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4.
J Nerv Ment Dis ; 199(8): 520-6, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21814072

RESUMO

Many patients with schizophrenia have psychological distress and receive some form of psychotherapy. Several different psychotherapeutic approaches for schizophrenia have been developed and studied. Of these approaches, cognitive behavior therapy (CBT) has the strongest evidence base and has shown benefit for symptom reduction in outpatients with residual symptoms. In addition to CBT, other approaches include compliance therapy, personal therapy, acceptance and commitment therapy, and supportive therapy. Although usually studied as distinct approaches, these therapies overlap with each other in their therapeutic elements. Psychotherapy for schizophrenia continues to evolve with the recent advent of such approaches as metacognitive therapy, narrative therapies, and mindfulness therapy. Future research may also consider three different goals of psychotherapy in this patient population: to provide emotional support, to enhance functional recovery, and to alter the underlying illness process.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Medicina Baseada em Evidências , Esquizofrenia/terapia , Humanos , Resultado do Tratamento
5.
Psychiatr Serv ; 62(6): 591-7, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21632725

RESUMO

OBJECTIVE: The Family-to-Family Education Program (FTF) is a 12-week course offered by the National Alliance on Mental Illness (NAMI) for family members of adults with mental illness. This study evaluated the course's effectiveness. METHODS: A total of 318 consenting participants in five Maryland counties were randomly assigned to take FTF immediately or to wait at least three months for the next available class with free use of any other NAMI supports or community or professional supports. Participants were interviewed at study enrollment and three months later (at course termination) regarding problem- and emotion-focused coping, subjective illness burden, and distress. A linear mixed-effects multilevel regression model tested for significant changes over time between intervention conditions. RESULTS: FTF participants had significantly greater improvements in problem-focused coping as measured by empowerment and illness knowledge. Exploratory analyses revealed that FTF participants had significantly enhanced emotion-focused coping as measured by increased acceptance of their family member's illness, as well as reduced distress and improved problem solving. Subjective illness burden did not differ between groups. CONCLUSIONS: This study provides evidence that FTF is effective for enhancing coping and empowerment of families of persons with mental illness, although not for reducing subjective burden. Other benefits for problem solving and reducing distress are suggested but require replication.


Assuntos
Cuidadores/educação , Transtornos Mentais/reabilitação , Grupo Associado , Adaptação Psicológica , Adulto , Idoso , Cuidadores/psicologia , Associações de Consumidores , Efeitos Psicossociais da Doença , Emoções , Feminino , Seguimentos , Humanos , Masculino , Maryland , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Resolução de Problemas , Apoio Social , Inquéritos e Questionários
7.
Psychiatr Serv ; 62(11): 1296-302, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22211208

RESUMO

OBJECTIVE: This study evaluated a Web-based tool to help patients with schizophrenia communicate with clinicians about evidence-based treatments. METHODS: Fifty patients used an interactive Web-based intervention featuring actors simulating a patient discussing treatment concerns (intervention group; N=24) or were shown an educational video about schizophrenia treatment before an appointment for routine follow-up care (control group; N=26). The visits were recorded and analyzed by using the Roter Interaction Analysis System. RESULTS: Visits by patients in the intervention group were longer (24 versus 19 minutes, p<.05) and had a proportionately greater patient contribution to the dialogue (288 versus 229 statements, p<.05) and a smaller ratio of clinician to patient talk (1.1 versus 1.4, p<.05) compared with visits by the control group. Patients in the intervention group asked more questions about treatment (2 versus .9, p<.05), disclosed more lifestyle information (76 versus 53 statements, p<.005), and more often checked that they understood information (3.6 versus 2.1 checks, p<.05). Clinicians asked more questions about treatment (7.5 versus 5.1, p<.05) and the medical condition (7.8 versus 4.7, p<.05) to control group patients but made more statements of empathy (1.3 versus .4, p<.03) and cues of interest (48 versus 22, p<.05) with the intervention group. The patient-centeredness ratio was greater for visits by patients in the intervention group than by the control group (8.5 versus 3.2, p<.05). Patients' tone was more dominant and respectful (p<.05) and clinicians' tone was more sympathetic (p<.05) during visits by patients in the intervention. CONCLUSIONS: The Web-based tool empowered persons with schizophrenia to engage more fully in a patient-centered dialogue about their treatment.


Assuntos
Atitude Frente a Saúde , Instrução por Computador/métodos , Relações Profissional-Paciente , Qualidade da Assistência à Saúde , Esquizofrenia/terapia , Serviços Comunitários de Saúde Mental , Medicina Baseada em Evidências , Feminino , Pessoal de Saúde , Humanos , Internet , Masculino , Pessoa de Meia-Idade , /estatística & dados numéricos
8.
Psychiatry Res ; 176(2-3): 242-5, 2010 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-20207013

RESUMO

In a cohort of Maryland Medicaid recipients with severe mental illness followed from 1993-2001, we compared mortality with rates in the Maryland general population including race and gender subgroups. Persons with severe mental illness died at a mean age of 51.8 years, with a standardized mortality ratio of 3.7 (95%CI, 3.6-3.7).


Assuntos
Causas de Morte , Transtornos Mentais/epidemiologia , Transtornos Mentais/mortalidade , Fatores Etários , Estudos de Coortes , Humanos , Maryland/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
10.
Schizophr Bull ; 36(1): 48-70, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19955389

RESUMO

The Schizophrenia Patient Outcomes Research Team (PORT) psychosocial treatment recommendations provide a comprehensive summary of current evidence-based psychosocial treatment interventions for persons with schizophrenia. There have been 2 previous sets of psychosocial treatment recommendations (Lehman AF, Steinwachs DM. Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull. 1998;24:1-10 and Lehman AF, Kreyenbuhl J, Buchanan RW, et al. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophr Bull. 2004;30:193-217). This article reports the third set of PORT recommendations that includes updated reviews in 7 areas as well as adding 5 new areas of review. Members of the psychosocial Evidence Review Group conducted reviews of the literature in each intervention area and drafted the recommendation or summary statement with supporting discussion. A Psychosocial Advisory Committee was consulted in all aspects of the review, and an expert panel commented on draft recommendations and summary statements. Our review process produced 8 treatment recommendations in the following areas: assertive community treatment, supported employment, cognitive behavioral therapy, family-based services, token economy, skills training, psychosocial interventions for alcohol and substance use disorders, and psychosocial interventions for weight management. Reviews of treatments focused on medication adherence, cognitive remediation, psychosocial treatments for recent onset schizophrenia, and peer support and peer-delivered services indicated that none of these treatment areas yet have enough evidence to merit a treatment recommendation, though each is an emerging area of interest. This update of PORT psychosocial treatment recommendations underscores both the expansion of knowledge regarding psychosocial treatments for persons with schizophrenia at the same time as the limitations in their implementation in clinical practice settings.


Assuntos
Medicina Baseada em Evidências , Esquizofrenia/reabilitação , Psicologia do Esquizofrênico , Comitês Consultivos , Alcoolismo/reabilitação , Terapia Comportamental , Terapia Cognitivo-Comportamental , Terapia Combinada , Serviços Comunitários de Saúde Mental , Readaptação ao Emprego , Terapia Familiar , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Esquizofrenia/diagnóstico , Socialização , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Reforço por Recompensa , Perda de Peso
11.
World Psychiatry ; 8(2): 89-90, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19516928
13.
Med Care ; 47(2): 199-207, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19169121

RESUMO

BACKGROUND: Schizophrenia medication and psychosocial treatment options have expanded since the Schizophrenia PORT was conducted. However, there also have been considerable changes in the delivery of mental health care in the public sector, as well as increasing state concerns about Medicaid cost containment. OBJECTIVES: To examine trends and patient characteristics associated with differences in schizophrenia medication and visit treatment quality in a Medicaid population. RESEARCH DESIGN: Observational study of claims data from July 1, 1996 to June 30, 2001. SUBJECTS: Florida Medicaid enrollees diagnosed with schizophrenia (N = 23,619). MEASURES: We examined the likelihood of meeting any 1 and all 4 of the following quality standards: (1) receiving antipsychotic medication, (2) antipsychotic continuity, (3) dosing consistent with PORT recommendations, and (4) mental health visit continuity. Separate models were fit for acute and maintenance phases of treatment. RESULTS: Approximately 18% of acute and 7% of maintenance phases met all 4 quality standards. Antipsychotic quality improved (largely driven by an increasingly likelihood of receiving any antipsychotic), while visit continuity declined. The greatest disparities were seen for persons with co-occurring substance use disorders and of black race. Quality differences were often phase specific and at times in opposite directions across treatment phases. CONCLUSIONS: The improvement in antipsychotic treatment quality is encouraging. However, visit continuity declined. This study highlights the importance of quality measurement that includes focus on different treatment modalities and phases of care, as well as for potentially vulnerable populations (such as persons with co-occurring substance use disorders and racial/ethnic minorities).


Assuntos
Antipsicóticos/uso terapêutico , Disparidades em Assistência à Saúde/tendências , Qualidade da Assistência à Saúde/tendências , Esquizofrenia/tratamento farmacológico , Adolescente , Adulto , Assistência Ambulatorial/estatística & dados numéricos , Estudos de Coortes , Comorbidade , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Relação Dose-Resposta a Droga , Feminino , Florida , Hospitalização/estatística & dados numéricos , Humanos , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Programas de Assistência Gerenciada/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Pessoa de Meia-Idade , Probabilidade , Qualidade da Assistência à Saúde/normas , Padrões de Referência , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos , Adulto Jovem
14.
Asian J Psychiatr ; 2(3): 100-102, 2009 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-20161434

RESUMO

We evaluate the influence of housing, services, and individual characteristics on housing loss among formerly homeless mentally ill persons who participated in a five-site (4-city) study in the U.S. Housing and service availability were manipulated within randomized experimental designs and substance abuse and other covariates were measured with a common protocol. Findings indicate that housing availability was the primary predictor of subsequent ability to avoid homelessness, while enhanced services reduced the risk of homelessness if housing was also available. Substance abuse increased the risk of housing loss in some conditions in some projects, but specific findings differed between projects and with respect to time spent in shelters and on the streets. We identify implications for research on homeless persons with mental illness that spans different national and local contexts and involves diverse ethnic groups.

15.
Schizophr Res ; 101(1-3): 304-11, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18255270

RESUMO

OBJECTIVE(S): To characterize the longitudinal patterns of antipsychotic treatment and to investigate the relationship between antipsychotic treatment patterns and acute hospitalizations among adults with schizophrenia. We hypothesized that continuous antipsychotic treatment would be associated with fewer hospitalizations and shorter lengths of stay. METHOD: Seven years of retrospective Maryland Medicaid administrative data were used to examine inpatient medical encounters and outpatient psychotropic treatment in community-based settings from 1993 through 2000. The sample consisted of 1727 adults continuously enrolled in the Maryland Medicaid program from July 1992 through June 1994, and diagnosed with schizophrenia. The main outcome measures were a) any schizophrenia hospitalization; b) number of schizophrenia hospitalizations; and c) inpatient days associated with a primary diagnosis of schizophrenia. RESULTS: The average duration of antipsychotic use was six months in any single year and four and one-half years across the entire study period. Compared to individuals with a more continuous pattern of antipsychotic treatment, individuals with moderate or light use had odds of hospitalization for schizophrenia that were 52 or 72% greater (95%CI: 30-75% greater, 49-100% greater respectively). Light users of antipsychotics have an average length of stay per hospitalization that is approximately 20% longer than the average for continuous users (95%CI: 2-39% longer). CONCLUSIONS: Findings emphasize the benefit of continuous antipsychotic treatment for individuals with schizophrenia.


Assuntos
Antipsicóticos/uso terapêutico , Hospitalização/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Esquizofrenia/tratamento farmacológico , Esquizofrenia/epidemiologia , Adulto , Revisão de Uso de Medicamentos , Feminino , Humanos , Masculino , Maryland , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Características de Residência , Estudos Retrospectivos
18.
J Clin Psychiatry ; 67(9): 1404-11, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17017827

RESUMO

OBJECTIVE: This study aimed to assess racial differences in clozapine prescribing, dosing, symptom presentation and response, and hospitalization status. This study extends previous studies of clozapine by examining patient- and treatment-related factors that may help explain or eliminate reasons for differential prescribing. METHOD: Clozapine records for 373 white and African American patients with schizophrenia or schizoaffective disorder treated between March 1, 1994, and December 31, 2000, in inpatient mental health facilities in the state of Maryland were examined. Records for this study were derived from 3 state of Maryland databases: the Clozapine Authorization and Monitoring Program, the State of Maryland Antipsychotic Database, and the Health Maintenance Information System Database. RESULTS: A total of 10.3% of African Americans (150/1458) with schizophrenia received clozapine treatment compared with 15.3% of whites (223/1453) (chi2 = 16.74, df = 1, p < .001) during inpatient treatment in the public mental health system in Maryland. Clozapine doses were lower in African Americans relative to whites (385.3 +/- 200.6 vs. 447.3 +/- 230.3 mg/day) (t = -2.66, df = 366, p = .008). At the time of clozapine initiation, whites had more activating symptoms as measured by the Brief Psychiatric Rating Scale (BPRS) (t = -3.98, df = 301, p < .0001); however, African Americans had significantly greater improvements in BPRS total symptoms (F = 4.80, df = 301, p = .03) and in anxiety/ depressive symptoms during 1 year of treatment with clozapine (F = 10.04, df = 303, p = .002). The estimated rate of hospital discharge was not significantly different for African Americans compared to whites prescribed clozapine (log-rank chi2 = 0.523, df = 1, p = .470); however, African Americans were more likely than whites to discontinue clozapine during hospitalization (log-rank chi2 = 4.19, df = 1, p = .041). CONCLUSION: Our data suggest underutilization of clozapine in African American populations. This racial disparity in clozapine treatment is of special concern because of the favorable outcomes associated with clozapine in treatment-resistant schizophrenia and in the specific benefits observed in African American patients. More research is needed to determine why disparities with clozapine treatment occur and why African Americans may be discontinued from clozapine at a higher rate, despite potential indicators of equal or greater effectiveness among African Americans compared with whites.


Assuntos
Afro-Americanos/estatística & dados numéricos , Antipsicóticos/uso terapêutico , Clozapina/uso terapêutico , Centros Comunitários de Saúde Mental/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Prática de Saúde Pública/estatística & dados numéricos , Esquema de Medicação , Uso de Medicamentos , Humanos , Maryland/etnologia , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/etnologia , Esquizofrenia/tratamento farmacológico , Esquizofrenia/etnologia
19.
Adm Policy Ment Health ; 33(3): 388-97, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16755397

RESUMO

This study explores the differential effect of a managed behavioral health Carve-Out (CO) on outpatient treatment quality for persons with schizophrenia (SCHZ) alone and co-occurring substance use disorders (SUD) (SCHZ+SUD). We used claims data from a state Medicaid program and employed a retrospective, quasi-experimental design with logit and difference in difference formula regression models. The results show the CO was associated with greater changes in treatment quality for the SCHZ population, compared to the SCHZ+SUD population. Most pronounced across both populations were decrements in receiving the psychosocial treatments for enrollees in the CO arrangement.


Assuntos
Serviços de Saúde Mental , Qualidade da Assistência à Saúde , Esquizofrenia , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Estudos de Coortes , Coleta de Dados , Feminino , Humanos , Formulário de Reclamação de Seguro , Masculino , Programas de Assistência Gerenciada , Estudos Retrospectivos
20.
J Nerv Ment Dis ; 194(1): 3-9, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16462548

RESUMO

Many patients with schizophrenia have psychological distress and receive some form of psychotherapy. Several different psychotherapeutic approaches for schizophrenia have been developed and studied. Of these approaches, cognitive behavior therapy has the strongest evidence base and has shown benefit for symptom reduction in outpatients with residual symptoms. In addition to cognitive behavior therapy, other approaches include compliance therapy, personal therapy, acceptance and commitment therapy, and supportive therapy. Although usually studied as distinct approaches, the therapies overlap with each other in their therapeutic elements. As psychotherapy for schizophrenia further evolves, it will likely be informed by other psychosocial interventions used with this clinical population. In particular, techniques of remediating cognitive deficits, teaching behavioral skills, and educating about schizophrenia may be incorporated with psychotherapy. Future research may also consider three different goals of psychotherapy with this population: to provide emotional support, to enhance skills for functional recovery, and to alter the underlying illness process.


Assuntos
Psicoterapia/métodos , Esquizofrenia/terapia , Assistência Ambulatorial , Terapia Comportamental/métodos , Transtornos Cognitivos/terapia , Terapia Cognitivo-Comportamental/métodos , Ensaios Clínicos Controlados como Assunto/estatística & dados numéricos , Humanos , Educação de Pacientes como Assunto , Projetos de Pesquisa/tendências , Psicologia do Esquizofrênico , Resultado do Tratamento
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