Motivational interviewing: Validation of a proposed NIC nursing intervention in persons with a severe mental illness.

INTRODUCTION: Low adherence to treatment is a common problem in the care of patients with severe mental illnesses. Motivational interviewing is a directive, client-centered counseling therapeutic approach designed to elicit behavior change by helping clients to explore and resolve ambivalence. Nurses use motivational interviewing, although it has not been defined from a nursing perspective nor with nursing language. Thus, nursing research on the use of these techniques is being carried out, supported by their effectiveness in many health problems. The development of motivational interviewing as a standardized nursing intervention for inclusion in the Nursing Interventions Classification (NIC) may promote its use by mental health nurses in their daily work and thus improve the quality of care. OBJECTIVES: To validate a proposed motivational interviewing nursing intervention for inclusion in the NIC. MATERIALS AND METHODS: We followed the validation methodology of the NIC of the Iowa and the Intervention Normalization for Nursing Practice projects. The study comprised theoretical (scientific and expert validation) and empirical (terminological and clinical validation) phases. RESULTS: There is ample evidence supporting the efficiency of the motivational interviewing to improve the therapeutic adherence of people with severe mental illness. The group of experts agreed on the label name "motivational interviewing" for the NIC based on the modified model by Miller & Röllnick (2015), which includes 28 associated activities through the phases of engaging, focusing, evoking, and planning. Development of the NANDA International and the Nursing Outcomes Classification nursing language was completed. Knowledge and drug attitude improved in the motivational intervention group. CONCLUSIONS: We validated the nursing intervention motivational interviewing for inclusion in the NIC that will help improve therapeutic adherence. The intervention may be used for other behavioral changes.

Gender Differences in Demographic and Clinical Features of Physicians Admitted to a Program for Medical Professionals with Mental Disorders.

OBJECTIVE: To examine the demographic and clinical differences between men and women admitted to a Physicians' Health Programme (PHP). METHOD: Retrospective chart review of 778 medical records of physicians admitted to the Barcelona PHP from February 1, 1998 until December 31, 2015. RESULTS: Women admitted to the Barcelona PHP were younger than men, were more likely to be self-referred and to be admitted for a non-addictive mental disorder. Prevalence of unipolar affective disorders (60.1 vs. 37.6%), adjustment disorders (62.4 vs. 37.6%), and obsessive-compulsive disorder (61.1 vs. 38.9%) was significantly higher among women, whereas prevalence of alcohol use disorders was lower (32.7 vs. 67.3%). Nevertheless, both groups were similar with regard to medical specialty, working status, length of their first treatment episode, and presence of hospitalization during that episode. After multivariate analysis, age, type of referral, and main diagnosis (addictive disorders vs. other mental disorders) discriminated the differences between groups. CONCLUSION: Women physicians seem to be more prone to voluntarily ask for help from PHPs and are more likely to suffer from mood and anxiety disorders compared to men. However, mental disorders' severity may be similar in both groups. More studies are needed to clarify the gender factors related to this behavior.

Estudio de aplicabilidad de la entrevista motivacional para potenciar la rehabilitación en pacientes geriátricos ingresados en una unidad de convalecencia / Feasibility study of motivational interviewing to improve rehabilitation in an Intermediate Care Hospital

Objetivo: La rehabilitación de las personas mayores es una intervención compleja, en la cual intervienen múltiples componentes (clínica, cognitiva, anímica etc.). Nuestro estudio pretende comprobar si la entrevista motivacional (EM) (basada en una atención centrada en la persona), con adaptaciones, es aplicable en pacientes con fractura de fémur o ictus que realizan rehabilitación en una unidad de convalecencia. Metodología: Se realizan entrevistas motivacionales a 20 pacientes > 65 años (10 con fractura de fémur y 10 con ictus). Un geriatra formado en EM realiza dos entrevistas a cada paciente, una inicial en < 72 horas del ingreso y otra de seguimiento la semana siguiente. Para que los pacientes recuerden los ejercicios acordados, se entregan trípticos adaptados. Resultados: Todos los pacientes aceptaron y valoraron satisfactoriamente las dos entrevistas. La segunda entrevista mostraba mejor aceptación si realizada antes del 6è día, porqué se recordaba mejor al profesional y los objetivos acordados. La demanda de esta intervención fue alta (4-5 pacientes/semana). El mejor momento per realizar la entrevista es por la tarde, evitando interferir en el funcionamiento de la planta. La EM en pacientes con deterioro cognitivo leu presenta mayor dificultad, y en 3 ocasiones se incorporó a la entrevista al cuidador principal, con muy buena respuesta. La motivación de los pacientes para realizar rehabilitación fue alta (poca ambivalencia), por ello durante las entrevistas no se trabajó tanto la ambivalencia, sino en empoderar a los pacientes y ayudarlos a encontrar herramientas para aumentar las probabilidades de éxito. Conclusiones: La EM es una herramienta fácilmente aplicable dentro del entorno socio sanitario, realizando algunas adaptaciones. La motivación de los pacientes es alta y la EM se centra sobre todo en empoderar al paciente. Este estudio abre la puerta a evaluar, en un futuro, si la intervención es efectiva en este ámbito

Objective: Our main objective was to test the feasibility of adding a patient centered motivational intervention to the usual rehabilitation in an Intermediate Care (IC) Hospital for patients admitted after a hip fracture or stroke. Methods: 20 patients>65 years (10 hip fracture;10 stroke) participated in the study, receiving two motivational interviewing sessions by a trained geriatrician, the first within the 72 hours after admission, the second one week later. All patients were given leaflets informing about different rehabilitation exercises to perform besides formal physical therapy provided in the hospital, among which they could choose those they felt more suitable. Data collected included socio-demographics, comorbidity, and clinical, cognitive and functional status. Results: The motivational intervention was accepted by all patients and all felt it to be appropriate. Opportunities for this intervention were high,4-5 patients per week, best time for the interventions was in the afternoons, which avoided interferences with hospital activities. In patients with mild cognitive impairment the intervention was harder, and in 3 occasions the primary caregiver was invited to participate, with high acceptance and enthusiasm. Patients at baseline were already highly motivated to do rehabilitation, and ambivalence was not big. Therefore most of the interviews focussed on empowering patients and helping them to identify and set their own goals during rehabilitation. Conclusions: Adding specific motivational interventions to usual rehabilitation treatment in older patients admitted after a hip fracture or stroke, is feasible and acceptable in our IC Hospital. Since patients are quite prone to rehabilitation, interviews tend to focus on empowerment. Further, rigorous research is needed

Differences in Physicians' and Nurses' Recent Suicide Attempts: An Exploratory Study.

The aim of this study was to examine the characteristics of physicians' and nurses' suicide attempts (SA). A retrospective review of 493 medical records of physicians and nurses admitted to an inpatient unit for health professionals; 36 patients had a recent SA. Depression, cluster B and C personality disorders, and a history of previous SA were more prevalent in patients with a recent SA compared to those without it. Both professional groups preferred drug overdose as a suicide method. Physicians made more lethal attempts and had a history of more previous stressors than nurses. Depression, cluster B and C personality disorders, and previous SA should be appropriately screened and treated in order to prevent SA amongst physicians and nurses.

Dual diagnosis among physicians: a clinical perspective.

Co-occurrence of mental disorders and substance use disorders (dual diagnosis) among doctors is a cause of serious concern due to its negative personal, professional, and social consequences. This work provides an overview of the prevalence of dual diagnosis among physicians, suggests a clinical etiological model to explain the development of dual diagnosis in doctors, and recommends some treatment strategies specifically for doctors. The most common presentation of dual diagnosis among doctors is the combination of alcohol use disorders and affective disorders. There are also high rates of self-medication with benzodiazepines, legal opiates, and amphetamines compared to the general population, and cannabis use disorders are increasing, mainly in young doctors. The prevalence of nicotine dependence varies from one country to another depending on the nature of public health policies. Emergency medicine physicians, psychiatrists, and anaesthesiologists are at higher risk for developing a substance use disorder compared with other doctors, perhaps because of their knowledge of and access to certain legal drugs. Two main pathways may lead doctors toward dual diagnosis: (a) the use of substances (often alcohol or self-prescribed drugs) as an unhealthy strategy to cope with their emotional or mental distress and (b) the use of substances for recreational or other purposes. In both cases, doctors tend to delay seeking help once a problem has been established, often for many years. Denial, minimization, and rationalization are common defense mechanisms, maybe because of the social stigma associated with mental or substance use disorders, the risk of losing employment/medical license, and a professional culture of perfectionism and denial of emotional needs or failures. Personal vulnerability interacts with these factors to increase the risk of a dual diagnosis developing in some individuals. When doctors with substance use disorders accept treatment in programs specifically designed for them (Physicians' Health Programs), they show better outcomes than the general population. However, physicians with dual diagnosis have more psychological distress and worse clinical prognosis than those with substance use disorders only. Future studies should contribute to a better comprehension of the risk and protective factors and the evidence-based treatment strategies for doctors with dual diagnosis.

Use of topiramate in treatment-resistant bipolar spectrum disorders.

To evaluate the effectiveness and safety of topiramate as add-on, long-term therapy for treatment-resistant bipolar-spectrum disorders, 34 DSM-IV bipolar-spectrum patients, including bipolar I (n = 28), bipolar II (n = 3), bipolar not otherwise specified (n = 2), and schizoaffective disorder bipolar type (n = 1), considered to be resistant to treatment with lithium, carbamazepine, and valproate, received increasing doses of topiramate as adjunctive therapy for their manic (n = 17), depressive (n = 11), hypomanic (n = 3), or mixed (n = 3) symptoms. Outcome measures included the Young Mania Rating Scale (YMRS), the Hamilton Rating Scale for Depression (HAM-D), and the Clinical Global Impression (CGI) for Severity. Patients were followed up for 6 months. Twenty-five patients (74%) completed the 6-month follow-up. Nine patients (26%) dropped out early due to lost of follow-up (n = 4), worsening of symptoms (n = 2), side effects (n = 1), hospitalization due to intercurrent illness (n = 1), and noncompliance (n = 1). By intent-to-treat analysis, there was a significant reduction in YMRS, HAM-D, and CGI scores (p < 0.0001 for all measures at the endpoint) after the introduction of topiramate. Most therapeutic effects appeared between weeks 2 and 6. Fifty-nine percent of manic patients and 55% of depressed patients were considered to be responders to the drug, which was well tolerated; only one patient discontinued due to side effects. The most common side effect was paraesthesia (n = 2). Ten patients experienced moderate weight loss during the follow-up period. The mean topiramate dose at endpoint was 202 +/- 65 mg/day. These preliminary results indicate that adjunctive topiramate may be useful in the long-term treatment of bipolar spectrum disorders, even in the most difficult-to-treat patients.