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Arahanthabailu P, Praharaj SK, Purohith AN, Yesodharan R, Bhandary RP, Sharma PSVN. Madison to Manipal: A narrative review of modified assertive community treatment programs. Asian J Psychiatr 2023; 88:103746. [PMID: 37625329 DOI: 10.1016/j.ajp.2023.103746] [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: 04/02/2023] [Revised: 07/22/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Assertive community treatment (ACT) is a multidisciplinary, team-based approach providing comprehensive individualized care for the patients with various mental illness, has been adapted variably across the world in terms of patient-staff ratio, selection of patients, the pattern of service delivery and frequency of contact. We aim to review the extant literature on the modifications of ACT programs for severe mental disorders and their effectiveness. METHODS Studies on modified ACT approaches for mental illnesses were searched in multiple databases. We adopted a rapid appraisal approach. The searches were restricted to articles published in English. We appraised the fidelity assessment of the ACT studies wherever available. In addition, we assessed the study quality using a grading tool based on ten practice components of ACT. RESULTS We found 23 reports (10 RCTs and 13 non-controlled studies) on modified ACT. The extant literature on modified ACT programs is heterogeneous. The modifications in ACT included changes in patient-to-staff ratio, team composition, service hours, and interventions carried out. Most controlled studies were conducted in high-income settings and had inconsistent outcome, possibly due to the comprehensive nature of the 'usual care.' In contrast, modified ACT services from low and middle-income countries reduced hospitalization rates and improved treatment adherence. CONCLUSIONS Modifications in ACT programs were done to cater to specific subpopulation and the changes in program structure to suit the resources and setting. The outcome of modified ACT appears heterogenous, though the findings from low and middle-income countries are promising.
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Affiliation(s)
- Praveen Arahanthabailu
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Abhiram N Purohith
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
| | - Renjulal Yesodharan
- Department of Psychiatric (Mental Health) Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Rajeshkrishna P Bhandary
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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Frisch S, Stasik E, Holzberger ML, Heider B, Wirth MC, Klein N, Becker-Scharwatz R, Fußer F. [Home treatment in geriatric psychiatry: an idea with a future?!]. DER NERVENARZT 2023; 94:428-432. [PMID: 37042953 DOI: 10.1007/s00115-023-01468-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 04/13/2023]
Affiliation(s)
- Stefan Frisch
- Klinik für Gerontopsychiatrie, Psychosomatik und Psychotherapie, Pfalzklinikum, Weinstr. 100, 76889, Klingenmünster, Deutschland.
- Institut für Psychologie, Goethe-Universität, Frankfurt am Main, Deutschland.
| | - Eileen Stasik
- Klinik für Gerontopsychiatrie, Psychosomatik und Psychotherapie, Pfalzklinikum, Weinstr. 100, 76889, Klingenmünster, Deutschland
| | - Marie-Luise Holzberger
- Klinik für Gerontopsychiatrie, Psychosomatik und Psychotherapie, Pfalzklinikum, Weinstr. 100, 76889, Klingenmünster, Deutschland
| | - Bianca Heider
- Klinik für Gerontopsychiatrie, Psychosomatik und Psychotherapie, Pfalzklinikum, Weinstr. 100, 76889, Klingenmünster, Deutschland
| | - Marie-Christin Wirth
- Klinik für Gerontopsychiatrie, Psychosomatik und Psychotherapie, Pfalzklinikum, Weinstr. 100, 76889, Klingenmünster, Deutschland
| | - Natalie Klein
- Klinik für Gerontopsychiatrie, Psychosomatik und Psychotherapie, Pfalzklinikum, Weinstr. 100, 76889, Klingenmünster, Deutschland
| | - Rita Becker-Scharwatz
- Klinik für Gerontopsychiatrie, Psychosomatik und Psychotherapie, Pfalzklinikum, Weinstr. 100, 76889, Klingenmünster, Deutschland
| | - Fabian Fußer
- Klinik für Gerontopsychiatrie, Psychosomatik und Psychotherapie, Pfalzklinikum, Weinstr. 100, 76889, Klingenmünster, Deutschland
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Frankfurt am Main, Frankfurt am Main, Deutschland
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Holthoff-Detto V, Nienaber A, Bötel N, Rapp M. [Complex treatment of severe mental illnesses in old age]. DER NERVENARZT 2021; 92:948-954. [PMID: 34142165 DOI: 10.1007/s00115-021-01150-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The needs for assistance, support and treatment of older people with severe mental illnesses (SMI) are very high and linked to additional age-associated somatic diseases and impairments. Old people prefer to live independently in their own homes and to receive necessary treatment and support there; however, a resettlement in a residential nursing home is often necessary due to a lack of alternatives. OBJECTIVE What is the current treatment reality in Germany for old people with SMI in their own homes and in residential nursing homes? How can coercive measures in this context be prevented? METHODS Selected results from the scientific literature on psychogeriatric care models in older people with SMI are summarized and discussed. RESULTS Multiprofessional psychogeriatric complex treatment models for older patients that include home visits and are adapted to the severity of mental disease are not available in Germany due to the lack of cross-sectoral network structures. Around 30% of the 730,000 nursing home residents in Germany experience coercive practices, whereas person-centered nursing concepts as well as guideline conform and individualized nonpharmacological treatment strategies and milieu therapeutic concepts are not sufficiently available. CONCLUSION The German healthcare system is in urgent need of multiprofessional psychogeriatric home treatment models in old people with severe mental illness in order to prevent worsening of psychiatric and somatic symptoms, to maintain individual social involvement, to strengthen individual autonomy and participative decision making and to protect from coercion. Multiprofessional expertise is essential as well as effective age-appropriate service models with multiprofessional teams delivering domiciliary visits and connecting complementary services for individual treatment requirements as part of the German health care system.
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Affiliation(s)
- Vjera Holthoff-Detto
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Alexianer St. Hedwig Kliniken, Krankenhaus Hedwigshöhe, Höhensteig 1, 12526, Berlin, Deutschland.
- Medizinische Fakultät, Technische Universität Dresden, Dresden, Deutschland.
| | - André Nienaber
- Münster School of Health (MSH), FH Münster - University of Applied Sciences, Münster, Deutschland
| | - Nora Bötel
- Friedrich-Husemann-KLinik, Buchenbach, Deutschland
| | - Michael Rapp
- Professur Sozial- und Präventivmedizin, Universität Potsdam, Potsdam, Deutschland
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Molinari V. Commentary: "Trends in Serious Mental Illness in US Assisted Living Compared to Nursing Homes and the Community: 2007-2017". Am J Geriatr Psychiatry 2021; 29:445-447. [PMID: 33023800 DOI: 10.1016/j.jagp.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Victor Molinari
- School of Aging Studies, University of South Florida, Tampa, FL.
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Schmit MK, Oller ML, Tapia‐Fuselier JL, Schmit EL. A Holistic Client Functioning Profile Comparison of People With Serious Mental Illness. JOURNAL OF COUNSELING AND DEVELOPMENT 2020. [DOI: 10.1002/jcad.12295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | - Marianna L. Oller
- Department of Counseling and Higher Education, University of North Texas
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Klug G, Gallunder M, Hermann G, Singer M, Schulter G. Effectiveness of multidisciplinary psychiatric home treatment for elderly patients with mental illness: a systematic review of empirical studies. BMC Psychiatry 2019; 19:382. [PMID: 31796012 PMCID: PMC6889722 DOI: 10.1186/s12888-019-2369-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/20/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The vast majority of older people with mental illness prefer to live independently in their own homes. Barriers caused by the health care system often prevent adequate, adapted treatments. With regard to the increasing ageing of the population, the determination of effective, age-appropriate service models for elderly patients with mental illness is clearly required. The aim of this review is to examine and to evaluate multidisciplinary psychogeriatric treatment models that include home visits, particularly with regard to the effects on psychiatric symptoms, social and mental health rehabilitation and quality of life. METHODS A systematic review was carried out of empirical studies with participants who were diagnosed with a mental illness according to ICD-10, aged 60 years or older, and who were living at home. The inclusion criteria comprised a duration of intervention of at least 12 weeks and a minimum of two interventions and domiciliary visits delivered by a multidisciplinary team. The online databases Medline, PsychInfo, Web of Science, Cochrane Register of Controlled Trials, and Google Scholar, as well as hand search, were used to search for relevant studies published between 1996 and 2016. An additional search was performed for studies published between 2016 and 2019. After removing duplicates, abstracts were screened and the remaining articles were included for full-text review. RESULTS Of the 3536 records discovered in total, 260 abstracts appeared to be potentially eligible. Of these, 30 full-text articles were assessed for eligibility. For the additional search 415 records and abstracts were screened and 11 articles were read full text. Finally, only three studies fully met the inclusion criteria for this review. The results indicate that psychogeriatric home treatment is associated with significant improvements of psychiatric symptoms and psychosocial problems, fewer admissions to hospital and nursing homes, as well as lower costs of care. CONCLUSIONS Psychogeriatric home treatment has positive effects on older people with mental illness. However, these findings are based upon a small number of studies. The need for further research, especially to specify the effective factors in psychogeriatric home treatment, is clearly indicated.
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Affiliation(s)
- Günter Klug
- Society for Mental Health Promotion, Plüddemanngasse 45, A-8010, Graz, Austria.
| | - Manuela Gallunder
- Society for Mental Health Promotion, Hasnerplatz 4, A-8010 Graz, Austria
| | - Gerhard Hermann
- Society for Mental Health Promotion, Hasnerplatz 4, A-8010 Graz, Austria
| | - Monika Singer
- Society for Mental Health Promotion, Plüddemanngasse 33, A-8010 Graz, Austria
| | - Günter Schulter
- 0000000121539003grid.5110.5Department of Psychology, Biological Psychology Unit, University of Graz, Universitätsplatz 2, A-8010 Graz, Austria
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Ignatyev Y, Mundt AP, von Peter S, Heinze M. Hospital length of stay among older people treated with flexible and integrative psychiatric service models in Germany. Int J Geriatr Psychiatry 2019; 34:1557-1564. [PMID: 31276239 DOI: 10.1002/gps.5165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/29/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Since 2012, a new law (§64b, Book V of the Social Security Code [SGB V]) regulates the implementation of flexible and integrative psychiatric treatment projects (FIT64b) in Germany. FIT64b allows rapid discharge of patients from inpatient to outpatient settings and cost reductions of hospital stays. Several psychiatric centres exclusively provide FIT64b; others provide FIT64b alongside with standard health care. The aim of the study was to assess the average hospital length of stay (AHLS) of older patients with mental illness included in FIT64b projects. METHODS A secondary data analysis was conducted using administrative data from eight German mental health centres providing FIT64b. The effects of gender, age, type of centre, and main diagnosis on AHLS were calculated for all older patients with age 65 years or older (n = 3495) treated in FIT64b in the year 2016. Data were analysed with descriptive statistics and robust multiway procedures. RESULTS The AHLS of older people with mental illness was 4.8 (SD = 11.5) days. The AHLS was shorter in centres exclusively providing FIT64b than in centres providing FIT64b alongside with standard health care: 3.2 (SD = 6.4) vs 8.4 (SD = 17.8) days, P = .001. This difference was particularly marked among patients with schizophrenia spectrum disorders, mood disorders, and neurotic, stress-related, and somatoform disorders. CONCLUSIONS FIT64b relates to very short AHLS even among older people. Centres using FIT64b alongside with standard health care usually provide standard care to most patients, which could lead to lower fidelity in the implementation of FIT64b.
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Affiliation(s)
- Yuriy Ignatyev
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Adrian P Mundt
- Medical Faculty, Universidad Diego Portales, Santiago, Chile.,Medical School, Universidad San Sebastián, Puerto Montt, Chile
| | - Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
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[Community-based psychosocial care for people with dementia]. Z Gerontol Geriatr 2017; 50:609-615. [PMID: 28983680 DOI: 10.1007/s00391-017-1316-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
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Sadler P, McIlvena A. Evaluation of a Rural-Based Community Aged Intensive Recovery Program for Older Adults With Severe Mental Illness. J Psychosoc Nurs Ment Health Serv 2015; 53:17-21. [DOI: 10.3928/02793695-20150622-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Innovative Versorgungsstrategien in der Gerontopsychiatrie und -psychotherapie. DER NERVENARZT 2015; 86:468-74. [DOI: 10.1007/s00115-014-4179-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stobbe J, Wierdsma AI, Kok RM, Kroon H, Depla M, Mulder CL. Decrease in unmet needs contributes to improved motivation for treatment in elderly patients with severe mental illness. Soc Psychiatry Psychiatr Epidemiol 2015; 50:125-32. [PMID: 24985314 DOI: 10.1007/s00127-014-0918-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 06/22/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate the pattern of associations between changes in unmet needs and treatment motivation in elderly patients with severe mental illness. METHODS Observational longitudinal study in 70 patients treated by an assertive community treatment team for the elderly. Unmet needs and motivation for treatment were measured using the Camberwell assessment of needs for the elderly and the stages-of-change (SoC) scale, respectively, at baseline, after 9 and 18 months. SoC scores were dichotomized into two categories: motivated and unmotivated. Multinomial logistic regression analyses were conducted to determine whether changes in motivation were parallel to or preceded changes in unmet needs. RESULTS The number of patients who were not motivated for treatment decreased over time (at baseline 71.4 % was not motivated, at the second measurement 51.4 %, and at 18 months 31.4 % of the patients were not motivated for treatment). A decrease in unmet needs, both from 0-9 to 0-18 months was associated with remaining motivated or a change from unmotivated to becoming motivated during the same observational period (parallel associations). A decrease in unmet needs from 0 to 9 months was also associated with remaining motivated or a change from unmotivated to motivated during the 9-18 months follow-up (sequential associations). CONCLUSIONS Our findings suggest that a decrease in unmet needs is associated with improvements in motivation for treatment.
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Affiliation(s)
- Jolanda Stobbe
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Center, PO Box 2040 Dp-0122, 3000 CA, Rotterdam, The Netherlands,
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