Tracking Needs-Based Community and Specialized Services of Young Adults and Their Parents Before and During a First Episode of Psychosis (FEP): Highlighting Intervention Trajectories in FEP

Aim

This article aims to document 10 service trajectories of young adults (YA) and their parents, informed by healthcare professionals (HP), before and during a first episode of psychosis (FEP).

Design

Based on a crisis model perspective of the Life Course Theory (Elder; Elder and Shanahan) developed by Carpentier and White, and adapted to the current context to track community and specialized services trajectories. Thematic analysis was used to code responses to open-ended questions around the need for help and accessing services by young adults affected by a psychotic disorder, and their parents.

Setting

In collaboration with FEP clinics, setting of choice by YA and their parents.

Participants

5 YA, 12 parents, and 6 HP.

Results

10 individual service trajectories grouped into 3 distinct types of trajectories (optimal, typical, and complex) based on grouping 5 similar characteristics, highlighting service access complexity and early intervention in FEP.

Conclusion

This study is the first of its kind to examine the experiences of those who seek needs-based community and specialized services leading up to and during a FEP. Findings provide key insights related to early intervention in FEP and recommendations on improving access to such services in Quebec.

[Sharing information and respecting confidentiality: Standards for improving the quality of mental health services]

Objectives Collaboration between family caregivers and professionals plays a critical role in the recovery of the person living with a mental health disorder. However, collaborative practices between family caregivers and professionals are impeded by issues relating to confidentiality, particularly in connection with bidirectional information sharing between the parties involved. In doing so, these issues affect the quality of mental health services. Method A qualitative study was conducted with 19 family caregivers and 19 mental health professionals from 2 Quebec regions[2] in order to identify issues related to information sharing and confidentiality from their combined perspective. The Photovoice method was used and individuals semi-directed interviews were conducted with the 38 participants. Results Confidentiality and the refusal of the person living with a mental health disorder to consent to share information remains important and current obstacles in mental health practises. The organization of mental health services should ensure better integration of family caregivers into care teams so that they can contribute to the person's recovery and thus receive all the support and information they need to exercise their role. This study shows that family caregivers have different information needs in order to carry out their role and accompany the person living with a mental health disorder, including the need for general and non-confidential information to better support the person. While respecting the fundamental rights and autonomy of the person, who is free to consent or not to sharing information concerning him or her, professionals and family caregivers can still interact and create an alliance that promotes collaboration and recovery. Conclusion This article offers benchmarks to facilitate dialogue among people living with a mental health disorder, family caregivers and professionals, and to support their actions around information-sharing and respect for confidentiality in mental health practises. Ultimately, the intention here is to foster collaborative practices that will help improve the quality of mental health services.

[Family-focused practices among adult mental health professionals: A portrait of the situation in Quebec]

Context Children living with a mentally ill parent are a vulnerable population, at higher risk of various psychosocial and mental health problems. They are overrepresented in youth mental health and child protection services. Adult mental health services that treat parents have the opportunity to identify and support children in these families. However, to date, there is still little knowledge on the extent of family-centered practices offered by professionals from different disciplinary fields in Quebec. Objective This study aims to document the family-focused practices of adult mental health professionals according to different disciplines (social work, nursing, psychoeducation, psychology, and special education). Method A total of 524 participants, from all regions of Quebec and working with adult mental health clients, responded to an online provincial survey. A subsample of 380 participants, members of a professional order or association, was retained for the present study. These come from five discipline: social work (n=127), nursing (n=99), psychoeducation (n=57), psychology (n=56) and special education (n=41) A MANCOVA analysis was performed to compare groups on the five subscales of the French version of the Family Focused Mental Health Practice (FFMHPQ-FR, Piché et al., in press), controlling for gender, years of experience working in mental health services and estimated proportion of clients with a parental role. Results Significant differences were found between social workers and psychologists in reported family-focused practices. Participants also reported very different levels of facilitating factors such as workplace support, openness to training, perceived knowledge and skills, and attitudes towards these practices. Discussion This study helps to increase knowledge on the use of family-focused practices by professionals from different disciplinary fields, in the context of adult mental health services in Quebec. The results allow to better support the adoption of such practices in mental health services.

[Psychosocial vulnerabilities of Quebec's rural populations during a pandemic]

INTRODUCTION

Psychosocial impacts of the coronavirus (COVID-19) pandemic, including those on mental health, are now recognized. However, the experience of the COVID-19 pandemic differs from one individual, group or context to another and solutions to cope with it must be adapted and contextualized.

AIM OF THE STUDY

This study aims to identify factors of psychosocial vulnerability in rural populations in Quebec (Canada).

METHOD

The approach is adapted from previous work on the prevention and reduction of the psychosocial impacts of climate change in non-metropolitan areas. A descriptive qualitative design based on several data sources was used. The data come from a press review, a review of the scientific literature, semi-structured interviews with key actors in the community and municipal domains.

RESULTS

Data triangulation and validation by community organization teams (public health department) identified forty-one (N = 41) factors (e.g., social cohesion, digital literacy) likely to increase or decrease the psychosocial vulnerability of rural populations in the context of a pandemic. These factors are grouped under six categories of determinants: 1) population's knowledge and attitudes towards the pandemic, 2) previous experience of difficult events, 3) community dynamism, social cohesion and solidarity, 4) citizens, municipalities and government authorities' involvement, 5) health and social services and those from their intersectoral partners, and 6) land use planning.

CONCLUSION

These results are useful for local and regional public health teams in developing local portraits of psychosocial vulnerabilities to support plans to strengthen community resilience and reduce social and health inequalities accentuated by the pandemic.

[Family Approaches in Early Intervention: Benchmarks to Guide Intervention and Support Families in First Episode Psychosis Programs (FEPP)]

There is now broad consensus on the usefulness of family approaches in early intervention programs. The evolution of knowledge about early psychosis and the development of family interventions have greatly influenced the perception of families in the recovery process. Objectives This article proposes a state of knowledge of family intervention practices by looking at family involvement in early intervention. Knowledge from the family journey constitutes the historical basis of the article, while more recent knowledge about psychotic disorders and family intervention form the basis of the article's content. The objectives are to: 1) document the specific impacts and needs of families during a first episode of psychosis (FEP); 2) review the main approaches in family intervention; 3) guide the application of family interventions in FEP programs and 4) raise issues related to family involvement in early intervention. Method Historical knowledge on the development of family intervention approaches in mental health was documented from the work of pioneers in the field of family intervention, while the state of current practices has been the subject of a literature review (intervention models and approaches, effectiveness of interventions, issues of intervention and family involvement, etc.). Results from recent studies conducted in Quebec and elsewhere provide an overview of intervention methods and the contribution of families in early intervention teams. Issues related to the establishment of collaborative practices, information sharing and respect for confidentiality in mental health are addressed. Results Knowledge from the literature review and recent research is highlighted in relation to the First Episode Psychosis Intervention Programs Framework (Cadre PPEP, 2018) and the Mental Health Action Plan measures (PASM 2015-2020), as well as to international best practice guidelines for early intervention. They identify what has been achieved as well as ways to move forward in order to continue developing family intervention practices in Quebec. Conclusion Recognition of the essential role of families and their involvement in early intervention presents challenges. While family interventions have demonstrated their effectiveness, both for the person with the disorder and for their family, actions must be taken to support the implementation of these practices and ensure their sustainability in early intervention teams.

Centrally mediated cardiovascular effects of nicergoline in the dog compared to those of clonidine

The intracisternal administration of nicergoline (5 micrograms/kg) or clonidine (4 micrograms/kg) in chloralose-anesthetized dogs induced significant decreases in blood pressure and heart rate. The same dose of nicergoline induced similar effects on atropine-pretreated dogs. Guanethidine pretreatment (30 mg/kg i.v. the day before) prevented the hypotension but not the bradycardia induced by clonidine. Guanethidine prevented both the hypotension and the bradycardia induced by nicergoline. Thus, nicergoline, unlike clonidine, does not increase cardiac parasympathetic activity. When administered by the same route at the same doses, nicergoline did not change the slope and reduced the amplitude whereas clonidine increased both the slope and the amplitude of the heart period vs. blood pressure curve obtained by intravenous administration of phenylephrine. Taken together, these results suggest that nicergoline and clonidine probably act on different structures within the central nervous system.