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1.
BMC Res Notes ; 14(1): 320, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419155

RESUMO

OBJECTIVES: Peer support is rapidly being introduced into mental health services internationally, yet peer support interventions are often poorly described, limiting the usefulness of research in informing policy and practice. This paper reports the development of a peer support intervention that aims to improve outcomes of discharge from inpatient to community mental health care. People with experiential knowledge of using mental health services-peer workers and service user researchers-were involved in all stages of developing the intervention: generating intervention components; producing the intervention handbook; piloting the intervention. RESULTS: Systematic review and expert panels, including our Lived Experience Advisory Panel, identified 66 candidate intervention components in five domains: Recruitment and Role Description of Peer Workers; Training for Peer Workers; Delivery of Peer Support; Supervision and Support for Peer Workers; Organisation and Team. A series of Local Advisory Groups were used to prioritise components and explore implementation issues using consensus methods, refining an intervention blueprint. A peer support handbook and peer worker training programme were produced by the study team and piloted in two study sites. Feedback workshops were held with peer workers and their supervisors to produce a final handbook and training programme. The ENRICH trial is registered with the ISRCTN clinical trial register, number ISRCTN 10043328, and was overseen by an independent steering committee and a data monitoring committee.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Aconselhamento , Humanos , Pacientes Internados , Transtornos Mentais/terapia , Saúde Mental , Revisões Sistemáticas como Assunto
2.
BMC Psychiatry ; 21(1): 357, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271902

RESUMO

BACKGROUND: Severe mental illness (SMI) is associated with care delivery problems because of the high levels of clinical resources needed to address patient's psychosocial impairment and to support inclusion in society. Current routine appointment systems do not adequately foster recovery care and are not systematically capturing information suggestive of urgent care needs. This study aimed to assess the feasibility, acceptability, and potential clinical benefits of a mobile technology health management tool to enhance community care for people with severe mental illness. METHODS: This randomised-controlled feasibility pilot study utilised mixed quantitative (measure on subjective quality of life as primary outcome; questionnaires on self-management skills, medication adherence scale as secondary outcomes) and qualitative (thematic analysis) methodologies. The intervention was a simple interactive technology (Short Message Service - SMS) communication system called 'Florence', and had three components: medication and appointment reminders, daily individually defined wellbeing scores and optionally coded request for additional support. Eligible participants (diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder ≥1 year) were randomised (1:1) to either treatment as usual (TAU, N = 29) or TAU and the technology-assisted intervention (N = 36). RESULTS: Preliminary results suggest that the health technology tool appeared to offer a practicable and acceptable intervention for patients with SMI in managing their condition. Recruitment and retention data indicated feasibility, the qualitative analysis identified suggestions for further improvement of the intervention. Patients engaged well and benefited from SMS reminders and from monitoring their individual wellbeing scores; recommendations were made to further personalise the intervention. The care coordinators did not utilise aspects of the intervention per protocol due to a variety of organisational barriers. Quantitative analysis of outcomes (including a patient-reported outcome measure on subjective quality of life, self-efficacy/competence and medication adherence measures) did not identify significant changes between groups over time in favour of the Florence intervention, given high baseline scores. The wellbeing scores, however, were positively correlated with all outcome measures. CONCLUSION: It is feasible to conduct an adequately powered full trial to evaluate this intervention. Inclusion criteria should be revised to include patients with a higher level of need and clinicians should receive more in-depth assistance in managing the tools effectively. The preliminary data suggests that this intervention can aid recovery care and individually defined wellbeing scores are highly predictive of a range of recovery outcomes; they could, therefore, guide the allocation of routine care resources. TRIAL REGISTRATION: ISRCTN34124141 ; retrospectively registered, date of registration 05/11/2019.


Assuntos
Transtornos Mentais , Qualidade de Vida , Tecnologia Biomédica , Estudos de Viabilidade , Humanos , Transtornos Mentais/terapia , Projetos Piloto
3.
BMC Psychiatry ; 20(1): 534, 2020 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-33176729

RESUMO

BACKGROUND: Peer support is being introduced into mental health services internationally, often in response to workforce policy. Earlier systematic reviews incorporate different modalities of peer support (i.e. group and one-to-one), offer inconsistent evidence of effectiveness, and also indicate substantial heterogeneity and issues of quality in the evidence base at that time. An updated review, focussed on one-to-one peer support, is timely given current policy interest. This study aims to systematically review evidence for the effectiveness of one-to-one peer support interventions for adults using mental health services, and to explore heterogeneity in peer support interventions. METHOD: We searched MEDLINE, PsycINFO, Embase, CINAHL and Cochrane databases from inception until 13 June 2019. Included studies were assessed for risk of bias, and meta-analyses conducted where multiple trials provided usable data. RESULTS: Twenty-three studies reporting nineteen trials were eligible, providing data from 3329 participants. While seven trials were of low to moderate risk of bias, incomplete reporting of data in many studies suggested bias in the evidence base. Peer support interventions included peer workers in paraclinical roles (e.g. case manager), providing structured behavioural interventions, or more flexible support for recovery. Meta-analyses were conducted for eleven outcomes, with evidence that one-to-one peer support may have a modest positive impact on self-reported recovery and empowerment. There was no impact on clinical symptoms or service use. Analyses of heterogeneity suggest that peer support might improve social network support. CONCLUSIONS: One-to-one peer support in mental health services might impact positively on psychosocial outcomes, but is unlikely to improve clinical outcomes. In order to better inform the introduction of peer support into mental health services, improvement of the evidence base requires complete reporting of outcome data, selection of outcomes that relate to intervention mechanisms, exploration of heterogeneity in the implementation of peer support and focused reviews of specific types of one-to-one peer support. TRIAL REGISTRATION: Prospero identifier: CRD42015025621 .


Assuntos
Serviços de Saúde Mental , Adulto , Aconselhamento , Humanos , Grupo Associado , Apoio Social
4.
Int Psychogeriatr ; : 1-24, 2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-32024558

RESUMO

OBJECTIVE: To identify barriers and facilitators to help seeking for a dementia diagnosis from the perspective of carers and people with dementia. DESIGN: A systematic review of the literature was conducted according to the PRISMA guidelines (PROSPERO protocol registration CRD42018092524). Nine electronic databases were searched for qualitative, quantitative, and mixed methods primary research studies. Two independent reviewers screened titles and abstracts, full texts of eligible studies, and conducted quality appraisal of included articles. A convergent qualitative synthesis approach was used. RESULTS: From 7496 articles, 35 papers representing 32 studies from 1986 to 2017 were included. Studies originated from 13 countries across 4 continents. Barriers and facilitators were reported predominantly by carers. A small number of studies included people with dementia. Barriers included denial, stigma and fear, lack of knowledge, normalization of symptoms, preserving autonomy, lack of perceived need, unaware of changes, lack of informal network support, carer difficulties, and problems accessing help. Facilitators included recognition of symptoms as a problem, prior knowledge and contacts, and support from informal network. CONCLUSIONS: Studies from a 30-year period demonstrated that barriers to help seeking persist globally, despite increasing numbers of national dementia policies. Barriers and facilitators rarely existed independently demonstrating the complexity of help seeking for a diagnosis of dementia. Multiple barriers compounded the decision-making process and more than one facilitator was often required to overcome them. Multi-faceted interventions to reduce barriers are needed, one approach would be a focus on the development of dementia friendly communities to reduce stigma and empower people with dementia and carers.

5.
BMC Psychiatry ; 19(1): 115, 2019 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-30991971

RESUMO

BACKGROUND: Involving mental health service users in planning and reviewing their care can help personalised care focused on recovery, with the aim of developing goals specific to the individual and designed to maximise achievements and social integration. We aimed to ascertain the views of service users, carers and staff in acute inpatient wards on factors that facilitated or acted as barriers to collaborative, recovery-focused care. METHODS: A cross-national comparative mixed-methods study involving 19 mental health wards in six service provider sites in England and Wales. This included a survey using established standardised measures of service users (n = 301) and staff (n = 290) and embedded case studies involving interviews with staff, service users and carers (n = 76). Quantitative and qualitative data were analysed within and across sites using descriptive and inferential statistics, and framework method. RESULTS: For service users, when recovery-oriented focus was high, the quality of care was rated highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Staff members rated the quality of therapeutic relationships higher than service users did. Staff accounts of routine collaboration contrasted with a more mixed picture in service user accounts. Definitions and understandings of recovery varied, as did views of hospital care in promoting recovery. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent. CONCLUSIONS: There is positive practice within acute inpatient wards, with evidence of commitment to safe, respectful, compassionate care. Recovery ideas were evident but there remained ambivalence on their relevance to inpatient care. Service users were aware of efforts taken to keep them safe, but despite measures described by staff, they did not feel routinely involved in care planning or risk management decisions. Research on increasing therapeutic contact time, shared decision making in risk assessment and using recovery focused tools could further promote personalised and recovery-focused care planning. This paper arises from a larger study published by National Institute for Health Research (Simpson A, et al, Health Serv Deliv Res 5(26), 2017).


Assuntos
Pessoal de Saúde/psicologia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Recuperação da Saúde Mental , Serviços de Saúde Mental , Unidade Hospitalar de Psiquiatria , Tomada de Decisões , Inglaterra/epidemiologia , Feminino , Pessoal de Saúde/tendências , Hospitalização/tendências , Humanos , Pacientes Internados/psicologia , Masculino , Transtornos Mentais/epidemiologia , Saúde Mental/tendências , Recuperação da Saúde Mental/tendências , Serviços de Saúde Mental/tendências , Unidade Hospitalar de Psiquiatria/tendências , Inquéritos e Questionários , País de Gales/epidemiologia
6.
PLoS One ; 13(10): e0205223, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30352071

RESUMO

BACKGROUND: Utility scores are integral to health economics decision-making. Typically, utility scores have not been scored or developed with mental health service users. The aims of this study were to i) collaborate with service users to develop descriptions of five mental health states (psychosis, depression, eating disorder, medication side effects and self-harm); ii) explore feasibility and acceptability of using scenario-based health states in an e-survey; iii) evaluate which utility measures (standard gamble (SG), time trade off (TTO) and rating scale (RS)) are preferred; and iv) determine how different participant groups discriminate between the health scenarios and rank them. DESIGN AND METHODS: This was a co-produced mixed methods cross-sectional online survey. Utility scores were generated using the SG, TTO and RS methods; difficulty of the completing each method, markers of acceptability and participants' preference were also assessed. RESULTS: A total of 119 participants (58%) fully completed the survey. For any given health state, SG consistently generated higher utility scores compared to RS and for some health states higher also than TTO (i.e. SG produces inflated utility scores relative to RS and TTO). Results suggest that different utility measures produce different evaluations of described health states. The TTO was preferred by all participant groups over the SG. The three participant groups scored four (of five) health scenarios comparably. Psychosis scored as the worst health state to live with while medication side-effects were viewed more positively than other scenarios (depression, eating disorders, self-harm) by all participant groups. However, there was a difference in how the depression scenario was scored, with service users giving depression a lower utility score compared to other groups. CONCLUSION: Mental health state scenarios used to generate utility scores can be co-produced and are well received by a broad range of participants. Utility valuations using SG, TTO and RS were feasible for use with service users, carers, healthcare professionals and members of the general public. Future studies of utility scores in psychiatry should aim to include mental health service users as both co-investigators and respondents.


Assuntos
Análise Custo-Benefício/métodos , Tomada de Decisões , Técnicas de Apoio para a Decisão , Serviços de Saúde Mental/organização & administração , Escalas de Graduação Psiquiátrica , Adulto , Idoso , Cuidadores/estatística & dados numéricos , Estudos Transversais , Depressão/diagnóstico , Depressão/economia , Depressão/terapia , Estudos de Viabilidade , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/economia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Serviços de Saúde Mental/economia , Pessoas Mentalmente Doentes/estatística & dados numéricos , Pessoa de Meia-Idade , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/economia , Transtornos Psicóticos/terapia , Comportamento Autodestrutivo/diagnóstico , Comportamento Autodestrutivo/economia , Comportamento Autodestrutivo/terapia , Inquéritos e Questionários/estatística & dados numéricos , Reino Unido , Adulto Jovem
7.
Int J Integr Care ; 18(3): 12, 2018 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-30220895

RESUMO

Introduction: Care coordination is intended to ensure needs are met and integrated services are provided. Formalised processes for the coordination of mental health care arrived in the UK with the introduction of the care programme approach in the early 1990s. Since then the care coordinator role has become a central one within mental health systems. Theory and methods: This paper contrasts care coordination as work that is imagined with care coordination as work that is done. This is achieved via a critical review of policy followed by a qualitative analysis of interviews, focusing on day-to-day work, conducted with 28 care coordinators employed in four NHS organisations in England and two in Wales. Findings: Care coordination is imagined as a vehicle for the provision of collaborative, recovery-focused, care. Those who practise care coordination are concerned with the quality of their relationships with service users and the tailoring of services, but limits exist to collaboration and open discussion. Care coordinators describe doing necessary work connecting people and the system of care. However, this work also brings significant administrative demands, is subject to performance management which distorts its primary purpose, and in a context of scarce resources promotes generic professional roles. Conclusion: Care coordination must be done. However, it is not consistently being done in the way policymakers imagine, and in the real world of work can be done differently.

8.
Brain Res Bull ; 140: 212-219, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29782908

RESUMO

Patients receiving cytokine immunotherapy with IFN-α frequently present with neuropsychiatric consequences and cognitive impairments, including a profound depressive-like symptomatology. While the neurobiological substrates of the dysfunction that leads to adverse events in IFN-α-treated patients remains ill-defined, dysfunctions of the hippocampus and prefrontal cortex (PFC) are strong possibilities. To date, hippocampal deficits have been well-characterised; there does however remain a lack of insight into the nature of prefrontal participation. Here, we used a PFC-supported temporal order memory paradigm to examine if IFN-α treatment induced deficits in performance; additionally, we used an object recognition task to assess the integrity of the perirhinal cortex (PRH). Finally, the utility of exercise as an ameliorative strategy to recover temporal order deficits in rats was also explored. We found that IFN-α-treatment impaired temporal order memory discriminations, whereas recognition memory remained intact, reflecting a possible dissociation between recognition and temporal order memory processing. Further characterisation of temporal order memory impairments using a longitudinal design revealed that deficits persisted for 10 weeks following cessation of IFN-α-treatment. Finally, a 6 week forced exercise regime reversed IFN-α-induced deficits in temporal order memory. These data provide further insight into the circuitry involved in cognitive impairments arising from IFN-α-treatment. Here we suggest that PFC (or the hippocampo-prefrontal pathway) may be compromised whilst the function of the PRH is preserved. Deficits may persist after cessation of IFN-α-treatment which suggests that extended patient monitoring is required. Aerobic exercise may be restorative and could prove beneficial for patients treated with IFN-α.


Assuntos
Terapia por Exercício , Fatores Imunológicos/efeitos adversos , Imunoterapia/efeitos adversos , Interferon-alfa/efeitos adversos , Transtornos da Memória/etiologia , Transtornos da Memória/terapia , Animais , Estudos Longitudinais , Masculino , Memória/efeitos dos fármacos , Memória/fisiologia , Distribuição Aleatória , Ratos Wistar , Percepção do Tempo/efeitos dos fármacos , Percepção do Tempo/fisiologia
9.
Health Expect ; 20(3): 471-483, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-27312732

RESUMO

BACKGROUND: Communication and information sharing are considered crucial to recovery-focused mental health services. Effective mental health care planning and coordination includes assessment and management of risk and safety. OBJECTIVE: Using data from our cross-national mixed-method study of care planning and coordination, we examined what patients, family members and workers say about risk assessment and management and explored the contents of care plans. DESIGN: Thematic analysis of qualitative research interviews (n = 117) with patients, family members and workers, across four English and two Welsh National Health Service sites. Care plans were reviewed (n = 33) using a structured template. FINDINGS: Participants have contrasting priorities in relation to risk. Patients see benefit in discussions about risk, but cast the process as a worker priority that may lead to loss of liberty. Relationships with workers are key to family members and patients; however, worker claims of involving people in the care planning process do not extend to risk assessment and management procedures for fear of causing upset. Workers locate risk as coming from the person rather than social or environmental factors, are risk averse and appear to prioritize the procedural aspects of assessment. CONCLUSIONS: Despite limitations, risk assessment is treated as legitimate work by professionals. Risk assessment practice operates as a type of fiction in which poor predictive ability and fear of consequences are accepted in the interests of normative certainty by all parties. As a consequence, risk adverse options are encouraged by workers and patients steered away from opportunities for ordinary risks thereby hindering the mobilization of their strengths and abilities.


Assuntos
Continuidade da Assistência ao Paciente , Serviços de Saúde Mental/estatística & dados numéricos , Planejamento de Assistência ao Paciente , Segurança do Paciente , Adulto , Comunicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Medição de Risco , Reino Unido
10.
BMC Psychiatry ; 16: 147, 2016 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-27184888

RESUMO

BACKGROUND: In the UK, concerns about safety and fragmented community mental health care led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require service users to have a care coordinator, written care plan and regular reviews of their care. Processes are required to be collaborative, recovery-focused and personalised but have rarely been researched. We aimed to obtain the views and experiences of stakeholders involved in community mental health care and identify factors that facilitate or act as barriers to personalised, collaborative, recovery-focused care. METHODS: We conducted a cross-national comparative study employing a concurrent transformative mixed-methods approach with embedded case studies across six service provider sites in England and Wales. The study included a survey of views on recovery, empowerment and therapeutic relationships in service users (n = 448) and recovery in care coordinators (n = 201); embedded case studies involving interviews with service providers, service users and carers (n = 117) and a review of care plans (n = 33). Quantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and framework method. RESULTS: Significant differences were found across sites for scores on therapeutic relationships. Variation within sites and participant groups was reported in experiences of care planning and understandings of recovery and personalisation. Care plans were described as administratively burdensome and were rarely consulted. Carers reported varying levels of involvement. Risk assessments were central to clinical concerns but were rarely discussed with service users. Service users valued therapeutic relationships with care coordinators and others, and saw these as central to recovery. CONCLUSIONS: Administrative elements of care coordination reduce opportunities for recovery-focused and personalised work. There were few common understandings of recovery which may limit shared goals. Conversations on risk appeared to be neglected and assessments kept from service users. A reluctance to engage in dialogue about risk management may work against opportunities for positive risk-taking as part of recovery-focused work. Research to investigate innovative approaches to maximise staff contact time with service users and carers, shared decision-making in risk assessments, and training designed to enable personalised, recovery-focused care coordination is indicated.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Pesquisas sobre Serviços de Saúde , Transtornos Mentais/terapia , Planejamento de Assistência ao Paciente , Estudos de Casos e Controles , Inglaterra , Humanos , País de Gales
11.
BMC Psychiatry ; 15: 145, 2015 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-26138855

RESUMO

BACKGROUND: The collaborative care planning study (COCAPP) is a cross-national comparative study of care planning and coordination in community mental healthcare settings. The context and delivery of mental health care is diverging between the countries of England and Wales whilst retaining points of common interest, hence providing a rich geographical comparison for research. Across England the key vehicle for the provision of recovery-focused, personalised, collaborative mental health care is the care programme approach (CPA). The CPA is a form of case management introduced in England in 1991, then revised in 2008. In Wales the CPA was introduced in 2003 but has now been superseded by The Mental Health (Care Co-ordination and Care and Treatment Planning) (CTP) Regulations (Mental Health Measure), a new statutory framework. In both countries, the CPA/CTP requires providers to: comprehensively assess health/social care needs and risks; develop a written care plan (which may incorporate risk assessments, crisis and contingency plans, advanced directives, relapse prevention plans, etc.) in collaboration with the service user and carer(s); allocate a care coordinator; and regularly review care. The overarching aim of this study is to identify and describe the factors that ensure CPA/CTP care planning and coordination is personalised, recovery-focused and conducted collaboratively. METHODS/DESIGN: COCAPP will employ a concurrent transformative mixed methods approach with embedded case studies. Phase 1 (Macro-level) will consider the national context through a meta-narrative mapping (MNM) review of national policies and the relevant research literature. Phase 2 (Meso-level and Micro-level) will include in-depth micro-level case studies of everyday 'frontline' practice and experience with detailed qualitative data from interviews and reviews of individual care plans. This will be nested within larger meso-level survey datasets, senior-level interviews and policy reviews in order to provide potential explanations and understanding. DISCUSSION: COCAPP will help identify the key components that support and hinder the provision of personalised, recovery-focused care planning and provide an informed rationale for a future planned intervention and evaluation.


Assuntos
Prestação Integrada de Cuidados de Saúde , Serviços de Saúde Mental/organização & administração , Planejamento de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Estudos de Casos e Controles , Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/organização & administração , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/organização & administração , Inglaterra , Humanos , Saúde Mental , Recuperação de Função Fisiológica , Projetos de Pesquisa
12.
Prim Health Care Res Dev ; 15(4): 452-63, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25146257

RESUMO

BACKGROUND: Lymphoedema secondary to cancer is a relatively neglected and under-researched condition. Few studies report people's experiences of care and treatment provision when living with the condition. Current practice focuses on the physical treatment yet psychosocial needs often remain unmet. A previous study examining the patient perspective identified the theme of being 'abandoned by medicine'. Perceived lack of support may result in a delayed adaptation and acceptance of this long-term condition and can significantly impact on psychological well-being. We explore this emerging theme alongside others in order to provide a guide to action for improvements for patient benefit. AIM: The central aim was to explore women's views of their care and treatment following a diagnosis with lymphoedema secondary to cancer. This forms part of a larger study aimed at assessing appropriate screening tools to measure psychosocial distress. METHODS: A mixed-methods approach was used for the main study. Here we report the qualitative component, derived from in-depth semi-structured interviews conducted in the homes of the participants (n = 14) and focus group discussions (n = 15). In addition, qualitative comments from questionnaire data from a large-scale postal survey are included (n = 104). FINDINGS: Participants identified considerable deficiencies in health care workers' knowledge and awareness of lymphoedema, which subsequently impacted on the patients' needs for information, support and understanding. Access to appropriate treatment was patchy and problems were identified with the process of obtaining compression garments, massage and other sources of help. Although lymphoedema is a long-term disfiguring condition, and much is known about how this impacts on patients' emotional well-being, little attention was paid by health professionals to potential psychosocial consequences. In essence women had to become experts of their own condition and cope as best as they could. We provide recommendations to improve service delivery and address these unmet needs.


Assuntos
Atitude Frente a Saúde , Neoplasias da Mama/complicações , Linfedema/etiologia , Linfedema/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Inglaterra , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Inquéritos e Questionários
13.
Behav Brain Res ; 272: 218-25, 2014 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-25017570

RESUMO

Adaptively responding to acute stress has been of great importance for human and animal survival. However, for our species, stress-related disorders are putting an ever-increasing burden on healthcare systems. It is thus crucial to understand the basic processes and cognitive changes associated with acute stress. Here, we examined the effects of acute stress exposure on spatial (water maze) and memory (delayed match to sample and episodic-memory-like tasks) performance. We found striking performance deficits in stressed animals navigating in the water maze. We also found, in an episodic-like memory task, striking object-location deficits, but not in temporal-object association learning in stressed animals. Finally, no differences were apparent for any delay periods (up to 30s) in a delayed match to sample task. Taken together, these results show a strong differential effect of acute stress on differing memory processes.


Assuntos
Memória Episódica , Memória de Curto Prazo , Memória Espacial , Estresse Psicológico , Doença Aguda , Animais , Condicionamento Operante , Masculino , Aprendizagem em Labirinto , Testes Neuropsicológicos , Estimulação Luminosa/efeitos adversos , Distribuição Aleatória , Ratos Wistar
14.
J Psychosoc Nurs Ment Health Serv ; 52(1): 22-30, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24305906

RESUMO

SUGAR (Service User and Carer Group Advising on Research) is an initiative established to develop collaborative working in mental health nursing research between mental health service users, carers, researchers, and practitioners at City University London, United Kingdom. This article will describe the background of SUGAR; how the group operates; some of the achievements to date, including researcher reflections; and case studies of how this collaboration influences our research. Written reflective narratives of service user and carer experiences of SUGAR were analyzed using constant comparative methods by the members. Common themes are presented with illustrative quotes. The article highlights the benefits and possible limitations identified to date by members of SUGAR, outlines future plans, and considers the findings in relation to literature on involvement and empowerment. This article, written by staff and members of SUGAR, is the first venture into collaborative writing of the group and reflects the shared ethos of collaborative working.


Assuntos
Cuidadores , Comportamento Cooperativo , Transtornos Mentais/enfermagem , Serviços de Saúde Mental/organização & administração , Participação do Paciente , Enfermagem Psiquiátrica/organização & administração , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa em Enfermagem , Recursos Humanos de Enfermagem no Hospital , Objetivos Organizacionais , Grupo Associado , Poder Psicológico , Avaliação de Programas e Projetos de Saúde , Reino Unido , Voluntários/organização & administração
15.
Neurobiol Aging ; 33(4): 835.e13-30, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21975308

RESUMO

As an antidiabetic agent, rosiglitazone (ROSI) binds and activates peroxisome proliferator-activator receptor gamma (PPARγ), altering the expression of genes involved in glucose uptake and disposal, ultimately affecting glucose regulation. ROSI might therefore be a potential treatment to ameliorate age-related decline in cognitive function, particularly on an insulin-resistant background, where improvements in peripheral insulin sensitivity and central nervous system (CNS) glucose utilization may facilitate recovery of cognitive function. We therefore examined the amelioration potential of ROSI for neurocognitive deficits resulting from aging in an animal model. Behaviorally, acute and chronic ROSI treatments enhanced acquisition of learning in the water plus maze, a modified version of the Morris water maze task. In parallel, restoration of synaptic plasticity in the dentate gyrus of ROSI-treated middle-aged rats was evident after a single dose intake. Additionally, the spatial receptive fields of hippocampal CA1 place cells were significantly improved by chronic ROSI administration. ROSI treatment reversed basal plasma insulin abnormalities and increased hippocampal glucose transporter (GLUT)-3 expression in middle-aged rats. Taken together, these results suggest that ROSI modulates hippocampal circuitry effectively to promote an improvement in cognitive function, possibly via a glucose transporter-3 mechanism.


Assuntos
Hipocampo/citologia , Hipoglicemiantes/farmacologia , Potenciação de Longa Duração/efeitos dos fármacos , Transtornos da Memória/tratamento farmacológico , Neurônios/efeitos dos fármacos , Tiazolidinedionas/farmacologia , Envelhecimento/efeitos dos fármacos , Análise de Variância , Animais , Biofísica , Estimulação Elétrica , Ensaio de Imunoadsorção Enzimática , Potenciais Pós-Sinápticos Excitadores/efeitos dos fármacos , Regulação da Expressão Gênica/efeitos dos fármacos , Transportador de Glucose Tipo 3/genética , Transportador de Glucose Tipo 3/metabolismo , Hipocampo/efeitos dos fármacos , Potenciação de Longa Duração/fisiologia , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , RNA Mensageiro/metabolismo , Ratos , Ratos Wistar , Rosiglitazona , Fatores de Tempo
16.
Neuropharmacology ; 59(1-2): 9-19, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20347854

RESUMO

Modafinil is a psychostimulant drug used widely for the treatment of narcolepsy, which also has additional positive effects on cognition. Here, we investigate the effects of modafinil on behavioural performance and synaptic plasticity in rats. Improved acquisition in the water maze task was observed in animals that underwent chronic treatment with modafinil. We found that the distance traveled and escape latency were reduced after the first day in chronically-treated rats, compared to controls. Importantly, swim velocity was similar for both groups, excluding pharmacological effects on motor skills. We also found that modafinil increases synaptic plasticity in the dentate gyrus of urethane-anaesthetized rats; modafinil induced a robust augmentation of the population spike, evident after application of 2 bursts of 200 Hz high-frequency stimulation. Furthermore, the modafinil-dependent enhancement of postsynaptic potentials correlated selectively with theta rhythm augmentation. We propose that modafinil may facilitate hippocampal-associated spatial representation via increased theta-related hippocampal plasticity.


Assuntos
Compostos Benzidrílicos/farmacologia , Estimulantes do Sistema Nervoso Central/farmacologia , Giro Denteado/efeitos dos fármacos , Aprendizagem em Labirinto/efeitos dos fármacos , Plasticidade Neuronal/efeitos dos fármacos , Sinapses/efeitos dos fármacos , Anestesia , Animais , Compostos Benzidrílicos/administração & dosagem , Estimulantes do Sistema Nervoso Central/administração & dosagem , Giro Denteado/fisiologia , Estimulação Elétrica , Potenciais Pós-Sinápticos Excitadores/efeitos dos fármacos , Masculino , Aprendizagem em Labirinto/fisiologia , Modafinila , Atividade Motora/efeitos dos fármacos , Neurônios/efeitos dos fármacos , Neurônios/fisiologia , Via Perfurante/efeitos dos fármacos , Via Perfurante/fisiologia , Ratos , Ratos Wistar , Sinapses/fisiologia , Ritmo Teta/efeitos dos fármacos , Fatores de Tempo , Uretana , Água
17.
Physiol Behav ; 95(1-2): 125-9, 2008 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-18571208

RESUMO

The anti-viral drug interferon-alpha (IFN-alpha) is widely-known to induce psychiatric and cognitive effects in patients. Previous work has shown that physical exercise can have a positive effect against brain insult. We investigated the effects of a clinically-comparable treatment regime of IFN-alpha on cognitive function in male Wistar rats and assessed the impact of chronic treadmill running on the deficits generated by IFN-alpha. We found that IFN-alpha induced significant impairments in performance on both spatial novelty and object novelty recognition. Chronic forced exercise did not protect against IFN-alpha-induced learning deficits in reactivity to spatial change, but did restore the capacity for novel object recognition in IFN-alpha-treated animals.


Assuntos
Interferon-alfa , Reconhecimento Visual de Modelos/fisiologia , Transtornos da Percepção/induzido quimicamente , Transtornos da Percepção/reabilitação , Condicionamento Físico Animal/métodos , Análise de Variância , Animais , Comportamento Animal , Comportamento Exploratório/efeitos dos fármacos , Comportamento Exploratório/fisiologia , Masculino , Reconhecimento Visual de Modelos/efeitos dos fármacos , Estimulação Luminosa , Ratos , Ratos Wistar
18.
J Clin Psychol ; 63(10): 943-60, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17828760

RESUMO

Spiritual and religious interventions in psychotherapy have increasingly received research attention, particularly with highly religious clients. This study examined client opinions about and experiences with religious interventions in psychotherapy. A sample of 152 clients at a counseling center of a university sponsored by the Church of Jesus Christ of Latter-Day Saints (LDS) completed a survey with ratings of specific religious interventions concerning appropriateness, helpfulness, and prevalence. Out-of-session religious interventions were considered more appropriate by clients than in-session religious interventions, but in-session interventions were rated as more helpful. Specific interventions considered both appropriate and helpful by the LDS participants included referencing scriptural passages, teaching spiritual concepts, encouraging forgiveness, involving religious community resources, and conducting assessments of client spirituality. Some religious interventions were perceived as inappropriate or not helpful, and clients provided explanations for why religious interventions can be either effective or ineffective in psychotherapy.


Assuntos
Igreja de Jesus Cristo dos Santos dos Últimos Dias/psicologia , Saúde Holística , Transtornos Mentais/terapia , Psicoterapia/métodos , Religião e Psicologia , Espiritualidade , Serviços de Saúde para Estudantes/métodos , Adolescente , Adulto , Aconselhamento/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/etnologia , Estudantes/psicologia , Inquéritos e Questionários , Universidades , Utah
19.
Int J Group Psychother ; 52(4): 555-87, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12375487

RESUMO

This article describes the collaborative effort of a team of discipline directors, administrators, and academicians to create a systematic program to enhance the group competencies of a large clinical staff working at a state hospital. The effects of the program were tested by a quasi-experimental field study. Quantitative measures of group process provided limited support for program effectiveness. Stronger support came from qualitative inquiry. The development and effectiveness of the program is examined within a larger context of group programs housed in large health care organizations.


Assuntos
Processos Grupais , Hospitais Psiquiátricos , Transtornos Mentais/terapia , Médicos , Desenvolvimento de Programas/métodos , Psicoterapia de Grupo/métodos , Adolescente , Adulto , Criança , Competência Clínica , Feminino , Hospitais com 300 a 499 Leitos , Hospitais Psiquiátricos/organização & administração , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Desenvolvimento de Programas/estatística & dados numéricos , Resultado do Tratamento
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