Painful Life Events in Psychiatric Disorders: A Quantitative and Qualitative Analysis.

We reported in a previous study the painful events experienced in the past in subjects with schizophrenia or major depression, in comparison to controls, and related them to the experimental pain sensitivity, anxiety, and the diagnosis. We present here the detailed analysis of these past painful events, with the aim of determining whether schizophrenic, depressive and control groups are qualitatively (type of painful events experienced, emotional or sensory components associated with pain) and quantitatively (duration, severity, and intensity) comparable concerning their past painful experiences. The questionnaire used relies on memory and feelings and will provide an indication about the way pain is experienced and memorized in daily life. The reported history of pain was not the same in the three groups. Depressed subjects differed from the others by the number of reported painful events. Painful events of everyday life, such as trauma without fracture and wounds, were the most highly reported painful events for all groups. Surprisingly, the daily pain events are associated to affective component of pain perception. Other kinds of event were differently reported between the groups. Experience of pain appears to be memorized and reported differently depending on the psychiatric disorder and type of event. The characteristics of each individual, their previous experience, contribute to the expression of psychiatric disorders, including in the field of pain. Past pain experience should be taken into account when attending someone for pain.

Head and Neck Cancer: Identifying Depression as a Comorbidity Among Patients.

Patients with head and neck cancer (HNC) are at high risk for developing depressive symptoms and a major depressive disorder as comorbidities. Depression can affect quality of life (QOL), with data indicating an associated increased risk of recurrence and mortality for patients with HNC. The purpose of this article is to urge oncology nurses to consider depression as an important comorbidity in the care plan for patients with HNC. Resources allocated for depression prevention and screening can decrease symptoms, the incidence of suicidal ideation, and healthcare-associated costs while improving QOL and mortality.

Testing the relationship between a self-management intervention for recurrent depression and health outcomes.

BACKGROUND: Depression is a leading cause of disability globally. It is a recurrent chronic illness that affects over three million people worldwide. Self-management has been found to positively impact depression outcomes but few techniques or interventions are theory-based and can be used either with or without the support of mental health care providers. OBJECTIVES: This study aimed to test the relationship between a self-management intervention called the Self-Regulated Illness Management of Depression (SRIM-D) intervention and specific health outcomes (depression, self-efficacy, social support and quality of life). SRIM-D was developed using metacognition and self-regulation theories. SAMPLE AND SETTING: Twenty-three individuals with major depressive disorder (MDD) participated in the study. Individuals over 21 years of age without a diagnosis of bipolar disorder, current substance abuse problem or suicidal ideations who suffered from MDD (BDI-II < 19) were considered for the study. METHODS: The intervention was delivered over three consecutive weeks of 1 ½â€¯hour sessions by two PhD prepared nurses with psychiatric experience. Participants were given a workbook manual with corresponding power point presentations conferring information about depression, and were led through a series of workbook activities designed to teach the self-regulation process as applied to their recurrent depression. Health outcomes were assessed via self-report survey prior to and six-month post-intervention. RESULTS: Six months post-intervention depressive symptoms decreased significantly (M = 6.62, SD = 14.76, t(15) = 5.60, p < .0001). Self-efficacy (M = 161.67, SD = 25.27); t(20) = -2.89, p < .01) and quality of life (13.25, SD = 3.61; t(19) = 2.62, p > .01) both improved significantly. Social support had a negligible, insignificant decrease from pre-intervention (M = 53.05, SD = 19.81) to six months post-intervention (M = 42.14, SD = 19.53). CONCLUSIONS: Overall, the SRIM-D intervention improved health outcomes in this study. The intervention demonstrated applicability to people with recurrent, chronic depression who might or might not have access to care.

The high price of depression: Family members' health conditions and health care costs.

OBJECTIVE: To compare the health conditions and health care costs of family members of patients diagnosed with a Major Depressive Disorder (MDD) to family members of patients without an MDD diagnosis. METHODS: Using electronic health record data, we identified family members (n=201,914) of adult index patients (n=92,399) diagnosed with MDD between 2009 and 2014 and family members (n=187,011) of matched patients without MDD. Diagnoses, health care utilization and costs were extracted for each family member. Logistic regression and multivariate models were used to compare diagnosed health conditions, health services cost, and utilization of MDD and non-MDD family members. Analyses covered the 5years before and after the index patient's MDD diagnosis. RESULTS: MDD family members were more likely than non-MDD family members to be diagnosed with mood disorders, anxiety, substance use disorder, and numerous other conditions. MDD family members had higher health care costs than non-MDD family members in every period analyzed, with the highest difference being in the year before the index patient's MDD diagnosis. CONCLUSIONS: Family members of patients with MDD are more likely to have a number of health conditions compared to non-MDD family members, and to have higher health care cost and utilization.

Comparing Affiliate Stigma Between Family Caregivers of People With Different Severe Mental Illness in Taiwan.

The family caregivers of people with mental illness may internalize the public stereotypes into the affiliate stigma (i.e., the self-stigma of family members). This study aimed to compare the affiliate stigma across schizophrenia, bipolar disorder, and major depressive disorder, and to investigate potential factors associated with affiliate stigma. Each caregiver of family members with schizophrenia (n = 215), bipolar disorder (n = 85), and major depressive disorder (n = 159) completed the Affiliate Stigma Scale, Rosenberg Self-Esteem Scale, Caregiver Burden Inventory, Taiwanese Depression Questionnaire, and Beck Anxiety Inventory. After controlling for potential confounders, the hierarchical regression models showed that caregivers of a family member with schizophrenia had a higher level of affiliate stigma than those of bipolar disorder (ß = -0.109; p < 0.05) and major depressive disorder (ß = -0.230; p < 0.001). Self-esteem, developmental burden, and emotional burden were significant factors for affiliate stigma. The affiliate stigma of caregivers is associated with their self-esteem, caregiver burden, and by the diagnosis.

Depression care among adults with co-occurring major depressive episodes and substance use disorders in the United States.

OBJECTIVE: We examined 12-month prevalence and correlates of receiving depression care and perceiving helpfulness of depression care among U.S. adults with major depressive episodes (MDE) and substance use disorders (SUD). METHOD: Data were from 325,800 adults who participated in the 2008-2014 National Surveys on Drug Use and Health (NSDUH). Descriptive analyses and bivariable and multivariable logistic regression models were applied. RESULTS: In the U.S., 3.3 million adults (1.4% of the adult population) had co-occurring MDE and SUD in the past year. Among adults with both disorders, 55.4% reported receiving past-year depression care. Among those with past-year depression care, 36.1% perceived it as helpful. Compared with adults who did not receive substance use treatment in the past year, those who received substance use treatment were significantly more likely to receive depression care, and those who received treatment of both disorders were more likely to perceive their depression care as helpful (adjusted risk ratios (ARRs) = 1.5-1.6). Compared with adults who received depression care only from general medical providers, those who received depression care from specialty mental health providers were more likely to report that their care was helpful (ARRs = 1.4-1.6). Receipt of prescription medication for MDE was associated with perceived helpfulness of depression care (ARR = 1.3, 95% CI = 1.05-1.73). CONCLUSIONS: Almost half of adults with co-occurring MDE and SUD did not receive past-year depression care. Among those who received depression care, most did not perceive it as helpful. Substance use treatment, specialty mental health treatment, and antidepressant medications were perceived as helpful aspects of depression care.

Emotional intelligence and coping strategies as determinants of quality of life in depressed patient-caregiver dyads: An actor-partner interdependence analysis.

OBJECTIVE: Patients with major depressive disorder (MDD) and their natural caregivers experience major lifestyle difficulties. Little is known concerning dyadic (i.e., patient and natural caregiver) characteristics' impact on quality of life. In a sample of depressed patient-caregiver dyads, we examined quality of life (QoL) levels compared with the general population and whether QoL is influenced by emotional intelligence (EI) and coping strategies using the actor-partner interdependence model (APIM). METHODS: This cross-sectional study involved 79 patient-caregiver dyads. The self-reported data, completed by patients and their primary caregivers, included QoL (SF-36), EI (TEIQue-SF) and coping strategies (BriefCope). The QoL of patients and caregivers was compared with 158 French age-sex-matched healthy controls. The dyadic interactions were analyzed using structural equation modeling. RESULTS: Patients and their caregivers experienced lower QoL levels than French age-sex-matched controls. The EI findings showed actor (degree to which the person's EI was associated with his/her own QoL) and partner (degree to which the person's EI was associated with QoL of the other member of the dyad) effects for patients and caregivers. The coping strategies (i.e., problem solving, positive thinking, avoidance and social support) revealed only actor effects. CONCLUSION: QoL is seriously impaired in depressed patients and their primary caregivers and is associated with EI and coping strategies. Targeted interventions focusing on EI and coping strategies could be offered to improve QoL in dyads.

[My stomach, the monster under my bed]. / Mon ventre, ce monstre caché sous mon lit.

Care for patients with eating disorders is complex and plurimodal. Care plans need to be adapted in order to take into account the body in crisis. A series of hospital admissions combined with specific psychomotor approaches, can contribute to the patient being reappropriated with their own body.

Assessment and Care of Childbearing Women With Severe and Persistent Mental Illness.

Severe and persistent mental illness (SPMI) refers to complex mood disorders that include major depressive disorder with or without psychosis; severe anxiety disorders resistant to treatment; affective psychotic disorders including bipolar affective disorder, schizophrenia, and schizoaffective disorder; and other nonaffective subtypes of schizophrenia. SPMIs affect 1 in 17 people and are among the leading causes of disability and impaired health-related quality of life in the United States. Caring for childbearing women with preexisting SPMI can be challenging for maternal-child health clinicians. This article provides an overview of SPMI during pregnancy and challenges for clinicians, including early identification, accuracy of diagnoses, and appropriate management through care coordination among an interdisciplinary team that includes obstetric providers, psychiatrists, nurses, and others.

Contemporary Treatment Approaches to Major Depression and Bipolar Disorders.

Mood disorders have a high incidence of coexisting psychiatric, substance use, and physical disorders. When these disorders are unrecognized and left untreated, patients are likely to have a reduced life expectancy and experience impaired functional and psychosocial deficits and poor quality of life. Psychiatric nurses are poised to address the needs of these patients through various approaches. Although the ideal approach for mood disorders continues to be researched, there is a compilation of data showing that integrated models of treatment that reflect person-centered, strength, and recovery-based principles produce positive clinical outcomes.

Mental Health Nursing in Greece: Nursing Diagnoses and Interventions in Major Depression.

The aim of the study was to assess nursing diagnoses and nursing interventions that were accordingly implemented during the care of inpatients with major depression in Greece. Twelve nurses working in three major psychiatric hospitals were recruited. Semi-structured interviews were used and audio-recorded data indicated that risk for suicide, social isolation, low self-esteem, sleep problems, and imbalanced nutrition are the nursing diagnoses most commonly reported. Establishing trust and rapport is the primary intervention, followed by specific interventions according to each diagnosis and the individualized care plan. The findings of the study also highlight the need for nursing training in order to teach nurses initial assessment procedures and appropriate evidence-based intervention techniques.

Breathing exercise combined with cognitive behavioural intervention improves sleep quality and heart rate variability in major depression.

AIMS AND OBJECTIVES: The aim of this study was to investigate the effects of a cognitive behavioural intervention combined with a breathing relaxation exercise on sleep quality and heart rate variability in patients with major depression. BACKGROUND: Depression is a long-lasting illness with significant effects not only in individuals themselves, but on their family, work and social relationships as well. Cognitive behavioural therapy is considered to be an effective treatment for major depression. Breathing relaxation may improve heart rate variability, but few studies have comprehensively examined the effect of a cognitive behavioural intervention combined with relaxing breathing on patients with major depression. DESIGN: An experimental research design with a repeated measure was used. METHODS: Eighty-nine participants completed this study and entered data analysed. The experimental group (n = 43) received the cognitive behavioural intervention combined with a breathing relaxation exercise for four weeks, whereas the control group (n = 46) did not. Sleep quality and heart rate variability were measured at baseline, posttest1, posttest2 and follow-up. Data were examined by chi-square tests, t-tests and generalised estimating equations. RESULTS: After adjusting for age, socioeconomic status, severity of disease and psychiatric history, the quality of sleep of the experimental group improved, with the results at posttest achieving significance. Heart rate variability parameters were also significantly improved. CONCLUSIONS: This study supported the hypothesis that the cognitive behavioural intervention combined with a breathing relaxation exercise could improve sleep quality and heart rate variability in patients with major depression, and the effectiveness was lasting. RELEVANCE TO CLINICAL PRACTICE: The cognitive behavioural intervention combined with a breathing relaxation exercise that included muscle relaxation, deep breathing and sleep hygiene could be provided with major depression during hospitalisation. Through group practice and experience sharing, participants could modulate their heart rate variability and share feeling about good sleep as well relaxation.

[Old age: knowing what self-neglect is]. / Grand âge: savoir de quoi l'incurie est le nom.

The issue of self-neglect in the elderly concerns society as well as caregivers who, in their practice, are ill at ease and frequently disorientated when faced with this behaviour which hampers the care approach. Here more than elsewhere, the choices of the people in question seem to collide with the care objectives, in such a way that it is important to remain curious in the face of what appears to be the height of incuriosity.

Factors influencing mental health nurses' attitudes towards people with mental illness.

This study aimed to investigate the factors influencing mental health nurses' attitudes towards people with mental illness. A descriptive correlation design was used. A sample of 180 Taiwanese mental health nurses was recruited from mental health-care settings. Data were analyzed with descriptive statistics, Pearson's product-moment correlation, Student's t-test, one-way anova, and a hierarchical multiple regression analysis. Negative attitudes were found among mental health nurses, especially with respect to individuals with substance abuse compared with those with schizophrenia and major depression. Mental health nurses who were older, had more clinical experiences in mental health care, and demonstrated greater empathy expressed more positive attitudes towards people with mental illness. Mental health nurses working at acute psychiatric units demonstrated more negative attitudes towards mental illness compared with those working in psychiatric rehabilitation units and outpatient clinics or community psychiatric rehabilitation centres. Particularly, length of mental health nursing practice and empathy significantly accounted for mental health nurses' attitudes towards mental illness. Understanding nurses' attitudes and their correlates towards people with mental illness is critical to deliver effective mental health nursing care.

[Mental disorders and dangerous acting out]. / Pathologies mentales et passages à l'acte dangereux.

The major mental disorders which are most likely to lead to dangerous acting out are adult psychoses (schizophrenia and paranoia) and severe mood disorders (major depressive episodes and mania). Good knowledge of the symptomatology of these pathologies and their identification can help to anticipate and prevent much of the violence which people with these disorders may inflict on others or themselves. After mental assessment, those who commit wrongful and criminal acts may be ruled to be criminally irresponsible. They are then handed over to the relevant health care authorities for treatment for their mental disorders.

Potential long-term effects of a mind-body intervention for women with major depressive disorder: sustained mental health improvements with a pilot yoga intervention.

Despite pharmacologic and psychotherapeutic advances over the past decades, many individuals with major depressive disorder (MDD) experience recurrent depressive episodes and persistent depressive symptoms despite treatment with the usual care. Yoga is a mind-body therapeutic modality that has received attention in both the lay and research literature as a possible adjunctive therapy for depression. Although promising, recent findings about the positive mental health effects of yoga are limited because few studies have used standardized outcome measures and none of them have involved long-term follow-up beyond a few months after the intervention period. The goal of our research study was to evaluate the feasibility, acceptability, and effects of a yoga intervention for women with MDD using standardized outcome measures and a long follow-up period (1year after the intervention). The key finding is that previous yoga practice has long-term positive effects, as revealed in both qualitative reports of participants' experiences and in the quantitative data about depression and rumination scores over time. Although generalizability of the study findings is limited because of a very small sample size at the 1-year follow-up assessment, the trends in the data suggest that exposure to yoga may convey a sustained positive effect on depression, ruminations, stress, anxiety, and health-related quality of life. Whether an individual continues with yoga practice, simple exposure to a yoga intervention appears to provide sustained benefits to the individual. This is important because it is rare that any intervention, pharmacologic or non-pharmacologic, for depression conveys such sustained effects for individuals with MDD, particularly after the treatment is discontinued.

Theoretical approaches to maternal-infant interaction: which approach best discriminates between mothers with and without postpartum depression?

OBJECTIVE: The purpose of this study was to determine which of the four common approaches to coding maternal-infant interaction best discriminates between mothers with and without postpartum depression. METHODS: After extensive training, four research assistants coded 83 three minute videotapes of maternal infant interaction at 12month postpartum visits. Four theoretical approaches to coding (Maternal Behavior Q-Sort, the Dyadic Mini Code, Ainsworth Maternal Sensitivity Scale, and the Child-Caregiver Mutual Regulation Scale) were used. Twelve month data were chosen to allow the maximum possible exposure of the infant to maternal depression during the first postpartum year. The videotapes were created in a laboratory with standard procedures. Inter-rater reliabilities for each coding method ranged from .7 to .9. The coders were blind to depression status of the mother. RESULTS: Twenty-seven of the women had major depressive disorder during the 12month postpartum period. Receiver operating characteristics analysis indicated that none of the four methods of analyzing maternal infant interaction discriminated between mothers with and without major depressive disorder. CONCLUSION: Limitations of the study include the cross-sectional design and the low number of women with major depressive disorder. Further analysis should include data from videotapes at earlier postpartum time periods, and alternative coding approaches should be considered. Nurses should continue to examine culturally appropriate ways in which new mothers can be supported in how to best nurture their babies.