Biological Perspectives: Anti-NMDA Receptor Encephalitis.

PURPOSE: This article explores the recently recognized anti-NMDA receptor encephalitis, which may produce psychiatric symptoms. CONCLUSIONS: Historically, some patients presenting for psychiatric care may have actually been suffering from anti-NMDA encephalitis; thus, awareness of this disorder may facilitate appropriate treatment. TREATMENT IMPLICATIONS: Early diagnosis and aggressive treatment promote better outcomes. First-line treatment includes immunotherapy.

Comparing the effectiveness of video-assisted oral debriefing and oral debriefing alone on behaviors by undergraduate nursing students during high-fidelity simulation.

Complex healthcare, less resources, high-level medical equipment, and fewer available clinical settings have led many health professionals to use simulation as a method to further augment educational experiences for nursing students. While debriefing is recommended in the literature as a key component of simulation, the optimal format in which to conduct debriefing is unknown. This pre- and posttest two-group randomized quasi-experimental design compared the effectiveness of video-assisted oral debriefing (VAOD) and oral debriefing alone (ODA) on behaviors of 48 undergraduate nursing students during high-fidelity simulation. Further, this study examined whether roles (e.g., team leader, medication nurse), type of scenarios (i.e., pulmonary and cardiac scenarios), and student simulation team membership (i.e., VAOD and ODA groups) influenced these behaviors. Behaviors observed in this study related to patient safety, communication among team members, basic- and problem-focused assessment, prioritization of care, appropriate interventions, and delegation to healthcare team members. Both human patient simulator practice and guidance using video-assisted oral debriefing and oral debriefing alone appeared to be comparable regarding behaviors, regardless of roles, type of scenarios, and student simulation team membership. These findings suggest that nurse educators may use either video-assisted oral debriefing or oral debriefing alone to debrief undergraduate nursing students during high-fidelity simulation.

An overview of the biological and psychosocial context surrounding neurocognition in HIV.

The presence of a psychiatric illness increases the risk of exposure to HIV and disease complications; however, effective treatments have substantially reduced mortality in adults with HIV. Despite such effective treatments, nearly half of adults with HIV experience neurocognitive deficits that can affect job-related and everyday tasks, thus reducing their quality of life. This article provides an overview of the context in which neurocognitive deficits occur in adults with HIV; it also includes implications for treatment and mitigation of such neurocognitive deficits. Understanding the underlying neurocognitive changes related to HIV can help psychiatric nurses provide better care to patients that may improve medication compliance and everyday functioning.

Biological perspectives: pain: it's not all in your head.

Neuroanatomy correlates with the psychological changes of pain. Neuroplastic transformation appears in the reduction of gray matter volume, or shrinkage in the top-down cortical areas vital for working memory, problem solving, sequencing and discrimination of different information and cognitive modulation of pain via the descending pain modulatory tracts and control over other cortical areas involved in the emotional perception of pain. These latter areas become more active,thereby intensifying the susceptibility to negative affect associated with pain (Geha & Apkarian, 2006).An animal model of chronic neuropathic pain was associated with impairment in the firing activity of the locus coeruleus and its expression of noradrenaline in ascending and descending pathways, which plays roles in not only pain perception, but mood, anxiety,attention and concentration, the sympathetic nervous system,and the activity of the hypothalamic-pituitary-adrenal axis,which serves to mobilize an organism's survival by the expression of cortisol in an immediate survival circumstance.

Neurological and psychiatric diseases and their unique cognitive profiles: implications for nursing practice and research.

To successfully negotiate and interact with one's environment, optimal cognitive functioning is needed. Unfortunately, many neurological and psychiatric diseases impede certain cognitive abilities such as executive functioning or speed of processing; this can produce a poor fit between the patient and the cognitive demands of his or her environment. Such nondementia diseases include bipolar disorder, schizophrenia, post-traumatic stress syndrome, depression, and anxiety disorders, just to name a few. Each of these diseases negatively affects particular areas of the brain, resulting in distinct cognitive profiles (e.g., deficits in executive functioning but normal speed of processing as seen in schizophrenia). In fact, it is from these cognitive deficits in which such behavioral and emotional symptoms may manifest (e.g., delusions, paranoia). This article highlights the distinct cognitive profiles of such common neurological and psychiatric diseases. An understanding of such disease-specific cognitive profiles can assist nurses in providing care to patients by knowing what cognitive deficits are associated with each disease and how these cognitive deficits impact everyday functioning and social interactions. Implications for nursing practice and research are posited within the framework of cognitive reserve and neuroplasticity.

Assessing and treating forgetfulness and cognitive problems in adults with HIV.

In addition to the immune system, HIV affects the nervous system and the brain, producing neurological sequelae, often resulting in forgetfulness and cognitive problems. These problems can compromise medication adherence, interfere with instrumental activities of daily living such as driving and managing finances, increase dependency, and decrease quality of life. Cognitive problems emerge due to a variety of reasons; likewise, several evidence-based methods to mitigate causes and compensate for cognitive problems can be used alone or in combination. This article focuses on nonpathological, nondementia forgetfulness and cognitive problems. However, dementia must be considered and assessed as measured by marked cognitive decline over time. Methods for assessing and measuring forgetfulness and cognitive problems are provided. In addition, methods of treating nonpathological cognitive problems are provided, ranging from Recommended for Practice to Not Recommended for Practice. A case study is presented to demonstrate how to implement recommended treatment options.

Does caregiver well-being predict stroke survivor depressive symptoms? A mediation analysis.

BACKGROUND AND PURPOSE: Studies suggest that family caregiver well-being (ie, depressive symptoms and life satisfaction) may affect stroke survivor depressive symptoms. We used mediation analysis to assess whether caregiver well-being might be a factor explaining stroke survivor depressive symptoms, after controlling for demographic factors and stroke survivor impairments and problems. METHODS: Caregiver/stroke participant dyads (N = 146) completed measures of stroke survivor impairments and problems and depressive symptoms and caregiver depressive symptoms and life satisfaction. Mediation analysis was used to examine whether caregiver well-being mediated the relationship between stroke survivor impairments and problems and stroke survivor depressive symptoms. RESULTS: As expected, more stroke survivor problems and impairments were associated with higher levels of stroke survivor depressive symptoms (P < .0001). After controlling for demographic factors, we found that this relationship was partially mediated by caregiver life satisfaction (29.29%) and caregiver depressive symptoms (32.95%). Although these measures combined to account for 40.50% of the relationship between survivor problems and impairments and depressive symptoms, the direct effect remained significant. CONCLUSIONS: Findings indicate that stroke survivor impairments and problems may affect family caregivers and stroke survivors and a high level of caregiver distress may result in poorer outcomes for stroke survivors. Results highlight the likely importance of intervening with both stroke survivors and family caregivers to optimize recovery after stroke.

Reasons why persons living with HIV include individuals in their chosen families.

HIV influences those with the disease as well as their families and social relationships. The chosen families of persons living with HIV (PLWH) provide structure, social support, and security. Our study identified reasons why PLWH included specific individuals in their chosen families (or families of choice). This mixed-method design used a convenience sample of 150 PLWH, ages 19-68 years. Self-reported reasons for including specific individuals in their chosen families were love and acceptance (n = 135; 90.0%), support (n = 100; 66.7%), blood and family ties (n = 37; 24.7%), and commonality (n = 28; 18.7%). Demographic and personal characteristics were unrelated to these themes, supporting the conclusion that reasons for choosing family members are universal across these variables. These findings emphasize the need for health care providers to encourage the development of friendships and relationships between PLWH and those who provide love and acceptance, support, blood/familial ties, and common interests.

Do social support, stigma, and social problem-solving skills predict depressive symptoms in people living with HIV? A mediation analysis.

Social support, stigma, and social problem solving may be mediators of the relationship between sign and symptom severity and depressive symptoms in people living with HIV (PLWH). However, no published studies have examined these individual variables as mediators in PLWH. This cross-sectional, correlational study of 150 PLWH examined whether social support, stigma, and social problem solving were mediators of the relationship between HIV-related sign and symptom severity and depressive symptoms. Participants completed self-report questionnaires during their visits at two HIV outpatient clinics in the Southeastern United States. Using multiple regression analyses as a part of mediation testing, social support, stigma, and social problem solving were found to be partial mediators of the relationship between sign and symptom severity and depressive symptoms, considered individually and as a set.

Biological perspectives: the role of glutamate in schizophrenia and its treatment.

Schizophrenia is a heartbreaking, debilitating, youth-stealing, lifetime disorder for most individuals afflicted with it. While the serendipitous discovery of chlorpromazine 60 plus years ago and the subsequent "discoveries" since have significantly reduced positive symptoms, the devastation of negative/cognitive symptoms continues to ruin lives. Given the cost in lives and dollars that schizophrenia drains out of our society, neuroscientists will continue to explore better approaches to fighting this disorder. The hypoglutamate model appears promising, yet there are miles to go before we sleep. As Nestler et al. (2009, p. 398) deftly acknowledge, ". . . it is important to point out that postulating a role for abnormal glutamatergic neurotransmission in schizophrenia is akin to proposing that the brain is involved in schizophrenia since every single neuron in the brain receives thousands of excitatory synapses that utilize glutamate as their neurotransmitter."