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1.
Epidemiol Psychiatr Sci ; 29: e109, 2020 Mar 11.
Artículo en Inglés | MEDLINE | ID: mdl-32157987

RESUMEN

AIMS: Community care units (CCUs) are a model of residential psychiatric rehabilitation aiming to improve the independence and community functioning of people with severe and persistent mental illness. This study examined factors predicting improvement in outcomes among CCU consumers. METHODS: Hierarchical regression using data from a retrospective cohort (N = 501) of all consumers admitted to five CCUs in Queensland, Australia between 2005 and 2014. The primary outcome was changed in mental health and social functioning (Health of the Nation Outcome Scale). Secondary outcomes were disability (Life Skills Profile-16), service use, accommodation instability, and involuntary treatment. Potential predictors covered service, consumer, and treatment characteristics. Group-level and individualised change were assessed between the year pre-admission and post-discharge. Where relevant and available, the reliable and clinically significant (RCS) change was assessed by comparison with a normative sample. RESULTS: Group-level analyses showed statistically significant improvements in mental health and social functioning, and reductions in psychiatry-related bed-days, emergency department (ED) presentations and involuntary treatment. There were no significant changes in disability or accommodation instability. A total of 54.7% of consumers demonstrated reliable improvement in mental health and social functioning, and 43.0% showed RCS improvement. The majority (60.6%) showed a reliable improvement in psychiatry-related bed-use; a minority demonstrated reliable improvement in ED presentations (12.5%). Significant predictors of improvement included variables related to the CCU care (e.g. episode duration), consumer characteristics (e.g. primary diagnosis) and treatment variables (e.g. psychiatry-related bed-days pre-admission). Higher baseline impairment in mental health and social functioning (ß = 1.12) and longer episodes of CCU care (ß = 1.03) increased the likelihood of RCS improvement in mental health and social functioning. CONCLUSIONS: CCU care was followed by reliable improvements in relevant outcomes for many consumers. Consumers with poorer mental health and social functioning, and a longer episode of CCU care were more likely to make RCS improvements in mental health and social functioning.


Asunto(s)
Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Trastornos Mentales/rehabilitación , Trastornos Mentales/terapia , Rehabilitación Psiquiátrica/organización & administración , Centros Comunitarios de Salud Mental , Humanos , Trastornos Mentales/psicología , Tratamiento Domiciliario , Estudios Retrospectivos
2.
Rev. psiquiatr. salud ment. (Barc., Ed. impr.) ; 12(4): 207-212, oct.-dic. 2019. tab
Artículo en Español | IBECS | ID: ibc-187019

RESUMEN

Introducción: A pesar del desarrollo de la hospitalización domiciliaria en España durante los últimos años, es llamativa la escasez de literatura. El siguiente estudio pretende exponer los datos obtenidos por la Unidad de Hospitalización a Domicilio de Psiquiatría del Hospital del Mar (HADMar). HADMar es un programa de hospitalización domiciliaria creado hace 2años, que recibe pacientes procedentes de servicios comunitarios y hospitalarios con un seguimiento limitado en el tiempo. Al alta, el paciente es derivado a la unidad de referencia ambulatoria apropiada para cada caso. Material y métodos: Se seleccionó a todos los pacientes visitados desde 2015 hasta la actualidad. Se llevó a cabo un estudio descriptivo que define las características sociodemográficas de la muestra. Las variables clínicas estudiadas fueron la gravedad de los síntomas, el riesgo de suicidio y los cambios en la funcionalidad. Resultados: Un total de 135 pacientes fueron incluidos en la muestra. La edad media de los pacientes fue de 44,6 años y no hubo diferencias entre ambos sexos. De ellos, 26 pacientes tenían un historial de intentos autolíticos y el 11,1% vivían solos. El 51,1% fueron diagnosticados de un trastorno psicótico. La puntuación media en la escala GEP en la variable gravedad de los síntomas psiquiátricos fue 2,39 y el riesgo medio de suicidio 0,49. La puntuación de EEAG al alta era mayor que al ingreso. Conclusiones: Los resultados obtenidos en nuestro estudio son consistentes con resultados reportados en estudios previos. Los equipos de hospitalización domiciliaria han demostrado ser una alternativa a la hospitalización tradicional. Sin embargo, se necesitan más estudios que apoyen estos resultados


Introduction: Although home hospitalization has begun to develop widely in recent years there is a notable lack of studies. The following study includes data from the Psychiatric Home Hospitalization Unit of the Hospital del Mar (HADMar). This program has been running for 2years and takes place in a socio-demographically depressed area in Barcelona. It receives patients from community and hospital services. Monitoring is limited in time and at discharge patient are referred to the ambulatory unit. Material and methods: All patients visited from 2015 to the present time were selected. A total of 135 patients were included in the sample. A qualitative descriptive study was carried out in order to define the socio-demographic characteristics. The severity of symptoms, suicidal risk and changes in the functionality were considered as clinical outcomes. Results: The mean age of patients was 44.6 years and there were no gender differences. A total of 26 patients had a history of suicidal attempts and 11.1% lived alone; 51.1% were diagnosed with a psychotic disorder. The mean GEP score for the severity of the psychiatric symptoms was 2.39 and the mean risk of suicide was 0.49. There is an increase in the EEAG score from admission to discharge, which means an improvement in the functionality of patients. Conclusions: The results obtained in our study are consistent with previous results. Home crisis intervention teams have proved to be an alternative to traditional hospitalization. However, more studies are needed to support these results


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Trastornos Mentales/terapia , Servicios de Atención a Domicilio Provisto por Hospital/organización & administración , Trastornos Psicóticos/terapia , Índice de Severidad de la Enfermedad , Ideación Suicida , Epidemiología Descriptiva , Trastorno de la Conducta/psicología , Centros Comunitarios de Salud Mental/organización & administración , Intervención en la Crisis (Psiquiatría)/organización & administración
3.
Rev. Asoc. Esp. Espec. Med. Trab ; 28(4): 300-310, dic. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-187677

RESUMEN

La satisfacción de los usuarios constituye un valioso indicador de la calidad asistencial ofrecida desde los Centros de Salud Mental (CSM). La satisfacción de los propios profesionales se evalúa con menos frecuencia a pesar de su posible influencia sobre dicha calidad asistencial. Consideramos relevante la evaluación de riesgos psicosociales en los trabajadores de salud mental por su metodologia de trabajo y el tipo de problemática atendida. Objetivo: El objetivo del presente estudio es evaluar y mostrar en un corte transversal la satisfacción de los usuarios de un CSM, así como la satisfacción y niveles de desgaste profesional de su plantilla. Método: se entregó a cada trabajador del centro de salud mental un conjunto de cuestionarios validados así como una encuesta de satisfacción profesional diseñada para el presente estudio. Resultados: Los resultados mostraron niveles elevados de satisfacción por parte de los usuarios, pero también una elevada presencia de desgaste profesional y baja satisfacción en el equipo profesional. Se discute la posible relación entre estos resultados así como las implicaciones tanto para la salud de los profesionales como para la calidad asistencial


Objetive: Satisfaction perceived by service users constitutes a valuable indicator of the quality of care offered in Mental Health Centers. Professionals satisfaction, however, is evaluated less frequently despite its possible influence on healthcare quality. We consider of particular relevance the evaluation of psychosocial risks in mental health workers due to their work methodology and the type of problems they address daily. Objetive: The objective of the present cross-section study is to assess the satisfaction of the users of a Mental Health Center, as well as the satisfaction and levels of professional burnout of its staff. Method: a set of validated questionnaires as well as a professional satisfaction survey designed for the present study were delivered to each worker of the Mental Health Center. Results: The results show high satisfaction perceived by users, but also a a relevant rate of burnout among the workforce in the Mental Health Center. We discuss the possible relationship between these results as well as the implications for both the health of professionals and the quality of care


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Satisfacción del Paciente/estadística & datos numéricos , Satisfacción en el Trabajo , Centros Comunitarios de Salud Mental , Centros Comunitarios de Salud Mental/normas , Agotamiento Psicológico/psicología , Relaciones Interprofesionales , Estudios Transversales , Encuestas y Cuestionarios
4.
Ghana Med J ; 53(2): 92-99, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31481804

RESUMEN

Background: Over the past few decades, there has been an emphasis on the de-institutionalisation of psychiatric care with a focus on community care. With Quality of Life (QoL) as an outcome measure, this study compared the QoL of patients with schizophrenia attending a psychiatric hospital and a community psychiatric centre. Design: This was a cross-sectional study in two psychiatric facilities. Methods: Data were obtained through a socio-demographic and clinical questionnaire; the QoL was assessed with the WHOQOL-BREF and patient satisfaction with care with CPOSS. Total and domain scores of WHOQOL-BREF for each group were calculated and compared with each other and other group characteristics. Diagnosis of schizophrenia was based on ICD-10. Results: Participants from the two centres did not differ significantly on any of the socio-demographic characteristics measured. Similarly, there was no significant difference in their overall mean WHOQOL-BREF scores as well as the mean WHOQOL-BREF of domain scores. However, the married and females from both centres significantly had higher mean WHOQOL-BREF scores than their male counterparts. Patients in remission for more than two years or those on a single type of medication (either oral or depot preparation) from both centres significantly had higher mean WHOQOL-BREF score compared with those who had less than two years of remission or on both oral and depot preparations. Conclusion: Overall QoL of patients managed at the two centres was comparable, with similar socio-demographic as well as clinical variables influencing QoL. This suggests that patients with schizophrenia can be well managed at community psychiatric centres. Funding: None declared.


Asunto(s)
Centros Comunitarios de Salud Mental , Hospitales Psiquiátricos , Calidad de Vida , Esquizofrenia , Adulto , Atención Ambulatoria , Desinstitucionalización , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Adulto Joven
5.
Psychiatriki ; 30(2): 97-107, 2019.
Artículo en Griego moderno | MEDLINE | ID: mdl-31425138

RESUMEN

During previous financial crises as well as the recent global financial crisis, a strong impact of the crisis on the population mental health in many countries has been observed. Similarly, in Greece, a series of epidemiological studies pointed out the consequences of the economic crisis on the population mental health. However, there is limited data available, both in Greece and worldwide, regarding the impact of the economic crisis from the perspective of mental health services. The goal of the present study was to examine possible changes on the community mental health during the first years of the Greek financial crisis, as they are reflected on the operation of a community mental health unit with a specific catchment area within Athens (Byron and Kessariani). The demographic, social and clinical characteristics of adult users who were admitted for the first time at ByronKessariani Mental Health Community Center during the years 2008-2013 were analysed. The impact of the financial crisis on the workload of the center was also assessed during the same period. The sample of the study consisted of 1865 adult users and the data was collected with the use of an ad hoc structured questionnaire as well as from the users' case files. No significant differentiation on the number of clients admitted to the center per year after the beginning of the financial crisis was found. However, it is possible that an upper limit has been reached on the center's capacity to admit new clients, i.e. a ceiling effect, as it is shown from the increased number of provided sessions per year as well as from the increase in the mean waiting time for the intake of new patients during the same period. A constant increase in the number of women among the new clients of ByronKessariani Mental Health Community Center was found, but no significant differentiations were detected during the study period. Moreover, the study showed an upward trend in aggressive behavior as a reason for admission, a significant and continuous increase in the rate of unemployed individuals among the new clients, as well as a statistically significant increase in the number of referrals for psychotherapy during the study period. There was also an increase in the number of patients who had psychiatric history, even though they were admitted to Byron-Kessariani Mental Health Community Center for the first time. No significant differentiations were found in the remaining users' demographic and clinical characteristics assessed. Our study showed that during the crisis community mental health services are under pressure due to the increased needs of patients, especially the needs for psychotherapeutic intervention and psychological support. The increased unemployment rates affect the influx of new patients as well as the therapeutic management of many users. Reinforcement of the community mental health service network is an important strategy against the consequences of the crisis on the population mental health.


Asunto(s)
Centros Comunitarios de Salud Mental/estadística & datos numéricos , Recesión Económica/estadística & datos numéricos , Adulto , Agresión , Centros Comunitarios de Salud Mental/organización & administración , Servicios Comunitarios de Salud Mental , Femenino , Grecia/epidemiología , Humanos , Masculino , Trastornos Mentales/economía , Trastornos Mentales/psicología , Salud Mental , Persona de Mediana Edad , Psicoterapia/estadística & datos numéricos , Factores Socioeconómicos , Desempleo/psicología , Desempleo/estadística & datos numéricos
6.
Psychiatriki ; 30(2): 108-119, 2019.
Artículo en Griego moderno | MEDLINE | ID: mdl-31425139

RESUMEN

Psychosocial rehabilitation for people with chronic-severe mental illness mainly aims to social integration by restoring independent functioning in the community, improving quality of life, and addressing risk factors that lead to social disability. Support groups (SG) are usually part of this multilevel mental health process. Given that non-adherence to treatment is a common phenomenon in people with chronic- severe mental illness, the aim of the current study was to identify which factors influence members' attendance in a support group in a vocational training Program of the Psychosocial Rehabilitation Unit of Byron-Kaissariani Community Mental Health Centre. The SG sessions were weekly, with 45-minute duration, opened to any new member of the Program and coordinated by two therapists. Members' demographic and psychiatric data were gathered from the medical records of the Center. Information about SG was obtained from the reports of the sessions. The sample consisted of 18 women, with mean age 38.56 (±6.92) years. Most of them were high school graduates (61.1%), unmarried (83.3%), with low socioeconomic status (55.5%), suffering from a schizophrenic spectrum disorder (61.1%) with a mean duration 15.22 (±8.44) years. Out of 83 sessions in total, twenty-two (26.5%) were in absence of a co-therapist, 11 (13.3%) after a member's entrance or withdrawal and 11 (13.3%) after a session cancellation. Furthermore, an average of four issues was discussed per session, with mental illness (62.7%) and interpersonal relationships (73.5%) being the most popular topics during the sessions. The statistical analysis demonstrated that members' demographic (age, education, marital status, residence, socioeconomic status, working experience) and psychiatric characteristics (diagnosis, illness duration, rehabilitation program experience) were not associated with the attendance rate in the SG. Similarly, the proportion of participants attending the sessions did not seem to be significantly related to the absence of a co-therapist, to a member's entrance or withdrawal and to a session cancellation. In contrast, attendance seemed to be significantly reduced when the topic of a session focused on members' future expectations/goals (having a family, further education, finding a job) (Beta=-0.32, p=0.006). This finding highlights the need for future research in order to incorporate interventions that promote and address future goals and expectations of people with chronic-severe mental illness in psychosocial rehabilitation services.


Asunto(s)
Trastornos Mentales/rehabilitación , Cooperación del Paciente/estadística & datos numéricos , Rehabilitación Psiquiátrica/organización & administración , Grupos de Autoayuda/estadística & datos numéricos , Adulto , Enfermedad Crónica , Centros Comunitarios de Salud Mental , Femenino , Humanos , Relaciones Interpersonales , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Rehabilitación Psiquiátrica/estadística & datos numéricos , Psicoterapia de Grupo , Esquizofrenia/rehabilitación , Factores Socioeconómicos
7.
Fam Syst Health ; 37(2): 173-175, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31180709

RESUMEN

In addition to providing critical behavioral health services for those with mental health issues and substance use disorders, some Community Mental Health Centers (CMHCs) in the United States have begun integrating primary care services, referred to as "reverse integration". Representing the interests of CMHCs across the United States, the National Council for Behavioral Health (NCBH) represents over 3,000 member organizations delivering mental health and/or addictions treatment and services to roughly 10 million patients and families. This article reflects a recent wide-ranging conversation with Linda Rosenberg, the president and CEO of NCBH. Trained as a social worker, Rosenberg was senior deputy commissioner of the New York State Office of Mental Health prior to joining the NCBH and is a dynamic and high-energy strategist and thought leader in the field of community mental health and integrated care. We discussed issues impacting payment for integrated care, including private equity investment, capitated payment, and the role of risk, and how these market dynamics impact vulnerable populations. For the sake of brevity, we summarize our conversation with Ms. Rosenberg and offer her perspective to integrated care practitioners and researchers who largely operate outside of this world of business built on calculated risks and rewards. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Gestión del Cambio , Centros Comunitarios de Salud Mental/tendencias , Prestación Integrada de Atención de Salud/tendencias , Centros Comunitarios de Salud Mental/organización & administración , Prestación Integrada de Atención de Salud/métodos , Prestación Integrada de Atención de Salud/organización & administración , Femenino , Humanos , Liderazgo , Trastornos Mentales/psicología , Trastornos Mentales/terapia , New York , Atención Primaria de Salud/métodos , Atención Primaria de Salud/tendencias , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/terapia , Estados Unidos
8.
Prax Kinderpsychol Kinderpsychiatr ; 68(4): 253-270, 2019 May.
Artículo en Alemán | MEDLINE | ID: mdl-31044679

RESUMEN

"I Would Never have done it Without Coercion …" - Experiences with Coercion and Compulsion in a Family Psychiatric and Psychotherapeutic Day Clinic Coercion and compulsion have negative connotations, especially in psychiatric therapy. But in families, children are always also affected if parents do not want or are not able to make use of therapy. The avoidance of therapy can be a symptom of illness, e. g. separation anxiety. Perceived or real external coercion, e. g. from the youth welfare office or school, can be used to initially open up access to therapy and to allow parents to become capable of acting again. Coercion can initially reduce the ambivalence of the parents. The Family Therapeutic Centre (FaTZ) is a psychiatric and psychotherapeutic day clinic for parents and children. Family constellations are described in which initial coercion was a door-opener to therapy. During courses of treatment therapeutic alliances could be established, hope for positive change emerged, and the outcome was favourable. School avoidance of the child (e. g. due to separation anxiety) in combination with mentally ill parents is an exemplary constellation in which initial coercion can pave the way to therapy for families that otherwise wouldn't get access. Afterwards, voluntary cooperation should be intended, as the overriding objective is to reduce coercive measures to a minimum.


Asunto(s)
Coerción , Centros Comunitarios de Salud Mental , Terapia Familiar/métodos , Tratamiento Psiquiátrico Involuntario/métodos , Trastornos Mentales/terapia , Padres/psicología , Psicoterapia/métodos , Negativa del Paciente al Tratamiento/psicología , Adolescente , Ansiedad de Separación , Niño , Hijo de Padres Discapacitados/psicología , Terapia Familiar/ética , Humanos , Tratamiento Psiquiátrico Involuntario/ética , Trastornos Mentales/psicología , Cooperación del Paciente/psicología , Psicoterapia/ética
9.
An. psicol ; 35(2): 233-241, mayo 2019. graf, tab
Artículo en Inglés | IBECS | ID: ibc-181693

RESUMEN

Dual patients are usually treated in drug users services, mental health units, or both. However, each patient can choose the service to receive the health care. The aim of this study is to analyze the similarities and differences of the patient profiles that are treated in each one of these centers. The sample consists of 170 patients diagnosed with dual pathology treated at Servicio Provincial de Drogodependencias de Huelva (SPDH) and Unidades de Salud Mental Comunitaria (USMC) in the province of Huelva. In SPDH, higher prevalence of patients with cocaine and heroin dependence profile was observed (35.9% vs 2% in MH and 16.4% in coordinated). In USMC there is higher prevalence of patients with cannabis dependence profile (41.2% vs 9.4% in the DU and 16.4% in the coordinated service). The odds ratio for patients with hypomanic episodes was 2,879 (p <0.05) in SPDH compared to other services. Odds ratio observed for manic episodes was 0.483 (p <0.05) in SPDH. Patients with comorbid psychotic disorders are more prevalent in USMC compared to SPDH services (66% vs 37.5%). The differences observed in the profiles should be considered in the care planning of these centers


La atención médica y psicológica de pacientes con patología dual es realizada por servicios de salud mental, adicciones, o coordinada. No obstante, es elección de los pacientes acudir a uno u otro servicio. Este trabajo tiene como objetivo analizar las semejanzas y diferencias de pacientes con patología dual que acuden a estos centros. El estudio se ha realizado con170 pacientes diagnosticados de patología dual atendidos en el Servicio Provincial de Drogodependencias de Huelva (SPDH) y Unidades de Salud Mental Comunitaria (USMC) de la provincia de Huelva. En el SPDH la prevalencia de pacientes con dependencia a heroína y cocaína es mayor (35.9% vs 2% en USMC y 16.4% en coordinado). En las USMC se observa una mayor prevalencia de pacientes con dependencia a cannabis (41.2% vs 9.4% en el CTA y 16.4% en coordinado). La odds ratio para pacientes con episodios hipomaníacos fue de 2.879 (p<0.05) en el SPDH, y de 0.483 (p<0.05) para episodios maníacos. Hay una mayor prevalencia de pacientes con trastornos psicóticos en las USMC en comparación con el SPDH (66% vs 37.5%). Las diferencias detectadas en los perfiles deben ser consideradas en la planificación asistencial de los centros que atienden a estos pacientes


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Diagnóstico Dual (Psiquiatría)/estadística & datos numéricos , Trastornos Mentales/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Mentales/complicaciones , Centros Comunitarios de Salud Mental/estadística & datos numéricos , Centros de Tratamiento de Abuso de Sustancias/estadística & datos numéricos
10.
Int J Geriatr Psychiatry ; 34(8): 1267-1274, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31034652

RESUMEN

OBJECTIVES: Memory clinics (MCs) have been established to improve diagnosis and treatment of cognitive disorders, including dementia. The aim of this study was to determine the characteristics and working methods of MCs in the Netherlands in 2016. More insight into different working methods can be used to improve the quality of care in Dutch MCs. Additionally, the findings will be compared with earlier results to investigate the development of MCs since 1998. METHODS: A survey was sent in 1998, 2004, 2009, and 2017 to all operational Dutch MCs with questions about organization, collaboration, patients, and diagnostic procedures. RESULTS: From 1998 to 2016, the number of MCs increased substantially from 12 to 91. The capacity increased from 1560 patients to 24,388. In 1998, most patients received a dementia diagnosis (85%), while in 2016, half of the patients were diagnosed with milder cognitive problems. MCs are more often part of regional care chains and are better embedded within regional care organizations. Diagnostic tools, such as blood tests (97%), neuropsychological assessment (NPA) (95%), and neuroimaging (92%), were used in nearly all MCs. The number of patients in whom these tools were used differed greatly between MCs (NPA: 5%-100%, neuroimaging: 10%-100%, and CSF: 0.5%-80%). There was an increase in the use of NPA, while the use of neuroimaging, CSF, and EEG/ECG decreased by 8% to 15% since 2009. CONCLUSIONS: Since 1998, MCs have developed substantially and outgrown the primarily research-based university settings. They are now accepted as regular care facilities for people with cognitive problems.


Asunto(s)
Trastornos del Conocimiento/terapia , Centros Comunitarios de Salud Mental/organización & administración , Trastornos de la Memoria/terapia , Anciano , Anciano de 80 o más Años , Trastornos del Conocimiento/diagnóstico , Centros Comunitarios de Salud Mental/tendencias , Femenino , Humanos , Masculino , Trastornos de la Memoria/diagnóstico , Persona de Mediana Edad , Países Bajos , Pruebas Neuropsicológicas
11.
Behav Cogn Psychother ; 47(5): 548-558, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30859928

RESUMEN

BACKGROUND: Cognitive behavioural therapy (CBT) is an evidence-based treatment for chronic fatigue syndrome (CFS). Stepped care for CFS, consisting of a minimal intervention followed by face-to-face CBT, was found efficacious when tested in a CFS specialist centre. Stepped care implemented in a community-based mental health centre (MHC) has not yet been evaluated. AIMS: (1) To test the effectiveness of stepped care for CFS implemented in a MHC at post-treatment and at long-term follow-up; and (2) compare post-treatment outcomes of implemented stepped care with treatment outcomes of a CFS specialist centre. METHOD: An uncontrolled study was used to test effectiveness of stepped care implemented in a MHC (n = 123). The outcomes of implemented care were compared with the outcomes of specialist care reported in previous studies (n = 583). Data on outcomes from implemented stepped care were gathered at post-treatment and at long-term follow-up. Mixed models were used as method of analysis. RESULTS: Fatigue decreased and physical functioning increased significantly following implemented stepped care (both p < .001). The follow-up was completed by 94 patients (78%) within 1-6 years after treatment. Treatment effects were sustained to follow-up. Patients in the MHC showed less improvement directly following stepped care compared with patients in a CFS specialist centre (p < .01). CONCLUSION: Implemented stepped care for CFS is effective with sustained treatment gains at long-term follow-up. There is room for improvement when compared with outcomes of a CFS specialist centre. Some suggestions are made on how to improve stepped care.


Asunto(s)
Terapia Cognitivo-Conductual , Centros Comunitarios de Salud Mental , Síndrome de Fatiga Crónica/terapia , Adolescente , Adulto , Fatiga/psicología , Fatiga/terapia , Síndrome de Fatiga Crónica/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven
12.
PLoS One ; 14(2): e0211938, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30768607

RESUMEN

PURPOSE: This study aims to describe factors associated to treatment continuity and psychiatric relapses in patients treated with Long Acting Injectable antipsychotics (LAIs) in Bologna Community Mental Health Centers (CMHCs). METHODS: New LAI treatments administered between July 1, 2010 and June 30, 2015 in CMHCs were selected. The cohort was followed-up for 6 months; predictors of continuity and psychiatric admissions were investigated by using logistic regression- and Cox- analysis respectively. RESULTS: Among the cohort of 1 070 patients, only 222 (21%) continued LAI treatment during the follow-up. LAI continuity was higher with first generation agents (OR: 1.71, 95%CI 1.18-2.49) and in case of previous psychiatric hospitalizations (OR 2.00, 95%CI 1.47-2.74). Incidence of psychiatric hospital admissions showed a sharp reduction in the follow-up compared with 6-month period before initiation (from 458 to 212), and was associated with previous psychiatric hospitalizations (HR 3.20, 95%CI 2.22-4.59), immigration (HR 3.13, 95%CI 1.28-7.69) and LAI discontinuation (HR 1.14, 95%Cl 1.01-1.97). CONCLUSIONS: Psychiatric hospital admission before LAI initiation was the main predictor both of LAI continuity and hospitalization during the follow-up.


Asunto(s)
Antipsicóticos/administración & dosificación , Centros Comunitarios de Salud Mental , Hospitalización , Trastornos Mentales/tratamiento farmacológico , Adulto , Femenino , Estudios de Seguimiento , Humanos , Italia , Masculino , Persona de Mediana Edad
13.
BMC Psychiatry ; 19(1): 65, 2019 02 11.
Artículo en Inglés | MEDLINE | ID: mdl-30744590

RESUMEN

BACKGROUND: Illness Management and Recovery (IMR) is a curriculum-based rehabilitation program for people with severe mental illness with the short-term aim of improving illness self-management and the long-term aim of helping people achieve clinical and personal recovery. METHOD: Participants with schizophrenia or bipolar disorders were recruited from three community mental health centers in the Capital Region of Denmark and randomized to receive group-based IMR and treatment as usual or only the usual intervention. All outcomes were assessed at baseline, postintervention, and the one-year follow-up. Long-term outcomes were categorized according to clinical recovery (i.e., symptoms, global functioning, and hospitalization) and personal recovery (i.e., hope and personal agency). Generalized linear mixed model regression analyses were used in the intent-to-treat analysis. RESULTS: A total of 198 participants were included. No significant differences were found between the IMR and control groups in the Global Assessment of Functioning one year after the intervention, nor were there significant differences in symptoms, number of hospital admissions, emergency room visits, or outpatient treatment. CONCLUSION: The present IMR trial showed no significant effect on clinical and personal recovery at the one-year follow-up. Together with the results of other IMR studies, the present study indicates that the effect of IMR on symptom severity is unclear, which raises questions regarding the impact of IMR on functioning. Additionally, IMR did not affect personal recovery. Although more research is needed, the results indicate that the development of other interventions should be considered to help people with severe mental illness achieve a better level of functioning and personal recovery. TRIAL REGISTRATION: Trial registered at http://www.clinicaltrials.gov ( NCT01361698 ).


Asunto(s)
Trastorno Bipolar/rehabilitación , Centros Comunitarios de Salud Mental , Salud Mental , Esquizofrenia/rehabilitación , Automanejo , Adulto , Anciano , Dinamarca , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven
14.
Int J Soc Psychiatry ; 65(1): 38-45, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30791796

RESUMEN

BACKGROUND: Latin America, and Chile in particular, has a rich tradition of community mental health services and programs. However, in vivo community-based psychosocial interventions, especially those with a recovery-oriented approach, remain scarce in the region. Between 2014 and 2015, a Critical Time Intervention-Task Shifting project (CTI-TS) was implemented in Santiago, Chile, as part of a larger pilot randomized control trial. CTI is a time-limited intervention delivered at a critical-time to users, is organized by phases, focuses on specific objectives and decreases in intensity over time. CTI-TS, which combines both the task-shifting strategy and the use of peers, introduces a novel approach to community mental health care that has not yet been tried in Chile. AIMS: We aim to evaluate the feasibility, acceptability and applicability of such a community-based psychosocial intervention in urban settings in Latin America - specifically, in Santiago (Chile) from a user perspective. METHOD: We analyzed 15 in-depth interviews ( n = 15) with service users who participated in the intervention about their perceptions and experiences with CTI-TS through thematic analysis. RESULTS: Three themes were revealed. The first was related to the structural characteristics of CTI-TS, especially regarding the timing, duration and phasic nature of the intervention. The second pertained to the acceptability of the in vivo community-based approach. The third theme dealt with the task-shifting aspect, that is, users' perceptions of the peer support workers and the community mental health workers. CONCLUSIONS: CTI-TS was generally acceptable in this Latin American context. Users' perspectives pointed to the need to make adjustments to some of the structural characteristics of the CTI model and to combine this type of intervention with others that can address stigma. Thus, future adaptations of CTI-TS or similar psychosocial interventions in Latin American contexts are feasible and can enhance community mental health in the region.


Asunto(s)
Psicoterapia/métodos , Trastornos Psicóticos/psicología , Autoimagen , Estigma Social , Adulto , Chile , Centros Comunitarios de Salud Mental , Femenino , Humanos , Entrevistas como Asunto , Masculino , Servicios de Salud Mental , Persona de Mediana Edad , Trastornos Psicóticos/prevención & control , Investigación Cualitativa , Ensayos Clínicos Controlados Aleatorios como Asunto , Adulto Joven
15.
Early Interv Psychiatry ; 13(4): 1011-1017, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-30672134

RESUMEN

AIM: To report on the development of an early intervention service in Modena, Italy, with information relevant to the first 4 years of implementation. METHODS: The 2-year service was offered to people aged 18-35 with psychotic manifestations, within 2 years from psychosis onset/or naïve to antipsychotics, by teams placed within community mental health Centres, according to a "specialist within generalist" model. Treatment included pharmacological consultation, psychoeducation and social inclusion programs. Health of the Nation Outcome Scale was administered at baseline and every 6 months. RESULTS: One hundred cases accepted the treatment from 1 March 2013 to 31 December 2016. Of these, 71% were male with a median age of 23. Ninety percent were diagnosed with non-affective psychosis, yielding an estimated treated incidence of 19.1/105 . General practitioners (GPs)represented the most frequent referrers to the program (38%), followed by referrals from acute general and psychiatric hospital units (22%) and self-referrals (14%). Meaningful clinical improvement was observed, 6 months after enrolment. CONCLUSIONS: An early intervention service for psychosis was successfully implemented within existing community outpatient services. GPs represented the main referrals, providing some validation of the "specialist within generalist" model of care. A promising clinical improvement and trend of reduction in duration of untreated psychosis was found, supporting the variety of early detection efforts in the community. The high median age and lack of information about pathways to care underline possible barriers to access for younger patients. These findings will inform refinement of treatments and service models for the Region.


Asunto(s)
Intervención Médica Temprana , Trastornos Psicóticos/terapia , Adulto , Atención Ambulatoria/organización & administración , Terapia Combinada , Centros Comunitarios de Salud Mental/organización & administración , Diagnóstico Precoz , Femenino , Implementación de Plan de Salud/organización & administración , Humanos , Italia , Masculino , Persona de Mediana Edad , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Derivación y Consulta/organización & administración , Adulto Joven
16.
Crisis ; 40(5): 326-332, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30644775

RESUMEN

Background: Early identification and appropriate referral services are priorities to prevent suicide. Aims: The aim of this study was to describe patterns of identification and referrals among three behavioral health centers and determine whether youth demographic factors and type of training received by providers were associated with identification and referral patterns. Method: The Early Identification Referral Forms were used to gather the data of interest among 820 youth aged 10-24 years who were screened for suicide risk (females = 53.8%). Descriptive statistics and binary logistic regressions were conducted to examine significant associations. Results: Significant associations between gender, race, and age and screening positive for suicide were found. Age and race were significantly associated with different patterns of referrals and/or services received by youths. For providers, being trained in Counseling on Access to Lethal Means was positively associated with number of referrals to inpatient services. Limitations: The correlational nature of the study and lack of information about suicide risk and comorbidity of psychiatric symptoms limit the implications of the findings. Conclusion: The results highlight the importance of considering demographic factors when identifying and referring youth at risk to ensure standard yet culturally appropriate procedures to prevent suicide.


Asunto(s)
Servicios Comunitarios de Salud Mental , Derivación y Consulta , Ideación Suicida , Suicidio/prevención & control , Adolescente , Afroamericanos , Americanos Asiáticos , Niño , Centros Comunitarios de Salud Mental , Grupo de Ascendencia Continental Europea , Femenino , Georgia , Hispanoamericanos , Humanos , Modelos Logísticos , Masculino , Tamizaje Masivo , Medición de Riesgo , Población Rural , Factores de Tiempo , Adulto Joven
17.
Psychiatr Prax ; 46(4): 200-205, 2019 May.
Artículo en Alemán | MEDLINE | ID: mdl-30541157

RESUMEN

OBJECTIVE: This study explores the conditions for the stakeholders' cooperation in an integrative care model for people with psychosocial problems. METHODS: Expert interviews on various community mental health care providers were led and content analyzed. RESULTS: Joint objectives and conceptually comparable financing models were found to be essential for cooperation across mental health and social integration services. CONCLUSIONS: Implementation of intersectoral financing for both clinical and social integration services can promote interagency cooperation.


Asunto(s)
Centros Comunitarios de Salud Mental , Relaciones Interinstitucionales , Trastornos Mentales/rehabilitación , Alemania , Humanos , Relaciones Interpersonales , Investigación Cualitativa , Seguridad Social
18.
Psychiatr Rehabil J ; 42(1): 32-40, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30299122

RESUMEN

OBJECTIVE: To measure community mental health agency staff attitudes about employment for persons with serious mental illness. METHODS: An online survey was developed and sent to 2,218 staff at 4 community mental health centers (CMHC) in 1 New England state. The survey collected quantitative and qualitative data about staff attitudes about employment for persons with serious mental illness. Descriptive statistics and qualitative results are provided. Results from analysis of variance are provided as well, assessing differences in staff views by staff characteristics. RESULTS: A mix of clinical and administrative staff participated in the survey (N = 221). Staff views on the benefits of work, the ability of clients to handle the demands of the worker role, and client motivation to work were mixed. Staff with higher levels of education held significantly more supportive views than those with less education. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: CMHC staff need to consistently convey supportive attitudes about employment to their clients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Actitud del Personal de Salud , Centros Comunitarios de Salud Mental/estadística & datos numéricos , Empleo , Trastornos Mentales/rehabilitación , Enfermos Mentales , Rehabilitación Vocacional , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad
19.
Community Ment Health J ; 55(1): 38-41, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30225578

RESUMEN

Supplemental security income (SSI), is the lifeline for our patients living in the community. Absent disability benefits most of our patients are homeless. Many will be hungry, poorly clothed, and have only rudimentary health care. The disability determination system will approve disability for < 30% of those adults making an initial application. The rate of actual disability is much higher. A large cohort (n = 251) of likely disability applicants had comprehensive diagnostic evaluations. These evaluations revealed extensive co-occurring psychiatric symptoms and features, particularly obsessive-compulsive features. Recognition and appreciation of the burden of co-occurring conditions leads to a robust increase in approval rates. Administrative or structural features of the disability determination system also depress allowance rates.


Asunto(s)
Evaluación de la Discapacidad , Personas con Discapacidad/psicología , Personas con Discapacidad/estadística & datos numéricos , Trastornos Mentales/epidemiología , Seguridad Social/estadística & datos numéricos , Chicago/epidemiología , Estudios de Cohortes , Centros Comunitarios de Salud Mental , Comorbilidad , Humanos , Estudios Retrospectivos , Estados Unidos
20.
Child Psychiatry Hum Dev ; 50(1): 1-12, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-29855819

RESUMEN

Research shows that parenting interventions are plagued with the problem of early treatment termination. A brief 6-week intervention, parent-child care (PC-CARE) was developed to minimize the time investment for parents while maximizing the probability of improving behavioral problems of their 1-10 year old children. The purpose of this study was to determine the feasibility of PC-CARE and examine preliminary outcomes. The data were collected as part of an open trial in a community mental health clinic and included pre- and post-treatment performance outcomes, weekly measures of treatment progress, and assessments of treatment fidelity. Participants were 64 children and their primary caregivers, referred by physicians, social workers, or self-referred for help with their children's difficult behaviors. The retention rate was 94%. Results of analyses pre- to post-intervention scores showed significant improvements in child behavioral problems as well as improvements in parenting stress and positive parenting skills. The findings suggest that PC-CARE may be a beneficial treatment for children with disruptive behaviors, encourage future research into the efficacy of this brief parenting intervention, and its effectiveness in other populations and contexts.


Asunto(s)
Trastornos de la Conducta Infantil , Conducta Infantil/psicología , Educación no Profesional/métodos , Relaciones Padres-Hijo , Responsabilidad Parental/psicología , Padres , Adulto , Niño , Trastornos de la Conducta Infantil/psicología , Trastornos de la Conducta Infantil/terapia , Cuidado del Niño , Preescolar , Centros Comunitarios de Salud Mental/estadística & datos numéricos , Femenino , Humanos , Lactante , Masculino , Padres/educación , Padres/psicología , Problema de Conducta/psicología , Técnicas Psicológicas
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