Barriers and facilitators to mental health treatment access and engagement for LGBTQA+ people with psychosis: a scoping review protocol.

BACKGROUND: The prevalence of psychosis has been shown to be disproportionately high amongst sexual and gender minority individuals. However, there is currently little consideration of the unique needs of this population in mental health treatment, with LGBTQA+ individuals facing barriers in accessing timely and non-stigmatising support for psychotic experiences. This issue deserves attention as delays to help-seeking and poor engagement with treatment predict worsened clinical and functional outcomes for people with psychosis. The present protocol describes the methodology for a scoping review which will aim to identify barriers and facilitators faced by LGBTQA+ individuals across the psychosis spectrum in help-seeking and accessing mental health support. METHODS: A comprehensive search strategy will be used to search Medline, PsycINFO, Embase, Scopus, LGBTQ+ Source, and grey literature. Original studies of any design, setting, and publication date will be included if they discuss barriers and facilitators to mental health treatment access and engagement for LGBTQA+ people with experiences of psychosis. Two reviewers will independently screen titles/abstracts and full-text articles for inclusion in the review. Both reviewers will then extract the relevant data according to pre-determined criteria, and study quality will be assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Key data from included studies will be synthesised in narrative form according to the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. DISCUSSION: The results of this review will provide a comprehensive account of the current and historical barriers and facilitators to mental healthcare faced by LGBTQA+ people with psychotic symptoms and experiences. It is anticipated that the findings from this review will be relevant to clinical and community services and inform future research. Findings will be disseminated through publication in a peer-reviewed journal and presented at conferences. SCOPING REVIEW REGISTRATION: This protocol is registered in Open Science Framework Registries ( https://doi.org/10.17605/OSF.IO/AT6FC ).

Identifying types of problems and relative priorities in the problem lists of participants in CBT for psychosis trials.

BACKGROUND: There is wide variation in the problems prioritised by people with psychosis in cognitive behavioural therapy for psychosis (CBTp). While research trials and mental health services have often prioritised reduction in psychiatric symptoms, service users may prioritise issues not directly related to psychosis. This discrepancy suggests potential challenges in treatment outcome research. AIMS: The present study aimed to examine the types of problems that were recorded on problem lists generated in CBTp trials. METHOD: Problem and goals lists for 110 participants were extracted from CBTp therapy notes. Subsequently, problems were coded into 23 distinct categories by pooling together items that appeared thematically related. RESULTS: More than half of participants (59.62%) listed a non-psychosis-related priority problem, and 22.12% did not list any psychosis related problems. Chi-square tests indicated there was no difference between participants from early intervention (EI) and other services in terms of priority problem (χ2 = 0.06, p = .804), but that those from EI were more likely to include any psychosis-related problems in their lists (χ2 = 6.66, p = .010). CONCLUSIONS: The findings of this study suggest that psychiatric symptom reduction is not the primary goal of CBTp for most service users, particularly those who are not under the care of EI services. The implications for future research and clinical practice are discussed.

Ocorrências iatrogênicas com medicação em Unidade de Terapia Intensiva: condutas adotadas e sentimentos expressos pelos enfermeiros / Ocurrencias iatrogénicas com medicamentos en Unidad de Cuidados Intensivos: conductas y sentimientos de los enfermeros / Iatrogenic occurrences with medication in I. C. U: nurse's procedures and feelings

Ocorrências iatrogênicas com medicação na UTI são eventos indesejáveis que exigem pronta intervenção do enfermeiro. Opresente estudo foi realizado com os seguintes objetivos:- verificar a conduta dos enfermeiros diante de uma ocorrência commedicação, identificar os sentimentos vividos nessas situações e caracterizar os fatores relacionados a esses eventos. Pormeio de um questionário respondido por 148 enfermeiros de UTI (76,7 por cento) de 7 hospitais do Município de São Paulo, nosanos de 1997 e 1998, os dados foram obtidos e analisados segundo freqüência absoluta e percentual. Os resultados permitiramconcluir que as condutas mais citadas incluíram: comunicar o fato ao médico (31,7 por cento), intensificar os controles (26,5 por cento) ecomunicar a chefia de enfermagem (13,5 por cento). Ansiedade, impotência e culpa foram sentimentos mais apontados com38,1 por cento, 14,6 por cento e 12,3 por cento, respectivamente. O fator relacionado às ocorrências mais freqüente foi a displicência do funcionário(23,1 por cento). Quanto à vivência desse tipo de ocorrência, a maior porcentagem (43,2 por cento) referiu ter vivido situação semelhanteraras vezes.

Iatrogenic occurrences with medication in ICU are adverse events that demand nurse's interventions. The aims of this studywere: - to identify nurse's procedures and feelings in this situation; - to characterize factors related to this kind of event inICU settings. A questionnaire was answered by 148 ICU nurses (76,7 percent) from 7 hospitals in São Paulo city, in 1997 and1998. The results showed that of 407 mentioned procedures, 31,7 percent included to comunicate the event to the doctor, followedby to intensify the patient control (26,5 percent). Regarding the 260 feelings informed by the nurses, anxiety and impotence werethe most frequent, respectively, 38,1 percent and 14,6 percent. Of 303 factors related to the occurrences nurses pointed out neglet (24,6 percent)and professional innexperience (15,1 percent) as the most important. Forty three point two per cent (43,2 percent) of the nurses hardlyexperimented this situation in their professional life in ICU.

Ocurrencias iatrogénicas com medicamentos en UCI no son hechos esperados y necesitan rápida actuación de los enfermeros.El estudio tuvo los siguientes objectivos: verificar la conducta de los enfermeros delante de una ocurrencia iatrogénica commedicamnetos; identificar los sentimientos provocados por tales situaciones y identificar los factores vinculados a talesocurrencias. Ciento cuarenta ocho enfermeros (76,7 por ciento) de 7 UCI de la ciudad de São Paulo, Brasil, contestaran una encuestaen los años de 1997 y 1998. Los resultados llevan a concluir que las conductas más frecuentes incluyeran: comunicar elhecho al médico (31,7 por ciento), aumentar los controles (26,5 por ciento) y comunicar el hecho al director de enfermería (13,5 por ciento). Ansiedad(38,1 por ciento), impotencia (14,6 por ciento) y culpa (12,3 por ciento)fueranlos sentimientos más frecuentes. El factor más importante relacionado a las ocurrencias iatrgénicas fue la falta de atención del trabajador de enfermería (23,1 por ciento). Otros 64 enfermeros (43,2 por ciento)relataran teneren vivido situaciones semejantes raras vetes.

[Iatrogenic events with medications at the intensive care unit: procedures and feelings expressed by nurses]. / Ocorrências iatrogênicas com medicação em unidade de terapia intensiva: condutas adotadas e sentimentos expressos pelos enfermeiros.

Iatrogenic occurrences with medication in ICU are adverse events that demand nurse's interventions. The aims of this study were:- to identify nurse's procedures and feelings in this situation;- to characterize factors related to this kind of event in ICU settings. A questionnaire was answered by 148 ICU nurses (76.7%) from 7 hospitals in São Paulo city, in 1997 and 1998. The results showed that of 407 mentioned procedures, 31.7% included to communicate the event to the doctor, followed by to intensify the patient control (26.5%). Regarding the 260 feelings informed by the nurses, anxiety and impotence were the most frequent, respectively, 38.1% and 14.6%. Of 303 factors related to the occurrences nurses pointed out neglect (24.6%) and professional inexperience (15.1%) as the most important. Forty three point two per cent (43.2%) of the nurses hardly experimented this situation in their professional life in ICU.