"It's That They Treated Me Like an Object": A Qualitative Study on the Participation of People Diagnosed with Psychotic Disorders in Their Health Care.

The mental health recovery model is based on shared decision making, in which patients' preferences and perceptions of the care received are taken into account. However, persons with psychosis usually have very few opportunities to participate in this process. The present study explores the experiences and perceptions of a group of patients with psychosis-in some cases longstanding, in others more recently diagnosed-concerning their participation in the decisions taken about the approach to their condition and about the attention received from healthcare professionals and services. For this purpose, we performed a qualitative analysis of the outcomes derived from five focus groups and six in-depth interviews (36 participants). Two major themes, with five sub-themes, were identified: shared decision-making (drug-centred approach, negotiation process, and lack of information) and the care environment and styles of clinical practice as determinants (aggressive versus person-centred environments, and styles of professional practice). The main conclusions drawn are that users want to participate more in decision making, they want to be offered a range of psychosocial options from the outset and that their treatment should be based on accessibility, humanity and respect. These findings are in line with the guidelines for clinical practice and should be taken into account in the design of care programmes and the organisation of services for persons with psychosis.

'I do not know where it comes from, I am suspicious of some childhood trauma' association of trauma with psychosis according to the experience of those affected.

Background: Trauma-related symptoms are often experienced after a first psychotic episode. Objective: In this study, we conduct a qualitative analysis of referred traumatic experiences of outpatients diagnosed with psychotic disorders. Method: Focus groups were formed and in-depth interviews conducted with 30 participants, focusing on their experience with the disorder and the health care received. Given the frequency with which trauma and psychosis have been associated in the scientific literature, the nature of this relation is addressed as a secondary objective, via a qualitative analysis. Results: Analysis revealed two main themes in the patients' discourse. On many occasions, traumatic experiences were related to the development of the disorder. Although most participants referred to traumatic experiences during childhood, episodes during adult life were also reported, which may have triggered the disorder. The second theme was that of the interlocking relationship between the psychotic experience and certain coercive practices undergone during the provision of health care for psychosis, and the traumatic effects thus generated. Conclusions: The participants considered both themes to be highly important. Accordingly, these issues should be carefully assessed and managed in order to provide appropriate person-centred care.

Antecedentes: Los síntomas relacionados con el trauma a menudo se experimentan después de un primer episodio psicótico.Objetivo: En este estudio, realizamos un análisis cualitativo de experiencias traumáticas de pacientes ambulatorios diagnosticados con trastornos psicóticos.Método: Se conformaron grupos focales y se realizaron entrevistas en profundidad a 30 participantes, enfocándose en su experiencia con el trastorno y la atención médica recibida. Dada la frecuencia con la que el trauma y la psicosis se han asociado en la literatura científica, la naturaleza de esta relación se aborda como un objetivo secundario, a través de un análisis cualitativo.Resultados: El análisis reveló dos temas principales en el discurso de los pacientes. En muchas ocasiones, las experiencias traumáticas se relacionaron con el desarrollo del trastorno. Aunque la mayoría de los participantes se refirieron a experiencias traumáticas durante la infancia, también se informaron episodios durante la vida adulta, los que pueden haber desencadenado el trastorno. El segundo tema fue el de la relación entrelazada entre la experiencia psicótica y ciertas prácticas coercitivas sufridas durante la prestación de atención médica para la psicosis, y los efectos traumáticos generados por ésta.Conclusiones: Los participantes consideraron que ambos temas eran de gran importancia. En consecuencia, estas situaciones deben evaluarse y gestionarse cuidadosamente para proporcionar una atención adecuada centrada en la persona.

Implicación de usuarios diagnosticados de Trastorno de Ansiedad Generalizada en la elaboración de una guía de práctica clínica / Involvement of Users Diagnosed with Generalized Anxiety Disorder in the Development of a Clinical Practice Guideline

Resumen En la actualidad hay un interés creciente en implicar a los usuarios de los servicios sanitarios en la elaboración de guías de práctica clínica, especialmente en los problemas de salud de mayor complejidad o frecuencia, como es el Trastorno de Ansiedad Generalizada (TAG). El objetivo del presente artículo es dar a conocer la novedosa metodología cualitativa utilizada para maximizar el impacto del punto de vista de un grupo de usuarios con TAG en la elaboración de una Guía de práctica clínica (GPC) sobre dicho trastorno. Para ello, se realizaron grupos focales y, a partir del análisis de contenido, se vincularon los testimonios de los usuarios con las recomendaciones basadas en la evidencia, situando ambas fuentes de información al mismo nivel de relevancia.

Abstract Currently, there is an increasing interest in involving the health service users in the development of Clinical practice guidelines (CPG), specially in the more complex and frequent health problems, as the Generalized Anxiety Disorder (GAD). The purpose of this article is to communicate the novel qualitative methodology that has been used to maximize the impact of the perspective of a group of users with GAD in the development of a CPG about it. To that end, focal groups were performed and, from the content analysis, the users testimonials were linked to the evidence-based recommendations of the CPG based on the same topic, in order to situate both sources of information at the same level of relevance.

¿En qué medida las guías de práctica clínica responden a las necesidades y preferencias de los usuarios diagnosticados de trastorno obsesivo compulsivo? / To What Extent do Clinical Practice Guidelines Respond to the Needs and Preferences of Patients Diagnosed with Obsessive-Compulsive Disorder?

RESUMEN Introducción: Para facilitar la toma de decisiones clínicas, están proliferando las guías de práctica clínica (GPC). Sin embargo, actualmente se carece de GPC para el trastorno obsesivo compulsivo (TOC) en las que se incluyan los requerimientos y las expectativas de los usuarios. Objetivos: El objetivo del presente trabajo es conocer si las recomendaciones de la guía «Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder¼ del National Institute for Clinical Excellence (NICE) se corresponden con las necesidades y preferencias de un grupo de usuarios diagnosticados de TOC. Métodos: Para ello, se conformaron 2 grupos focales con un total de 12 pacientes, a los que se preguntó sobre el impacto del TOC en sus vidas, su experiencia con los servicios de salud mental, la satisfacción con los tratamientos recibidos y los recursos personales de afrontamiento. Las preferencias y necesidades de los usuarios se compararon con las recomendaciones de la guía y, para facilitar su accesibilidad, se agruparon en 4 grandes áreas temáticas: información, accesibilidad, abordaje terapéutico y relación terapéutica. Resultados: Se observó una alta correspondencia entre las recomendaciones y las preferencias de los usuarios; por ejemplo, respecto a las intervenciones psicológicas de alta intensidad. La escasez de intervenciones psicológicas de baja intensidad antes de acudir al servicio de salud mental o la dificultad para acceder a los profesionales son algunas de las experiencias narradas que discreparon con las recomendaciones de la guía y de las necesidades expresadas por este grupo de usuarios. Conclusiones: Hay coincidencia entre las recomendaciones y las preferencias y necesidades de los usuarios; sin embargo, los servicios sanitarios responden a ellas parcialmente.

ABSTRACT Introduction: The number of Clinical Practice Guidelines (CPG) to help in making clinical decisions is increasing. However, there is currently a lack of CPG for Obsessive-Compulsive Disorder that take into account the requirements and expectations of the patients. Objective: The aim of the present study was to determine whether recommendations of the NICE guideline, "Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder" agrees with the needs and preferences of patients diagnosed with OCD in the mental health service. Material and method: Two focal groups were formed with a total of 12 participants. They were asked about the impact of the disorder in their lives, their experiences with the mental health services, their satisfaction with treatments, and about their psychological resources. Preferences and needs were compared with the recommendations of the guidelines, and to facilitate their analysis, they were classified into four topics: information, accessibility, treatments, and therapeutic relationship. Results: The results showed a high agreement between recommendations and patients preferences, particularly as regards high-intensity psychological interventions. Some discrepancies included the lack of prior low-intensity psychological interventions in mental health service, and the difficulty of rapid access the professionals. Conclusions: There is significant concordance between recommendations and patients preferences and demands, which are only partially responded to by the health services.

To What Extent do Clinical Practice Guidelines Respond to the Needs and Preferences of Patients Diagnosed with Obsessive-Compulsive Disorder? / ¿En qué medida las guías de práctica clínica responden a las necesidades y preferencias de los usuarios diagnosticados de trastorno obsesivo compulsivo?

INTRODUCTION: The number of Clinical Practice Guidelines (CPG) to help in making clinical decisions is increasing. However, there is currently a lack of CPG for Obsessive-Compulsive Disorder that take into account the requirements and expectations of the patients. OBJECTIVE: The aim of the present study was to determine whether recommendations of the NICE guideline, "Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder" agrees with the needs and preferences of patients diagnosed with OCD in the mental health service. MATERIAL AND METHOD: Two focal groups were formed with a total of 12 participants. They were asked about the impact of the disorder in their lives, their experiences with the mental health services, their satisfaction with treatments, and about their psychological resources. Preferences and needs were compared with the recommendations of the guidelines, and to facilitate their analysis, they were classified into four topics: information, accessibility, treatments, and therapeutic relationship. RESULTS: The results showed a high agreement between recommendations and patients preferences, particularly as regards high-intensity psychological interventions. Some discrepancies included the lack of prior low-intensity psychological interventions in mental health service, and the difficulty of rapid access the professionals. CONCLUSIONS: There is significant concordance between recommendations and patients preferences and demands, which are only partially responded to by the health services.

Gender Dysphoria and Social Anxiety: An Exploratory Study in Spain.

INTRODUCTION: Social anxiety in gender dysphoria is still under investigation. AIM: To determine the prevalence and associated factors of social anxiety in a sample of individuals with gender dysphoria. METHODS: A cross-sectional design was used in a clinical sample attending a public gender identity unit in Spain. The sample consisted of 210 individuals (48% trans female and 52% trans male). MAIN OUTCOME MEASURES: Mini-International Neuropsychiatric Interview (MINI) for diagnosis of social anxiety disorder, Structured Clinical Interview, Exposure to Violence Questionnaire (EVQ), Beck Depression Inventory (BDI-II), and Functional Social Support Questionnaire (Duke-UNC-11). RESULTS: Of the total sample, 31.4% had social anxiety disorder. Social anxiety disorder was highly correlated with age (r = -0.181; CI = 0.061-0.264; P = .009) and depression (r = 0.345; CI = 0.213-0.468; P < .001); it is strongly associated to current cannabis use (relative risk [RR] = 1.251; CI = 1.070-1.463; P = .001) and lifetime suicidal ideation (RR = 1.902; CI 1.286-2.814; P < .001). Moreover, it is significantly associated to lifetime nonsuicidal self-injury (RR = 1.188; CI 1.018-1.386; P = .011), nationality (RR = 7.792; CI 1.059-57.392; P = .013), perceived violence at school during childhood and adolescence (r = 0.169; CI = 0.036-0.303; P = .014), unemployment (RR = 1.333; CI 1.02-1.742; P = .021), and hospitalization of parents in childhood (RR = 1.146; CI = 1.003-4.419; P = .046). Using multivariable analysis, the highly significant variables within the model were depression score (odds ratio [OR] = 1.083; CI = 1.045-1.123; P < .001) and current cannabis use (OR = 3.873; CI = 1.534-9.779, P = .004), also age (OR = 0.948; CI = 0.909-0.989; P = .012), hospitalization of parents during childhood (OR = 2.618; CI = 1.107-6.189; P = .028), and nationality (OR = 9.427; CI = 1.065-83.457; P = .044) were associated with social anxiety disorder. CONCLUSION: This study highlights the necessity of implementing actions to prevent and treat social anxiety in this high-risk population.

Substance use and social anxiety in transsexual individuals.

OBJECTIVE: This study examined social anxiety and use of cannabis and cocaine among transsexuals. METHODS: A total of 379 transsexuals seeking treatment or consultation participated in this study, providing data on sociodemographics, substance use, and anxiety. Analyses were based on (a) lifetime but not current use versus never used and (b) current use only versus no current use (lifetime only or never used). RESULTS: Lifetime only cannabis users (n = 72, 19%) and lifetime only cocaine users (n = 36, 9.8%) were older, had more victimization, and received more mental health treatment that those who never used. Current cannabis users (n = 47, 12.4%) had higher scores on fear of negative evaluation and social avoidance than those not currently using (p <.01). Multivariate analysis showed that social avoidance and fear of negative evaluation were associated with current cannabis use (p <.05), but not cocaine. Further, being single was associated with current cannabis use, after controlling for social avoidance and fear of negative evaluation (p <.05). CONCLUSIONS: Transsexuals' levels of anxiety and cannabis/cocaine use are comparable to those in the general population. Cannabis may be used to control anxiety and can have detrimental clinical implications for transsexuals.