'I am more than my diagnosis': Amplifying the voice of consumers in the design and delivery of mental health services.

OBJECTIVE: In line with the Australian Government's Vision 2030, this research foregrounds consumer experiences of recovery to inform the (co)design and delivery of mental health services for people living with complex needs and/or a severe and persistent mental health condition. SETTING: The research takes a specialist focus on the regional setting, with data collected from client experiences within Western NSW, Australia, in the context of the National Disability Insurance Scheme (NDIS) implementation and inclusion of psycho-social disability within the NDIS service environment. PARTICIPANTS: Thirty-seven people aged 19-70 years living with complex needs and/or a diagnosis of a severe and persistent mental health condition were recruited from services where they had a care plan or where they were members of a consumer reference group for recovery-oriented services. DESIGN: A tripartite framework integrating recovery oriented, trauma-informed and collective impact approaches for a qualitative, arts-based (photovoice) study. RESULTS: In areas of the mental health service system that had not yet applied a personalised understanding of recovery or embraced trauma-informed practice there were a range of issues and gaps in service delivery relating to authentic relationships, belonging and connection, service cultures, trauma-informed care, and workforce investment. CONCLUSION: Clinical and non-clinical services need to ensure consistent person-centred and trauma-informed practice is implemented throughout the mental health service system to meet the needs of the consumer. An eight-point checklist serves as the basis for services to reflect on how they are working with consumers and to support the review of systems and clinical governance frameworks.

The effect of lansoprazole on MK-801-induced schizophrenia-like behaviors in mice.

As a heterogeneous disorder, schizophrenia is known to be associated with neuroinflammation. A recent study showed that several cytokines are higher in the plasma and cerebrospinal fluid of schizophrenia patients. Lansoprazole, a proton pump inhibitor used for treating erosive esophagitis, has been reported to reduce INF-γ-induced neurotoxicity and decrease inflammatory cytokines including IL-1ß, IL-6, and TNF-α. These findings persuaded us to examine whether lansoprazole ameliorates schizophrenia-like symptoms. The schizophrenia mouse model was induced by the acute administration of MK-801, an NMDA receptor antagonist. Sensorimotor gating, Barnes maze, and social novelty preference tests were conducted to evaluate schizophrenia-like behaviors. We found that lansoprazole (0.3, 1, or 3 mg/kg) ameliorated sensorimotor gating deficits, spatial learning, and social deficits caused by MK-801 treatment (0.2 mg/kg). The catalepsy test, balance beam test, and rotarod test were performed to reveal the adverse effects of lansoprazole on motor coordination. The behavioral results indicated that lansoprazole did not result in any motor function deficits. Moreover, lansoprazole decreased inflammatory cytokines including IL-6 and TNF-α only in the cortex, but not in the hippocampus. Collectively, these results suggest that lansoprazole could be a potential candidate for treating schizophrenia patients who suffer from sensorimotor gating deficits or social disability without any motor-related adverse effects.

What is the degree of social disability risk in China under the background of the aging population? Social disability risk measurement index system design and evaluation research based on China.

Objective: The impact of the aging population in China varies between regions. It is because regions with different resource endowments, such as those related to economy, population, and medical care, have different degrees of disability risk in the face of the increases in the disabled and semi-disabled older population caused by the overall aging of the population. This study aimed to construct an evaluation system to monitor and measure the degree of social disability risk in different regions in China and to evaluate and compare the degree of social disability risk in different regions using empirical data. Method: This study used the Delphi method to construct a social disability risk measurement index system with macro, meso, and micro dimensions. At the same time, based on the data of CHARLS2018, an AHP-entropy method was used to calculate the index's total weight, and the standard deviation classification method was used to classify the total and criterion-level measurement scores of 28 provinces. Results: The regional degree of social disability risk was analyzed in subdimensions. Our research indicates that China's social disability risk situation is not promising, with a general medium to high-risk level. The score of degree of social disability risk among provinces is consistent with the regional economic development level to a large extent. The risk of social disability varies significantly among the eastern and central, and western regions of China and the provinces within the three regions. Discussion: Currently, the situation facing the degree of social disability risk in China is that the overall risk level of the country is higher, and the difference between regions is significant. It is necessary to take measures to meet better the needs of the aging population and the disabled and semi-disabled older populations in a large-range, large-scale, multilevel way.

Yoga therapy for social cognition in schizophrenia: An experimental medicine-based randomized controlled trial.

Negative symptoms and cognitive deficits are difficult-to-treat symptoms of schizophrenia. In this single blind randomized controlled study, we compared change in social cognitive performance in persons with Schizophrenia (PWS) (as per DSM-5), after 6 weeks of yoga intervention with a waitlist control group. We also examined changes in putative Mirror Neuron System (MNS) activity measured by Transcranial Magnetic Stimulation (TMS) in a subset of sample (n = 30). 51 PWS stabilized on antipsychotic medication for at least 6 weeks, were assigned to add-on yoga therapy (YT) (n = 26) or waitlist (WL) (n = 25). Subjects in the YT group received add-on yoga therapy (20 sessions in 6 weeks). Both the groups continued their standard treatment and were assessed at baseline and after 6 weeks for social cognition, clinical symptoms and social disability. RM-ANOVA showed significant interaction between time and group for social cognition composite score (SCCS) (F = 42.09 [1,44], P < 0.001); negative symptoms (SANS) (F = 74.91 [1,45], P < 0.001); positive symptoms (SAPS) (F = 16.05 [1,45], P < 0.001) and social disability (GSDS) (F = 29.91 [1,46], P < 0.001). MNS activity had increased after 6 weeks in both groups but not of statistical significance. This study demonstrates that 6 weeks of add-on yoga therapy could improve social cognition in PWS compared to waitlist control subjects. However, the change in social cognition was not associated with a change in the putative MNS-activity. It necessiatates further studies to investigate the mechanistic processes of yoga and replicate these observations in a larger sample.

Improved social functioning following social recovery therapy in first episode psychosis: Do social cognition and neurocognition change following therapy, and do they predict treatment response?

There is a need to develop and refine psychosocial interventions to improve functioning in First Episode Psychosis (FEP). Social cognition and neurocognition are closely linked to functioning in psychosis; examinations of cognition pre- and post- psychosocial intervention may provide insights into the mechanisms of these interventions, and identify which individuals are most likely to benefit. METHOD: Cognition was assessed within a multi-site trial of Social Recovery Therapy (SRT) for individuals with FEP experiencing poor functioning (<30 h weekly structured activity). Fifty-nine participants were randomly allocated to the therapy group (SRT + Early intervention), and 64 were allocated to treatment as usual group (TAU - early intervention care). Social cognition and neurocognition were assessed at baseline and 9 months; assessors were blind to group allocation. It was hypothesized that social cognition would improve following therapy, and those with better social cognition prior to therapy would benefit the most from SRT. RESULTS: There was no significant impact of SRT on individual neurocognitive or social cognitive variables, however, joint models addressing patterns of missingness demonstrate improvement across a number of cognitive outcomes following SRT. Further, regression analyses showed those who had better social cognition at baseline were most likely to benefit from the therapy (ß = 0.350; 95% CI = 0.830 to 8.891; p = .019). CONCLUSION: It is not clear if SRT impacts on social cognitive or neurocognitive function, however, SRT may be beneficial in those with better social cognition at baseline.

Retrospective and Current Peer Victimization in College Students with Disabilities: Examining the Intersectionality of Sexual Orientation and Gender.

The present, exploratory study examined retrospective and current peer victimization in a multi-university sample of 58 college students with disabilities, 18 (31%) of whom identified as sexual minorities. Fifty-seven participants reported peer victimization during childhood, and approximately half reported experiencing peer victimization in the past 2 months. Students who identified as sexual minorities reported more retrospective victimization but current victimization did not differ between the two groups. Current and retrospective peer victimization were significantly correlated with present psychological distress. Professionals who work with students with disabilities should be aware of the high prevalence of peer victimization and its psychological correlates in this population.

An asymmetric burden: Experiences of men and women as caregivers of people with psycho-social disabilities in rural North India.

Caring for a family member with a psycho-social disability can be both rewarding and burdensome. This study analyses the experiences of caregivers of people with psychosocial disabilities (PPSDs) in rural communities in North India using relational gender theory. In-depth interviews with 18 female and male caregivers of PPSDs probed the social, emotional and health impacts of their caregiving role. Nine themes were identified that were grouped under three meta-themes: intra-personal, inter-personal and institutional impacts. Under the intra-personal meta-theme, all caregivers experienced high tension, with women describing almost overwhelming stress. Women minimised their role as caregivers, and felt negative and hopeless about their futures, while men had a more positive view of the future and themselves. Embodied experiences of psychological and social distress were consistently described by women, but not by men. Within the interpersonal meta-theme, men experienced opportunity for social connection and social support that was seldom available to women. Interpersonal violence with other household members was described by both men and women. Within the institutional meta-theme, both men and women described strength in unity, and gestures leading to the reordering of gender relations. These findings underline the significant and diffuse impacts of a gender order that values males and disadvantages females as caregivers of PPSDs, with the asymmetry of a greater burden for women. The findings point to the urgent need for global mental health policies that support and empower caregivers and that strengthen gender equality.

Correlations between impairment, psychological distress, disability, and quality of life in peripheral facial palsy. / Correlación entre deficiencia, afectación psicológica, discapacidad y calidad de vida en la parálisis facial periférica.

INTRODUCTION: This paper analyses the correlations between scores on scales assessing impairment, psychological distress, disability, and quality of life in patients with peripheral facial palsy (PFP). MATERIAL AND METHODS: We conducted a retrospective cross-sectional study including 30 patients in whom PFP had not resolved completely. We used tools for assessing impairment (Sunnybrook Facial Grading System [FGS]), psychological distress (Hospital Anxiety and Depression Scale [HADS]), disability (Facial Disability Index [FDI]), and quality of life (Facial Clinimetric Evaluation [FaCE] scale). RESULTS: We found no correlations between FGS and HADS scores, or between FGS and FDI social function scores. However, we did find a correlation between FGS and FDI physical function scores (r=0.54; P<.01), FDI total score (r=0.4; P<.05), FaCE total scores (ρ=0.66; P<.01), and FaCE social function scores (ρ=0.5; P<.01). We also observed a correlation between HADS Anxiety scores and FDI physical function (r=-0.47; P<.01), FDI social function (r=-0.47; P<.01), FDI total (r=-0.55; P<.01), FaCE total (ρ=-0.49; P<.01), and FaCE social scores (ρ=-0.46; P<.05). Significant correlations were also found between HADS Depression scores and FDI physical function (r=-0.61; P<.01), FDI social function (r=-0.53; P<.01), FDI total (r=-0.66; P<.01), FaCE total (ρ=-0.67; P<.01), and FaCE social scores (ρ=-0.68; P<.01), between FDI physical function scores and FaCE total scores (ρ=0.87; P<.01) and FaCE social function (ρ=0.74; P<.01), between FDI social function and FaCE total (ρ=0.66; P<.01) and FaCE social function scores (ρ=0.72; P<.01), and between FDI total scores and FaCE total (ρ = 0,87; P<.01) and FaCE social function scores (ρ=0.84; P<.01). CONCLUSION: In our sample, patients with more severe impairment displayed greater physical and global disability and poorer quality of life without significantly higher levels of social disability and psychological distress. Patients with more disability experienced greater psychological distress and had a poorer quality of life. Lastly, patients with more psychological distress also had a poorer quality of life.

The relationship between insomnia and disability in workers with mild traumatic brain injury/concussion: Insomnia and disability in chronic mild traumatic brain injury.

AIM/BACKGROUND: The principal aim of this study was to, for the first time, examine the relationship between insomnia and perceived disability among workers with mild traumatic brain injury (mTBI)/concussion. PATIENTS/METHODS: A cross-sectional study was conducted at the Workplace Safety and Insurance Board Clinic of the largest rehabilitation teaching hospital in Canada. Data from questionnaires, insurer records and clinical investigations were analysed. The Insomnia Severity Index measured the primary independent variable, and the Sheehan Disability Scale measured disability outcomes, classified as 'mild/moderate' or 'marked/extreme'. Two-sided t-tests and Chi-squared tests were used for bivariate associations. A binomial logistic regression model was fit using previously identified variables. RESULTS: The sample comprised 92 workers (45.1 ± 9.9 years old, 61% male) with mTBI/concussion at median time 196 days after injury. When compared with workers reporting lower disability, workers with higher disability were found with more severe insomnia, depression, anxiety and pain. In the multivariable analysis, the odds of reporting higher global disability increased with increasing insomnia and pain [adjusted odds ratio (OR) 1.16 (95% CI 1.03-1.31) and 1.117 (95% CI 1.01-1.24), respectively]. Insomnia was the only significant covariate in a fully adjusted work disability model. None of the variables studied were statistically significant in the social and family life disability models. CONCLUSIONS: Greater attention should be given to the diagnosis and management of insomnia in persons with mTBI/concussion.

Índice de depresión y de inhabilidad social del Rorschach en adultos con trastornos depresivos / Rorschach index of depression and social disability in adults with depressive disorders

RESUMEN El Psicodiagnóstico de Rorschach es una prueba proyectiva que se aplica en la evaluación de la personalidad y trastornos psicopatológicos. Constituyó una investigación aplicada, descriptiva-transversal con un enfoque cuantitativo, entre 2015 y 2018. El presente texto tiene como objetivo analizar la frecuencia de las variables del Índice de depresión y del Índice de inhabilidad social en protocolos de adultos con trastornos depresivos residentes en la provincia de Camagüey. Los 210 protocolos pertenecientes a sujetos con trastornos depresivos que conformaron la muestra, fueron seleccionados de manera intencional pura, no probabilística. En la generalidad de los protocolos, el Índice de depresión no fue eficaz para diagnosticar la depresión de los sujetos y el Índice de inhabilidad social fue positivo. Las variables más frecuentes en el Índice de depresión y de inhabilidad social indican la presencia de una actividad cognitiva poco elaborada, escasa sensibilidad hacia el propio mundo personal y hacia el entorno, así como dificultades en la esfera de relaciones interpersonales. El estudio responde a la Cátedra Honorífica Hermann Rorschach de la Universidad de Camagüey.

ABSTRACT The Rorschach Psychodiagnosis is a projective test that is applied in the evaluation of personality and psychopathological disorders. It was an applied, descriptive-cross-sectional research with a quantitative approach, between 2015 and 2018. This text aims to analyze the frequency of the variables of the Depression Index and the Social Disability Index in protocols for adults with depressive disorders residing in the Camagüey province. The 210 protocols belonging to subjects with depressive disorders that made up the sample were intentionally selected in a pure, non-probabilistic manner. In most protocols, the Depression Index was not effective in diagnosing subjects' depression, and the Social Disability Index was positive. The most frequent variables in the Depression and Social Disability Index indicate the presence of poorly developed cognitive activity, low sensitivity to one's personal world and the environment, as well as difficulties in the sphere of interpersonal relationships. The study responds to the Hermann Rorschach Honorary Chair at the University of Camagüey.

Autistic traits in children with and without ADHD.

OBJECTIVE: To assess the implications of autistic traits (ATs) in youth with attention-deficit/hyperactivity disorder (ADHD) without a diagnosis of autism. METHODS: Participants were youth with (n = 242) and without (n = 227) ADHD and controls without ADHD in whom a diagnosis of autism was exclusionary. Assessment included measures of psychiatric, psychosocial, educational, and cognitive functioning. ATs were operationalized by using the withdrawn + social + thought problems T scores from the Child Behavior Checklist. RESULTS: A positive AT profile was significantly overrepresented among ADHD children versus controls (18% vs 0.87%; P < .001). ADHD children with the AT profile were significantly more impaired than control subjects in psychopathology, interpersonal, school, family, and cognitive domains. CONCLUSIONS: A substantial minority of ADHD children manifests ATs, and those exhibiting ATs have greater severity of illness and dysfunction.

Correlates of suicidal ideation in general healthcare patients - Results of the WHO Collaborative Study on Psychological Problems in General Health Care (WHO-PPGHC).

In the WHO study on Psychological Problems in General Health Care (WHO-PPGHC), a random sample of 5438 patients from 15 international centres were investigated to study prevalence and type of mental disorders by use of standardized methods. Using the General Health Questionnaire, 9.7% of the practice attenders admitted that they have or recently had suicidal ideations. In a logistic regression analysis, predictors of suicidal ideation were hopelessness, presence of an ICD-10 diagnosis, social disability in terms of occupational role functioning and daily routine, and lack of social adaptation in terms of lower age and being less educated. The predictors are discussed in an explanatory model of suicidal ideation in general healthcare. Implications for patient care in general healthcare are discussed.