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1.
Psychiatr Hung ; 34(4): 380-392, 2019.
Artigo em Húngaro | MEDLINE | ID: mdl-31767798

RESUMO

The provision and coordination of good quality care in mental health represents a major challenge worldwide. The direct and indirect costs of psychiatric disorders, including costs due to substance use disorders are very high in the countries of the European Union. The prevalence of both mental disorders and substance use disorders is significant in Hungary. Leaders of the psychiatric profession joined forces and assembled a complex plan for the development of mental health care in Hungary. The National Programme of Mental Health represents both challenges and opportunities for this area. The main objective is a stepped care and collaborative care model for individuals with psychiatric disorders that incorporates the primary care system (general practitioners) and the community psychiatry providers. Primary care needs to develop competence to identify and treat people with common mental disorders, supported by a new care model of clinical psychologist counseling services. The tasks of these psychologists include screening (assessment interviews), giving information, leading patients to the optimal therapeutic pathways, psychoeducation and low-intensity psychological interventions. The psychologist represents a bridge between the family doctor and psychiatric care. The programme aims to shift mental health services from hospitals to community mental health facilities services. However there is a parallel organization of health and social care systems in Hungary that inhibits the complex care of patients. It is necessary to develop a closer coordination (or collaboration) of out-patient psychiatric care and the community-based services, to provide more and better facilities for reintegration of patients. Continuity of care can beestablished by psychiatrists being responsible for treatment plans and pathways, including the frequency of follow-up visits or the need for transferring patients to family doctors or to psychiatric hospitals. In some areas there is an important need for the development of specialized teams or units (for example crisis intervention service, forensic psychiatric unit, mother-child unit, psychiatric emergency rooms, high security wards). Human resources represent a major problem, the numbers of psychiatric nurses and psychiatrists are insufficient. The dysfunctional distribution of human resources leads to the deterioration of services. This is principally financial question. In the future the psychiatry should take advantage of the possibilities offered by digital technology. In this paper we present the main elements of the National Programme of Mental Health. We hope that the programme can be realized in the coming years with financial support of the Hungarian Government.


Assuntos
Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/tendências , Saúde Mental , Humanos , Hungria , Transtornos Mentais/terapia , Psiquiatria/organização & administração , Psiquiatria/tendências
2.
Psychiatr Danub ; 31(Suppl 3): 395-399, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488759

RESUMO

BACKGROUND: According to the United Nations High Commissioner for Refugees the number of people forced to leave their home as a result of conflict, persecution, violence or human rights violations remains high with 68.5 million forcibly displaced people worldwide. Asylum seekers are vulnerable in terms of mental health but they receive very little specific psychiatric care. The purpose of this literature review is to examine current situation regarding asylum seekers' psychiatric healthcare. SUBJECTS AND METHODS: This research was conducted using a keyword search on Medline, PubMed and Google Scholar. RESULTS: The literature on the management of the mental health of asylum seekers focuses on the issue of post-traumatic stress disorder. There is little data on other forms of mental illness in this population. The prevalence of post-traumatic stress disorder among asylum seekers is higher than in the general population and its clinical expression is varied and often complex because it involves various vulnerability factors. Guidelines for post-traumatic stress disorder recommend cognitive behavioral therapy with, in some cases, the use of pharmacotherapy. Given the specificities of the asylum seekers' population, in many cases it is not possible to set up such therapy immediately. Asylum seekers face a number of challenges in accessing mental healthcare. CONCLUSION: Management of the mental health of asylum seekers requires special attention and guidelines for the general population are not directly applicable to this specific population. The literature focuses on the issue of post-traumatic stress disorder. This review was not able to analyse the state of existing care offer in Belgium for managing the mental health of asylum seekers and the care pathways they take.


Assuntos
Saúde Mental , Psiquiatria , Refugiados/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Bélgica , Humanos , Saúde Mental/estatística & dados numéricos , Prevalência , Psiquiatria/organização & administração , Psiquiatria/estatística & dados numéricos
3.
Psychiatr Danub ; 31(Suppl 3): 418-420, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488764

RESUMO

BACKGROUND: A reformation of psychiatry was set up in Belgium with the establishment of mobile crisis teams. SUBJECTS AND METHODS: We performed a retrospective analysis of the patients referred to the mobile team "Pharos" in the period between December 2013 and December 2018. RESULTS: The number of patients is growing over the years and the most common referral reasons are suicidal thoughts and depressive mood. We have a high percentage of inclusions, maybe because the main referrers are GPs. Alcohol withdrawal at home is feasable and safe. CONCLUSION: Many psychiatric crisis situations can be managed at home with support of mobile teams, but further research is needed to provide evidence on outcome and cost effectiveness.


Assuntos
Intervenção na Crise/estatística & dados numéricos , Serviços de Emergência Psiquiátrica/provisão & distribução , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Psiquiatria/métodos , Psiquiatria/organização & administração , Transtornos Relacionados ao Uso de Álcool/terapia , Bélgica/epidemiologia , Depressão/epidemiologia , Depressão/terapia , Humanos , Estudos Retrospectivos , Ideação Suicida
5.
Am J Health Syst Pharm ; 76(8): 554-559, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-31361866

RESUMO

PURPOSE: Implementation of the SAFE PAIN algorithm for reducing opioid use for chronic pain in older adults is described. SUMMARY: A multidisciplinary team at Sheppard Pratt Health System, the largest private provider of psychiatric care in Maryland, used lean methodology to identify the root causes for noncompliance to evidence-based practices for patients in the geropsychiatry unit treated for osteoarthritis or chronic back pain. The team collaborated to develop a facility-specific treatment algorithm, called SAFE PAIN (Sheppard Pratt Health System Algorithm For Elderly Patient Centered Analgesia Interdisciplinary Nagara), was based on the Center for Disease Control and Prevention's evidence-based recommendations that included nonpharmacologic interventions as a first-line therapy for patients with osteoarthritis or chronic back pain. Rates of prescribing new opioids and prescribing evidence-based alternative medications via the SAFE PAIN algorithm were evaluated from March 1 to September 30, 2017 and compared with baseline (2012-2016). The lean methodology interventions led to zero new opioid orders during the study period, a significant decrease compared with previous years (p < 0.01). The rates of prescribing evidence-based alternative medications increased significantly from the baseline period to postimplementation (p < 0.01). Lean methodology interventions also decreased waste in several processes. CONCLUSION: The prescribing rate of new opioids for osteoarthritis and chronic back pain decreased and the prescribing rate for evidence-based medications increased after implementation of the SAFE PAIN algorithm in a geropsychiatry unit.


Assuntos
Analgésicos Opioides/efeitos adversos , Dor Crônica/tratamento farmacológico , Procedimentos Clínicos , Osteoartrite/tratamento farmacológico , Manejo da Dor/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/etiologia , Dor Crônica/reabilitação , Prescrições de Medicamentos/estatística & dados numéricos , Medicina Baseada em Evidências/organização & administração , Medicina Baseada em Evidências/normas , Feminino , Geriatria/organização & administração , Geriatria/normas , Fidelidade a Diretrizes , Implementação de Plano de Saúde , Humanos , Masculino , Maryland , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Osteoartrite/complicações , Osteoartrite/reabilitação , Manejo da Dor/normas , Equipe de Assistência ao Paciente/organização & administração , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Psiquiatria/organização & administração , Psiquiatria/normas
6.
Prax Kinderpsychol Kinderpsychiatr ; 68(5): 419-437, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31250723

RESUMO

Family Psychiatry - The Attachment-Focused, Systemic-Oriented, Integrative Concept of the Family Therapy Centre (FaTC), an Acute Multi-Family Day Clinic Up to three quarters of the children of mentally ill parents develop a mental disorder during their lifetime. The transmission occurs essentially through dysfunctional interaction and disturbed attachment. Parent-child interaction is characterized by a vicious circle of escalating symptoms in the child and increasing helplessness in the parents. For this family psychiatric approaches are helpful, which address the interaction in addition to the individual disorders. The Family Therapy Centre (FaTC) Neckargemünd offers family psychiatric, integrated therapy for parents and children in an acute day clinic multi-family setting. The basic therapeutic principles are attachment orientation, mentalisation and systemic perspective with a multi-family therapy approach. Typical family psychiatric case constellations are presented, for which the concept seems particularly helpful: (1) Early childhood regulatory disorders in interaction with mentally ill parents, (2) mother with PTSD and expansive-aggressive preschool child and (3) adolescents with separation anxiety and depressive-anxious mother. The previous experiences are reflected by a moderated focus group of the entire FaTC team. The FaTC concept was evaluated as very helpful. It was positively judged that the family system is visibly present on site (and not only virtually). The focus is on interaction, therefore causal therapy can be offered rather than symptomatic treatment. Limitations of the concept are therapy of severely aggressive adolescents or parents who do not want to participate. The concept of the FaTC is currently being scientifically evaluated.


Assuntos
Filho de Pais Incapacitados/psicologia , Terapia Familiar/métodos , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Relações Pais-Filho , Pais/psicologia , Psiquiatria/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Terapia Familiar/organização & administração , Feminino , Grupos Focais , Humanos , Masculino , Psiquiatria/organização & administração
7.
Tijdschr Psychiatr ; 61(5): 343-351, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31180573

RESUMO

BACKGROUND: In participatory action research (par), researchers, practitioners and the community engage in a research process together. This research approach has the potential to assist in bridging the research-practice gap by starting from practice needs and using joint expertise and experiences to enrich scientific knowledge, optimise clinical practice and empower stakeholders from different backgrounds.
AIM: To discuss the potential benefits of par for clients, professionals and researchers in the field of mental healthcare.
METHOD: Starting from the literature on par, fundamental characteristics and benefits of this research approach in the field of mental healthcare are described and illustrated with an example from practice.
RESULTS: par in mental healthcare can contribute to enriching prepositional and practical knowledge, facilitate positive social change in care delivery, empower all stakeholders, and ultimately make a significant contribution to the integration of research and practice.
CONCLUSION: par is valuable for clients, professionals and researchers in a variety of projects in mental healthcare.


Assuntos
Serviços Comunitários de Saúde Mental/organização & administração , Pesquisa Participativa Baseada na Comunidade/organização & administração , Psiquiatria , Pesquisa sobre Serviços de Saúde , Humanos , Saúde Mental , Psiquiatria/organização & administração , Psiquiatria/normas , Pesquisadores
8.
Nervenarzt ; 90(7): 680-689, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31165212

RESUMO

BACKGROUND: Currently, it is a topic of debate whether psychiatric hospitals can and should be managed with a full open door policy. The revised legislation of public law for involuntary commitment explicitly allows or even encourages such practice in several German federal states. In parts of Austria, open doors are required for legal reasons. A systematic literature search was conducted for articles providing empirical data related to this issue. METHOD: Literature search in PubMed augmented by a manual search in references of retrieved papers and reviews with similar objectives. RESULTS: A total of 26 articles reporting empirical data could be identified. Most of these articles came from Germany or Switzerland. The majority were published within the past 5 years. The definition of "open doors" ranged from an only vaguely defined open door policy up to explicit set time periods with open doors. Some studies reported a decrease in coercive interventions. No study reported any associated adverse events resulting from open doors in psychiatric wards. DISCUSSION: Generally, all studies had methodological weaknesses. Prospective randomized controlled studies or quasi-experimental studies are missing in the context of European healthcare systems. The risk of bias was considerable in most studies. A final conclusion regarding the possible extent of psychiatry with open doors and the associated risks is currently not possible. There is an urgent need for future high-quality prospective studies.


Assuntos
Hospitais Psiquiátricos , Transtornos Mentais , Psiquiatria , Europa (Continente) , Hospitais Psiquiátricos/normas , Humanos , Transtornos Mentais/terapia , Estudos Prospectivos , Psiquiatria/métodos , Psiquiatria/organização & administração , Psiquiatria/normas
9.
Artigo em Inglês | MEDLINE | ID: mdl-31170335

RESUMO

Background: The Institute of Mental Health (IMH), the leading tertiary psychiatric hospital in Singapore, has managed patients' psychiatric issues for decades. However, these patients' existing medical conditions often require care in subspeciality outpatient clinics of restructured hospitals. Given the need to reduce follow-up appointments in subspeciality outpatient clinics for conditions that can be managed by family physicians, a novel family medicine-psychiatry collaborative initiative between Sengkang General Hospital and IMH was implemented to address this issue. Methods: Data were retrospectively collected on patients with upcoming appointments who were seen by family physicians at IMH from January 2 to May 14, 2017. Patients with upcoming appointments in the subspeciality outpatient clinics were scheduled for review by family physicians. Continuous data were summarized as median (range) and count (percentage). Results: At 4.5 months, 272 patients with 426 preexisting specialty appointments had been seen by family physicians. Of the specialty appointments, 150 (35.2%) were cancelled, as the conditions could be managed by family physicians. In 64 (15.0%) cases, a memo requesting transfer of care was given to the subspecialty consultant to ensure a consensus regarding the patient's management. Conclusions: Family physicians embedded in mental health institutions can reduce the need to transfer patients out of the hospital to receive care for nonpsychiatric conditions.


Assuntos
Agendamento de Consultas , Medicina de Família e Comunidade/organização & administração , Hospitais Psiquiátricos/estatística & dados numéricos , Colaboração Intersetorial , Psiquiatria/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Singapura , Adulto Jovem
10.
Soins ; 64(835): 43-45, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31079788

RESUMO

TOWARDS ADVANCED PRACTICE FOR NURSES IN PSYCHIATRY: Advanced nursing practice in psychiatry is a major challenge for the discipline. It must meet the needs of the population as well as conform to national policies and tackle the problems within the mental health and psychiatric sector. For a long time, psychiatric nurses have developed their practices on the basis of precise indications and health policies. Advanced practice will not be able to replace these existing situations.


Assuntos
Prática Avançada de Enfermagem , Enfermagem Psiquiátrica , Psiquiatria/organização & administração , França , Política de Saúde , Humanos , Transtornos Mentais/enfermagem
12.
BMC Health Serv Res ; 19(1): 120, 2019 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-30764822

RESUMO

BACKGROUND: Collaborative care involves active engagement of primary care and hospital physicians in shared care of patients beyond usual discharge summaries. This enhances community-based care and reduces dependence on specialists and hospitals. The model, successfully implemented in chronic care management, may have utility for treatment of depression in cancer. The aim of this systematic review was to identify components, delivery and roles and responsibilities within collaborative interventions for depression in the context of cancer. METHODS: Medline, PsycINFO, CINAHL, Embase, Cochrane Library and Central Register for Controlled Trials databases were searched to identify studies of randomised controlled trials comparing a treatment intervention that met the definition of collaborative model of depression care with usual care or other control condition. Studies of adult cancer patients with major depression or a non-bipolar depressive disorder published in English between 2005 and January 2018 were included. Cochrane checklist for risk of bias was completed (Study Prospero registration: CRD42018086515). RESULTS: Of 8 studies identified, none adhered to the definition of 'collaborative care'. Interventions delivered were multi-disciplinary, with care co-ordinated by nurses (n = 5) or social workers (n = 2) under the direction of psychiatrists (n = 7). Care was primarily delivered in cancer centres (n = 5). Care co-ordinators advised primary care physicians (GPs) of medication changes (n = 3) but few studies (n = 2) actively involved GPs in medication prescribing and management. CONCLUSIONS: This review highlighted joint participation of GPs and specialist care physicians in collaborative care depression management is promoted but not achieved in cancer care. Current models reflect hospital-based multi-disciplinary models of care. PROTOCOL REGISTRATION: The protocol for this systematic review has been registered with PROSPERO. The registration number is CRD42018086515.


Assuntos
Transtorno Depressivo Maior/terapia , Neoplasias/terapia , Equipe de Assistência ao Paciente/organização & administração , Adulto , Institutos de Câncer/organização & administração , Ensaios Clínicos Controlados como Assunto , Assistência à Saúde/organização & administração , Depressão/terapia , Feminino , Humanos , Masculino , Corpo Clínico Hospitalar/organização & administração , Neoplasias/psicologia , Participação do Paciente , Atenção Primária à Saúde/organização & administração , Psiquiatria/organização & administração , Ensaios Clínicos Controlados Aleatórios como Assunto , Especialização/estatística & dados numéricos
14.
Telemed J E Health ; 25(1): 18-24, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29742036

RESUMO

BACKGROUND: Emergency departments (EDs) have recognized an increasing number of patients presenting with mental health (MH) concerns. This trend imposes greater demands upon EDs already operating at capacity. Many ED providers do not feel they are optimally prepared to provide the necessary MH care. One consideration in response to this dilemma is to use advanced telemedicine technology for psychiatric consultation. INTRODUCTION: We examined a rural- and community-based health system operating 21 EDs, none of which has direct access to psychiatric consultation. Dedicated beds to MH range from zero (in EDs with only 3 beds) to 6 (in an ED with 38 beds). MATERIALS AND METHODS: We conducted a needs assessment of this health system. This included a survey of emergency room providers with a 67% response rate and site visits to directly observe patient flow and communication with ED staff. A visioning workshop provided input from ED staff. Data were also obtained, which reflected ED admissions for the year 2015. RESULTS: The data provide a summary of provider concerns, a summary of MH presentations and diagnosis, and age groupings. The data also provide a time when most MH concerns present to the ED. DISCUSSION: Based upon these results, a proposed model for delivering comprehensive regional emergency telepsychiatry and behavioral health services is proposed. CONCLUSIONS: Emergency telepsychiatry services may be a tenable solution for addressing the shortage of psychiatric consultation to EDs in light of increasing demand for MH treatment in the ED.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Consulta Remota/organização & administração , Serviços de Saúde Rural/organização & administração , Adolescente , Adulto , Idoso , Feminino , Acesso aos Serviços de Saúde/organização & administração , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Psiquiatria/organização & administração , População Rural , Adulto Jovem
15.
Australas Psychiatry ; 27(1): 75-79, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30058350

RESUMO

OBJECTIVES:: This paper describes, from the personal perspective of a mid-career researcher, principles and advice regarding the development of an embedded clinical psychiatric research program within a medical school and public sector mental health service. From this experience, some general principles are drawn. CONCLUSIONS:: Through careful strategic planning, together with collaboration with the mental health service, it is possible to bootstrap and develop an embedded clinical research program.


Assuntos
Pesquisa Biomédica , Médicos , Psiquiatria , Pesquisa Biomédica/economia , Pesquisa Biomédica/organização & administração , Humanos , Serviços de Saúde Mental , Psiquiatria/economia , Psiquiatria/organização & administração , Faculdades de Medicina
16.
Med Care ; 57(1): 79-84, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30439791

RESUMO

OBJECTIVES: Behavioral health home (BHH) models have been developed to integrate physical and mental health care and address medical comorbidities for individuals with serious mental illnesses. Previous studies identified population health management capacity and coordination with primary care providers as key barriers to BHH implementation. This study examines the BHH leaders' perceptions of and organizational capacity to conduct these functions within the community mental health programs implementing BHHs in Maryland. METHODS: Interviews and surveys were conducted with 72 implementation leaders and 627 front-line staff from 46 of 48 Maryland BHH programs. In-depth coding of the population health management and primary care coordination themes identified subthemes related to these topics. RESULTS: BHH staff described cultures supportive of evidence-based practices, but limited ability to effectively perform population health management or primary care coordination. Tension between population health management and direct, clinical care, lack of experience, and state regulations for service delivery were identified as key challenges for population health management. Engaging primary care providers was the primary barrier to care coordination. Health information technology and staffing were barriers to both functions. CONCLUSIONS: BHHs face a number of barriers to effective implementation of core program elements. To improve programs' ability to conduct effective population health management and care coordination and meaningfully impact health outcomes for individuals with serious mental illness, multiple strategies are needed, including formalized protocols, training for staff, changes to financing mechanisms, and health information technology improvements.


Assuntos
Serviços Comunitários de Saúde Mental/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Gestão da Saúde da População , Atenção Primária à Saúde/métodos , Psiquiatria/organização & administração , Comorbidade , Prática Clínica Baseada em Evidências , Feminino , Pessoal de Saúde/educação , Humanos , Maryland , Médicos de Atenção Primária/organização & administração , Médicos de Atenção Primária/psicologia , Atenção Primária à Saúde/organização & administração , Inquéritos e Questionários
19.
Arq Neuropsiquiatr ; 76(10): 713-715, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30427512

RESUMO

OBJECTIVE: To describe the highlights in the personal, professional, and political life of the first Brazilian Professor of Psychiatry. METHODS: The article draws on a wide range of documents: newspaper articles, documents of Brazilian medical institutions, scientific articles, theses, and books. RESULTS: João Carlos Teixeira Brandão was a distinguished 19th-century Brazilian psychiatrist and leader of the institutionalization and consolidation of the field of Psychiatry in Brazil. He contributed to the recognition of the professional jurisdiction of the "alienist", a specialized professional, qualified in clinical practice, diagnosis, and the definition of the boundaries between sanity and madness, based on scientific criteria, in the late 19th and early 20th centuries. CONCLUSION: This article highlights the key moments in the professional and political career of Professor João Carlos Teixeira Brandão, from his graduation from the Rio de Janeiro School of Medicine in 1877 to his death in 1921, when he was still active in national politics.


Assuntos
Psiquiatria/história , Brasil , Docentes de Medicina/história , História do Século XIX , História do Século XX , Psiquiatria/organização & administração
20.
Neuropsychiatr ; 32(4): 182-186, 2018 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-30167986

RESUMO

A successful and sustainable treatment of psychiatric patients is based on intensive relationship work. After the introduction of the new Working Hours Act the standards of evidence-based treatment are endangered. Using the data of the official working schedule of the Psychiatric Department of the Danube hospital in Vienna, before and after the introduction of the new Working Hours Act, we demonstrate a significant decrease of the medical consistency of the patient-related doctors. New approaches must be considered in order to solve this problem of quality.


Assuntos
Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Admissão e Escalonamento de Pessoal/organização & administração , Unidade Hospitalar de Psiquiatria/organização & administração , Psiquiatria/organização & administração , Áustria , Humanos
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