1
|
Yang H, Zhu D, Liu Y, Xu Z, Liu Z, Zhang W, Cai J. Employing graph attention networks to decode psycho-metabolic interactions in Schizophrenia. Psychiatry Res 2024; 335:115841. [PMID: 38522150 DOI: 10.1016/j.psychres.2024.115841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/31/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024]
Abstract
Schizophrenia is a severe mental disorder characterized by intricate and underexplored interactions between psychological symptoms and metabolic health, presenting challenges in understanding the disease mechanisms and designing effective treatment strategies. To delve deeply into the complex interactions between mental and metabolic health in patients with schizophrenia, this study constructed a psycho-metabolic interaction network and optimized the Graph Attention Network (GAT). This approach reveals complex data patterns that traditional statistical analyses fail to capture. The results show that weight management and medication management play a central role in the interplay between psychiatric disorders and metabolic health. Furthermore, additional analysis revealed significant correlations between the history of psychiatric symptoms and physical health indicators, as well as the key roles of biochemical markers(e.g., triglycerides and low-density lipoprotein cholesterol), which have not been sufficiently emphasized in previous studies. This highlights the importance of medication management approaches, weight management, psychological treatment, and biomarker monitoring in comprehensive treatment and underscores the significance of the biopsychosocial model. This study is the first to utilize a GNN to explore the interactions between schizophrenia symptoms and metabolic features, providing new insights into understanding psychiatric disorders and guiding the development of more comprehensive treatment strategies for schizophrenia.
Collapse
Affiliation(s)
- Hongyi Yang
- School of Design, Shanghai Jiao Tong University, Shanghai, PR China
| | - Dian Zhu
- School of Design, Shanghai Jiao Tong University, Shanghai, PR China
| | - YanLi Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zhiqi Xu
- School of Design, Shanghai Jiao Tong University, Shanghai, PR China
| | - Zhao Liu
- School of Design, Shanghai Jiao Tong University, Shanghai, PR China.
| | - Weibo Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, PR China; Mental Health Branch, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, PR China.
| | - Jun Cai
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Mental Health Branch, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, PR China.
| |
Collapse
|
2
|
Vázquez-Reyes A, Martín-Rodríguez A, Pérez-San-Gregorio MÁ, Vázquez-Morejón AJ. Survival of patients with severe mental disorders: Influence of social functioning. Int J Soc Psychiatry 2023; 69:1157-1165. [PMID: 36708399 DOI: 10.1177/00207640231152201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Patients with severe mental disorders have a high risk of premature death due to the interaction of various factors. Social functioning is a strategic functional factor in understanding the course of psychotic disorders. AIM Analyze the relationship between social functioning and its various dimensions and survival during a 10-year follow-up. METHOD The Social Functioning Scale (SFS) was administered to 163 close relatives of patients under treatment at a Community Mental Health Unit. Survival was described by Kaplan-Meier analysis and any differences in survival by level of social functioning were found by long-rank analysis. Finally, Cox regression was used to predict premature mortality. RESULTS Significant differences in mortality were identified in the interpersonal behavior dimension of social functioning, while there were no significant gender or diagnostic differences in the rest of the dimensions. The interpersonal behavior dimension and age were found to be factors predicting premature death. CONCLUSION These findings show the protective effect of social functioning retained by patients with psychotic disorders on their survival, and the need to apply evidence-based psychotherapy focused on recovery of social functioning in the early stages of the disorder.
Collapse
Affiliation(s)
| | - Agustín Martín-Rodríguez
- Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment. University of Seville, Seville, Spain
| | - María Ángeles Pérez-San-Gregorio
- Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment. University of Seville, Seville, Spain
| | - Antonio J Vázquez-Morejón
- Mental Health Service, University Hospital Virgen del Rocío, Seville, Spain
- Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment. University of Seville, Seville, Spain
| |
Collapse
|
3
|
Favre S, Richard-Lepouriel H. Self-stigma and bipolar disorder: A systematic review and best-evidence synthesis. J Affect Disord 2023; 335:273-288. [PMID: 37207946 DOI: 10.1016/j.jad.2023.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Bipolar disorder is a severe and chronic mental illness characterized by recurrent major depressive episodes and mania or hypomania. In addition to the burden of the disease and its consequences, self-stigma can impact people with bipolar disorder. This review investigates the current state of research in self-stigma in bipolar disorder. METHODS An electronic search was carried out until February 2022. Three academic databases were systematically searched, and best-evidence synthesis was made. RESULTS Sixty-six articles were related to self-stigma in bipolar disorder. Seven key themes were extracted from these studies: 1/ Comparison of self-stigma in bipolar disorder and other mental illnesses, 2/ Sociocultural context and self-stigma, 3/ Correlates and predictors of self-stigma, 4/ Consequences of self-stigma, 5/ Treatments and self-stigma, 6/ Management of self-stigma, and 7/ Self-stigma and recovery in bipolar disorder. LIMITATIONS Firstly, a meta-analysis could not be performed due to the heterogeneity of the studies. Secondly, limiting the search to self-stigma has excluded other forms of stigma that also have an impact. Thirdly, the under-reporting of negative or nonsignificant results due to publication bias and unpublished studies might have limited the accuracy of this reviews' synthesis. CONCLUSION Research on self-stigma in persons with bipolar disorder has been the focused on different aspects, and interventions to reduce self-stigmatization have been developed, but evidence of their effectiveness is still sparse. Clinicians need to be attentive to self-stigma, its assessment, and its empowerment in their daily clinical practice. Future work is required to establish valid strategies to fight self-stigma.
Collapse
Affiliation(s)
- Sophie Favre
- Mood disorder unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland
| | - Hélène Richard-Lepouriel
- Mood disorder unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland.
| |
Collapse
|
4
|
Lin C, Wan X, Zhang R, Yang X, Liu Y. Quality of life and its influencing factors in patients with schizophrenia. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2023; 48:472-480. [PMID: 37164931 PMCID: PMC10930085 DOI: 10.11817/j.issn.1672-7347.2023.220438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Indexed: 05/12/2023]
Abstract
Schizophrenia is a chronic mental disease. With the change of medical model, quality of life has gradually become an important prognostic indicator for patients with schizophrenia. People with schizophrenia have a lower quality of life than the general population or people with other chronic diseases, Sociodemographic factors such as age, gender, employment, education level, income and living situation; clinical factors such as psychiatric symptoms, medication compliance and insight; and psychosocial factors such as social support, cognition, stigma, self-esteem and needs are the main influencing factors for schizophrenia patients. Medication and psychological interventions such as social skills training, family intervention, cognitive correction and cognitive behavioral therapy can be used to improve the quality of life of patients with schizophrenia. Understanding the factors affecting the quality of life of schizophrenia patients and the improvement measures helps to provide reference for improving their quality of life.
Collapse
Affiliation(s)
- Chunying Lin
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041.
| | - Xiaoyan Wan
- Center of Health Management Cadre Training, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041
| | - Ruohan Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041
| | - Xianmei Yang
- Department of Mental Health and Social Services, Sichuan Mental Health Center (Third Hospital of Mianyang), Mianyang Sichuan 621054, China
| | - Yuanyuan Liu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041.
| |
Collapse
|
5
|
Wu MC, Hung CC, Fang SC, Lee TSH. Change of home visit frequency by public health nurses predicts emergency escorts for psychiatric patients living in the community: A retrospective medical record review. Front Public Health 2023; 11:1066908. [PMID: 36844831 PMCID: PMC9948617 DOI: 10.3389/fpubh.2023.1066908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023] Open
Abstract
Background Improper or insufficient treatment of mental health illness harms individuals, families, and society. When psychiatric treatment shifts from a hospital-based to a community-based health care system, risk management is essential to the provision of effective care. Objective We examine whether an upgrade in home visit frequency of psychiatric patients as identified by public health nurses can predict the subsequent need for emergency escort services for medical treatment. Design A 2-year retrospective medical record review. Settings A district of New Taipei City in Taiwan. Participants A total of 425 patients with a diagnosed mental health illness cared for through home visits by public health nurses from January 2018 to December 2019. Methods We accessed the Ministry of Health and Welfare's psychiatric care management information system to identify a set of medical records, and analyzed these records using chi-square and regression analyses. Results The analyses indicated that the groups experiencing the greatest need for emergency escort services were: male, 35-49 years old, with a senior high school level of education, without a disability identification card, with a schizophrenia diagnosis, and had been reported by the nurse as having progressed to a serious level. Nurses' increased frequency of home visits (an indicator that the patient's overall condition was worsening) and nurses' reports of increased severity of problems were significant predictors of the need for emergency escort services. Conclusions The nurses' adjustment of visit frequency based on the results of the visit assessment predicts the need for emergency escort services for mental patients. The findings support not only the professional roles and functions of public health nurses, but also the importance of strengthening psychiatric health community support services.
Collapse
Affiliation(s)
- Meng-Chieh Wu
- Department of Health Education and Health Promotion, National Taiwan Normal University, Taipei, Taiwan
| | - Chia-Chun Hung
- Continuing Education Master's Program of Addiction Prevention and Treatment, National Taiwan Normal University, Taipei, Taiwan
| | - Su-Chen Fang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Tony Szu-Hsien Lee
- Department of Health Education and Health Promotion, National Taiwan Normal University, Taipei, Taiwan,Continuing Education Master's Program of Addiction Prevention and Treatment, National Taiwan Normal University, Taipei, Taiwan,*Correspondence: Tony Szu-Hsien Lee ✉
| |
Collapse
|
6
|
Schröter R, Lambert M, Rohenkohl A, Kraft V, Rühl F, Luedecke D, Gallinat J, Karow A, Schmidt SJ. Mediators of quality of life change in people with severe psychotic disorders treated in integrated care: ACCESS II study. Eur Psychiatry 2022; 66:e1. [PMID: 36329654 PMCID: PMC9879911 DOI: 10.1192/j.eurpsy.2022.2332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Patients with severe psychotic disorders exhibit a severely reduced quality of life (QoL) at all stages of the disease. Integrated care often led to an improvement in QoL. However, the specific mediators of QoL change are not yet well understood. METHODS The ACCESS II study is a prospective, long-term study investigating the effectiveness of an integrated care program for people with severe psychotic disorders (IC-TACT) that includes Therapeutic Assertive Community Treatment within a care network of in- and outpatient services at the University Medical Center Hamburg-Eppendorf, Germany. We examined longitudinal associations between QoL and the hypothesized mediators of change (i.e., negative symptoms, depression, and anxiety), using cross-lagged panel models. RESULTS The sample includes 418 severely ill patients treated in IC-TACT for at least 1 year. QoL increased, whereas symptom severity decreased significantly from baseline to 6-month follow-up (p-values ≤ 0.001), and remained stable until 12-month follow-up. QoL and symptom severity demonstrated significant auto-correlated effects and significant cross-lagged effects from QoL at baseline to negative symptoms (6 months, β = -0.20, p < 0.001) to QoL (12 months, β = -0.19, p < 0.01) resulting in a significant indirect, mediated effect. Additionally, negative symptoms after 6 months had a significant effect on the severity of depression after 12 months (β = 0.13, p < 0.05). CONCLUSIONS Negative symptoms appear to represent an important mechanism of change in IC-TACT indicating that improvement of QoL could potentially be achieved through optimized intervention on negative symptoms. Moreover, this may lead to a reduction in the severity of depression after 12 months.
Collapse
Affiliation(s)
- Romy Schröter
- Centre for Psychosis and Bipolar Disorders, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- Centre for Psychosis and Bipolar Disorders, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rohenkohl
- Centre for Psychosis and Bipolar Disorders, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vivien Kraft
- Centre for Psychosis and Bipolar Disorders, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friederike Rühl
- Centre for Psychosis and Bipolar Disorders, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Luedecke
- Centre for Psychosis and Bipolar Disorders, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Centre for Psychosis and Bipolar Disorders, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Karow
- Centre for Psychosis and Bipolar Disorders, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie J Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, 3012Bern, Switzerland
| |
Collapse
|
7
|
Vázquez-Reyes A, Ángeles Pérez-San-Gregorio M, Martín-Rodríguez A, Vázquez-Morejón AJ. Ten-year follow-up of social functioning and behaviour problems in people with schizophrenia and related disorders. Int J Soc Psychiatry 2022; 68:1324-1335. [PMID: 34096361 DOI: 10.1177/00207640211023083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In recent years, several variables in the course of schizophrenia and related psychotic disorders have been studied. However, an instrumental analysis of the evolution of social functioning and behaviour problems has scarcely been explored. AIM To analyse the evolution of social functioning and behaviour problems and find any diagnosis or gender differences. METHOD The Social Functioning Scale (SFS) and the Behaviour Problems Inventory (BPI) were administered in Stages I (2003-2007) and II (2014-2017) to 100 close relatives of patients under treatment at a Community Mental Health Unit. A related samples t-test, analysis of variance and multivariate analysis of variance were performed to study the evolution and differences in social functioning and behaviour problems. Then a stepwise multiple linear regression analysis was done to predict the evolution of social functioning. RESULTS No deterioration in the evolution of social functioning or behaviour problems was observed, and schizophrenia patient scores were lower. Women scored higher in withdrawal/social engagement, interpersonal behaviour, independence-performance, independence-competence and total social functioning, with no significant differences in behaviour problems. Previous social functioning, underactivity/social withdrawal and education are predictive factors in the evolution of social functioning. Conclusion: The results show the need for implementing psychosocial intervention programs that promote functional recovery and keep problems from becoming chronic.
Collapse
Affiliation(s)
| | - María Ángeles Pérez-San-Gregorio
- Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | - Agustín Martín-Rodríguez
- Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | - Antonio J Vázquez-Morejón
- Mental Health Service, University Hospital Virgen del Rocío, Seville, Spain.,Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| |
Collapse
|
8
|
Thornicroft G, Sunkel C, Alikhon Aliev A, Baker S, Brohan E, El Chammay R, Davies K, Demissie M, Duncan J, Fekadu W, Gronholm PC, Guerrero Z, Gurung D, Habtamu K, Hanlon C, Heim E, Henderson C, Hijazi Z, Hoffman C, Hosny N, Huang FX, Kline S, Kohrt BA, Lempp H, Li J, London E, Ma N, Mak WWS, Makhmud A, Maulik PK, Milenova M, Morales Cano G, Ouali U, Parry S, Rangaswamy T, Rüsch N, Sabri T, Sartorius N, Schulze M, Stuart H, Taylor Salisbury T, Vera San Juan N, Votruba N, Winkler P. The Lancet Commission on ending stigma and discrimination in mental health. Lancet 2022; 400:1438-1480. [PMID: 36223799 DOI: 10.1016/s0140-6736(22)01470-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK.
| | | | - Akmal Alikhon Aliev
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Sue Baker
- Mind international, London, UK; Changing Minds Globally, London, UK
| | - Elaine Brohan
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | | | - Kelly Davies
- Centre for Implementation Science, King's College London, London UK
| | - Mekdes Demissie
- College of Health Sciences and Medicine, School of Nursing and Midwifery, Haramaya University, Ethiopia; Centre for Innovative Drug Development and Therapeutic Studies for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Ethiopia
| | | | - Wubalem Fekadu
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Petra C Gronholm
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | - Zoe Guerrero
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| | - Dristy Gurung
- Centre for Implementation Science, King's College London, London UK; Transcultural Psychosocial Organization (TPO), Kathmandu Nepal
| | - Kassahun Habtamu
- Addis Ababa University, School of Psychology, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; WHO Collaborating Centre for Mental Health Research and Training, King's College London, London UK; Department of Psychiatry, School of Medicine, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva Heim
- Institut de Psychologie, University of Lausanne, Lausanne, Switzerland
| | - Claire Henderson
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | | | | | - Nadine Hosny
- Institut de Psychologie, University of Lausanne, Lausanne, Switzerland
| | | | | | - Brandon A Kohrt
- Division of Global Mental Health, George Washington University, Washington DC, USA
| | - Heidi Lempp
- Institute of Psychiatry, Psychology and Neuroscience, and Academic Department of Rheumatology, King's College London, London UK
| | - Jie Li
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Ning Ma
- Institute of Mental Health, Peking University, Beijing, China
| | - Winnie W S Mak
- Department of Psychology, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Akerke Makhmud
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | - Pallab K Maulik
- George Institute for Global Health, New Delhi, India; University of New South Wales, Sydney, NSW, Australia
| | - Maria Milenova
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK; Centre for Implementation Science, King's College London, London UK
| | | | - Uta Ouali
- Razi Hospital and El Manar Medical School, University of Tunis, La Manouba, Tunisia
| | - Sarah Parry
- South London and the Maudsley NHS Foundation Trust, London, UK
| | | | - Nicolas Rüsch
- Department of Psychiatry II, Ulm University and BKH Günzburg, Ulm, Germany; Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Taha Sabri
- Taskeen Health Initiative, Karachi, Pakistan
| | - Norman Sartorius
- Association for the Improvement of Mental health Programs, Geneva, Switzerland
| | | | | | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London UK
| | - Norha Vera San Juan
- Health Service and Population Research Department, King's College London, London UK
| | - Nicole Votruba
- and Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Petr Winkler
- National Institute of Mental Health (Czechia), WHO Collaborating Centre for Public Mental Health Research and Service Development, Klecany, Czechia
| |
Collapse
|
9
|
Peritogiannis V, Rousoudi S, Vorvolakos T, Gioti P, Gogou A, Arre A, Samakouri M. A comparative study of two Mobile Mental Health Units in different catchment rural areas in Greece. Int J Soc Psychiatry 2022; 68:324-333. [PMID: 33472480 DOI: 10.1177/0020764020985896] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mental healthcare service delivery in rural and remote areas in Greece is challenging due to socioeconomic and geographical reasons, and distant facilities. To address the needs of the underserved areas, the Greek state has launched a number of Mobile Mental Health Units (MMHUs). AIM The objective of the present study was to explore the differences among two MMHUs, one being run by a university general hospital (MMHU UHA) and the other being run by a nongovernmental organization (MMHU I-T). METHODS The two MMHUs deliver services in rural areas of northeast and northwest Greece, respectively. Both MMHUs use the infrastructures of the primary healthcare system and have the potential for domiciliary visits. RESULTS Medical and nursing staff is much more in the MMHU UHA, whereas MMHU I-T has more psychologists, social workers and health visitors. Patients attended the MMHU I-T were significantly older than the patients attended the MMHU UHA (mean age 64.5 vs. 55.3 years) and the percentage of the elderly patients in treatment with the MMHU I-T (56.5%) is significantly higher than the corresponding percentage of the MMHU UHA (20%). The proportion of patients that received home-based care by the two MMHUs was almost identical. The percentage of patients with schizophrenia spectrum disorders that attended the MMHU UHA was significantly higher. Patients with affective disorders, anxiety disorders and organic brain disorders that attended the MMHU I-T were significantly more. CONCLUSIONS Despite the similarities among the MMHUs in rural Greece, this study recorded some important differences. The differences in staffing may be accounted for by the availability of resources. The differences in the patients' population may be explained by the fact that the MMHU UHA was designed from its beginning to treat patients with severe mental illnesses, mainly psychoses, and it accepts loss of referrals within the general hospital's network of psychiatric services. The MMHU I-T is an independent, locally based service that may be better perceived as an expansion of the primary care system. The results of the study could inform service practice and mental health policy.
Collapse
Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Sofia Rousoudi
- Postgraduate Program in Social Psychiatry, Democritus University of Thrace, Alexandroupolis, Greece
| | - Theofanis Vorvolakos
- Department of Psychiatry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Panagiota Gioti
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Afroditi Gogou
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Argiri Arre
- Postgraduate Program in Social Psychiatry, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Psychiatry, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Maria Samakouri
- Department of Psychiatry, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.,Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| |
Collapse
|
10
|
Kassir G, El Hayek S, Charara R, Cherro M, Itani H, El Khoury J. Predictors of admission to an assertive outreach service for psychosis in Lebanon. PLOS Glob Public Health 2022; 2:e0001428. [PMID: 36962861 PMCID: PMC10021548 DOI: 10.1371/journal.pgph.0001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/04/2022] [Indexed: 12/29/2022]
Abstract
Schizophrenia is a chronic, debilitating mental illness that contributes significantly to the global burden of disease. Assertive outreach treatment for patients with schizophrenia and psychotic disorders has been implemented to improve treatment adherence and outcomes. The suitability of this model of care outside the western context has not been fully established. We describe the characteristics of 45 patients enrolled in the Psychosis Recovery Outreach Program (PROP), a program developed at a leading psychiatric facility in Lebanon. We collected twelve-month data for patients and used logistic regression models to identify predictor variables for enrollment in the service compared to those receiving standard treatment. Patients were mostly males (77.8%), younger than 39 years (80%), of college or higher education (68.2%), and diagnosed with schizophrenia (46.7%) or schizoaffective disorder (48.9%). About one-quarter (22.7%) had a comorbid cannabis use disorder. A majority received more than one oral antipsychotic (75.6%) while half (51.1%) were maintained on a long-acting injectable (LAI) antipsychotic. The following variables were significant predictors of enrollment in PROP: having a comorbid cannabis use disorder (OR 2.83 [1.25 - 6.37]), being prescribed a LAI antipsychotic (OR 9.99 [4.93-20.24]) or more than one oral antipsychotic (OR 4.57 [2.22-9.39]), visiting the emergency department more than once (OR 8.7 [2.64-28.68]), and admission to the psychiatry unit (OR 13.91 [3.17-60.94]). In addition, those following up in PROP were younger and less likely to be in the oldest age group (over 54 years) [OR 0.11 (0.01-0.93)], less likely to be females (OR 0.39 [0.18-0.81]), and less likely to be diagnosed with "other psychotic disorder" as compared to schizophrenia (OR 0.14 [0.03 - 0.62]). Our findings highlight that the assertive outreach model of care is applicable to its target population in the context of psychiatric care in Lebanon, namely young individuals with psychosis, higher comorbidities and a severe course of illness.
Collapse
Affiliation(s)
- Ghida Kassir
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Samer El Hayek
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Raghid Charara
- Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Michele Cherro
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Hala Itani
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Joseph El Khoury
- Department of Psychiatry and Behavioral Health, American Hospital Dubai, Dubai, United Arab Emirates
| |
Collapse
|
11
|
Chugunov D, Shmilovich A. Primary and secondary negative disorders in schizophrenia as an actual problem of modern clinical psychiatry. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:41-47. [DOI: 10.17116/jnevro202212208141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
12
|
Schosser A, Senft B, Rauner M. The benefit of an ambulant psychiatric rehabilitation program in Vienna, Austria: an uncontrolled repeated measures study. Cent Eur J Oper Res 2021; 30:19-48. [PMID: 34658666 PMCID: PMC8501920 DOI: 10.1007/s10100-021-00773-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
We investigated the benefit of a 6-week ambulant psychiatric rehabilitation program in an ambulant psychiatric rehabilitation clinic in Vienna, Austria, from January 2014 to December 2016 by an uncontrolled repeated measures study. The potential of this intervention program was assessed by effectiveness and cost measures using suitable statistical analyses. We compared the effectiveness and cost measures of this ambulant psychiatric rehabilitation program on patients for the period of up to 12 months after discharge to the period of 12 months before admission to the intervention program based on self-reported catamnesis questionnaires. For the program's effectiveness measures, we accounted for both psychological indices for measuring depression severity, symptom burden, and functioning to document the health improvement of patients and economy-related indices such as the number of sick leave days for patients. For the program's cost measures, both direct tangible treatment and medication costs and indirect tangible costs based on the productivity loss measured in non-working days of the patients were considered. The results significantly demonstrated that all psychological effectiveness measures for the patients highly improved by the 6-weeks rehabilitation program and remained rather stable 12 months after discharge. We found that costs for the 6-week ambulant psychiatric rehabilitation program could be easily covered within 12 months after discharge once a total societal cost perspective was considered. Even additional total cost savings of up to over 5000 Euro could be achieved which were highest for employed patients, followed by unemployed patients receiving rehabilitation allowance due to both their high direct medication and treatment costs as well as high indirect costs for productivity loss. The most important finding was that this treatment program was especially beneficial for rehabilitation patients in earlier stages of psychiatric diseases who were still employed, indicating the need for early intervention in mental disorder.
Collapse
Affiliation(s)
- Alexandra Schosser
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Zentren für seelische Gesundheit, BBRZ-Med, Schererstrasse 30, 1210 Vienna, Austria
- Faculty of Medicine, Sigmund Freud University, Freudplatz 3, 1020 Vienna, Austria
- Arbeitsgemeinschaft für Verhaltensmodifikation, Paris-Lodron-Straße 32, 5020 Salzburg, Austria Birgit Senf Vienna, Austria
| | - Birgit Senft
- Zentren für seelische Gesundheit, BBRZ-Med, Schererstrasse 30, 1210 Vienna, Austria
| | - Marion Rauner
- Faculty of
Business, Economics, and Statistics, Institute for Business Decisions and
Analytics, University of Vienna, Oskar-Morgenstern-Platz
1, 1090 Vienna, Austria
| |
Collapse
|
13
|
González-rodríguez A, Alvarez A, Guàrdia A, Penadés R, Monreal JA, Palao DJ, Labad J, Seeman MV. Psychiatric Partial Hospitalization Programs: Following World Health Organization Guidelines with a Special Focus on Women with Delusional Disorder. Women 2021; 1:80-96. [DOI: 10.3390/women1020008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The World Health Organization (WHO) developed a 7-year Mental Health Action Plan in 2013, which recommends integration of health and social care services into community-based settings, implementation of strategies for health promotion and prevention of illness, and support of research. In this review, we highlight partial hospitalization programs (PHPs) for delusional disorder (DD), with a special focus on the health and psychosocial needs of women. We suggest that PHPs are, in many ways, ideal settings for carrying out WHO recommendations. PHPs are multidisciplinary and consequently are able to provide a wide range of flexible program offerings. Programming in PHPs is able to address, with proven efficacy, individual needs, such as those presented by women at the various stages of their reproductive life. PHPs are a community bridge between hospital and outpatient services and can quickly adapt to specific needs as affected by gender, but also by age and cultural origins. They are ideal settings for professional training and for conducting clinical research. PHPs operate on the principle of shared decision making, and thus more readily than many other treatment sites, engaging difficult-to-treat patients, such as those with DD, by successfully establishing long-term relationships of trust.
Collapse
|
14
|
Kim SY, Kim AR. Effectiveness of community-based interventions for patients with schizophrenia spectrum disorders: a study protocol for a systematic review. Syst Rev 2021; 10:106. [PMID: 33845902 PMCID: PMC8042964 DOI: 10.1186/s13643-021-01662-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/05/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Schizophrenia requires a community-based intervention approach combined with standard treatment to prevent relapses. A literature review is required to understand the effectiveness of community-based interventions and to enhance quality in countries where they have not been fully established. This is a protocol for a systematic review of the effectiveness of community-based interventions for patients with schizophrenia spectrum disorders. METHODS We will search (from inception to January 2021) PubMed/MEDLINE, EMBASE, PsycINFO, CENTRAL, CINAHL, and Research Information Sharing Service/Korean databases. Randomized controlled trials on community-based interventions for patients with schizophrenia spectrum disorders will be eligible. The comparison groups will include patients with schizophrenia spectrum disorders who are only receiving the usual care and those who also receive community-based interventions. The schizophrenia spectrum disorders referred to in this study are defined according to the DSM-5: delusional disorders, schizophrenic disorders, and schizoaffective disorder will be included. Relapse/re-hospitalization rates (primary outcome) and quality of life (secondary outcome) will be identified for each group. Two reviewers will independently screen study titles, abstract data, and full-text articles and perform the data extraction process. Potential conflicts will be resolved through discussion. The study risk of bias will be appraised using the Cochrane Risk of Bias 2.0 tool. Results will be descriptively synthesized and will be structured according to patients' characteristics, intervention type and exposure, and outcome type. If feasible and appropriate, outcome data will be used to perform random effects meta-analyses. Discrete variables will be calculated via odds ratio, and continuous variables will be calculated via standardized mean difference using RevMan 5.3 software. DISCUSSION We will provide a summary of the available evidence on the effectiveness of community-based interventions and specific guidelines to improve their outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO ( CRD42019145660 ).
Collapse
Affiliation(s)
- Soo-Yeon Kim
- Department of Nursing, Daegu Haany University, Hanuidae-ro, Gyeongsan-si, Gyeongsangbuk-do, 38609, Republic of Korea.
| | - Ah Rim Kim
- Department of Nursing, Far East University, Chungchungbuk-do, South Korea
| |
Collapse
|
15
|
Carmona-Huerta J, Durand-Arias S, Rodriguez A, Guarner-Catalá C, Cardona-Muller D, Madrigal-de-León E, Alvarado R. Community mental health care in Mexico: a regional perspective from a mid-income country. Int J Ment Health Syst 2021; 15:7. [PMID: 33430918 PMCID: PMC7802166 DOI: 10.1186/s13033-020-00429-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/18/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Access to mental health care is a worldwide public health challenge. In Mexico, an unacceptably high percentage of the population with mental disorders does not receive the necessary treatment, which is mainly due to the lack of access to mental health care. The community mental health care model was created and has been implemented to improve this situation. In order to properly plan and implement this model a precise situational diagnosis of the mental health care network is required, thus this is a first approach to evaluate the community mental health networks in the state of Jalisco. METHODS Two components from the EvaRedCom-TMS instrument were used including a general description and accessibility of the community mental health care network. A geographic and economic accessibility evaluation was carried out for the different regions of the state ranging from scattered rural to urban communities using information gathered from health institutions, telephone interviews and computer applications. RESULTS Jalisco's community mental health network includes a total of 31 centers and 0.64 mental health workers for every 10,000 inhabitants > 15 years of age. The mean transportation cost required to access mental health care was 16.25 USD per visit. The time needed to reach the closest mental health center in 7 of the 13 analyzed regions was more than 30 min and the mean time required to reach a prolonged stay center was 172.7 min with transportation cost (taxi, private and public transport) of 22.3 USD. Some marginalized regions in the state have a mean 114 min required to reach the closest mental health care center and 386 min to reach a prolonged stay center. CONCLUSIONS This first approach to evaluate the mental health networks in Mexico showed that there are multiple barriers to access its care including an unfavorable number of human resources, long distances, and high costs. The identification of Jalisco's mental health network deficiencies is the first step towards establishing a properly planned community mental health care model within the country.
Collapse
Affiliation(s)
- Jaime Carmona-Huerta
- Instituto Jalisciense de Salud Mental, Avenida Zoquipan 1000-A, Zip Code 45170, Zapopan, Jalisco, México
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra Mojada 950 Colonia Independencia, Zip Code 44340, Guadalajara, Jalisco, México
| | - Sol Durand-Arias
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, México
| | - Allen Rodriguez
- Instituto Jalisciense de Salud Mental, Avenida Zoquipan 1000-A, Zip Code 45170, Zapopan, Jalisco, México
| | | | - David Cardona-Muller
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra Mojada 950 Colonia Independencia, Zip Code 44340, Guadalajara, Jalisco, México.
| | | | - Rubén Alvarado
- Programa de Salud Mental, Escuela de Salud Pública Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| |
Collapse
|
16
|
Chen Y, Lam CS, Deng H, Yau E, Ko KY. The Effectiveness of a Community Psychiatric Rehabilitation Program Led by Laypeople in China: A Randomized Controlled Pilot Study. Front Psychiatry 2021; 12:671217. [PMID: 34867500 PMCID: PMC8634635 DOI: 10.3389/fpsyt.2021.671217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 10/08/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Community psychiatric rehabilitation has proven effective in supporting individuals and their families in recovering from mental illness. The delivery of evidence-based community rehabilitation services, however, requires health care workers to possess a set of specially trained knowledge and skills. Most developing countries, including China, do not have specially trained mental health personnel. The purpose of this study was to test the feasibility and efficacy of a community psychiatric rehabilitation program delivered by laypeople. Method: We conducted a randomized controlled study. Patients at two sites in Chengdu, China, were randomly assigned to either the laypeople-delivered (LPD) community psychiatric rehabilitation group (N = 49) or the drop-in center control group (N = 45). The outcomes were changes in symptoms, social functioning, and family functioning over 6 months, as measured by the Positive and Negative Syndrome Scale (PANSS), the Personal and Social Performance Scale (PSP), the Family Burden Scale of Disease (FBS), and the Family APGAR index. Results: The number of sessions received over the 12-week period of treatment ranged from 20 to 100%, with a mean completion rate of 77.32% for all 12 sessions. Statistically significant interactions between group and time were found for the total PANSS [F (2, 94) = 12.51, p < 0.001] and both the Negative PANSS [F (2, 94) = 5.89, p < 0.01] and Positive PANSS [F (2, 94) = 6.65, p < 0.01] as well as the PSP [F (2, 94) = 3.34, p < 0.05], FBS [F (2, 94) = 5.10, p < 0.01], and Family APGAR index [F (2, 94) = 4.58, p < 0.01]. The results showed that the experimental group outperformed their counterparts in symptom management, personal social functioning, family care burden, and coherence. Conclusion: These results support the feasibility and efficacy of having laypeople deliver psychiatric rehabilitation services. A discussion and limitations of the study have been included.
Collapse
Affiliation(s)
- Ying Chen
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chow S Lam
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, United States
| | - Hong Deng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Eva Yau
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.,Departement of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Kam Ying Ko
- Hong Kong Youth Foundation, Hong Kong SAR, China
| |
Collapse
|
17
|
Peritogiannis V, Gioti P, Gogou A, Samakouri M. Decrease of hospitalizations and length of hospital stay in patients with schizophrenia spectrum disorders treated in a community mental health service in rural Greece. Int J Soc Psychiatry 2020; 66:693-699. [PMID: 32552161 DOI: 10.1177/0020764020924462] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The treatment of severe and chronic mental disorders, such as schizophrenia and related syndromes, is largely based on community mental health services. AIMS The objective of the present study was to assess hospital admissions and length of hospital stay in patients with schizophrenia and related disorders, who are engaged to treatment with a Mobile Mental Health Unit (MMHU I-T) in a defined rural catchment area in Greece. METHOD Data were retrieved retrospectively for 76 patients with schizophrenia and related disorders. For each patient, comparison was made for the same interval prior and after engagement to treatment with the MMHU I-T. RESULTS The average age of patients was 56 years and the mean illness duration was 28 years. The mean follow-up duration was 5.3 years. There was a statistically significant decrease in the annual average of the number of voluntary and involuntary hospitalizations and on days of hospital stay after treatment engagement with the MMHU I-T. CONCLUSIONS Treatment of schizophrenia spectrum disorders in rural residents by the MMHUs may contribute to the reduction of patients' admissions and length of hospital stay. Future research should address the cost-effectiveness of such interventions.
Collapse
Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Panagiota Gioti
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Afroditi Gogou
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Maria Samakouri
- Department of Psychiatry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| |
Collapse
|
18
|
Roos E, Bjerkeset O, Steinsbekk A. Health care utilization and cost after discharge from a mental health hospital; an RCT comparing community residential aftercare and treatment as usual. BMC Psychiatry 2018; 18:363. [PMID: 30419894 PMCID: PMC6233284 DOI: 10.1186/s12888-018-1941-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/24/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Community residential aftercare (step-down) services can ease the transition after a mental health hospital stay for patients with severe mental illness (SMI). AIMS To investigate use of community and specialised mental health care services and costs in patients with SMI the first 12 months after discharge from a mental health hospital (MHH), comparing community residential aftercare (CRA) and treatment as usual. METHODS An open parallel group randomised controlled trial with 41 participants. Data on use of specialist services (hospital, ambulant treatment and outpatient treatment) and community services (residential stays, home help, home care nursing, mental health consultation) were collected from specialist and community registers and health records. RESULTS For the primary outcome, utilisation of community mental health services, the intervention group used, on average, 29% fewer hours (mean differences - 21.6 h, 95% CI -93.1 to 44.9, p = .096) with a cost saving of 29% (mean differences - 1845 EUR, 95% CI -8267 to 4171, p = .102), but the estimates were imprecise. For the secondary outcome, the study groups had the same total number of inpatient days (66 days), but the intervention group had on average of 13.4 fewer inpatient days in the mental health hospital (95% CI -29.9 to 0.9. p = .008). The number of inpatient admissions (mean difference - 0.9 admissions, 95% CI -3.5 to 1.5, p = .224) and readmissions (- 0.8, 95% CI -2.5 to 0.9. p = .440) was lower in the intervention group. The intervention group had on average a total cost saving of 38.5% (mean differences - 23,071 EUR, 95% CI -45,450 to 3027. p = .057). A post hoc multivariable regression analysis controlling for baseline characteristics gave a reduction in total cost in favour of the intervention group of - 19,781 EUR (95% CI -44,072 to 4509, p=,107). CONCLUSION In this study, it was not possible to draw a definite conclusion about the effect, due to the small sample and imprecision of the estimates. The direction of the results and size of the point estimate, in addition to findings in other studies, indicates that transferring patients ready for discharge from mental hospital to community residential aftercare can have the potential to reduce total consumption of health services and costs without increased hospital admissions. TRIAL REGISTRATION Registered in clinicaltrials.gov ( NCT01719354 ).
Collapse
Affiliation(s)
- Eirik Roos
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491, Trondheim, Norway. .,Health and Welfare, Trondheim, Norway.
| | - Ottar Bjerkeset
- grid.465487.cFaculty of Nursing and Health Sciences, Nord University, Levanger, Norway ,0000 0001 1516 2393grid.5947.fDepartment of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Aslak Steinsbekk
- 0000 0001 1516 2393grid.5947.fDepartment of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| |
Collapse
|
19
|
Schmidt SJ, Lange M, Schöttle D, Karow A, Schimmelmann BG, Lambert M. Negative symptoms, anxiety, and depression as mechanisms of change of a 12-month trial of assertive community treatment as part of integrated care in patients with first- and multi-episode schizophrenia spectrum disorders (ACCESS I trial). Eur Arch Psychiatry Clin Neurosci 2018; 268:593-602. [PMID: 28540411 DOI: 10.1007/s00406-017-0810-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/17/2017] [Indexed: 02/06/2023]
Abstract
Assertive community treatment (ACT) has shown to be effective in improving both functional deficits and quality of life (QoL) in patients with severe mental illness. However, the mechanisms of this beneficial effect remained unclear. We examined mechanisms of change by testing potential mediators including two subdomains of negative symptoms, i.e. social amotivation as well as expressive negative symptoms, anxiety, and depression within a therapeutic ACT model (ACCESS I trial) in a sample of 120 first- and multi-episode patients with a schizophrenia spectrum disorder (DSM-IV). Path modelling served to test the postulated relationship between the respective treatment condition, i.e. 12-month ACT as part of integrated care versus standard care, and changes in functioning and QoL. The final path model resulted in 3 differential pathways that were all significant. Treatment-induced changes in social amotivation served as a starting point for all pathways, and had a direct beneficial effect on functioning and an additional indirect effect on it through changes in anxiety. Expressive negative symptoms were not related to functioning but served as a mediator between changes in social amotivation and depressive symptoms, which subsequently resulted in improvements in QoL. Our results suggest that social amotivation, expressive negative symptoms, depression, and anxiety functioned as mechanisms of change of ACCESS. An integrated and sequential treatment focusing on these mediators may optimise the generalisation effects on functioning as well as on QoL by targeting the most powerful mechanism of change that fits best to the individual patient.
Collapse
|
20
|
Lattanzi GM, Buzzanca A, Frascarelli M, Di Fabio F. Genetic and clinical features of social cognition in 22q11.2 deletion syndrome. J Neurosci Res 2018; 96:1631-1640. [DOI: 10.1002/jnr.24265] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 05/12/2018] [Accepted: 05/15/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Guido Maria Lattanzi
- Department of Human Neurosciences; Sapienza University; Rome 00185 Italy
- Department of Psychosis Studies; Institute of Psychiatry, Psychology and Neuroscience, King's College; London SE5 8AF United Kingdom
| | - Antonino Buzzanca
- Department of Human Neurosciences; Sapienza University; Rome 00185 Italy
| | | | - Fabio Di Fabio
- Department of Human Neurosciences; Sapienza University; Rome 00185 Italy
| |
Collapse
|
21
|
Li J, Huang YG, Ran MS, Fan Y, Chen W, Evans-Lacko S, Thornicroft G. Community-based comprehensive intervention for people with schizophrenia in Guangzhou, China: Effects on clinical symptoms, social functioning, internalized stigma and discrimination. Asian J Psychiatr 2018; 34:21-30. [PMID: 29627721 DOI: 10.1016/j.ajp.2018.04.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/24/2018] [Accepted: 04/01/2018] [Indexed: 02/04/2023]
Abstract
Comprehensive interventions including components of stigma and discrimination reduction in schizophrenia in low- and middle-income countries (LMICs) are lacking. We developed a community-based comprehensive intervention to evaluate its effects on clinical symptoms, social functioning, internalized stigma and discrimination among patients with schizophrenia. A randomized controlled trial including an intervention group (n = 169) and a control group (n = 158) was performed. The intervention group received comprehensive intervention (strategies against stigma and discrimination, psycho-education, social skills training and cognitive behavioral therapy) and the control group received face to face interview. Both lasted for nine months. Participants were measured at baseline, 6 months and 9 months using the Internalized Stigma of Mental Illness scale (ISMI), Discrimination and Stigma Scale (DISC-12), Global Assessment of Functioning (GAF), Schizophrenia Quality of Life Scale (SQLS), Self-Esteem Scale (SES), Brief Psychiatric Rating Scale (BPRS) and PANSS negative scale (PANSS-N). Insight and medication compliance were evaluated by senior psychiatrists. Data were analyzed by descriptive statistics, t-test, chi-square test or Fisher's exact test. Linear Mixed Models were used to show intervention effectiveness on scales. General Linear Mixed Models with multinomial logistic link function were used to assess the effectiveness on medication compliance and insight. We found a significant reduction on anticipated discrimination, BPRS and PANSS-N total scores, and an elevation on overcoming stigma and GAF in the intervention group after 9 months. These suggested the intervention may be effective in reducing anticipated discrimination, increasing skills overcoming stigma as well as improving clinical symptoms and social functioning in Chinese patients with schizophrenia.
Collapse
Affiliation(s)
- Jie Li
- Guangzhou Huiai Hospital, Guangzhou Medical University, Guangzhou, China.
| | - Yuan-Guang Huang
- Guangzhou Huiai Hospital, Guangzhou Medical University, Guangzhou, China.
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong.
| | - Yu Fan
- Guangzhou Huiai Hospital, Guangzhou Medical University, Guangzhou, China.
| | - Wen Chen
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Sun Yat-sen Center for Migrant Health Policy, Guangzhou, China.
| | - Sara Evans-Lacko
- Personal Social Services Research Unit, London School of Economics and Political Science, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| |
Collapse
|
22
|
Peritogiannis V, Manthopoulou T, Gogou A, Mavreas V. Mental Healthcare Delivery in Rural Greece: A 10-year Account of a Mobile Mental Health Unit. J Neurosci Rural Pract 2017; 8:556-561. [PMID: 29204014 PMCID: PMC5709877 DOI: 10.4103/jnrp.jnrp_142_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Patients living in rural and remote areas may have limited access to mental healthcare due to lack of facilities and socioeconomic reasons, and this is the case of rural areas in Eastern Europe countries. In Greece, community mental health service delivery in rural areas has been implemented through the development of the Mobile Mental Health Units (MMHUs). Methods: We present a 10-year account of the operation of the MMHU of the prefectures of Ioannina and Thesprotia (MMHU I-T) and report on the impact of the service on mental health delivery in the catchment area. The MMHU I-T is a multidisciplinary community mental health team which delivers services in rural and mountainous areas of Northwest Greece. Results: The MMHU I-T has become an integral part of the local primary care system and is well known to the population of the catchment area. By the end of 2016, the majority of patients (60%) were self-referred or family-referred, compared to 24% in the first 2 years. Currently, the number of active patients is 293 (mean age 63 years, 49.5% are older adults), and the mean caseload for each member of the team is 36.6. A significant proportion of patients (28%) receive care with regular domiciliary visits, and the provision of home-based care was correlated with the age of the patients. Within the first 2 years of operation of the MMHU I-T hospitalizations of treatment, engaged patients were reduced significantly by 30.4%, whereas the treatment engagement rates of patients with psychotic disorders were 67.2% in 5 years. Conclusions: The MMHU I-T and other similar units in Greece are a successful paradigm of a low-cost service which promotes mental health in rural, remote, and deprived areas. This model of care may be informative for clinical practice and health policy given the ongoing recession and health budget cuts. It suggests that rural mental healthcare may be effectively delivered by integrating generic community mental health mobile teams into the primary care system.
Collapse
Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Thiresia Manthopoulou
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Afroditi Gogou
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Venetsanos Mavreas
- Department of Psychiatry, School of Medicine, University of Ioannina, Ioannina, Greece
| |
Collapse
|
23
|
Kirschner M, Aleman A, Kaiser S. Secondary negative symptoms - A review of mechanisms, assessment and treatment. Schizophr Res 2017; 186:29-38. [PMID: 27230288 DOI: 10.1016/j.schres.2016.05.003] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 05/01/2016] [Accepted: 05/04/2016] [Indexed: 11/20/2022]
Abstract
Negative symptoms in schizophrenia may be classified as primary or secondary. Primary negative symptoms are thought to be intrinsic to schizophrenia, while secondary negative symptoms are caused by positive symptoms, depression, medication side-effects, social deprivation or substance abuse. Most of the research on secondary negative symptoms has aimed at ruling them out in order to isolate primary negative symptoms. However, secondary negative symptoms are common and can have a major impact on patient-relevant outcomes. Therefore, the assessment and treatment of secondary negative symptoms are clinically relevant. Furthermore, understanding the mechanisms underlying secondary negative symptoms can contribute to an integrated model of negative symptoms. In this review we provide an overview of concepts, evidence, assessment and treatment for the major causes of secondary negative symptoms. We also summarize neuroimaging research relevant to secondary negative symptoms. We emphasize the relevance of recent developments in psychopathological assessment of negative symptoms, such as the distinction between amotivation and diminished expression, which have only rarely been applied in research on secondary negative symptoms.
Collapse
Affiliation(s)
- Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland.
| | - André Aleman
- Neuro-imaging Center, University of Groningen, University Medical Center Groningen, the Netherlands; Department of Psychology, University of Groningen, Antonius Deusinglaan 2, 9713 AW Groningen, the Netherlands
| | - Stefan Kaiser
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Neuroscience Center Zurich, Zurich, Switzerland
| |
Collapse
|
24
|
Ito S, Goto A, Ishii K, Ota M, Yasumura S, Fujimori K. Fukushima Mothers’ Concerns and Associated Factors After the Fukushima Nuclear Power Plant Disaster. Asia Pac J Public Health 2017; 29:151S-160S. [DOI: 10.1177/1010539516684533] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This study aimed to clarify the frequency of and temporal changes in the content of mothers’ free written opinions obtained in the Fukushima Health Management Survey Pregnancy and Birth Survey from 2011 to 2013. A self-administered questionnaire was mailed to women who delivered babies in Fukushima Prefecture. The questionnaire asked about maternal and child health. Expression of mothers’ concerns about radiation decreased over time. Common to the top 5 codes across the 3 years were “radiation effect on fetus and infant” and “information provision including survey results.” Participants who wrote free opinions were significantly more likely to be aged ≥30 years and to have depressive symptoms. Our descriptive analysis of the qualitative data showed a clear shift in mothers’ concerns from radiation-related issues to their own physical and mental health. Mothers who expressed concerns were more likely to report negative physical and mental health.
Collapse
Affiliation(s)
- Shinya Ito
- Fukushima Medical University, Fukushima, Japan
| | - Aya Goto
- Fukushima Medical University, Fukushima, Japan
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan
| | - Kayoko Ishii
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan
| | - Misao Ota
- Fukushima Medical University, Fukushima, Japan
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan
| | | | - Keiya Fujimori
- Fukushima Medical University, Fukushima, Japan
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan
| | | |
Collapse
|
25
|
Abstract
Only one out of seven patients recovers after a first episode of psychosis despite psychiatric care. Rehabilitation interventions have been developed to improve functional outcomes and to promote recovery. We conducted a systematic review of the effectiveness of the main psychiatric rehabilitation interventions following a search of the electronic databases Pubmed, ScienceDirect, and Google Scholar using combinations of terms relating to cognitive remediation, psychoeducation, cognitive-behavioral therapies, and schizophrenia. Eighty articles relevant to the topic of interest were found. According to results, cognitive remediation has been found to be effective in reducing the impact of cognitive impairment, social skills in the learning a variety of skills and to a lesser extent in reducing negative symptoms, psychoeducation in improving compliance and reducing relapses, and cognitive therapy in reducing the intensity of or distress related to positive symptoms. All psychosocial rehabilitation interventions should be considered as evidence-based practices for schizophrenia and need to become a major part of the standard treatment of the disease.
Collapse
Affiliation(s)
- Laurent Morin
- Resource Center of Psychosocial Rehabilitation and Cognitive Remediation, Le Vinatier Hospital, Lyon, France.,Centre Hospitalier Le Vinatier, Lyon, France
| | - Nicolas Franck
- Resource Center of Psychosocial Rehabilitation and Cognitive Remediation, Le Vinatier Hospital, Lyon, France.,Centre Hospitalier Le Vinatier, Lyon, France.,UMR 5229 CNRS & Claude Bernard University, University of Lyon, Lyon, France
| |
Collapse
|
26
|
Lo TL, Warden M, He Y, Si T, Kalyanasundaram S, Thirunavukarasu M, Amir N, Hatim A, Bautista T, Lee C, Emsley R, Olivares J, Yang YK, Kongsakon R, Castle D. Recommendations for the optimal care of patients with recent-onset psychosis in the Asia-Pacific region. Asia Pac Psychiatry 2016; 8:154-71. [PMID: 27062665 PMCID: PMC4834614 DOI: 10.1111/appy.12234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 12/29/2015] [Indexed: 12/31/2022]
Abstract
Providing optimal care to patients with recent-onset psychosis can improve outcomes and reduce relapse. However, there is a lack of consistency of the implementation of guidelines for such patients across the Asia-Pacific region. We determined a pragmatic set of recommendations for use on a day-to-day basis to help provide optimal care at this crucial stage of illness. The recommendations were developed over a series of meetings by an international faculty of 15 experts from the Asia-Pacific region, Europe, and South Africa. A structured search of the PubMed database was conducted. This was further developed based on the faculty's clinical experience and knowledge of the literature into 10 key aspects of optimal care for patients during the first five years of a diagnosis of a psychotic disorder, with particular relevance to the Asia-Pacific region. Several common principles emerged: adherence to antipsychotic medications is crucial; substance abuse, psychiatric and medical comorbidities should be addressed; psychosocial interventions play a pivotal role; and family members can play a vital role in overall patient care. By following these recommendations, clinicians may improve outcomes for patients with recent-onset psychosis.
Collapse
Affiliation(s)
| | - Matthew Warden
- Hobart and Southern CMHTTasmanian Health Organisation – SouthTasmaniaAustralia
| | - Yanling He
- Department of Epidemiology Shanghai Mental Health CenterShanghai Jiao Tong UniversitySchool of MedicineShanghaiChina
| | - Tianmei Si
- Department of PsychopharmacologyPeking University Institute of Mental HealthPekingChina
| | | | | | - Nurmiati Amir
- Department of Psychiatry National General HospitalCiptomangunkusumo/Faculty of MedicineUniversity of IndonesiaJakartaIndonesia
| | - Ahmad Hatim
- Department of Psychological MedicineUniversity of MalayaKuala LumpurMalaya
| | - Tomas Bautista
- College of Medicine Philippine General HospitalUniversity of the PhilippinesManilaPhilippines
| | - Cheng Lee
- Department of Community PsychiatryInstitute of Mental HealthSingapore
| | - Robin Emsley
- Department of PsychiatryUniversity of StellenboschStellenboschSouth Africa
| | - Jose Olivares
- Department of PsychiatryComplejo Hospitalario Universitario de VigoVigoSpain
| | - Yen Kuang Yang
- Department of PsychiatryNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainan CityTaiwan
| | | | - David Castle
- Department of PsychiatrySt. Vincent's HospitalThe University of MelbourneMelbourneAustralia
| |
Collapse
|
27
|
Caqueo-Urízar A, Urzúa A, Jamett PR, Irarrazaval M. Objective and subjective burden in relatives of patients with schizophrenia and its influence on care relationships in Chile. Psychiatry Res 2016; 237:361-5. [PMID: 26809366 DOI: 10.1016/j.psychres.2016.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/04/2015] [Accepted: 01/07/2016] [Indexed: 01/28/2023]
Abstract
This study examined the burden on family members of patients with schizophrenia in a Chilean community. Sixty-five caregivers underwent the Subjective and Objective Family Burden Interview. The results showed moderate to high levels of subjective burden and low levels of support from others in providing care. Burden and containment of disturbed behaviour were correlated with worse relationships between patients and caregivers, with the latter spending less time working outside the home. The assessed sample showed a similar pattern of burden to that of caregivers from developed countries; however, the extent of the burden tended to be higher in Chilean caregivers.
Collapse
Affiliation(s)
| | - Alfonso Urzúa
- Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
| | | | - Matias Irarrazaval
- Departamento de Psiquiatría, Facultad de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile; Instituto Milenio para la Investigación en Depresión y Personalidad, Santiago, Chile
| |
Collapse
|