Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.429
Filtrar
Mais filtros

Intervalo de ano de publicação
1.
BMC Psychiatry ; 24(1): 256, 2024 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-38575916

RESUMO

BACKGROUND: Severe mental illness (SMI) imposes a substantial worldwide burden of disability, highlighting the need for comprehensive and adaptable mental health services. This study aims to assess the efficacy and cost-effectiveness of community-based mental health services (CBMHS) in reducing relapse and rehospitalization rates among individuals with SMI in Iran. METHOD: A systematic review and meta-analysis were conducted. Medline, EMBASE, ISI, SCOPUS, and ProQuest were searched until December 2022. We focused on randomized controlled trials, quasi-experimental studies, or economic studies related to individuals with SMI. Out of 127 articles, 17 were selected for a full-text review. The primary outcomes were the severity of psychopathology, rehospitalization rates, and the mental health of caregivers. We also examined community-based interventions and their impact on various outcomes. Data extraction and risk of bias assessment were performed, and critical appraisal was conducted using JBI checklists. Meta-analysis was carried out using STATA software. (PROSPERO registration. CRD42022332660). RESULT: Rehospitalization rates among patients who received CBMHS were significantly lower, with an odds ratio of 2.14 (95% CI: 1.44 to 3.19), indicating a 2.14 times lower likelihood than those who received treatment as usual. A reduction in psychopathology accompanied this, SMD: -0.31, 95% CI: -0.49 to -0.13, I2 = 40.23%). Moreover, there was a notable improvement in social skills (SMD: -0.7, 95% CI: -0.98 to -0.44, I2 = 0.00%). The burden on caregivers also decreased (SMD: -0.55, 95% CI: -0.99 to -0.1, I2 = 63.2). The Incremental Cost-Effectiveness Ratio (ICER) for QUALY was acceptable, albeit with a wide range of 613 to 8400 Dollars. CONCLUSION: CBMHS has demonstrated effectiveness and efficiency in Iran as a developing country. Additionally, it shows promise in mitigating the shortage of acute psychiatry beds. Using multiple data collection tools poses a limitation regarding data consolidation and conducting a meta-analysis.


Assuntos
Serviços Comunitários de Saúde Mental , Transtornos Mentais , Humanos , Serviços de Saúde Comunitária , Análise Custo-Benefício , Irã (Geográfico) , Transtornos Mentais/terapia , Transtornos Mentais/psicologia
3.
Eur Heart J ; 45(12): 987-997, 2024 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-38538149

RESUMO

Patients with severe mental illness (SMI) including schizophrenia and bipolar disorder die on average 15-20 years earlier than the general population often due to sudden death that, in most cases, is caused by cardiovascular disease. This state-of-the-art review aims to address the complex association between SMI and cardiovascular risk, explore disparities in cardiovascular care pathways, describe how to adequately predict cardiovascular outcomes, and propose targeted interventions to improve cardiovascular health in patients with SMI. These patients have an adverse cardiovascular risk factor profile due to an interplay between biological factors such as chronic inflammation, patient factors such as excessive smoking, and healthcare system factors such as stigma and discrimination. Several disparities in cardiovascular care pathways have been demonstrated in patients with SMI, resulting in a 47% lower likelihood of undergoing invasive coronary procedures and substantially lower rates of prescribed standard secondary prevention medications compared with the general population. Although early cardiovascular risk prediction is important, conventional risk prediction models do not accurately predict long-term cardiovascular outcomes as cardiovascular disease and mortality are only partly driven by traditional risk factors in this patient group. As such, SMI-specific risk prediction models and clinical tools such as the electrocardiogram and echocardiogram are necessary when assessing and managing cardiovascular risk associated with SMI. In conclusion, there is a necessity for differentiated cardiovascular care in patients with SMI. By addressing factors involved in the excess cardiovascular risk, reconsidering risk stratification approaches, and implementing multidisciplinary care models, clinicians can take steps towards improving cardiovascular health and long-term outcomes in patients with SMI.


Assuntos
Doenças Cardiovasculares , Transtornos Mentais , Humanos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Doenças Cardiovasculares/complicações , Fatores de Risco , Transtornos Mentais/complicações , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Medição de Risco , Fatores de Risco de Doenças Cardíacas
4.
Br J Psychiatry ; 224(4): 115-116, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38470301

RESUMO

The enormous impact of mental illness on work and productivity is a global challenge, with immense costs to wider society. Now is the time for action, with new international guidelines and an emergent consensus on occupational mental healthcare. Alongside governments, organisations and employers, psychiatrists have a leading role to play.


Assuntos
Transtornos Mentais , Saúde Mental , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Consenso , 60475
5.
BMC Psychiatry ; 24(1): 120, 2024 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-38355467

RESUMO

BACKGROUND: Persons with mental illness as their sole underlying medical condition are eligible to access medical assistance in dying (MAiD) in a small number of countries, including Belgium, the Netherlands, Luxemburg and Switzerland. In Canada, it is anticipated that people experiencing mental illness as their sole underlying medical condition (MI-SUMC) will be eligible to request MAiD as of March 17th 2024. To date, few studies have addressed patient and family perspectives on MAiD MI-SUMC care processes. This study aimed to address this gap and qualitatively explore the perspectives of persons with lived experience of mental illness and family members on care considerations during MI-SUMC implementation. METHODS: Thirty adults with lived experience of mental illness and 25 adult family members residing in Ontario participated in this study. To facilitate participant engagement, the semi-structured interview used a persona-scenario exercise to discuss perspectives on MAiD MI-SUMC acceptability and care considerations. Framework analysis was used to inductively analyze data using NVivo 12 Pro. Steps, processes, or other care considerations suggested by the participants were charted in a framework matrix after familiarization with the narratives. Key themes were further identified. A lived-experience advisory group participated in every aspect of this study. RESULTS: Six themes were developed from the patient and family narratives: (1) Raising MAiD MI-SUMC awareness; (2) Sensitive Introduction of MAiD MI-SUMC in goals of care discussions; (3) Asking for MAiD MI-SUMC: a person-focused response; (4) A comprehensive circle of MAiD MI-SUMC care; (5) A holistic, person-centered assessment process; and (6) Need for support in the aftermath of the decision. These themes highlighted a congruence of views between patient and family members and described key desired process ingredients, including a person-centred non-judgmental stance by care providers, inter-professional holistic care, shared decision making, and the primacy of patient autonomy in healthcare decision making. CONCLUSIONS: Family and patient perspectives on the implementation of MAiD MI-SUMC offer important considerations for service planning that could complement existing and emerging professional practice standards. These stakeholders' perspectives will continue to be essential in MAiD MI-SUMC implementation efforts, to better address the needs of diverse communities and inform improvement efforts.


Assuntos
Transtornos Mentais , Suicídio Assistido , Assistência Terminal , Adulto , Humanos , Transtornos Mentais/terapia , Canadá , Ontário , Assistência Médica
6.
BMJ Open ; 14(2): e078091, 2024 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-38413156

RESUMO

BACKGROUND: The burden of common mental disorders in low and middle-income countries (LMICs) is growing with little known about how to allocate limited resources to reach the greatest number of people undergoing instances of significant psychological distress. We present a study protocol for a multicentre, parallel-group, superiority, randomised controlled trial. METHODS AND ANALYSIS: Adults with significant psychological distress (K10 score ≥20) will be randomised to receive a stepped care programme involving a self-guided course (Doing What Matters) followed by a more intensive group programme (Problem Management Plus) or the self-guided course alone, both of which will take place in addition to enhanced treatment as usual comprising of a follow-up referral session to available services within the community. We will include 800 participants. An intent-to-treat and completer analysis will explore the impact of the stepped model of care on anxiety and depression symptoms (as measured by the Hopkins Symptom Checklist; HSCL-25) at 24 weeks from baseline. Secondary outcomes include positive psychological well-being, agency, changes in patient-identified problems, quality of life and cost-effectiveness. Linear mixed models will be used to assess the differential impact of the conditions over time. Analyses will focus on the primary outcome (HSCL-25) and secondary outcomes (agency subscale, WHO Well-Being Index, WHO Disability Assessment Schedule V.2.0, EQ-5D, Psychological Outcomes Profiles Scale) for both conditions, with the main outcome time point being the 3-month follow-up, relative to baseline. ETHICS AND DISSEMINATION: This will be the first randomised controlled trial to assess the benefits of a stepped model of care to addressing psychological distress in a LMIC setting. Results will provide important insights for managing limited resources to mental healthcare in these settings and will be accordingly disseminated to service providers and organisations via professional training and meetings, and via publication in relevant journals and conference presentations. We will also present these findings to the Jordanian Ministry of Health, where this institute will guide us on the most appropriate format for communication of findings, including written reports, verbal presentations and/or brochures. Ethical approval was obtained from the University of Jordan School of Nursing Research Ethics Committee (number: PF.22.10). TRIAL REGISTRATION NUMBER: ACTRN12621000189820p; Australian New Zealand Clinical Trials Registry.


Assuntos
Transtornos Mentais , Qualidade de Vida , Adulto , Humanos , Análise Custo-Benefício , Aconselhamento , Jordânia , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
Assessment ; 31(1): 199-215, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-37706296

RESUMO

Researchers and clinicians working within the Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition, Text Rev (DSM-5-TR) framework face a difficult question: what does it mean to have an evidence-based assessment of a nonevidence-based diagnostic construct? Alternative nosological approaches conceptualize psychopathology as (a) hierarchical, allowing researchers to move between levels of description and (b) dimensional, eliminating artificial dichotomies between disorders and the dichotomy between mental illness and mental well-being. In this article, we provide an overview of ongoing efforts to develop validated measures of transdiagnostic nosologies (i.e., the Hierarchical Taxonomy of Psychopathology; HiTOP) with applications for measurement-based care. However, descriptive models like HiTOP, which summarize patterns of covariation among psychopathology symptoms, do not address dynamic processes underlying the problems associated with psychopathology. Ambulatory assessment, well-suited to examine such dynamic processes, has also developed rapidly in recent decades. Thus, the goal of the current article is twofold. First, we provide a brief overview of developments in constructing valid measures of the HiTOP model as well as developments in ambulatory assessment practices. Second, we outline how these parallel developments can be integrated to advance measurement-based treatment. We end with a discussion of some major challenges for future research to address to integrate advances more fully in transdiagnostic and ambulatory assessment practices.


Assuntos
Transtornos Mentais , Humanos , Transtornos Mentais/terapia , Psicopatologia , Saúde Mental , Manual Diagnóstico e Estatístico de Transtornos Mentais , Bem-Estar Psicológico
13.
Nervenarzt ; 95(1): 18-27, 2024 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-38110535

RESUMO

BACKGROUND: In Germany different offers of social support are available for families that are provided by different sectors, e.g., the youth welfare and the healthcare systems. OBJECTIVE: Documentation of the utilized help, child-related factors that are associated with the utilization and the parental desires for support. MATERIAL AND METHODS: Survey of 160 parents undergoing (partial) inpatient treatment in psychiatric hospitals via an oral interview using standardized and semi-standardized instruments. RESULTS: The results show that nonprofessional help by family and friends as well as support offers provided by the healthcare system are used most frequently. Families that perceived their children as more burdened receive more help than families with children judged as being less burdened. There are regional differences especially in the utilization of high-threshold help by the healthcare system. DISCUSSION: Support offers seem to reach families with mental illnesses, especially those that are particularly burdened; however, there are regional differences regarding the utilization of support as well as the wishes for specific support offers.


Assuntos
Filho de Pais Incapacitados , Transtornos Mentais , Pessoas Mentalmente Doentes , Adolescente , Humanos , Pessoas Mentalmente Doentes/psicologia , Pais/psicologia , Transtornos Mentais/terapia , Família , Filho de Pais Incapacitados/psicologia
14.
Salud Colect ; 19: e4627, 2023 Nov 28.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-38055370

RESUMO

The following text presents the results of a integrative review whose purpose was to identify and analyze the production of academic literature on mad activism in the field of mental health and its link with the notions of disability and neurodiversity. From searches conducted in May 2023 in the Web of Science, Scopus, and PubMed databases, 52 articles were selected, and thematic content analysis strategies were applied. The results account for various articulations between the concepts addressed, establishing a critical look at the biomedical model in mental health. In the forms of mad activism, the human rights approach, the fight against stigma and its influence on the reform processes of the mental health system become relevant. On the other hand, a framework of social justice, identity policies and practices of mutual support from the community are established. As a whole, they emphasize methodological innovations and an intersectional perspective on the production of knowledge. It is concluded that it is possible to situate madness as a field of constitution of a political actor and epistemic subject. Based on this, possible lines of research on mad activisms in Latin America are formulated.


Se exponen los resultados de una revisión integrativa que tuvo como propósito identificar y analizar la producción de literatura académica sobre el activismo loco en el campo de la salud mental y su vinculación con las nociones de discapacidad y neurodiversidad. De las búsquedas realizadas en mayo del 2023, en las bases de datos Web of Science, Scopus y PubMed, se seleccionaron 52 artículos, y se aplicaron estrategias de análisis de contenido temático. Los resultados dan cuenta de diversas articulaciones entre los conceptos abordados, estableciendo una mirada crítica hacia el modelo biomédico en salud mental. En las formas de activismo loco, adquieren relevancia el enfoque de derechos humanos, la lucha contra el estigma y su influencia en los procesos de reforma al sistema de salud mental. Por otra parte, establecen un marco de justicia social, políticas de identidad y prácticas de apoyo mutuo desde la comunidad. En su conjunto, enfatizan innovaciones metodológicas y una mirada interseccional en la producción de conocimientos. Se concluye que es posible situar la locura como campo de constitución de un actor político y sujeto epistémico. Con base en ello, se formulan posibles líneas de investigación sobre los activismos locos en América Latina.


Assuntos
Transtornos Mentais , Saúde Mental , Humanos , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Direitos Humanos , Justiça Social/psicologia , Estigma Social
15.
Artigo em Inglês | MEDLINE | ID: mdl-38055874

RESUMO

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Prim Care Companion CNS Disord. 2023;25(6):23f03544. Author affiliations are listed at the end of this article.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Transtornos Mentais , Psiquiatria , Humanos , Doença de Alzheimer/complicações , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/tratamento farmacológico , Anticorpos Monoclonais , Disfunção Cognitiva/complicações , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/tratamento farmacológico , Transtornos Mentais/terapia , Hospitais Gerais , Encaminhamento e Consulta
16.
Asian J Psychiatr ; 90: 103804, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37913651

RESUMO

Incorporating the experiences of patients with severe mental disorders (SMD) into clinical practice offers valuable insights for optimizing psychological care's effectiveness with more patient-centered and personalized interventions. The study aimed to develop a patient-reported experience measure regarding psychological care (PREMIUM-PSY) using adaptive testing and investigate its association with quality of life. In a multicenter study involving 443 patients with SMD, PREMIUM-PSY demonstrated both validity and efficiency (6-item average). Positive patient experiences were associated with enhanced mental and physical quality of life (ß = 3.15[2.17;4.12], p < 0.001 and ß = 1.18[0.04;2.32], p = 0.042), suggesting PREMIUM-PSY's potential for optimizing psychological care outcomes.


Assuntos
Transtornos Mentais , Qualidade de Vida , Humanos , Transtornos Mentais/terapia , Avaliação de Resultados da Assistência ao Paciente
17.
BMC Health Serv Res ; 23(1): 1243, 2023 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-37951906

RESUMO

BACKGROUND: Data on resource use are frequently required for healthcare assessments. Studies on healthcare utilization (HCU) in individuals with mental disorders have analyzed both self-reports and administrative data. Source of data may affect the quality of analysis and compromise the accuracy of results. We sought to ascertain the degree of agreement between self-reports and statutory health insurance (SHI) fund claims data from patients with mental disorders. METHODS: Claims data from six German SHI and self-reports were obtained along with a cost-effectiveness analysis performed as a part of a controlled prospective multicenter cohort study conducted in 18 psychiatric hospitals in Germany (PsychCare), including patients with pre-defined psychiatric disorders. Self-reports were collected using the German adaption of the Client Sociodemographic and Service Receipt Inventory (CSSRI) questionnaire with a 6-month recall period. Data linkage was performed using a unique pseudonymized identifier. Missing responses were coded as non-use for all analyses. HCU was calculated for inpatient and outpatient care, day-care services, home treatment, and pharmaceuticals. Concordance was measured using Cohen's Kappa (κ) and intraclass correlation coefficient (ICC). Regression approaches were used to investigate the effect of independent variables on the agreements. RESULTS: In total 274 participants (mean age 47.8 [SD = 14.2] years; 47.08% women) were included in the analysis. No significant differences were observed between the linked and unlinked patients in terms of baseline characteristics. Total agreements values were 63.9% (κ = 0.03; PABAK = 0.28) for outpatient contacts, 69.3% (κ = 0.25; PABAK = 0.39) for medication use, 81.0% (κ = 0.56; PABAK = 0.62) for inpatient days and 86.1% (κ = 0.67; PABAK = 0.72) for day-care services. There was varied quantitative agreement between data sources, with the poorest agreement for outpatient care (ICC [95% CI] = 0.22 [0.10-0.33]) and the best for psychiatric day-care services (ICC [95% CI] = 0.72 [0.66-0.78]). Marital status and time since first treatment positively affected the chance of agreement on utilization of outpatient services. CONCLUSIONS: Although there were high levels of absolute agreement, the measures of concordance between administrative records and self-reports were generally minimal to moderate. Healthcare investigations should consider using linked or at least different data sources to estimate HCU for specific utilization areas, where unbiased information can be expected. TRIAL REGISTRATION: This study was part of the multi-center controlled PsychCare trial (German Clinical Trials Register No. DRKS00022535; Date of registration: 2020-10-02).


Assuntos
Transtornos Mentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos de Coortes , Seguro Saúde , Transtornos Mentais/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Prospectivos , Autorrelato , Adulto
18.
Indian J Med Res ; 157(5): 387-394, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37955215

RESUMO

Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have seen rapid strides with several initiatives, including (i) expansion of DMHPs to 90 per cent of the total districts of the country, (ii) the National Mental Health Policy and (iii) strengthening the Mental Health Legislation by way of providing explicit provisions for rights of persons with mental illnesses. Among others, factors responsible for this accelerated growth include the easily accessible digital technology as well as judicial activism. Federal and State cooperation is another notable feature of this expansion. In this review, the authors summarize the available information on the evolution of implementation and research aspects related to India's NMHP over the years and provide a case for the positive turn of events witnessed in the recent years. However, the authors caution that these are still baby steps and much more remains to be done.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Humanos , Saúde Mental , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Política de Saúde , Índia/epidemiologia
19.
JAAPA ; 36(12): 42-45, 2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-37989170

RESUMO

ABSTRACT: In Canada, unmet mental health care needs remain a major issue despite mental disorders ranking as the second largest source of years lost to disability. As discussions continue on alternative models of healthcare to reduce the long waiting times for mental health treatment, leveraging the skills and resources available from physician associates/assistants (PAs) and NPs becomes imperative. Relatively few PAs in Canada work in psychiatry, despite widespread acceptance in other medical disciplines. Sustainable funding models for the training, recruitment, and retention of PAs in mental health care are vital. More research, policy development, and interprofessional collaboration can enhance the effective integration of PAs into mental health care.


Assuntos
Transtornos Mentais , Profissionais de Enfermagem , Assistentes Médicos , Médicos , Humanos , Saúde Mental , Canadá , Atenção à Saúde , Transtornos Mentais/terapia , Assistentes Médicos/educação
20.
J Clin Psychiatry ; 85(1)2023 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-38019591

RESUMO

Objective: We sought to characterize patterns of utilization of telemental health among commercially insured individuals over the decade preceding COVID-19.Methods: We developed telemental health service groups from the US PharMetrics Plus database, using diagnostic codes to identify those diagnosed with mental health conditions and procedure codes to capture mental health visits delivered via telehealth sessions. We analyzed 2 indicators of utilization between January 1, 2010, and December 31, 2019: (1) the percentage of patients with mental health needs who used telemental health services and (2) the percentage of all mental health services provided via telehealth. We stratified our analyses by year, patient gender, patient age, and geographic region.Results: The proportion of mental health visits delivered via telemental health increased from 0.002% to 0.162% between 2010 and 2019. A larger proportion of males received telemental health services as compared to females; however, the proportion of mental health visits delivered via telehealth was higher for females than for males. Patients aged 18 to 34 years and those in the western US had the highest utilization compared to other age groups and geographic regions.Conclusions: Telemental health utilization comprised a small fraction of overall mental health services and beneficiaries in the IQVIA PharMetrics Plus claims data, but increased over time, with differences documented in utilization based on patient gender, patient age, geographic region, and type of telemental health claim. Evidence from this study may serve as a pre-pandemic baseline for comparison against future evaluations of telehealth expansion policies.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Telemedicina , Masculino , Feminino , Humanos , Estados Unidos/epidemiologia , Seguro Saúde , Saúde Mental , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Telemedicina/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA