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1.
PLoS One ; 19(4): e0300521, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38558082

RESUMO

Calls to leverage routinely collected data to inform health system improvements have been made. Misalignment between home care services and client needs can result in poor client, caregiver, and system outcomes. To inform development of an integrated model of community-based home care, grounded in a holistic definition of health, comprehensive clinical profiles were created using Ontario, Canada home care assessment data. Retrospective, cross-sectional analyses of 2017-2018 Resident Assessment Instrument Home Care (RAI-HC) assessments (n = 162,523) were completed to group home care clients by service needs and generate comprehensive profiles of each group's dominant medical, functional, cognitive, and psychosocial care needs. Six unique groups were identified, with care profiles representing home care clients living with Geriatric Syndromes, Medical Complexity, Cognitive Impairment and Behaviours, Caregiver Distress and Social Frailty. Depending on group membership, between 51% and 81% of clients had identified care needs spanning four or more Positive Health dimensions, demonstrating both the heterogeneity and complexity of clients served by home care. Comprehensive clinical profiles, developed from routinely collected assessment data, support a future-focused, evidence-informed, and community-engaged approach to research and practice in integrated home-based health and social care.


Assuntos
Serviços de Assistência Domiciliar , Reabilitação Psiquiátrica , Adulto , Humanos , Idoso , Ontário , Estudos Retrospectivos , Estudos Transversais , Participação da Comunidade , Participação dos Interessados , Cognição
2.
Cien Saude Colet ; 29(2): e19932022, 2024 Feb.
Artigo em Português, Inglês | MEDLINE | ID: mdl-38324843

RESUMO

This study evaluated factors associated with hospitalization related to the mental health of people undergoing follow-up in Psychosocial Care Centers (CAPS, in Portuguese) in the city of São Paulo, Brazil, referred from Primary Health Care (PHC). This was an evaluative study conducted with 297 individuals in 24 adult CAPS. This study analyzed the prevalence ratios (PR) and their respective 95% confidence intervals (95% CI), obtained through Poisson Regression with robust variance. A statistically significant association was found with hospitalization during follow-ups in CAPS: having health insurance and/or medical plan; waiting time between the diagnosis and the first consultation with a non-medical professional of more than seven days; not having received medical advice regarding how long to use medication; not having received a psychopharmaceutical prescription at PHC; and having a medical history of the hospitalization due to mental health. The results warn of the need to expand access to the more socially vulnerable population, in addition to a restructuring of the services in order to provide more interactive and inclusive practices geared toward the singularities of the users.


Avaliaram-se os fatores associados à internação relacionadas à saúde mental de pessoas em acompanhamento nos Centros de Atenção Psicossocial (CAPS) do município de São Paulo, encaminhadas pela atenção primária (APS). Pesquisa avaliativa com 297 pessoas em 24 CAPS Adulto. Analisaram-se as razões de prevalência (RP) e seus respectivos intervalos de confiança de 95% (IC), obtidas por meio da regressão de Poisson com variância robusta. Mostraram associação estatisticamente significativa com a internação durante o acompanhamento no CAPS: ter plano de saúde/convênio médico; tempo de espera entre diagnóstico e primeiro atendimento com profissional não médico maior que sete dias; não ter sido orientado sobre o tempo de uso da medicação; não receber prescrição de psicofármaco na APS; e ter histórico de ocorrência de internação por saúde mental. Os resultados alertam para a necessidade de ampliação do acesso à população com maior vulnerabilidade social, além de uma reestruturação dos serviços para a oferta de prática mais articuladas e inclusivas, voltadas às singularidades dos usuários.


Assuntos
Reabilitação Psiquiátrica , Humanos , Adulto , Brasil/epidemiologia , Seguimentos , Hospitalização , Atenção Primária à Saúde
3.
BMC Psychiatry ; 24(1): 104, 2024 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-38321443

RESUMO

BACKGROUND: Mental health rehabilitation services provide specialist treatment to people with particularly severe and complex problems. In 2018, the Care Quality Commission reported that over half the 4,400 mental health inpatient rehabilitation beds in England were provided by the independent sector. They raised concerns that the length of stay and cost of independent sector care was double that of the NHS and that their services tended to be provided much further from people's homes. However, there has been no research comparing the two sectors and we therefore do not know if these concerns are justified. The ACER Study (Assessing the Clinical and cost-Effectiveness of inpatient mental health Rehabilitation services provided by the NHS and independent sector) is a national programme of research in England, funded from 2021 to 2026, that aims to investigate differences in inpatient mental health rehabilitation provided by the NHS and independent sector in terms of: patient characteristics; service quality; patient, carer and staff experiences; clinical and cost effectiveness. METHODS: ACER comprises a:1) detailed survey of NHS and independent sector inpatient mental health rehabilitation services across England; 2) qualitative investigation of patient, family, staff and commissioners' experiences of the two sectors; 3) cohort study comparing clinical outcomes in the two sectors over 18 months; 4) comprehensive national comparison of inpatient service use in the two sectors, using instrumental variable analysis of routinely collected healthcare data over 18 months; 5) health economic evaluation of the relative cost-effectiveness of the two sectors. In Components 3 and 4, our primary outcome is 'successful rehabilitation' defined as a) being discharged from the inpatient rehabilitation unit without readmission and b) inpatient service use over the 18 months. DISCUSSION: The ACER study will deliver the first empirical comparison of the clinical and cost-effectiveness of NHS and independent sector inpatient mental health rehabilitation services. TRIAL REGISTRATION: ISRCTN17381762 retrospectively registered.


Assuntos
Reabilitação Psiquiátrica , Humanos , Medicina Estatal , Estudos de Coortes , Análise de Custo-Efetividade , Análise Custo-Benefício , Pacientes Internados
4.
BMJ ; 384: e076506, 2024 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-38325873

RESUMO

OBJECTIVE: To evaluate whether a structured online supervised group physical and mental health rehabilitation programme can improve health related quality of life compared with usual care in adults with post-covid-19 condition (long covid). DESIGN: Pragmatic, multicentre, parallel group, superiority randomised controlled trial. SETTING: England and Wales, with home based interventions delivered remotely online from a single trial hub. PARTICIPANTS: 585 adults (26-86 years) discharged from NHS hospitals at least three months previously after covid-19 and with ongoing physical and/or mental health sequelae (post-covid-19 condition), randomised (1:1.03) to receive the Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN) intervention (n=298) or usual care (n=287). INTERVENTIONS: Best practice usual care was a single online session of advice and support with a trained practitioner. The REGAIN intervention was delivered online over eight weeks and consisted of weekly home based, live, supervised, group exercise and psychological support sessions. MAIN OUTCOME MEASURES: The primary outcome was health related quality of life using the patient reported outcomes measurement information system (PROMIS) preference (PROPr) score at three months. Secondary outcomes, measured at three, six, and 12 months, included PROMIS subscores (depression, fatigue, sleep disturbance, pain interference, physical function, social roles/activities, and cognitive function), severity of post-traumatic stress disorder, general health, and adverse events. RESULTS: Between January 2021 and July 2022, 39 697 people were invited to take part in the study and 725 were contacted and eligible. 585 participants were randomised. Mean age was 56 (standard deviation (SD) 12) years, 52% were female participants, mean health related quality of life PROMIS-PROPr score was 0.20 (SD 0.17), and mean time from hospital discharge was 323 (SD 144) days. Compared with usual care, the REGAIN intervention led to improvements in health related quality of life (adjusted mean difference in PROPr score 0.03 (95% confidence interval 0.01 to 0.05), P=0.02) at three months, driven predominantly by greater improvements in the PROMIS subscores for depression (1.39 (0.06 to 2.71), P=0.04), fatigue (2.50 (1.19 to 3.81), P<0.001), and pain interference (1.80 (0.50 to 3.11), P=0.01). Effects were sustained at 12 months (0.03 (0.01 to 0.06), P=0.02). Of 21 serious adverse events, only one was possibly related to the REGAIN intervention. In the intervention group, 141 (47%) participants fully adhered to the programme, 117 (39%) partially adhered, and 40 (13%) did not receive the intervention. CONCLUSIONS: In adults with post-covid-19 condition, an online, home based, supervised, group physical and mental health rehabilitation programme was clinically effective at improving health related quality of life at three and 12 months compared with usual care. TRIAL REGISTRATION: ISRCTN registry ISRCTN11466448.


Assuntos
COVID-19 , Reabilitação Psiquiátrica , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Custo-Benefício , Dor , Síndrome Pós-COVID-19 Aguda , Qualidade de Vida , Resultado do Tratamento
5.
Curr Opin Psychiatry ; 37(3): 131-139, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38410981

RESUMO

PURPOSE OF REVIEW: Schizophrenia Spectrum Disorders (SSD) are severe conditions that frequently produce significant impairment in cognitive performance, social skills and psychosocial functioning. As pharmacological treatment alone often provides only limited improvements on these outcomes, several psychosocial interventions are employed in psychiatric rehabilitation practice to improve of real-world outcomes of people living with SSD: the present review aims to provide a critical overview of these treatments, focusing on those that show consistent evidence of effectiveness. RECENT FINDINGS: Several recent systematic reviews and meta-analyses have investigated in detail the acceptability, the effectiveness on several specific outcomes and moderators of response of different psychosocial interventions, and several individual studies have provided novel insight on their implementation and combination in rehabilitation practice. SUMMARY: Cognitive remediation, metacognitive training, social skills training, psychoeducation, family interventions, cognitive behavioral therapy, physical exercise and lifestyle interventions, supported employment and some other interventions can be fully considered as evidence-based treatments in SSD. Psychosocial interventions could be of particular usefulness in the context of early intervention services. Future research should focus on developing newer interventions, on better understanding the barriers and the facilitators of their implementation in clinical practice, and exploring the opportunities provided by novel technologies.


Assuntos
Terapia Cognitivo-Comportamental , Remediação Cognitiva , Reabilitação Psiquiátrica , Esquizofrenia , Humanos , Esquizofrenia/reabilitação , Intervenção Psicossocial
6.
Eur J Psychotraumatol ; 15(1): 2300586, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38197257

RESUMO

Introduction: The early post-trauma period is a key time to provide psychological support to acutely injured children. This is often when they present to emergency departments (EDs) with their families. However, there is limited understanding of the feasibility of implementing psychological support for children and their families in EDs. The aim of this study was to explore UK and Irish ED clinicians' perspectives on developing and implementing psychosocial care which educates families on their children's post-trauma psychological recovery.Methods: Semi-structured individual and group interviews were conducted with 24 UK and Irish ED clinicians recruited via a paediatric emergency research network.Results: Clinicians expressed that there is value in offering psychological support for injured children and their families; however, there are barriers which can prevent this from being effectively implemented. Namely, the prioritisation of physical health, time constraints, understaffing, and a lack of training. Therefore, a potential intervention would need to be brief and accessible, and all staff should be empowered to deliver it to all families.Conclusion: Overall, participants' views are consistent with trauma-informed approaches where a psychosocial intervention should be able to be implemented into the existing ED system and culture. These findings can inform implementation strategies and intervention development to facilitate the development and delivery of an accessible digital intervention for acutely injured children and their families.


The emergency department provides an opportunity for early trauma-informed care for acutely injured children and their families.Addressing psychological distress in emergency care for acutely injured children and their families should adopt a universal trauma-informed approach.The development of a paediatric trauma-informed intervention should consider barriers which can impact implementation into emergency care. Particular barriers highlighted by clinicians include staff shortages, time constraints, and high caseloads.


Assuntos
Reabilitação Psiquiátrica , Humanos , Criança , Pesquisa Qualitativa , Serviço Hospitalar de Emergência , Intervenção Psicossocial , 60710
7.
Endocrinol Metab Clin North Am ; 53(1): 107-122, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38272590

RESUMO

The intensive demands of diabetes care can be difficult for youth with type 1 diabetes and their families to integrate into daily life. Standards of care in pediatric diabetes highlight the importance of evidence-based psychosocial interventions to optimize self-management behaviors and psychological well-being. The current review summarizes select systematic reviews and meta-analyses on evidence-based behavioral health interventions in pediatric diabetes. Interventions include strategies to strengthen youth psychosocial skills, improve family dynamics and caregiver mental health, enhance health and mental health equity, and address psychosocial factors related to diabetes technology use.


Assuntos
Diabetes Mellitus Tipo 1 , Reabilitação Psiquiátrica , Autogestão , Humanos , Criança , Adolescente , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 1/psicologia , Terapia Comportamental
9.
Altern Ther Health Med ; 30(1): 332-338, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37820660

RESUMO

Objective: To explore the effect of Naikan mindfulness therapy on psychiatric rehabilitation for chronic schizophrenia. Methods: 100 chronic schizophrenic patients in a third-class psychiatric hospital from July 2020 to August 2021 were selected as the research object. The following criteria were adopted: a clinician clearly diagnosed chronic schizophrenia, the patient was between 18 and 65 years old, and the patient agreed to participate in the study and signed an informed consent form.The random mathematical table method divided them into the control group (50 cases treated with Naikan therapy) and the experimental group (50 cases treated with Naikan mindfulness therapy). The LSIA(Life Satisfaction Index in Schizophrenia) score, SSFPI (Social Satisfaction and Functioning in Patients with Schizophrenia)score and satisfaction of psychiatric rehabilitation nursing were compared between the two groups. Result: In terms of LSIA score, there was no significant difference in baseline score between the two groups (P > .05). At 6 and 12 weeks after the intervention, the scores of the two groups increased, but the scores of the experimental group at 6 and 12 weeks after the intervention were higher than those of the control group, the difference was statistically significant (P < .05). In terms of SSFPI score, there was no significant difference in baseline score between the two groups (P < .05); At 6 and 12 weeks after the intervention, the scores of the two groups increased, but the scores of the experimental group at 6 and 12 weeks after the intervention were higher than those of the control group, the difference was statistically significant (P < .05). In terms of satisfaction with psychiatric rehabilitation nursing, there was no significant difference between the experimental group and the control group 6 weeks after intervention (P > .05); 12 weeks after the intervention, the satisfaction scores of the two groups increased significantly, and the scores of the experimental group were significantly higher than those of the control group (P < .05). Naikan mindfulness therapy led to significant improvements in LSIA scores, SSFPI scores, and satisfaction with psychiatric rehabilitation nursing at both 6 and 12 weeks. Conclusion: The life satisfaction, social function, and the satisfaction of psychiatric rehabilitation nursing of the chronic schizophrenics can be improved by the combination of Naikan mindfulness therapy. This study found that by using Naikan therapy, we can improve life satisfaction, social functioning, and satisfaction with psychiatric rehabilitation care in patients with chronic schizophrenia. This has important practical implications for patient treatment and care, including improving quality of life, enhancing social integration, improving rehabilitation outcomes, and reducing the burden on medical staff. This research provides a useful method for comprehensive care of patients with schizophrenia and is expected to have a positive impact on improving patients' lives and recovery in the future.


Assuntos
Atenção Plena , Reabilitação Psiquiátrica , Esquizofrenia , Adolescente , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Qualidade de Vida , Esquizofrenia/terapia , Resultado do Tratamento
10.
Nord J Psychiatry ; 78(1): 54-63, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37815430

RESUMO

PURPOSE: Psychiatric disorders may have a negative effect on individuals' living, forming intimate relationships, education, and employment. The aim of psychiatric rehabilitation is to promote recovery - finding ways to cope with mental disorders despite debilitating symptoms. This study aimed to explore the outcomes of accommodation, social inclusion, psychiatric symptoms, substance and service use, quality of life and subjective recovery of young adults with severe mental illness after psychiatric rehabilitation. MATERIALS AND METHODS: The study population consisted of individuals who had been in residential psychiatric rehabilitation between the ages of 18-29 years. Data on outcomes were collected using a questionnaire after a flexible follow-up period (mean 29 months). The questionnaire was answered by 32 eligible persons. We analysed multiple outcomes and compared the proportion of persons living independently at the start, after psychiatric rehabilitation, and at the follow-up point. RESULTS: At the start of the rehabilitation, 33%, at the end, 69%, and at follow-up, 78% lived independently. However, most had not reached competitive employment nor were studying. Cognitive symptoms were the most common psychiatric symptoms, followed by depressive symptoms. More than 80% of the sample felt that they had partly recovered from their severe mental illness. CONCLUSION: According to the results of this study residential psychiatric rehabilitation may have positive effects on functioning and independent living at follow-up. Reaching competitive employment is difficult for persons with severe mental disorders and effective rehabilitation interventions need to be implemented. However, this study had limitations, and these results should be considered preliminary.


Assuntos
Transtornos Mentais , Reabilitação Psiquiátrica , Adulto Jovem , Humanos , Adolescente , Adulto , Qualidade de Vida , Transtornos Mentais/psicologia , Emprego
11.
Encephale ; 50(1): 91-98, 2024 Feb.
Artigo em Francês | MEDLINE | ID: mdl-37718195

RESUMO

OBJECTIVES: Addictive behaviors constitute complex behaviors that are usually related to social habits, such as substance use, gambling or gaming activities, or sexual or physical activity. They progressively overrun and stifle the routine habits of the concerned individuals, for example within their occupational or family spheres of life, as well as in their hobbies or in their main physiological functions, such as sleep or eating cycles. The rehabilitation approach of care integrates the objective of restoring the altered habits and functional rhythms, to optimize the clinical outcomes and improve quality of life of the concerned persons. METHODS: Using a focused and narrative literature review, we aimed to explain what psychosocial rehabilitation consists in, and why this approach is particularly relevant for the addiction care, although to date it has remained insufficiently developed in the routine practice of many facilities. RESULTS: The "rehab" approach, is first based on a structured and comprehensive assessment of the clinical and functional aspects of the patient, which secondarily allows to frame an individualized project of care that is closely built together with the patient. This project of care can integrate classical pharmacotherapeutic and psychotherapeutic tools, but it also emphasizes wider approaches for restoring some basic social and physiological functions of the concerned person, such as sleep, eating, social functioning, physical activity, or spiritual needs. Priorities among these different dimensions have to be defined by the concerned person. CONCLUSIONS: The "rehab" approach is particularly relevant in addiction medicine. It represents a more global conception of care that conceives the recovery of social and physiological functioning as a core treatment objective for the concerned persons. The consequences for care organization are that many additional professionals should be integrated into the treatment schemes for addiction, including peer counselors, occupational therapists, physical activity coaches, or dieticians.


Assuntos
Medicina do Vício , Comportamento Aditivo , Reabilitação Psiquiátrica , Transtornos Relacionados ao Uso de Substâncias , Humanos , Qualidade de Vida , Transtornos Relacionados ao Uso de Substâncias/psicologia
12.
Clin Rehabil ; 38(2): 263-284, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37933440

RESUMO

OBJECTIVE: Stroke has a major impact on a person's life. While much research exists on stroke prevention and treatment, explorations into psychosocial recovery needs are lacking. This review critically consolidates the challenges and needs of stroke survivors and develops a trajectory that encapsulates their journey from illness to recovery. DATA SOURCES: Six major databases were searched, including Academic Search Premier, CINAHL, Global Health, Medline, PsycArticles, and PsycINFO. METHODS: This review adhered to the PRISMA guidelines and employed the PICo (population, phenomena of interest, context) framework to screen for relevant qualitative reviews published between 1 January 2010 and 31 August 2023. Following full-text screening and the assessment of methodological quality using a modified version of the Assessment of Multiple Systematic Reviews scale, a total of 17 reviews were included for thematic synthesis. RESULTS: Included reviews referenced 400 qualitative primary studies involving more than 5623 stroke survivors. Data synthesis revealed 18 themes that were further organized into six conceptual categories: (1) The unfamiliar body, (2) compassionate healthcare system, (3) holistic rehabilitation, (4) intrapersonal strength, (5) interpersonal relations, and (6) thriving forward to form the psychosocial rehabilitation trajectory of stroke survivor (PReTS) model. The model recognizes the losses that can occur after a stroke and emphasizes the essentiality of addressing psycho-socio-emotional and spiritual needs alongside physical impairments. CONCLUSION: The PReTS model is the first to highlight stroke survivors' losses, recovery journeys, and psychosocial needs. The conceptualization serves to inform and advance stroke rehabilitation practices with holistic and wellness recovery research.


Assuntos
Reabilitação Psiquiátrica , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Revisões Sistemáticas como Assunto , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/psicologia , Pesquisa Qualitativa , Sobreviventes/psicologia
13.
Diabetes Care ; 47(1): 17-25, 2024 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-38117989

RESUMO

Psychological factors and psychosocial care for individuals with diabetic neuropathy (DN), a common and burdensome complication of diabetes, are important but overlooked areas. In this article we focus on common clinical manifestations of DN, unremitting neuropathic pain, postural instability, and foot complications, and their psychosocial impact, including depression, anxiety, poor sleep quality, and specific problems such as fear of falling and fear of amputation. We also summarize the evidence regarding the negative impact of psychological factors such as depression on DN, self-care tasks, and future health outcomes. The clinical problem of underdetection and undertreatment of psychological problems is described, together with the value of using brief assessments of these in clinical care. We conclude by discussing trial evidence regarding the effectiveness of current pharmacological and nonpharmacological approaches and also future directions for developing and testing new psychological treatments for DN and its clinical manifestations.


Assuntos
Diabetes Mellitus , Neuropatias Diabéticas , Reabilitação Psiquiátrica , Humanos , Neuropatias Diabéticas/diagnóstico , Acidentes por Quedas , Medo , Ansiedade/psicologia
14.
Rev Bras Enferm ; 76(6): e20230124, 2023.
Artigo em Inglês, Português | MEDLINE | ID: mdl-38055494

RESUMO

OBJECTIVE: to analyze the meaning attributed to nurses' role in mental health care in Child and Adolescent Psychosocial Care Centers. METHODS: qualitative research, anchored in the paradigm of complexity. Data collection was carried out through online semi-structured interviews with ten nurses from São Paulo, between March and September 2022, being analyzed thematically. RESULTS: the diversity and specificity of a child and adolescent mental health clinic, with the need for expanded, territorial and intersectoral care, were unveiled in addition to a fragmented training in the area. There was a need for a deconstruction of being a nurse to make it possible to produce more inclusive and salutogenic practices. FINAL CONSIDERATIONS: the need for training nurses with adequate knowledge and skills to care for the mental health of children, adolescents and their families is reinforced as well as permanent education of working teams.


Assuntos
Enfermeiras e Enfermeiros , Reabilitação Psiquiátrica , Criança , Humanos , Adolescente , Papel do Profissional de Enfermagem , Brasil , Saúde Mental , Pesquisa Qualitativa
15.
Anasthesiol Intensivmed Notfallmed Schmerzther ; 58(11-12): 666-674, 2023 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-38056446

RESUMO

The improvement of intensive care treatment options leads to an increasing number of patients being treated in this setting. For the majority of those affected and their relatives, this treatment is associated with tremendous stress, but also subsequent physical, psychological and cognitive impairments, the post-intensive care syndrome. The aim of psychosocial support in the intensive care unit is to stabilise and minimise the acute stress. This is done through care services oriented towards trauma therapy interventions and emergency psychology. Equally central are the needs of the patient's relatives and ways to stabilise and relieve them. The third pillar of psychosocial work in the intensive care unit is the support of the treatment team. Finally, an outlook is given for the specialised aftercare of these complex patients in PICS outpatient clinics.


Assuntos
Reabilitação Psiquiátrica , Humanos , Unidades de Terapia Intensiva , Cuidados Críticos , Estado Terminal/psicologia , Estado Terminal/terapia
16.
Australas Psychiatry ; 31(6): 791-794, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37907834

RESUMO

OBJECTIVE: This paper outlines the evolution of mental health rehabilitation in NSW, where allocation of health resources has repeatedly contradicted the policy intention to reorient services from inpatient to community-based services, leaving community rehabilitation the poor and disconnected cousin of inpatient services. The expanding role of community-managed organisations (CMOs) in psychosocial rehabilitation, the introduction of the National Disability Insurance Scheme (NDIS), and emerging service models have helped foster a maturing housing and social care environment, but present reality and the integration of health and social care services remains at a distance from best evidence practice. CONCLUSION: The challenge of the next decade of mental health reform is to embrace and consolidate greater service diversity and complexity. Understanding what factors influenced present reality is important in providing guardrails for the future, enabling the current wave of renewal and reinvestment in NSW to build on the strengths of past developments and steer a course around their weaknesses.


Assuntos
Serviços Comunitários de Saúde Mental , Seguro por Invalidez , Transtornos Mentais , Reabilitação Psiquiátrica , Humanos , Reforma dos Serviços de Saúde , Saúde Mental , Transtornos Mentais/reabilitação
17.
Scand J Trauma Resusc Emerg Med ; 31(1): 77, 2023 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-37946286

RESUMO

BACKGROUND: Caring for people who are ill or injured in pre-hospital environments is emotionally draining and physically demanding. This article focuses on the Psychosocial and Mental Health Programme commissioned by the Faculty of Pre-Hospital Care (FPHC) at the Royal College of Surgeons of Edinburgh (RCSEd) in 2018 to investigate the experiences and needs of responders to pre-hospital emergencies and make recommendations. It summarises the report to FPHC published in 2022, and adds material from research published subsequently. METHOD: FPHC appointed a team to undertake the work. Team members conducted a literature review, and a systematic review of the literature concerning the impacts on the mental health of pre-hospital practitioners. They conducted fieldwork, participated in training and had conversations with trainees and established practitioners, and took evidence from the Pre-hospital Emergency Medicine Trainees Association (PHEMTA). RESULTS: The Results summarise the evidence-based theoretical background derived from the programme and practical guidance for practitioners, professional organisations, and employers who deliver pre-hospital care on the implications of, preventing and intervening with pre-hospital providers who experience psychosocial and mental health problems. CONCLUSION: This paper summarises the outputs from a multidisciplinary programme of scholarship, research, and fieldwork. The authors condense the findings and the guidance developed by the Programme Team to provide a summary of the report and guidance on implementation. They believe that the recommendations are applicable to all healthcare organisations and particularly those that employ responders to emergencies and provide pre-hospital care.


Assuntos
Emergências , Reabilitação Psiquiátrica , Humanos , Atenção à Saúde , Hospitais , Saúde Mental
18.
Psychiatr Rehabil J ; 46(4): 368-372, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37956063

RESUMO

OBJECTIVE: Severe loneliness infrequently occurs in the general population but has very significant impacts on health and quality of life. This study examined the extent to which severe loneliness is experienced by adults with serious mental illnesses (SMIs) relative to adults in the general population and its possible implications for psychiatric rehabilitation services. METHOD: Data were gathered from samples of individuals with SMI (N = 231) and a general community sample of adults (N = 300) using the University of California, Los Angeles Loneliness Scale. RESULTS: The results indicate that loneliness was much greater among those with SMI than the general adult population sample (Cohen's d = 1.220) and approximately 41% of the participants with SMI were "severely lonely" versus 7.3% of the non-SMI adult sample. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Severe loneliness is extremely common among individuals with SMI. Psychiatric rehabilitation services that focus on socialization and mattering are needed to address this significant public health issue. (PsycInfo Database Record (c) 2024 APA, all rights reserved).


Assuntos
Transtornos Mentais , Reabilitação Psiquiátrica , Adulto , Humanos , Solidão/psicologia , Transtornos Mentais/reabilitação , Qualidade de Vida , Los Angeles
20.
Artigo em Russo | MEDLINE | ID: mdl-37994892

RESUMO

OBJECTIVE: To analyze the socio-demographic, clinical and psychological characteristics of patients with residual schizophrenia, to identify variants of residual states and to determine measures for psychosocial rehabilitation on this basis. MATERIAL AND METHODS: At the time of investigation, 91 patients with the diagnosis of residual schizophrenia (F20.5xx according to ICD-10) were under dispensary supervision in the psychoneurological dispensary No. 18 of Moscow. A study of the medical records of all these patients was carried out. Twenty-three patients consented to face-to-face examination. The Positive and negative syndrome scale (PANSS), the Symptom Checklist-90-Revised (SCL-90-R), the Brief Assessment of Cognitive Functions in Schizophrenia (BACS) and the author's questionnaire concerning the opinion of psychiatrists on the clinical and social characteristics of patients with residual schizophrenia were used. Mathematical and statistical methods implemented in the STATISTICA 12.1 software and the Excel office suite were used. The method of stochastic nesting of neighbors («T-distributed Stochastic Neighbor Embedding¼, t-SNE) implemented in the Python program to cluster cases and identify variants of residual states was used. RESULTS: The patients with residual schizophrenia belonged to the cohort of elderly patients (mean age 66.3±13.28 years) with a predominance of females (62.22%). At the time of examination, the course of the schizophrenic process had a negative impact on the social life and professional activities of patients, which led to disability of 74.72% patients and 91.55% of them had disability due to a mental disorder. The analysis showed that patients with residual schizophrenia was a heterogeneous group with a predominant presence of negative symptoms in the clinical picture (the composite score on the PANSS negative subscale was17.79±6.67). Three variants of residual states were identified using clustering by the t-SNE method of individual PANSS indicators. Deficiency symptoms with features of pseudoorganic syndrome prevailed in the first variant. In the second variant, patients had mild positive symptoms, mainly in the form of paranoia and residual delirium, as well as a psychopathic syndrome. The third, small group, included patients with the most favorable variant of remission, having a fairly high level of social adaptation, mainly with personality changes. CONCLUSION: The obtained data were correlated with the results of a psychological examination. It was revealed that patients with residual schizophrenia were not sufficiently included in the process of psychosocial treatment and rehabilitation. Taking into account the identified variants of residual states, the directions of possible psychosocial interventions were determined.


Assuntos
Reabilitação Psiquiátrica , Transtornos Psicóticos , Esquizofrenia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Masculino , Análise por Conglomerados , Demografia
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