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1.
PLoS One ; 16(9): e0257270, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34529705

RESUMO

BACKGROUND: The prominence of telemental health, including providing care by video call and telephone, has greatly increased during the COVID-19 pandemic. However, there are clear variations in uptake and acceptability, and concerns that digital exclusion may exacerbate previous inequalities in access to good quality care. Greater understanding is needed of how service users experience telemental health, and what determines whether they engage and find it acceptable. METHODS: We conducted a collaborative framework analysis of data from semi-structured interviews with a sample of people already experiencing mental health problems prior to the pandemic. Data relevant to participants' experiences and views regarding telemental health during the pandemic were identified and extracted. Data collection and analysis used a participatory, coproduction approach where researchers with relevant lived experience, contributed to all stages of data collection, analysis and interpretation of findings alongside clinical and academic researchers. FINDINGS: The experiences and preferences regarding telemental health care of the forty-four participants were dynamic and varied across time and settings, as well as between individuals. Participants' preferences were shaped by reasons for contacting services, their relationship with care providers, and both parties' access to technology and their individual preferences. While face-to-face care tended to be the preferred option, participants identified benefits of remote care including making care more accessible for some populations and improved efficiency for functional appointments such as prescription reviews. Participants highlighted important challenges related to safety and privacy in online settings, and gave examples of good remote care strategies they had experienced, including services scheduling regular phone calls and developing guidelines about how to access remote care tools. DISCUSSION: Participants in our study have highlighted advantages of telemental health care, as well as significant limitations that risk hindering mental health support and exacerbate inequalities in access to services. Some of these limitations are seen as potentially removable, for example through staff training or better digital access for staff or service users. Others indicate a need to maintain traditional face-to-face contact at least for some appointments. There is a clear need for care to be flexible and individualised to service user circumstances and preferences. Further research is needed on ways of minimising digital exclusion and of supporting staff in making effective and collaborative use of relevant technologies.


Assuntos
COVID-19/prevenção & controle , Atenção à Saúde/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adolescente , Adulto , COVID-19/epidemiologia , COVID-19/virologia , Atenção à Saúde/métodos , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Saúde Mental/normas , Pessoa de Meia-Idade , Pandemias , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , SARS-CoV-2/fisiologia , Inquéritos e Questionários/estatística & dados numéricos , Telemedicina/métodos , Adulto Jovem
2.
J Ment Health ; : 1-7, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33961753

RESUMO

BACKGROUND: There is evidence that peer support can be helpful for people suffering from psychosis, but there is a lack of research describing peer support in the context of Early Intervention in Psychosis (EIP). AIMS: We aim to investigate the key elements of peer support in EIP and how peer support workers might best be recruited and supported in their work. METHOD: We used purposive sampling to recruit seven participants for semi-structured interviews. Thematic analysis was used to analyse the data. RESULTS: Destigmatisation of psychotic experiences is a central concept that runs through all themes. Participants perceived peer support as a meaningful source of support that could provide benefits to peers (service users) and peer support workers. Themes included a "symbol of hope," "practical support," "mutuality and reciprocity," "bridge between service and peers," "ideal requirements of peer support workers," "delivering peer support," and "team-working and role clarification." CONCLUSIONS: Peer support makes a strong contribution to destigmatising psychosis. Findings potentially contribute to developing peer support workers' roles in EIP. Future research is recommended to investigate the perspectives of ethnic minorities on this topic and practical applications of these findings.

3.
Artigo em Inglês | MEDLINE | ID: mdl-31709459

RESUMO

In the original publication of the article there was an error in the results section of the abstract. The first sentence should have read.

4.
Soc Psychiatry Psychiatr Epidemiol ; 55(1): 111-121, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31641826

RESUMO

PURPOSE: Evidence-based policy making is increasingly being advocated by governments and scholars. To show that policies are informed by evidence, policy-related documents that cite external sources should ideally provide direct access to, and accurately represent, the referenced source and the evidence it provides. Our aim was to find a way to systematically assess the prevalence of referencing accuracy and accessibility issues in referenced statements selected from a sample of mental health-related policy documents. METHOD: 236 referenced statements were selected from 10 mental health-related policy documents published between 2013 and 2018. Policy documents were chosen as the focus of this investigation because of their relative accessibility and impact on clinical practice. Statements were rated against their referenced sources in terms of the (i) content accuracy in relation to the information provided by the referenced source and (ii) degree of accessibility of the source and the required evidence from the references provided. RESULTS: Of the 236 statements, 141 (59.7%) accurately represented the referenced source, 45 (19.1%) contained major errors and 50 (21.2%) contained minor errors in accuracy. For accessibility, 126 (53.4%) directly referenced primary sources of evidence that supported the claims made, 36 (15.3%) contained indirect references, 18 (7.6%) provided 'dead-end' references, and 11 (4.7%) references were completely inaccessible. CONCLUSIONS: With only slightly over half of all statements assessed providing fully accessible references and accurately representing the referenced source, these components of referencing quality deserve further attention if evidence-informed policy goals are to be achieved. The rating framework used in the current study proved to be a simple and straightforward method to assess these components and can provide a baseline against which interventions can be designed to improve referencing quality.


Assuntos
Prática Clínica Baseada em Evidências/normas , Política de Saúde , Saúde Mental/legislação & jurisprudência , Formulação de Políticas , Humanos
6.
Health Technol Assess ; 23(45): 1-108, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31460865

RESUMO

BACKGROUND: Cannabis is the most prevalent illicit substance among people with psychosis, and its use is associated with poorer clinical and social outcomes. However, so far, there has been limited evidence that any treatment is effective for reducing use. Contingency management (CM) is an incentive-based intervention for substance misuse that has a substantial evidence base across a range of substances and cohorts. However, to date there have been no randomised controlled trials (RCTs) of CM as a treatment for cannabis use specifically in psychosis. OBJECTIVE: To conduct a RCT investigating the clinical effectiveness and cost-effectiveness of CM in reducing cannabis use among Early Intervention in Psychosis (EIP) service users. DESIGN: The CIRCLE (Contingency Intervention for Reduction of Cannabis in Early Psychosis) trial was a rater-blinded, multicentre RCT with two arms. Participants were randomised 1 : 1 to either an CM arm, in which participants received CM for cannabis use alongside an optimised treatment-as-usual programme including structured psychoeducation, or a control arm in which participants received the treatment as usual only. SETTING: EIP services across the Midlands and the south-east of England. PARTICIPANTS: The main eligibility criteria were EIP service users with a history of psychosis, aged 18-36 years, and having used cannabis at least once per week during 12 of the previous 24 weeks. INTERVENTION: The CM intervention offered financial incentives (i.e. shopping vouchers) for cannabis abstinence over 12 once-weekly sessions, confirmed using urinalysis. The maximum value in vouchers that participants could receive was £240. MAIN OUTCOME MEASURES: The main outcome was time to relapse, operationalised as admission to an acute mental health service or hospital. The primary outcome was assessed at 18 months post inclusion using electronic patient records. Secondary outcomes assessed the clinical effectiveness and cost-effectiveness of the intervention, for which data were collected at 3 and 18 months. RESULTS: A total of 278 participants were randomised to the CM arm and 273 were randomised to the control arm. In total, 530 (96%) participants were followed up for the primary outcome. There was no significant difference in time to admission between trial arms by 18 months following consent (hazard ratio 1.03, 95% confidence interval 0.76 to 1.40). There were no statistically significant differences in most secondary outcomes, including cannabis use, at either follow-up assessment. There were 58 serious adverse events, comprising 52 inpatient episodes, five deaths and one arrest. LIMITATIONS: Participant retention was low at 18 months, limiting the assessment of secondary outcomes. A different CM intervention design or reward level may have been effective. CONCLUSIONS: The CM intervention did not appear to be effective in reducing cannabis use and acute relapse among people with early psychosis and problematic cannabis use. FUTURE WORK: Cannabis use is still a significant clinical concern in this population. A pressing need remains to identify suitable treatments. A wider perspective on the social circumstances of young people with psychosis may be needed for a successful intervention to be found. TRIAL REGISTRATION: Current Controlled Trials ISRCTN33576045. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 45. See the NIHR Journals Library website for further project information.


Assuntos
Terapia Comportamental/economia , Cannabis/efeitos adversos , Transtornos Psicóticos/terapia , Recidiva , Adolescente , Adulto , Análise Custo-Benefício/economia , Inglaterra , Feminino , Humanos , Masculino , Motivação , Transtornos Relacionados ao Uso de Substâncias/terapia , Resultado do Tratamento , Adulto Jovem
7.
BMC Psychiatry ; 12: 102, 2012 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-22871335

RESUMO

BACKGROUND: Delusions and hallucinations are classic positive symptoms of schizophrenia. A contemporary cognitive theory called the 'forward output model' suggests that the misattribution of self-generated actions may underlie some of these types of symptoms, such as delusions of control - the experience of self-generated action being controlled by an external agency. In order to examine the validity of this suggestion, we performed a longitudinal functional magnetic resonance imaging (fMRI) study examining neuronal activation associated with motor movement during acute psychosis. METHODS: We studied brain activation using fMRI during a motor task in 11 patients with schizophrenia and 9 healthy controls. The patient group was tested at two time points separated by 6-8 weeks. RESULTS: At initial testing, the patient group had a mean Positive and Negative Syndrome Scale score of 56.3, and showed significantly increased activation within the left inferior parietal lobe (IPL) compared to controls. Patients reported significantly decreased positive symptoms at 6-8 week followup and IPL activation had returned to normal. Our results demonstrate that first-rank positive symptoms are associated with hyperactivation in the secondary somatosensory cortex (IPL). CONCLUSIONS: These findings lend further credence to the theory that a dysfunction in the sensory feedback system located in the IPL, and which is thought to underlie our sense of agency, may contribute to the aetiology of delusions of control.


Assuntos
Encéfalo/fisiopatologia , Movimento/fisiologia , Neurônios/fisiologia , Transtornos Psicóticos/fisiopatologia , Esquizofrenia/fisiopatologia , Adulto , Afeto , Mapeamento Encefálico , Sinais (Psicologia) , Delusões/diagnóstico , Delusões/fisiopatologia , Feminino , Neuroimagem Funcional , Alucinações/diagnóstico , Alucinações/fisiopatologia , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Desempenho Psicomotor/fisiologia , Esquizofrenia/diagnóstico
8.
Can J Exp Psychol ; 64(4): 241-55, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21186908

RESUMO

Implicit memory is widely regarded as an unconscious form of memory. However, evidence for what is arguably a defining characteristic of implicit memory-that its contents are not accessible to awareness-has remained elusive. Such a finding of "pure" implicit memory would constitute evidence against a single-system model of recognition and priming that predicts that priming will not occur in the (true) absence of recognition. In three experiments, using a rapid serial visual presentation procedure at encoding, we tested this prediction by attempting to replicate some previous studies that claimed to obtain pure implicit memory. We found no evidence of priming in the absence of recognition; instead, priming and recognition were associated across experiments: when priming was absent, recognition was also absent (Experiments 1 and 2), and when priming was reliably greater than chance, recognition was similarly greater than chance (Experiment 3). The results are consistent with the prediction of a single-system model, which was fit to the data from all the experiments. The results are also consistent with the notion that the memory driving priming is accessible to awareness.


Assuntos
Discriminação Psicológica/fisiologia , Modelos Psicológicos , Reconhecimento Psicológico/fisiologia , Detecção de Sinal Psicológico/fisiologia , Adolescente , Adulto , Conscientização , Percepção de Cores/fisiologia , Feminino , Humanos , Masculino , Rememoração Mental , Testes Neuropsicológicos , Estimulação Luminosa/métodos , Tempo de Reação/fisiologia , Vocabulário , Adulto Jovem
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