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1.
Subst Use Misuse ; 54(13): 2229-2240, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31339418

RESUMO

Background: Research suggests that there is a dose-response relationship between Adverse Childhood Experiences (ACEs) and cigarette smoking, such that as ACE score increases, so do the odds of smoking behavior, but little is known about what factors moderate this relationship. Objectives: The goal of this study was to examine demographic characteristics as potential moderators of relationship between ACE score and cigarette smoking. Methods: A secondary data analysis was conducted using the 2013 California Behavioral Risk Factor Surveillance System data. The sample included 2,604 U.S. adults (54.8% female; Age: M = 53.3, SD = 8.10). We used multinomial logistic regression to test sex, race, income, and education as moderators of the relationship between ACE score and smoking. Results: ACEs were not significantly associated with smoking behavior. No interactions between ACE score and sex, race, education, or income significantly predicted smoking outcomes. Sex, race, education, and income were significantly and independently associated with smoking outcomes. Men, individuals with lower income and education, and certain ethnic/racial groups reported greater odds of smoking. Conclusions/Importance: Results suggest that there may not be a relationship between ACEs and smoking later in life. Additionally, the relationship between ACEs and smoking in adulthood may not depend on basic demographic features. Knowing which populations are more vulnerable to smoking can help clinicians better assess and tailor interventions to meet the needs of their patients by using culturally sensitive interventions and obtaining resources to help improve treatment access, motivation, and success.


Assuntos
Adultos Sobreviventes de Eventos Adversos na Infância/psicologia , Fumar Cigarros/psicologia , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , California/epidemiologia , Fumar Cigarros/epidemiologia , Grupos Étnicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Terapia Socioambiental
2.
Health Serv Res ; 54(4): 782-792, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30864179

RESUMO

OBJECTIVE: To estimate the cost of infections associated with multidrug-resistant organisms (MDROs) during inpatient hospitalization in the United States. DATA SOURCES/STUDY SETTING: 2014 National Inpatient Sample. STUDY DESIGN: Multivariable regression models assessed the incremental effect of MDROs on the cost of hospitalization and hospital length of stay among patients with bacterial infections. DATA COLLECTION/EXTRACTION METHODS: We retrospectively identified 6 385 258 inpatient stays for patients with bacterial infection. PRINCIPAL FINDINGS: The national incidence rate of inpatient stays with bacterial infection is 20.1 percent. At least 10.8 percent of such stays-and as many as 16.9 percent if we account for undercoded infections-show evidence of one or more MDROs. MRSA, C. difficile, infection with another MDRO, and the presence of more than one MDRO are associated with $1718 (95% CI, $1609-$1826), $4617 (95% CI, $4407-$4827), $2302 (95% CI, $2044-$2560), and $3570 (95% CI, $3019-$4122) in additional costs per stay, respectively. The national cost of infections associated with MDROs is at least $2.39 billion (95% CI, $2.25-$2.52 billion) and as high as $3.38 billion (95% CI, $3.13-$3.62 billion) if we account for undercoded infections. CONCLUSIONS: Infections associated with MDROs result in a substantial cost burden to the US health care system.


Assuntos
Infecções Bacterianas/economia , Infecções Bacterianas/epidemiologia , Infecção Hospitalar/economia , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla , Hospitais/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Economia Hospitalar , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Características de Residência , Estudos Retrospectivos , Terapia Socioambiental
3.
J Affect Disord ; 248: 81-90, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30716615

RESUMO

BACKGROUND: Chronic unpredictable mild stress (CUMS) is an important risk factor for depression and cognitive deficits in humans. Enriched environment (EE) showed a beneficial effect on depression and cognition by enhancing brain derived neurotrophic factor (BDNF) expression and synaptic plasticity. However, it is still not clearly understood whether an epigenetic mechanism is involved in the BDNF modulation and synaptic plasticity that occurs after EE treatment for the depressive-like behaviors and cognitive deficits elicited by CUMS. In this study, we investigated the possible mechanism of the neuroprotective effect of EE. METHODS: All rats were exposed to the 5-week CUMS procedure except the control group. After CUMS procedure, some rats were stereotaxically injected with SIRT1 pharmacologic inhibitor EX527 or SIRT1 knocking down lentivirus (sh-SIRT1) in the hippocampus followed by EE treatment for 3 weeks. Other rats were directly subjected to EE treatment without stereotaxic injection. Behavioral tests were used to appraise depression and cognition after EE treatment. Then epigenetic molecules, synaptic proteins, dendritic spine density and branches, and synaptic morphology of the dorsal hippocampus were determined. RESULTS: We found that CUMS induced depressive-like behaviors including decreased sucrose preference ratio, prolonged immobility and reduced locomotor and exploratory activity; cognitive deficits including spatial learning and memory impairment; reduced dendritic spine density and number of branches; thinned postsynaptic density; downregulated SIRT1/microRNA-134 pathway, decreased BDNF and synaptic proteins including synaptophysin (SYN) and postsynaptic density protein 95 (PSD95) expression in the hippocampus. However, the CUMS-induced depressive-like behaviors, cognitive deficits, dendritic spine density and branch number reduction, postsynaptic density thinning, SIRT1/microRNA-134 pathway downregulation, BDNF and synaptic proteins reduction, including synaptophysin (SYN) and postsynaptic density protein 95 (PSD95), were reversed by EE treatment. However, depressive-like behaviors and cognitive deficits were observed again in rats subjected to stereotaxic injection with EX527 or sh-SIRT1. Furthermore, this study also found that SIRT1/microRNA-134 regulates the downstream molecules BDNF, and the synaptic proteins SYN and PSD95 in primary cultured hippocampal neurons. CONCLUSIONS: This study provides evidence for the neuroprotective role of EE on depression and cognitive deficits by activating the SIRT1/microRNA-134 pathway, which accounts for the regulation of synaptic proteins, including BDNF, PSD95 and SYN, dendritic remodeling and ultrastructure changes of synapses in the hippocampus.


Assuntos
Disfunção Cognitiva/metabolismo , Depressão/metabolismo , Hipocampo/metabolismo , Transdução de Sinais/fisiologia , Terapia Socioambiental/métodos , Estresse Psicológico/psicologia , Animais , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Carbazóis/administração & dosagem , Doença Crônica , Disfunção Cognitiva/psicologia , Disfunção Cognitiva/terapia , Depressão/psicologia , Depressão/terapia , Modelos Animais de Doenças , Masculino , MicroRNAs/metabolismo , Plasticidade Neuronal/fisiologia , Ratos , Sirtuína 1/administração & dosagem , Sirtuína 1/metabolismo , Sinaptofisina/metabolismo
4.
Arch Suicide Res ; 23(1): 15-33, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29220609

RESUMO

The current study investigated the impact of adding the Suicide Status Form (SSF) to a suicide-focused group therapy for veterans recently discharged from an inpatient psychiatry setting. A sample of 141 veterans was enrolled and randomized into a Usual Assessment Group Therapy or SSF-Assessment Group Therapy. Participants completed interviews at baseline, 1, and 3 months. No significant differences were observed between groups regarding group attendance (IRR = 1.01, Std. Err = 0.08, 95% CI = 0.87, 1.18) or client satisfaction (ß = 0.23, Std. Err = 0.66, p = 0.73, d = -.25). No main effects were observed across the study on secondary outcomes of interest for suicidal ideation and overall symptom distress, although participants in both treatment conditions reported significant improvements on these outcomes over the course of the study. Patients in the Usual Assessment Group Therapy demonstrated greater reductions in overall symptom distress across the 3-month follow-up window (ß = 6.08, Std. Err = 2.04, p = 0.003; f2 = 0.05). Follow-up path analyses revealed that more frequent session attendance was significantly related to less suicidal ideation at 1-month, higher working alliance between individual members and group facilitators was associated with greater suicidal ideation at 1-month, and higher group cohesion among group members at 1-month was significantly associated with less thwarted belongingness at 1-month. Although the SSF did not improve the impact of an existing suicide-focused group therapy, the study findings support future research on group treatments for suicidal veterans.


Assuntos
Assistência ao Convalescente , Comportamento Cooperativo , Relações Interpessoais , Psicoterapia de Grupo/métodos , Suicídio , Veteranos/psicologia , Adulto , Assistência ao Convalescente/métodos , Assistência ao Convalescente/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas Psicológicas , Integração Social , Terapia Socioambiental/métodos , Ideação Suicida , Suicídio/prevenção & controle , Suicídio/psicologia , Saúde dos Veteranos
5.
Schizophr Res ; 202: 369-377, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30031616

RESUMO

BACKGROUND: Psychological and pharmacological treatments have been shown to reduce rates of transition to psychosis in Ultra High Risk (UHR) young people. However, social functioning deficits have been unresponsive to current treatments. AIMS: The study aims were to: i) describe the theoretical basis and therapeutic targets of a novel intervention targeting social functioning in UHR young people; and ii) examine its acceptability, safety and preliminary effect on social functioning. METHODS: An international, multidisciplinary team developed a new intervention (MOMENTUM) to improve social functioning in UHR young people. MOMENTUM blends two novel approaches to social recovery: strengths and mindfulness-based intervention embedded within a social media environment, and application of the self-determination theory of motivation. The acceptability and safety of MOMENTUM were tested through a 2-month pilot study with 14 UHR participants. RESULTS: System usage was high, with over 70% of users being actively engaged over the trial. All participants reported a positive experience using MOMENTUM, considered it safe and would recommend it to others. 93% reported it to be helpful. There were large, reliable improvements in social functioning (d = 1.83, p < 0.001) and subjective wellbeing (d = 0.75, p = 0.03) at follow-up. There were significant increases in the mechanisms targeted by the intervention including strengths usage (d = 0.70, p = 0.03), mindfulness skills (d = 0.66, p = 0.04) and components of social support. Social functioning improvement was significantly correlated with indicators of system usage. CONCLUSION: MOMENTUM is engaging and safe. MOMENTUM appeared to engage the hypothesized mechanisms and showed promise as a new avenue to improve social functioning in UHR young people.


Assuntos
Internet , Atenção Plena/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Satisfação do Paciente , Transtornos Psicóticos/reabilitação , Autoeficácia , Rede Social , Apoio Social , Terapia Socioambiental/métodos , Adolescente , Adulto , Feminino , Humanos , Masculino , Projetos Piloto , Risco , Adulto Jovem
6.
Mol Autism ; 9: 36, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29946415

RESUMO

Background: Autism spectrum disorder (ASD) is characterized by impaired social interactions and repetitive patterns of behavior. Symptoms appear in early life and persist throughout adulthood. Early social stimulation can help reverse some of the symptoms, but the biological mechanisms of these therapies are unknown. By analyzing the effects of early social stimulation on ASD-related behavior in the mouse, we aimed to identify brain structures that contribute to these behaviors. Methods: We injected pregnant mice with 600-mg/kg valproic acid (VPA) or saline (SAL) at gestational day 12.5 and evaluated the effect of weaning their offspring in cages containing only VPA animals, only SAL animals, or mixed. We analyzed juvenile play at PD21 and performed a battery of behavioral tests in adulthood. We then used preclinical PET imaging for an unbiased analysis of the whole brain of these mice and studied the function of the piriform cortex by c-Fos immunoreactivity and HPLC. Results: Compared to control animals, VPA-exposed animals play less as juveniles and exhibit a lower frequency of social interaction in adulthood when reared with other VPA mice. In addition, these animals were less likely to investigate social odors in the habituation/dishabituation olfactory test. However, when VPA animals were weaned with control animals, these behavioral alterations were not observed. Interestingly, repetitive behaviors and depression-related behaviors were not affected by social enrichment. We also found that VPA animals present high levels of glucose metabolism bilaterally in the piriform cortex (Pir), a region known to be involved in social behaviors. Moreover, we found alterations in the somatosensory, motor, and insular cortices. Remarkably, these effects were mostly reversed after social stimulation. To evaluate if changes in glucose metabolism in the Pir correlated with changes in neuronal activity, we measured c-Fos immunoreactivity in the Pir and found it increased in animals prenatally exposed to VPA. We further found increased dopamine turnover in the Pir. Both alterations were largely reversed by social enrichment. Conclusions: We show that early social enrichment can specifically rescue social deficits in a mouse model of ASD. Our results identified the Pir as a structure affected by VPA-exposure and social enrichment, suggesting that it could be a key component of the social brain circuitry.


Assuntos
Transtorno do Espectro Autista/terapia , Efeitos Tardios da Exposição Pré-Natal/tratamento farmacológico , Comportamento Social , Terapia Socioambiental/métodos , Ácido Valproico/toxicidade , Animais , Transtorno do Espectro Autista/etiologia , Encéfalo/diagnóstico por imagem , Feminino , Masculino , Camundongos , Gravidez , Efeitos Tardios da Exposição Pré-Natal/etiologia , Ácido Valproico/administração & dosagem
7.
J Autism Dev Disord ; 48(7): 2293-2307, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29423608

RESUMO

Group social skills interventions (GSSIs) are a commonly offered treatment for children with high functioning ASD. We critically evaluated GSSI randomised controlled trials for those aged 6-25 years. Our meta-analysis of outcomes emphasised internal validity, thus was restricted to trials that used the parent-report social responsiveness scale (SRS) or the social skills rating system (SSRS). Large positive effect sizes were found for the SRS total score, plus the social communication and restricted interests and repetitive behaviours subscales. The SSRS social skills subscale improved with moderate effect size. Moderator analysis of the SRS showed that GSSIs that include parent-groups, and are of greater duration or intensity, obtained larger effect sizes. We recommend future trials distinguish gains in children's social knowledge from social performance.


Assuntos
Transtorno do Espectro Autista/terapia , Terapia Comportamental/métodos , Habilidades Sociais , Terapia Socioambiental/métodos , Adolescente , Adulto , Transtorno do Espectro Autista/reabilitação , Criança , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
PLoS One ; 13(2): e0192921, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29447248

RESUMO

INTRODUCTION: Exposure to nature may reduce stress in low-income parents. This prospective randomized trial compares the effect of a physician's counseling about nature with or without facilitated group outings on stress and other outcomes among low-income parents. MATERIALS AND METHODS: Parents of patients aged 4-18 years at a clinic serving low-income families were randomized to a supported park prescription versus independent park prescription in a 2:1 ratio. Parents in both groups received physician counseling about nature, maps of local parks, a journal, and pedometer. The supported group received additional phone and text reminders to attend three weekly family nature outings with free transportation, food, and programming. Outcomes measured in parents at baseline, one month and three months post-enrollment included: stress (using the 40-point Perceived Stress Scale [PSS10]); park visits per week (self-report and journaling); loneliness (modified UCLA-Loneliness Scale); physical activity (self-report, journaling, pedometry); physiologic stress (salivary cortisol); and nature affinity (validated scale). RESULTS: We enrolled 78 parents, 50 in the supported and 28 in the independent group. One-month follow-up was available for 60 (77%) participants and three-month follow up for 65 (83%). Overall stress decreased by 1.71 points (95% CI, -3.15, -0.26). The improvement in stress did not differ significantly by group assignment, although the independent group had more park visits per week (mean difference 1.75; 95% CI [0.46, 3.04], p = 0.0085). In multivariable analysis, each unit increase in park visits per week was associated with a significant and incremental decrease in stress (change in PSS10-0.53; 95% CI [-0.89, -0.16]; p = 0.005) at three months. CONCLUSION: While we were unable to demonstrate the additional benefit of group park visits, we observed an overall decrease in parental stress both overall and as a function of numbers of park visits per week. Paradoxically the park prescription without group park visits led to a greater increase in weekly park visits than the group visits. To understand the benefits of this intervention, larger trials are needed. TRIAL REGISTRATION: ClinicalTrials.gov NCT02623855.


Assuntos
Aconselhamento , Pais/psicologia , Parques Recreativos , Terapia Socioambiental , Estresse Psicológico/reabilitação , Acelerometria , Adolescente , Adulto , Criança , Pré-Escolar , Exercício Físico , Feminino , Seguimentos , Humanos , Hidrocortisona/metabolismo , Masculino , Pessoa de Meia-Idade , Pobreza , Saliva/metabolismo , Autorrelato , Estresse Psicológico/fisiopatologia , Resultado do Tratamento , Adulto Jovem
9.
Int Psychogeriatr ; 30(7): 1057-1068, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29335035

RESUMO

ABSTRACTBackground:People with dementia at green care farms (GCFs) are physically more active, have more social interactions, are involved in a larger variety of activities, and come outdoors more often than those in other long-term dementia care settings. These aspects may positively affect health and well-being. This study explored which and how characteristics of GCFs could be implemented in other long-term dementia care settings, taking into account possible facilitators and barriers. METHODS: Semi-structured interviews were conducted with 23 professionals from GCFs, independent small-scale long-term care facilities, and larger scale long-term care facilities in the Netherlands. The framework method was used to analyze the data. RESULTS: Several characteristics of GCFs (e.g. homelike aspects, domestic activities, and access to outdoor environments) have already been applied in other types of long-term dementia care settings. However, how and the extent to which these characteristics are being applied differ between GCFs and other types of long-term dementia care settings. Facilitators and barriers for the implementation of characteristics of GCFs were related to the physical environment in which the care facility is situated (e.g. the degree of urbanization), characteristics and competences of staff members (e.g. flexibility, creativity), characteristics and competences of managers (e.g. leadership, vision), and the political context (e.g. application of risk and safety protocols). CONCLUSION: Several characteristics can be implemented in other dementia care settings. However, to realize innovation in dementia care it is important that not only the physical environment but also the social and organizational environments are supporting the process of change.


Assuntos
Atitude do Pessoal de Saúde , Demência , Fazendas , Instituição de Longa Permanência para Idosos/organização & administração , Assistência de Longa Duração , Casas de Saúde/organização & administração , Terapia Socioambiental/métodos , Idoso , Demência/psicologia , Demência/reabilitação , Demência/terapia , Feminino , Humanos , Relações Interpessoais , Assistência de Longa Duração/métodos , Assistência de Longa Duração/organização & administração , Masculino , Pessoa de Meia-Idade , Modelos Organizacionais , Países Baixos , Pesquisa Qualitativa
10.
J Am Acad Psychiatry Law ; 45(1): 40-43, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28270461

RESUMO

Forensic psychiatric units are high-risk environments for aggressive behavior. Many elements are necessary for the successful reduction or elimination of aggression in the process of creating a safe treatment environment. Many specific interventions have been attempted over the years with various degrees of, usually limited, success. Tolisano et al. present an integrated behavioral approach with solid theoretical underpinnings and opportunities to support significant safety improvements for select patients, albeit with several caveats.


Assuntos
Agressão/psicologia , Terapia Comportamental/métodos , Hospitais Psiquiátricos , Terapia Ambiental/métodos , Prisioneiros/legislação & jurisprudência , Psicotrópicos/uso terapêutico , Terapia Socioambiental/métodos , Adulto , Terapia Combinada , Feminino , Humanos , Masculino , Prisioneiros/psicologia , Violência/legislação & jurisprudência , Violência/prevenção & controle , Violência/psicologia
11.
Int J Geriatr Psychiatry ; 32(10): 1094-1103, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27640872

RESUMO

BACKGROUND: Very few interventional studies have directly examined the impact of treatment approaches on health-related quality of life (HRQL) in people with dementia. This is of particular importance in therapies to address behavioural symptoms, where HRQL is often severely affected. METHODS: Analysis within the WHELD cluster randomised factorial study in 16 UK care homes examining the impact of person-centred care in combination with antipsychotic review, social interaction and exercise interventions. This study analysed impact on HRQL through the DEMQOL-Proxy. RESULTS: Data on HRQL were available for 187 participants. People receiving antipsychotic review showed a significant worsening in two DEMQOL-Proxy domains (negative emotion: p = 0.02; appearance: p = 0.04). A best-case scenario analysis showed significant worsening for total DEMQOL-Proxy score. Social interaction intervention resulted in a significant benefit to HRQL (p = 0.04). There was no deterioration in HRQL in groups receiving both antipsychotic review and social interaction (p = 0.62). CONCLUSIONS: This demonstrates an important detrimental impact of discontinuation of antipsychotics in dementia on HRQL, highlighting the need for careful review of best practice guidelines regarding antipsychotic use and emphasising the importance of providing evidence-based non-pharmacological interventions in conjunction with antipsychotic review. Copyright © 2016 John Wiley & Sons, Ltd.


Assuntos
Antipsicóticos/uso terapêutico , Demência/terapia , Relações Interpessoais , Casas de Saúde/estatística & dados numéricos , Qualidade de Vida , Terapia Socioambiental/métodos , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Demência/diagnóstico , Terapia por Exercício/métodos , Feminino , Nível de Saúde , Humanos , Masculino , Psicoterapia Centrada na Pessoa/métodos
12.
Dev Med Child Neurol ; 59(5): 550-556, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27911014

RESUMO

AIM: Outdoor adventure programmes aim to improve interpersonal relationships using adventurous activities. The current study examined the effectiveness of an outdoor adventure programme in children with autism spectrum disorders (ASD). METHOD: The study included 51 participants (40 males, 11 females; age 3y 4mo-7y 4mo) enrolled in ASD special education kindergartens. Only the intervention group (n=30) participated in the outdoor adventure programme for 13 weeks, completing challenging physical activities that required cooperation and communication with peers and instructors. The control group (n=21) was not significantly different from the research group in age, sex, cognitive, and adaptive behaviour measures. RESULTS: Outcomes after the intervention revealed significant improvement in social-communication and different directions in the two groups in the social cognition, social motivation, and autistic mannerisms subdomains of the Social Responsiveness Scale. While the group that received an outdoor adventure programme showed a tendency toward a reduction in severity, the control group showed the opposite (p<0.010). INTERPRETATION: The outdoor adventure programme required problem-solving skills and forced the child to communicate in exciting situations. This study suggests that an outdoor adventure programme may be an effective intervention in addition to traditional treatments in young children with ASD. Future studies should examine the outcome of outdoor adventure programmes delivered for longer periods of time and maintenance of the achievements over time.


Assuntos
Transtorno do Espectro Autista/psicologia , Transtorno do Espectro Autista/reabilitação , Terapia Cognitivo-Comportamental/métodos , Relações Interpessoais , Comportamento Social , Terapia Socioambiental/métodos , Adaptação Psicológica , Análise de Variância , Criança , Pré-Escolar , Comunicação , Feminino , Humanos , Masculino , Resultado do Tratamento
13.
Tidsskr Nor Laegeforen ; 136(19): 1639-1642, 2016 10.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-27790891

RESUMO

BACKGROUND: In recent decades the pattern of substance use among patients admitted for detoxification has changed from predominantly single-substance use to simultaneous multi-substance use. The evidence base for pharmacological treatment of polydrug users remains inadequate. MATERIAL AND METHOD: A non-experimental cohort study was conducted with 284 polydrug users in the Detoxification Unit of Sørlandet Hospital in 2013. The therapeutic approach was standardised, and was based on social therapy and symptomatic treatment of withdrawal symptoms with valproate and clonidine as key medications. RESULTS: Three quarters of the patients were male and they had used more than three different substances on average. The average age was 39 years. In total, 75 % of patients completed the detoxification programme, and for 95 % detoxification occurred without complications. In 89 % of cases, the standard treatment protocol was followed. There was a weak but significant correlation between treatment discontinuation and the number of substances used (OR = 1.42, p < 0.05). In terms of complications, 1.1 % experienced delirium tremens, 1.1 % epileptic seizures and 1.4 % substance-induced psychosis. Transfer to a somatic ward was necessary for 2.1 % of patients, and to a psychiatric ward for 1.4 %. INTERPRETATION: The completion rate in this study was considerably higher than in previous detoxification studies, and the complication rate was lower. In view of the good results observed and the high degree of standardised treatment, the regimen can be considered a safe treatment option for other detoxification units.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Anticonvulsivantes/uso terapêutico , Clonidina/uso terapêutico , Terapia Socioambiental , Transtornos Relacionados ao Uso de Substâncias/terapia , Ácido Valproico/uso terapêutico , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Pacientes Desistentes do Tratamento , Avaliação de Programas e Projetos de Saúde , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
14.
Br J Soc Psychol ; 55(4): 613-642, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27578549

RESUMO

In this research, we introduce Social Identity Mapping (SIM) as a method for visually representing and assessing a person's subjective network of group memberships. To provide evidence of its utility, we report validating data from three studies (two longitudinal), involving student, community, and clinical samples, together comprising over 400 participants. Results indicate that SIM is easy to use, internally consistent, with good convergent and discriminant validity. Each study also illustrates the ways that SIM can be used to address a range of novel research questions. Study 1 shows that multiple positive group memberships are a particularly powerful predictor of well-being. Study 2 shows that social support is primarily given and received within social groups and that only in-group support is beneficial for well-being. Study 3 shows that improved mental health following a social group intervention is attributable to an increase in group compatibility. In this way, the studies demonstrate the capacity for SIM to make a contribution both to the development of social-psychological theory and to its practical application.


Assuntos
Processos Grupais , Satisfação Pessoal , Psicometria/métodos , Identificação Social , Apoio Social , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Terapia Socioambiental/métodos , Adulto Jovem
15.
J Dev Behav Pediatr ; 37(6): 475-82, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27355881

RESUMO

OBJECTIVE: Evaluate the acceptability, feasibility, and preliminary outcomes of a peer-mediated intervention to improve social competence of brain tumor survivors and classmates. METHOD: Twelve childhood brain tumor survivors and 217 classroom peers in intervention (n = 8) or comparison (n = 4) classrooms completed measures of social acceptance and reputation at 2 time points in the year. The intervention (5-8 sessions over 4-6 weeks) taught peer leaders skills for engaging classmates. Individual and classroom outcomes were analyzed with analysis of covariance. RESULTS: Recruitment rates of families of brain tumor survivors (81%) and schools (100%) were adequate. Peer leaders reported satisfaction with the intervention. Preliminary outcome data trended toward some benefit in increasing the number of friend nominations for survivors of brain tumors but no changes in other peer-reported metrics. Preliminary results also suggested some positive effects on classroom levels of victimization and rejection. CONCLUSION: A peer-mediated intervention was acceptable to families of brain tumor survivors and feasible to implement in schools. Findings warrant a larger trial to evaluate improvements for children with brain tumors and their peers.


Assuntos
Neoplasias Encefálicas/psicologia , Sobreviventes de Câncer/psicologia , Grupo Associado , Habilidades Sociais , Terapia Socioambiental , Adolescente , Criança , Estudos de Viabilidade , Feminino , Humanos , Liderança , Masculino , Aceitação pelo Paciente de Cuidados de Saúde
17.
Aging Ment Health ; 20(3): 262-70, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-25677721

RESUMO

OBJECTIVES: The study examined the effect of an individualized social activities intervention (ISAI) on quality of life among older adults with mild to moderate cognitive impairment in a geriatric psychiatry facility. METHOD: This randomized control trial consisted of 52 older adults (M = 70.63, SD = 5.62) with mild to moderate cognitive impairment in a geriatric inpatient psychiatry facility. A 2 (group condition) × 2 (time of measurement) design was used to compare the control (treatment-as-usual) and intervention (treatment-as-usual plus ISAI) conditions at pre- and post-treatment. ISAI consisted of 30- to 60-minute sessions for up to 15 consecutive days. The Dementia Quality of Life instrument and Neurobehavioral Rating Scale-Revised were used to examine quality of life and behavioral and psychological symptoms of dementia at pre- and post-treatment. RESULTS: Intent-to-treat analyses indicated a significant time × group condition interaction on quality of life, with this effect remaining when only completer data were included. There was no evidence of a significant treatment effect on behavioral and psychological symptoms of dementia. CONCLUSION: Findings suggest that individualized social activities are a promising treatment for cognitively impaired geriatric inpatients.


Assuntos
Disfunção Cognitiva/reabilitação , Demência/reabilitação , Qualidade de Vida/psicologia , Terapia Socioambiental/métodos , Idoso , Feminino , Hospitais Psiquiátricos , Humanos , Masculino , Pessoa de Meia-Idade , Psicoterapia , Resultado do Tratamento
19.
Am J Psychiatry ; 173(3): 252-62, 2016 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-26585409

RESUMO

OBJECTIVE: This study evaluated the impact of antipsychotic review, social interaction, and exercise, in conjunction with person-centered care, on antipsychotic use, agitation, and depression in people with dementia living in nursing homes. METHOD: A cluster-randomized factorial controlled trial with two replications was conducted in people with dementia in 16 U.K. nursing homes. All homes received training in person-centered care. Eight homes were randomly assigned to antipsychotic review, to a social interaction intervention, and to an exercise intervention for 9 months, with most homes assigned to more than one intervention. The primary outcome measures were antipsychotic use, agitation, and depression. Secondary outcome measures were overall neuropsychiatric symptoms and mortality. RESULTS: Antipsychotic review significantly reduced antipsychotic use by 50% (odds ratio 0.17, 95% confidence interval [CI] 0.05 to 0.60). Antipsychotic review plus the social interaction intervention significantly reduced mortality (odds ratio 0.26, 95% CI 0.13 to 0.51) compared with the group receiving neither. The group receiving antipsychotic review but not the social intervention showed significantly worse outcome in neuropsychiatric symptoms compared with the group receiving neither (score difference +7.37, 95% CI 1.53 to 13.22). This detrimental impact was mitigated by concurrent delivery of the social intervention (-0.44, CI -4.39 to 3.52). The exercise intervention significantly improved neuropsychiatric symptoms (-3.59, 95% CI -7.08 to -0.09) but not depression (-1.21, CI -4.35 to 1.93). None of the interventions had a significant impact specifically on agitation. CONCLUSIONS: While reductions in antipsychotic use can be achieved by using a "real world" intervention, this may not be of benefit to people with dementia in the current climate of more judicious prescribing unless nonpharmacological interventions such as social interaction or exercise are provided in parallel.


Assuntos
Antipsicóticos/uso terapêutico , Demência , Terapia por Exercício/métodos , Relações Interpessoais , Qualidade de Vida , Terapia Socioambiental/métodos , Idoso , Análise por Conglomerados , Demência/diagnóstico , Demência/psicologia , Demência/terapia , Depressão/terapia , Feminino , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Masculino , Casas de Saúde/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Escalas de Graduação Psiquiátrica , Agitação Psicomotora/terapia
20.
J Psychiatr Ment Health Nurs ; 23(1): 3-11, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26459928

RESUMO

INTRODUCTION: Three interconnected pathways to relapse have been identified as stressful life events, medication non-adherence and disruptions in social rhythms (daily activity and routine). The role of medication and stressful life events is generally better understood than the role of social rhythms. There is no previous review of interventions that target social rhythms. AIM: To identify the evidence for the effectiveness of interventions that target social rhythms for improving mood symptoms. METHOD: A quantitative systematic review was conducted. Results Seven studies were included in the review: four reporting interpersonal and social rhythm therapy (IPSRT) interventions and three sleep/light interventions. DISCUSSION: The results suggest that IPSRT may have a potential benefit in improving mood symptoms and relapse, but it is not clear whether this is of greater benefit than an intensive supportive care intervention of similar duration. The sleep/light interventions demonstrated rapid mood improvements; however, it was not clear how long this improvement was sustained. IMPLICATIONS FOR PRACTICE: Attention to social rhythms and the implementation of interventions that target these could be useful for mental health nursing practice may provide people with BD a clinically effective adjunctive intervention to medication.


Assuntos
Transtorno Bipolar/terapia , Cronoterapia/métodos , Fototerapia/métodos , Terapia Socioambiental/métodos , Humanos
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