, Zigman D. A Simulation-Based Communication Skills Training in Treating First-Episode Psychosis for Psychiatry Residents. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:638-639. [PMID: 32720209 DOI: 10.1007/s40596-020-01287-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
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9
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Beentjes TAA, van Gaal BGI, van Achterberg T, Goossens PJJ. Self-Management Support Needs From the Perspectives of Persons With Severe Mental Illness: A Systematic Review and Thematic Synthesis of Qualitative Research. J Am Psychiatr Nurses Assoc 2020; 26:464-482. [PMID: 31578904 DOI: 10.1177/1078390319877953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: The development of de-hospitalization policies in mental health has resulted in a growing emphasis on self-management. In the chronic care model, self-management support is an essential element. Because of the episodic nature of severe mental illness (SMI) and its high relapse rates, we assume that the extent of self-management support needs of individuals with an SMI is considerable. However, a clear overview of the nature of the self-management support needs of persons with SMI is missing. AIMS: This study aimed to identify self-management support needs from the perspective of individuals with SMI. METHOD: A systematic review was conducted using the method of thematic synthesis of qualitative studies. After searching the databases MEDLINE, PsycINFO, CINAHL, and EMBASE, we screened the papers for the eligibility criteria: individuals with an SMI, adequately representing the voice of persons with SMI and describing their self-management support needs. Thirty-one papers were included. RESULTS: The main findings showed that participants in the studies described the need for informational support, emotional support, acknowledgment, encouragement, and guidance to make sense of their illness experiences, ease suffering, obtain validation and recognition, execute self-management tasks, and be led through unfamiliar territory. CONCLUSION: The perspectives of persons with SMI can provide a road map for constructing a self-management support intervention for persons with SMI. Important others have an essential role in fulfilling support needs. Independently managing an SMI is difficult. Therefore, it is preferable to let important others participate in self-management interventions and to introduce peer support.
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Affiliation(s)
- Titus A A Beentjes
- Titus A. A. Beentjes, MScN, APRN, RN, Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands; Dimence Group Mental Health Care Centre, Deventer, the Netherlands; Centre for Nursing Research, Saxion University of Applied Science, Deventer, the Netherlands
| | - Betsie G I van Gaal
- Betsie G. I. van Gaal, PhD, FEANS, Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands; HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | - Theo van Achterberg
- Theo van Achterberg, PhD, FEANS, KU Leuven, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Peter J J Goossens
- Peter J. J. Goossens, PhD, APRN, RN, FEANS, Dimence Group Mental Health Care Centre, Deventer, the Netherlands; University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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10
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Hackmann C, Balhara YPS, Clayman K, Nemec PB, Notley C, Pike K, Reed GM, Sharan P, Rana MS, Silver J, Swarbrick M, Wilson J, Zeilig H, Shakespeare T. Perspectives on ICD-11 to understand and improve mental health diagnosis using expertise by experience (INCLUDE Study): an international qualitative study. Lancet Psychiatry 2019; 6:778-785. [PMID: 31296444 DOI: 10.1016/s2215-0366(19)30093-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 12/16/2022]
Abstract
Developed in collaboration with WHO Department of Mental Health and Substance Abuse, this study (conducted in India, the UK, and the USA) integrated feedback from mental health service users into the development of the chapter on mental, behavioural, and neurodevelopmental disorders for ICD-11. The ICD-11 will be used for health reporting from January, 2022. As a reporting standard and diagnostic classification system, ICD-11 will be highly influential by informing policy, clinical practice, and research that affect mental health service users. We report here the first study to systematically seek and collate service user perspectives on a major classification and diagnostic guideline. Focus groups were used to collect feedback on five diagnoses: depressive episode, generalised anxiety disorder, schizophrenia, bipolar type 1 disorder, and personality disorder. Participants were given the official draft diagnostic guidelines and a parallel lay translation. Data were then thematically analysed, forming the basis of co-produced recommendations for WHO, which included features that could be added or revised to better reflect lived experience and changes to language that was confusing or objectionable to service users. The findings indicated that an accessible lay language version of the ICD-11 could be beneficial for service users and their supporters.
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Affiliation(s)
- Corinna Hackmann
- Department of Research and Development, Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Norwich, UK; Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi, India
| | - Kelsey Clayman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Kathleen Pike
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi, India
| | - Mona Sharma Rana
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi, India
| | - Jody Silver
- Collaborative Support Programs of New Jersey, Freehold, NJ, USA
| | - Margaret Swarbrick
- Collaborative Support Programs of New Jersey, Freehold, NJ, USA; Practice Innovation and Wellness, Rutgers Health University, Behavioral Health Care, Piscataway, NJ, USA
| | - Jon Wilson
- Department of Research and Development, Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Norwich, UK; Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Hannah Zeilig
- London College of Fashion, University of the Arts London, London, UK
| | - Tom Shakespeare
- Infectious and Tropical Diseases Department, International Centre for Evidence in Disability, London School of Health and Tropical Hygiene, Keppel Street, London, UK
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11
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Hackmann C, Wilson J, Perkins A, Zeilig H. Collaborative diagnosis between clinician and patient: why to do it and what to consider. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYThis article discusses findings from the literature and our own research related to the experience of the diagnostic process in mental healthcare, primarily from the perspective of patients, and it focuses on the benefits of collaboration. A common finding throughout our research is that, if a diagnostic process is undertaken, the majority of patients want to be actively involved and feel valued in it. This helps ensure that they find the process and the resulting diagnosis to be meaningful, informative and useful. We believe that collaboration could also mitigate some of the reported negative unintended consequences of diagnosis, including feeling stigmatised, labelled and disempowered. Our work has led us to conceive of diagnosis as having two overarching elements: the diagnostic process and the resulting diagnostic label. This article focuses specifically on the diagnostic process; we do not consider here the debate surrounding the evidence base for the validity of psychiatric classification.LEARNING OBJECTIVESAfter reading this article you will be able to:
•understand patients' experiences of the diagnostic process•achieve a shared and collaborative diagnostic process with patients•reflect on potential barriers and facilitators to collaborative diagnosis in your own practice.DECLARATION OF INTERESTNone.
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Experiencing mental health diagnosis: a systematic review of service user, clinician, and carer perspectives across clinical settings. Lancet Psychiatry 2018; 5:747-764. [PMID: 29680468 DOI: 10.1016/s2215-0366(18)30095-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 11/23/2022]
Abstract
Receiving a mental health diagnosis can be pivotal for service users, and it has been described in both positive and negative terms. What influences service-user experience of the diagnostic process is unclear; consequently, clinicians report uncertainty regarding best practice. This Review aims to understand and inform diagnostic practice through a comprehensive synthesis of qualitative data on views and experiences from key stakeholders (service users, clinicians, carers, and family). We searched five databases and identified 78 papers for inclusion, originating from 13 countries and including 2228 participants. Eligible papers were assessed for quality, and data were coded and then developed into themes, which generated a model representing factors to consider for clinicians conveying, and individuals receiving, mental health diagnoses. Themes included disclosure, information provision, collaboration, timing, stigma, and functional value of diagnosis for recovery. Variations between different stakeholders and clinical contexts are explored. Findings support an individualised, collaborative, and holistic approach to mental health diagnosis.
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Ditton-Phare P, Sandhu H, Kelly B, Kissane D, Loughland C. Pilot Evaluation of a Communication Skills Training Program for Psychiatry Residents Using Standardized Patient Assessment. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2016; 40:768-75. [PMID: 27137767 DOI: 10.1007/s40596-016-0560-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/04/2016] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Mental health clinicians can experience difficulties communicating diagnostic information to patients and their families/carers, especially about distressing psychiatric disorders such as schizophrenia. There is evidence for the effectiveness of communication skills training (CST) for improving diagnostic discussions, particularly in specialties such as oncology, but only limited evidence exists about CST for psychiatry. This study evaluated a CST program specifically developed for psychiatry residents called ComPsych that focuses on conveying diagnostic and prognostic information about schizophrenia. METHOD The ComPsych program consists of an introductory lecture, module booklets for trainees, and exemplary skills videos, followed by small group role-plays with simulated patients (SPs) led by a trained facilitator. A standardized patient assessment (SPA) was digitally recorded pre- and post-training with a SP using a standardized scenario in a time-limited (15 min) period. Recorded SPAs were independently rated using a validated coding system (ComSkil) to identify frequency of skills used in five skills categories (agenda setting, checking, questioning, information organization, and empathic communication). RESULTS Thirty trainees (15 males and 15 females; median age = 32) undertaking their vocational specialty training in psychiatry participated in ComPsych training and pre- and post-ComPsych SPAs. Skills increased post-training for agenda setting (d = -0.82), while questioning skills (d = 0.56) decreased. There were no significant differences in any other skills grouping, although checking, information organization, and empathic communication skills tended to increase post-training. A dose effect was observed for agenda setting, with trainees who attended more CST sessions outperforming those attending fewer. CONCLUSION Findings support the generalization and translation of ComPsych CST to psychiatry.
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Affiliation(s)
- Philippa Ditton-Phare
- Hunter New England Mental Health, Newcastle, NSW, Australia.
- University of Newcastle, Newcastle, NSW, Australia.
| | | | - Brian Kelly
- University of Newcastle, Newcastle, NSW, Australia
| | - David Kissane
- Monash University, Clayton, VIC, Australia
- Schizophrenia Research Institute (SRI), Sydney, NSW, Australia
| | - Carmel Loughland
- University of Newcastle, Newcastle, NSW, Australia
- Schizophrenia Research Institute (SRI), Sydney, NSW, Australia
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Ditton-Phare P, Halpin S, Sandhu H, Kelly B, Vamos M, Outram S, Bylund CL, Levin T, Kissane D, Cohen M, Loughland C. Communication skills in psychiatry training. Australas Psychiatry 2015; 23:429-31. [PMID: 26104774 DOI: 10.1177/1039856215590026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Mental health clinicians can experience problems communicating distressing diagnostic information to patients and their families, especially about severe mental illnesses such as schizophrenia. Evidence suggests that interpersonal communication skills can be effectively taught, as has been demonstrated in the specialty of oncology. However, very little literature exists with respect to interpersonal communication skills training for psychiatry. This paper provides an overview of the communication skills training literature. CONCLUSIONS The report reveals significant gaps exist and highlights the need for advanced communication skills training for mental health clinicians, particularly about communicating a diagnosis and/or prognosis of schizophrenia. A new communication skills training framework for psychiatry is described, based on that used in oncology as a model. This model promotes applied skills and processes that are easily adapted for use in psychiatry, providing an effective platform for the development of similar training programs for psychiatric clinical practice.
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Affiliation(s)
- Philippa Ditton-Phare
- Hunter New England Mental Health, Mater Hospital Campus, Newcastle, NSW, and; School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia
| | - Sean Halpin
- School of Psychology, Faculty of Science and Information Technology, University of Newcastle, Callaghan, NSW, Australia
| | - Harsimrat Sandhu
- Hunter New England Mental Health, Mater Hospital Campus, Newcastle, NSW, Australia
| | - Brian Kelly
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, and; Priority Research Centre for Translational Neuroscience and Mental Health, Mater Hospital Campus, Newcastle, NSW, Australia
| | - Marina Vamos
- Hunter New England Mental Health, Mater Hospital Campus, Newcastle, NSW, and; School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia
| | - Sue Outram
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, and; Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia
| | - Carma L Bylund
- Department of Medical Education, Hamad Medical Corporation, Weill Cornell Medical College, Doha-Qatar
| | - Tomer Levin
- Department of Psychiatry and Behavioral Health, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Kissane
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, and; Schizophrenia Research Institute (SRI), Australia
| | - Martin Cohen
- Hunter New England Mental Health, Mater Hospital Campus, Newcastle, NSW, Australia
| | - Carmel Loughland
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, and; Priority Research Centre for Translational Neuroscience and Mental Health, Mater Hospital Campus, Newcastle, NSW, and; Schizophrenia Research Institute (SRI), Australia
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