Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.729
Filtrar
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.
Nord J Psychiatry ; 73(8): 539-545, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31517547

RESUMO

Background: Depressive symptoms often occur in patients with personality disorders. Along the lines of the precious concepts of reactive and melancholic forms of depression, two different patterns of depressive symptoms can be identified. Reactive forms of depression is considered to be related to dysfunction of emotional regulation and social functioning, and to personality disorders. This study aimed at exploring the pattern of depressive symptoms in patients with Narcissistic Personality Disorder (NPD) compared to a group of depressed patients without Personality Disorder (PD). The Newcastle Diagnostic Depression Scale (NDDS) is a clinical instrument designed to differentiate reactive depression from melancholic depression. Method: The study investigated patterns of depressive symptoms in 117 out-patients, divided into two groups. One group containing 56 patients with depressive symptoms by no PD and the other group comprised of 61 patients with depressive symptoms and NPD. The participants were interviewed using the Newcastle Diagnostic Depression Scale. Results: There was a significant difference between the groups, as the NPD group suffered from reactive forms of depression. The NPD group showed a pattern of depressive symptoms characterized by fluctuation of the depressive state, without time demarcation of depressive episode, ruminations preoccupied with hostility and accusatory feelings towards other, but not self-accusatory feelings, fluctuation suicidal ideation triggered by external events accompanied by parasuicidal behavior, lack of neuro-vegetative symptoms such as insomnia with early wakening, loss of appetite and weight loss. The No PD group showed the opposite pattern. Conclusion: Based on these results NDDS is considered to be an applicable instrument for identifying personality pathology in patients with depressive symptoms, by recognizing the specific pattern. This is thought to be important for adequate treatment planning.


Assuntos
Depressão/epidemiologia , Depressão/psicologia , Transtornos da Personalidade/epidemiologia , Transtornos da Personalidade/psicologia , Adulto , Estudos Transversais , Dinamarca/epidemiologia , Depressão/diagnóstico , Feminino , Humanos , Masculino , Serviços de Saúde Mental/tendências , Pessoa de Meia-Idade , Transtornos da Personalidade/diagnóstico , Escalas de Graduação Psiquiátrica
3.
Actas Esp Psiquiatr ; 47(4): 149-57, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31461154

RESUMO

INTRODUCTION: The clinical management of patients with psychotic disorders (PDs) can be particularly complex if it takes place in the context of consultation-liaison psychiatry (CLP) services within a general hospital. However, there are few studies specifically investigating the acute treatment procedures for these patients in CLP settings. OBJECTIVES: To examine the characteristics of a sample of inpatients with a primary PD referred to a CLP service over a 10-year period and to compare the clinical features of this subgroup with patients with other diagnoses (ODs). MATERIALS AND METHODS: Observational and descriptive study over a 10-year period (2005-2014) assessing prospectively adult inpatients admitted to non-psychiatric units of the University Clinical Hospital of Barcelona who were consecutively referred to our CLP service. We performed a posthoc analysis to compare the clinical features between the subgroup of patients with PDs and the rest of patients who meet the criteria for ODs. RESULTS: We requested 393 consultations for patients who either already had the diagnosis of a primary PD and 9,415 for patients with ODs. Our results showed that patients with PDs were younger than the patients with ODs, had a higher prevalence of somatic illnesses related with an unhealthy lifestyle (such as infectious, endocrine, or metabolic diseases), less frequency of cancer, and a need to receive a more intensive psychiatric care. CONCLUSIONS: Inpatients with PDs referred to CLP have different clinical features compared with those who met the criteria for ODs. They are a highly complex group with specific psychiatric care needs.


Assuntos
Serviços de Saúde Mental/tendências , Transtornos Psicóticos/diagnóstico , Encaminhamento e Consulta/tendências , Adulto , Idoso , Feminino , Hospitalização , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Espanha
4.
JMIR Mhealth Uhealth ; 7(7): e12347, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31267980

RESUMO

BACKGROUND: Youth homelessness is a substantial issue, and many youths experiencing homelessness have mental health issues as both a cause and consequence of homelessness. These youths face many barriers to receiving traditional mental health services, and as a result, only a few youths experiencing homelessness receive any form of mental health care. OBJECTIVE: This project aimed to develop and determine the feasibility and acceptability of engaging young adults (ie, individuals aged 18-24 years) experiencing homelessness in a remotely delivered mental health intervention. This intervention provided brief emotional support and coping skills, drawing from cognitive behavioral principles as an introduction into psychosocial support. The intervention was piloted in a homeless shelter network. METHODS: A total of 35 young adults experiencing homelessness participated in a single-arm feasibility pilot trial. Participants received a mobile phone, a service and data plan, and 1 month of support from a coach consisting of up to 3 brief phone sessions, text messaging, and mobile mental health apps. We evaluated feasibility by looking at completion of sessions as well as the overall program and acceptability with satisfaction ratings. We also collected clinical symptoms at baseline and the end of the 1-month support period. We used validity items to identify participants who might be responding inappropriately and thus only report satisfaction ratings and clinical outcomes from valid responses. RESULTS: Most participants (20/35, 57%) completed all 3 of their phone sessions, with an average of 2.09 sessions (SD 1.22) completed by each participant. Participants sent an average of 15.06 text messages (SD 12.62) and received an average of 19.34 messages (SD 12.70). We found higher rates of satisfaction among the participants with valid responses, with 100% (23/23) of such participants indicating that they would recommend participation to someone else and 52% (12/23) reporting that they were very or extremely satisfied with their participation. We found very little change from pre- to posttreatment on measures of depression (d=0.27), post-traumatic stress disorder (d=0.17), and emotion regulation (d=0.10). CONCLUSIONS: This study demonstrated that it was feasible to engage homeless young adults in mental health services in this technology-based intervention with high rates of satisfaction. We did not find changes in clinical outcomes; however, we had a small sample size and a brief intervention. Technology might be an important avenue to reach young adults experiencing homelessness, but additional work could explore proper interventions to deliver with such a platform. TRIAL REGISTRATION: ClinicalTrials.gov NCT03620682; https://clinicaltrials.gov/ct2/show/NCT03620682.


Assuntos
Jovens em Situação de Rua/psicologia , Serviços de Saúde Mental/tendências , Aplicativos Móveis/normas , Adaptação Psicológica , Adolescente , Chicago , Estudos de Viabilidade , Feminino , Jovens em Situação de Rua/estatística & dados numéricos , Humanos , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Aplicativos Móveis/estatística & dados numéricos , Projetos Piloto , Psicometria/instrumentação , Psicometria/métodos , Inquéritos e Questionários , Mensagem de Texto/instrumentação , Mensagem de Texto/normas , Mensagem de Texto/estatística & dados numéricos , Adulto Jovem
5.
Intern Med J ; 49(7): 911-914, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31295788

RESUMO

Transition from paediatric to adult diabetes care can be associated with a deterioration in metabolic control and hospitalisation. This was a retrospective review (2012-2016) of medical records of all patients attending a transition diabetes clinic in a teaching hospital with paediatric and adult diabetes on the same site. Among the 91/102 (89.2%) patients with type 1 diabetes, mean age at first visit was 19 ± 2 years, last body mass index was 25.2 ± 4.7 kg/m2 , diabetes duration was 11 ± 6 years and 22 (24%) used continuous subcutaneous insulin infusions. Loss to follow-up was 15 (14.7%). Mental health issues were common (59%), as were prior pregnancies (23%) and diabetic ketoacidosis since diagnosis (39%). Those with diabetic ketoacidosis had a higher mean glycated haemoglobin (70 ± 19 vs 86 ± 25 mmol/mol or 8.6 ± 1.7 vs 10.0 ± 2.3%; P = 0.001), fewer clinic attendances (8 ± 5 vs 5 ± 4; P = 0.008) and fewer years in clinic (1.8 ± 1.7 vs 2.3 ± 1.4; P = 0.114). Our data suggest that investment in joint approaches with mental health services should be considered.


Assuntos
Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/psicologia , Cetoacidose Diabética/diagnóstico , Cetoacidose Diabética/psicologia , Serviços de Saúde Mental , Adolescente , Diabetes Mellitus Tipo 1/sangue , Cetoacidose Diabética/sangue , Feminino , Humanos , Sistemas de Infusão de Insulina/psicologia , Sistemas de Infusão de Insulina/tendências , Masculino , Serviços de Saúde Mental/tendências , Estudos Retrospectivos , Adulto Jovem
6.
West J Emerg Med ; 20(4): 557-572, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31316694

RESUMO

Cannabis legalization has led to significant health consequences, particularly to patients in emergency departments and hospitals in Colorado. The most concerning include psychosis, suicide, and other substance abuse. Deleterious effects on the brain include decrements in complex decision-making, which may not be reversible with abstinence. Increases in fatal motor vehicle collisions, adverse effects on cardiovascular and pulmonary systems, inadvertent pediatric exposures, cannabis contaminants exposing users to infectious agents, heavy metals, and pesticides, and hash-oil burn injuries in preparation of drug concentrates have been documented. Cannabis dispensary workers ("budtenders") without medical training are giving medical advice that may be harmful to patients. Cannabis research may offer novel treatment of seizures, spasticity from multiple sclerosis, nausea and vomiting from chemotherapy, chronic pain, improvements in cardiovascular outcomes, and sleep disorders. Progress has been slow due to absent standards for chemical composition of cannabis products and limitations on research imposed by federal classification of cannabis as illegal. Given these factors and the Colorado experience, other states should carefully evaluate whether and how to decriminalize or legalize non-medical cannabis use.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Uso da Maconha/efeitos adversos , Uso da Maconha/tendências , Acidentes de Trânsito/tendências , Sintomas Comportamentais/induzido quimicamente , Cannabis/química , Colorado/epidemiologia , Dirigir sob a Influência/tendências , Contaminação de Medicamentos , Overdose de Drogas/epidemiologia , Hospitalização/tendências , Humanos , Legislação de Medicamentos , Transtornos Mentais/induzido quimicamente , Serviços de Saúde Mental/tendências , Envenenamento/epidemiologia , Vômito/epidemiologia
7.
J Couns Psychol ; 66(5): 577-587, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31259575

RESUMO

Although the importance of religion in the help-seeking processes of Latinx populations has been discussed (e.g., Moreno & Cardemil, 2013), few studies have considered the effects of religious and cultural factors on Mexican American women's underutilization of professional mental health services and less willingness to seek counseling. To address this gap in the literature, this study focuses on religious cultural values reported by Mexican American college women and how sociocultural factors, such as spiritual and biological etiology beliefs and self-stigma, can shape their willingness to seek counseling, using the cultural influences on mental health (CIMH) theoretical framework (Hwang, Myers, Abe-Kim, & Ting, 2008). Using structural equation modeling, we tested 2 theoretically and empirically derived models of willingness to seek counseling among 276 Mexican American college women at a large Hispanic-serving university in the Southwest. The findings highlighted the direct and indirect ways in which religious cultural values related to willingness to seek counseling and the importance of accounting for etiology beliefs and self-stigma. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Aconselhamento/tendências , Americanos Mexicanos/psicologia , Religião e Psicologia , Estigma Social , Estudantes/psicologia , Universidades/tendências , Adolescente , Adulto , Características Culturais , Feminino , Humanos , Serviços de Saúde Mental/tendências , Adulto Jovem
8.
JMIR Mhealth Uhealth ; 7(6): e13364, 2019 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-31199338

RESUMO

BACKGROUND: Despite high rates of smartphone ownership in psychiatric populations, there are very little data available characterizing smartphone use in individuals with mental illness. In particular, few studies have examined the interest and use of smartphones to support mental health. OBJECTIVE: This study aimed to (1) characterize general smartphone app and social media usage in an acute transdiagnostic psychiatric sample with high smartphone ownership, (2) characterize current engagement and interest in the use of smartphone apps to support mental health, and (3) test demographic and clinical predictors of smartphone use. METHODS: The survey was completed by all patients attending an adult partial hospital program, with no exclusion criteria. The primary outcomes were frequency of use of general and mental health smartphone apps (smartphone use survey) and the frequency of social media use and phone-checking behavior (mobile technology engagement scale). RESULTS: Overall, 322 patients (aged mean 33.49, SD 13.87 years; 57% female) reported that their most frequently used app functions were texting, email, and social media. Younger individuals reported more frequent use across most types of apps. Baseline depression and anxiety symptoms were not associated with the frequency of app use. Participants reported health care, calendar, and texting apps as most supportive of their mental health and social media apps as most negatively affecting their mental health. Most patients reported an interest in (73.9% [238/322]) and willingness to use (81.3% [262/322]) a smartphone app to monitor their mental health condition. Less than half (44%) of the patients currently had a mental health app downloaded on their smartphone, with mindfulness and meditation apps being the most common type. CONCLUSIONS: The high interest in and willingness to use mental health apps, paired with the only moderate current reported usage, indicate a potential unmet treatment opportunity in psychiatric populations. There is potential to optimize non-mental health-specific apps to better support the needs of those with mental illness and to design a new wave of mental health apps that match the needs of these populations as well as the way they use smartphones in daily life.


Assuntos
Serviços de Saúde Mental/tendências , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Mídias Sociais/instrumentação , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Mídias Sociais/estatística & dados numéricos , Inquéritos e Questionários
9.
JMIR Mhealth Uhealth ; 7(6): e11677, 2019 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-31165709

RESUMO

BACKGROUND: Digital tools have the potential to support patient activation and shared decision making in the face of increasing levels of mental health problems in young people. There is a need for feasibility trials of digital interventions to determine the usage and acceptability of interventions. In addition, there is a need to determine the ability to recruit and retain research participants to plan rigorous effectiveness trials and, therefore, develop evidence-based recommendations for practice. OBJECTIVE: This study aimed to determine the feasibility of undertaking a cluster randomized controlled trial to test the effectiveness of a smartphone app, Power Up, co-designed with young people to support patient activation and shared decision making for mental health. METHODS: Overall, 270 young people were screened for participation and 52.5% (142/270) were recruited and completed baseline measures across 8 specialist child mental health services (n=62, mean age 14.66 (SD 1.99) year; 52% [32/62] female) and 2 mainstream secondary schools (n=80; mean age 16.88 [SD 0.68] years; 46% [37/80] female). Young people received Power Up in addition to management as usual or received management as usual only. Posttrial interviews were conducted with 11 young people from the intervention arms (specialist services n=6; schools n=5). RESULTS: Usage data showed that there were an estimated 50 (out of 64) users of Power Up in the intervention arms. Findings from the interviews indicated that young people found Power Up to be acceptable. Young people reported (1) their motivation for use of Power Up, (2) the impact of use, and (3) barriers to use. Out of the 142 recruited participants, 45.0% (64/142) completed follow-up measures, and the approaches to increase retention agreed by the steering group are discussed. CONCLUSIONS: The findings of this study indicate that the app is acceptable, and it is feasible to examine the effectiveness of Power Up in a prospective cluster randomized controlled trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT02552797; https://clinicaltrials.gov/ct2/show/NCT02552797 (Archived by WebCite at http://www.webcitation.org/6td6MINP0).


Assuntos
Serviços de Saúde Mental/tendências , Aplicativos Móveis/normas , Adolescente , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Aplicativos Móveis/estatística & dados numéricos , Participação do Paciente/psicologia , Participação do Paciente/estatística & dados numéricos , Estudos Prospectivos , Smartphone/instrumentação , Smartphone/estatística & dados numéricos , Inquéritos e Questionários
10.
J Couns Psychol ; 66(5): 626-639, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31144848

RESUMO

This article reports the development and psychometric properties of the 27-item Barriers to Seeking Mental Health Counseling (BMHC) scale, which assesses perceived help-seeking barriers among college-aged students. Across 2 studies involving ethnically diverse samples (e.g., Latinx majority students), the authors provided evidence for this new measure's validity and reliability. Exploratory and confirmatory factor analyses (including a bifactor analysis) provided support for the BMHC scale's multidimensionality reflecting 6 barriers: Negative Perceived Value, Discomfort with Emotions, Ingroup Stigma, Lack of Knowledge, Lack of Access, and Cultural Barriers. Evidence for criterion-related validity was shown through significant but differential correlations with self-stigma, emotional control, and the 4 components of Ajzen's (1991) Theory of Planned Behavior model-attitude, subjective norm of social stigma, perceived behavioral control, and mental health help-seeking intention. Discriminant evidence of validity was established through nonsignificant or small correlations between BMHC subscales and 2 measures of socially desirable responding. The authors also found evidence for incremental validity and measurement invariance across race, and evidence for internal reliability and temporal stability of the BMHC subscales. Findings are discussed in light of the conceptual, methodological, and clinical contributions of the BMHC scale. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde Mental , Saúde Mental , Estigma Social , Serviços de Saúde para Estudantes , Estudantes/psicologia , Adolescente , Feminino , Humanos , Intenção , Masculino , Saúde Mental/tendências , Serviços de Saúde Mental/tendências , Psicometria , Reprodutibilidade dos Testes , Serviços de Saúde para Estudantes/tendências , Adulto Jovem
11.
JMIR Mhealth Uhealth ; 7(4): e12578, 2019 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-30950799

RESUMO

BACKGROUND: The growing field of personal sensing harnesses sensor data collected from individuals' smartphones to understand their behaviors and experiences. Such data could be a powerful tool within mental health care. However, it is important to note that the nature of these data differs from the information usually available to, or discussed with, health care professionals. To design digital mental health tools that are acceptable to users, understanding how personal sensing data can be used and shared is critical. OBJECTIVE: This study aimed to investigate individuals' perspectives about sharing different types of sensor data beyond the research context, specifically with doctors, electronic health record (EHR) systems, and family members. METHODS: A questionnaire assessed participants' comfort with sharing six types of sensed data: physical activity, mood, sleep, communication logs, location, and social activity. Participants were asked about their comfort with sharing these data with three different recipients: doctors, EHR systems, and family members. A series of principal component analyses (one for each data recipient) was performed to identify clusters of sensor data types according to participants' comfort with sharing them. Relationships between recipients and sensor clusters were then explored using generalized estimating equation logistic regression models. RESULTS: A total of 211 participants completed the questionnaire. The majority were female (171/211, 81.0%), and the mean age was 38 years (SD 10.32). Principal component analyses consistently identified two clusters of sensed data across the three data recipients: "health information," including sleep, mood, and physical activity, and "personal data," including communication logs, location, and social activity. Overall, participants were significantly more comfortable sharing any type of sensed data with their doctor than with the EHR system or family members (P<.001) and more comfortable sharing "health information" than "personal data" (P<.001). Participant characteristics such as age or presence of depression or anxiety did not influence participants' comfort with sharing sensed data. CONCLUSIONS: The comfort level in sharing sensed data was dependent on both data type and recipient, but not individual characteristics. Given the identified differences in comfort with sensed data sharing, contextual factors of data type and recipient appear to be critically important as we design systems that harness sensor data for mental health treatment and support.


Assuntos
Armazenamento e Recuperação da Informação/classificação , Serviços de Saúde Mental/tendências , Privacidade/psicologia , Smartphone/normas , Adolescente , Adulto , Idoso , Confidencialidade/psicologia , Confidencialidade/normas , Estudos Transversais , Feminino , Humanos , Masculino , Serviços de Saúde Mental/normas , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Smartphone/estatística & dados numéricos , Inquéritos e Questionários
13.
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
14.
Isr J Health Policy Res ; 8(1): 31, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30879464

RESUMO

BACKGROUND: The public Educational Psychology Services provide mental health services for children and youth in Israel, alongside the Ministry of Health and the Ministry of Social Affairs and Services. The Psychological and Counseling Services Division of the Ministry of Education (known as SHEFI - Sherut Psychology Yeutzi), funds and supervises local Educational Psychology Services which are aimed at supporting child development and enhancing the emotional welfare of children and their families. The demand for the services of educational psychologists is increasing. Yet this demand is not being met due to the insufficient number of job slots allocated, the geographical distances in outlying peripheral areas, the already high loads in the psychologists' daily routine, and other such problems. A wide range of effective psychological services can be offered via the internet. The internet therefore has the potential to serve as a useful and efficient missing link between the high demands for educational psychology services on the one hand and the ability and desire among educational psychologists to meet those needs on the other. Moreover, even if the services were fully staffed, the resources would still be insufficient to provide personal (face-to-face) treatment for all, so that internet-based access to services would still need to be developed. Those services provide unique advantages such as overcoming distance and enabling higher availability of mental health professionals. The objectives of the current study were to describe the prevalence of public educational psychology services available online in Israel, with specific focus on the Arab minority and the peripheral regions, and to highlight the benefits of expanding those services. METHOD: During 2016, we conducted a survey comprising all 252 Public Educational Psychology Service units in Israel (n = 170 in the Jewish sector, and n = 82 in the Arab sector). The method used to search for online sites was in line with the actions taken by an average end-user searching for information on the internet. RESULTS: The survey found that 125 of the units in the Jewish sector (73.5% of those units) and all 82 units in the Arab sector had no online site at all, constituting 82.2% of all the units in Israel. Of the 45 Jewish websites located by the survey, 42 (93.3% of the sites) were not user friendly (not interactive), and only three offered the possibility of interacting with psychologists (6.7% of the sites). Nevertheless, all the sites (n = 45) offered a high degree of quality and variety that exceeded basic information. CONCLUSION: We believe that the presence of educational psychologists on the internet is essential in order to meet the challenges presented by the growing needs of students, parents and teachers in the current digital era. The survey revealed that the public educational psychology system in Israel has not yet bridged the technological gap. Special attention should be directed to the peripheral regions and to the Arab sector, where the technological services can make a significant contribution. The local public services' attempts to create and operate websites (45 Jewish websites according to the survey), are indicative of the determination to offer psychological support to the community at large, and of the ambition to overcome availability and accessibility problems. The concept of internet services might be useful not only for the SHEFI, but also for the array of mental health services for children and youth in Israel. Thus, we recommend that a policy should be formulated regarding internet-based mental health services for children and youth in Israel, and we call for a collaboration between the various ministries in implementing this process.


Assuntos
Internet/instrumentação , Serviços de Saúde Mental/estatística & dados numéricos , Psicologia Educacional/métodos , Adolescente , Criança , Feminino , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Israel , Masculino , Serviços de Saúde Mental/tendências , Psicologia Educacional/instrumentação , Inquéritos e Questionários
15.
J Prof Nurs ; 35(2): 133-137, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30902405

RESUMO

Of the children and adolescents with mental health concerns who receive treatment, most do so in outpatient community mental health service sites, systems of care which have largely failed to produce significant clinical outcomes. Suggested strategies to improve care in child mental health treatment include improving families' access to services, increasing use of evidence-based practices (EBPs), and holding service sites accountable for demonstrating outcomes. Producing a workforce to implement these strategies will require cultivating providers who have developed specific competencies within a range of agencies that naturally interface with the daily lives of families and their children. The authors report on a recently developed interprofessional child community fellowship for psychiatry residents and psychiatric mental health nurse practitioners aimed at training providers to deliver child mental health services in a variety of community settings. Activities that focus the fellowship are outlined along with the development of the related competencies: EBP translation, collaboration skills, and outcome measurement. Evaluation strategies for fellows' competency development are discussed.


Assuntos
Centros Comunitários de Saúde , Prática Clínica Baseada em Evidências , Relações Interprofissionais , Profissionais de Enfermagem/educação , Psiquiatria/educação , Recursos Humanos , Adolescente , Criança , Educação de Pós-Graduação em Medicina , Bolsas de Estudo , Humanos , Internato e Residência , Serviços de Saúde Mental/provisão & distribução , Serviços de Saúde Mental/tendências , Enfermagem Psiquiátrica
16.
Health Mark Q ; 36(2): 93-106, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30907260

RESUMO

This article explores the physicians' perspective regarding the potential of computerized cognitive behavioral therapies (cCBTs) to overcome inequalities in the context of mental health care provision. The main benefits were related to the ability of cCBTs to provide care in a convenient and efficient manner, enhancing its accessibility. These aspects were perceived more important than cost-effectivity of treatment, which is often claimed to be the key benefit of cCBTs. Age and general acceptance of CBT were the most significant individual-level separators of perceptions, while the sector in which the physician works was seen as the main structural-level separator.


Assuntos
Disparidades nos Níveis de Saúde , Serviços de Saúde Mental/organização & administração , Médicos/psicologia , Terapia Assistida por Computador/métodos , Adulto , Idoso , Atitude do Pessoal de Saúde , Terapia Cognitivo-Comportamental , Feminino , Finlândia , Acesso aos Serviços de Saúde , Humanos , Masculino , Serviços de Saúde Mental/tendências , Pessoa de Meia-Idade , Inquéritos e Questionários
17.
Mil Med ; 184(Suppl 1): 418-425, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901426

RESUMO

The U.S. Defense Department partnered with the International Initiative for Mental Health Leadership on effective leadership and operational practices for delivery of mental health (MH) as well as addiction services throughout the world for Service Members (SM) and beneficiaries. A Military Issues Work Group (MIWG) was established in 2011 to focus on challenges experienced by military SM and beneficiaries among countries. The MIWG found common concerns related to MH care delivery to rural and remote beneficiaries. Gaps in access to care were identified and prioritized to explore. This led to better collaboration and understanding of telemental health (TMH) practices and technology applications (apps) which increase access to care for rural and remote SMs and beneficiaries. An assessment of the number of SMs and dependents distant from MH care services in the USA was conducted, as well as an environmental scan for psychological health-focused mobile apps and TMH services geared toward SM, veterans, and beneficiaries. The MIWG is developing a compendium of existing military TMH programs and apps that address MH concerns and extant literature on use of technology to extend global access to care for military members and their families across the world.


Assuntos
Assistência à Saúde/métodos , Serviços de Saúde Mental/tendências , Austrália , Canadá , Assistência à Saúde/tendências , Dinamarca , Humanos , Serviços de Saúde Mental/normas , Família Militar/estatística & dados numéricos , Militares/estatística & dados numéricos , Aplicativos Móveis/provisão & distribução , Nova Zelândia , Reino Unido , Estados Unidos , United States Department of Defense/organização & administração , United States Department of Defense/tendências
18.
Inf. psiquiátr ; (235): 41-46, ene.-mar. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-183984

RESUMO

La depresión es la enfermedad psiquiátrica más frecuente en los pacientes de edad avanzada. Supone la primera causa entre los pacientes que se suicidan a esta edad, genera gran sufrimiento en el propio paciente y en su familia, y es fuente de importante discapacidad por la propia enfermedad y por la repercusión en la evolución de otras enfermedades comórbidas. Una vez diagnosticada y tratada, la evolución de la enfermedad puede ser a una recuperación completa del paciente, tanto en lo sintomático como en lo funcional. Sin embargo, es frecuente, en este periodo de la vida, que la enfermedad depresiva sea recurrente y que por tanto haya que mantener el tratamiento antidepresivo durante varios años o de manera continuada. También resulta habitual que algunos de los síntomas no respondan de la misma manera al tratamiento farmacológico o de psicoterapia. En este caso, pueden hacerlo más tarde que los síntomas nucleares o quedar como síntomas residuales. Estos síntomas pueden tener tanta importancia y repercutir de tal manera en la vida de los pacientes que condicionen el pronóstico de la enfermedad que padecen. Los síntomas cognitivos, la ansiedad y las alteraciones de los ritmos biológicos, sobre todo el sueño, son los que requieren una mayor atención, pero las ideas de muerte y de suicidio, los síntomas somáticos y la apatía constituyen también síntomas para tener en cuenta. En este artículo se pretende revisar las posibles evoluciones y sus opciones terapéuticas, abordar si existe riesgo de encarnizamiento terapéutico, y finalizar con algunas cuestiones de la vida de estos pacientes que influyen en el afrontamiento de la enfermedad


Depression is the most frequent psychiatric illness in elderly patients. It is the first cause among patients who commit suicide at this age, generates great suffering in the patients and in their family, and is a source of significant disability due to the disease itself and the impact on the evolution of other comorbid diseases. Once diagnosed and treated, the evolution of the disease can be to a complete recovery of the patient, symptomatic and functional recovery. However, it is frequent, in this period of life, that the depressive illness would be recurrent and that therefore it would be necessary to maintain the antidepressant treatment for several years or continuously. It is also common that some of the symptoms do not respond in the same way to the pharmacological treatment or psychotherapy. In this case, they can do it later than core symptoms do, or remain as residual symptoms. These symptoms can be so important and affect in such a way the life of the patients that condition the prognosis of the disease they suffer. Cognitive symptoms, anxiety and alterations of biological rhythms, especially sleep, are those that require more attention, but the ideas of death and suicide, somatic symptoms and apathy are also symptoms to be taken into account. Finally, some patients have resistant forms and do not respond to the treatment used, or they do it very partially. This article aims to review possible evolutions, to approach therapeutic harassment possibilities, and, finally, to examine some issues in the lives of these patients that could influence the coping of the disease


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Depressão/terapia , Ansiedade/complicações , Psiquiatria Geriátrica/tendências , Serviços de Saúde Mental/tendências , Sistemas de Apoio Psicossocial
19.
PLoS Med ; 16(2): e1002748, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30763321

RESUMO

BACKGROUND: In low-income countries, care for people with mental, neurological, and substance use (MNS) disorders is largely absent, especially in rural settings. To increase treatment coverage, integration of mental health services into community and primary healthcare settings is recommended. While this strategy is being rolled out globally, rigorous evaluation of outcomes at each stage of the service delivery pathway from detection to treatment initiation to individual outcomes of care has been missing. METHODS AND FINDINGS: A combination of methods were employed to evaluate the impact of a district mental healthcare plan for depression, psychosis, alcohol use disorder (AUD), and epilepsy as part of the Programme for Improving Mental Health Care (PRIME) in Chitwan District, Nepal. We evaluated 4 components of the service delivery pathway: (1) contact coverage of primary care mental health services, evaluated through a community study (N = 3,482 combined for all waves of community surveys) and through service utilisation data (N = 727); (2) detection of mental illness among participants presenting in primary care facilities, evaluated through a facility study (N = 3,627 combined for all waves of facility surveys); (3) initiation of minimally adequate treatment after diagnosis, evaluated through the same facility study; and (4) treatment outcomes of patients receiving primary-care-based mental health services, evaluated through cohort studies (total N = 449 depression, N = 137; AUD, N = 175; psychosis, N = 95; epilepsy, N = 42). The lack of structured diagnostic assessments (instead of screening tools), the relatively small sample size for some study components, and the uncontrolled nature of the study are among the limitations to be noted. All data collection took place between 15 January 2013 and 15 February 2017. Contact coverage increased 7.5% for AUD (from 0% at baseline), 12.2% for depression (from 0%), 11.7% for epilepsy (from 1.3%), and 50.2% for psychosis (from 3.2%) when using service utilisation data over 12 months; community survey results did not reveal significant changes over time. Health worker detection of depression increased by 15.7% (from 8.9% to 24.6%) 6 months after training, and 10.3% (from 8.9% to 19.2%) 24 months after training; for AUD the increase was 58.9% (from 1.1% to 60.0%) and 11.0% (from 1.1% to 12.1%) for 6 months and 24 months, respectively. Provision of minimally adequate treatment subsequent to diagnosis for depression was 93.9% at 6 months and 66.7% at 24 months; for AUD these values were 95.1% and 75.0%, respectively. Changes in treatment outcomes demonstrated small to moderate effect sizes (9.7-point reduction [d = 0.34] in AUD symptoms, 6.4-point reduction [d = 0.43] in psychosis symptoms, 7.2-point reduction [d = 0.58] in depression symptoms) at 12 months post-treatment. CONCLUSIONS: These combined results make a promising case for the feasibility and impact of community- and primary-care-based services delivered through an integrated district mental healthcare plan in reducing the treatment gap and increasing effective coverage for MNS disorders. While the integrated mental healthcare approach does lead to apparent benefits in most of the outcome metrics, there are still significant areas that require further attention (e.g., no change in community-level contact coverage, attrition in AUD detection rates over time, and relatively low detection rates for depression).


Assuntos
Serviços Comunitários de Saúde Mental/normas , Assistência à Saúde/normas , Recursos em Saúde/normas , Transtornos Mentais/terapia , Doenças do Sistema Nervoso/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Adulto , Estudos de Coortes , Serviços Comunitários de Saúde Mental/métodos , Serviços Comunitários de Saúde Mental/tendências , Assistência à Saúde/métodos , Assistência à Saúde/tendências , Feminino , Recursos em Saúde/economia , Humanos , Masculino , Transtornos Mentais/economia , Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/normas , Serviços de Saúde Mental/tendências , Pessoa de Meia-Idade , Nepal/epidemiologia , Doenças do Sistema Nervoso/economia , Doenças do Sistema Nervoso/epidemiologia , Vigilância da População/métodos , Transtornos Relacionados ao Uso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Resultado do Tratamento , Adulto Jovem
20.
BMC Psychiatry ; 19(1): 39, 2019 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-30678676

RESUMO

BACKGROUND: Web-based mental health applications may be beneficial, but adoption is often low leaving optimal implementation and payment models unclear. This study examined which users were interested in extended access to a web-based application beyond an initial 3-month trial period and evaluated if an additional 3 months of access was beneficial. METHODS: This study was a concealed extension of a multi-center, pragmatic randomized controlled trial that assessed the benefit of 3 months of access to the Big White Wall (BWW), an anonymous web-based moderated, multi-component mental health application offering self-directed activities and peer support. Trial participants were 16 years of age or older, recruited from hospital-affiliated mental health programs. Participants who received access to the intervention in the main trial and completed 3-month outcome assessments were offered participation. We compared those who were and were not interested in an extension of the intervention, and re-randomized consenting participants 1:1 to receive extended access or not over the subsequent 3 months. Use of the intervention was monitored in the extension group and outcomes were measured at 3 months after re-randomization in both groups. The primary outcome was mental health recovery as assessed by total score on the Recovery Assessment Scale (RAS-r), as in the main trial. Linear mixed models were used to examine the time by group interaction to assess for differences in responses over the 3-month extension study. RESULTS: Of 233 main trial participants who responded, 119 (51.1%) indicated an interest in receiving extended BWW access. Those who were interested had significantly higher baseline anxiety symptoms compared to those who were not interested. Of the 119, 112 were re-randomized (55 to extended access, 57 to discontinuation). Only 21 of the 55 extended access participants (38.2%) used the intervention during the extension period. Change in RAS-r scores over time was not significantly different between groups (time by group, F(1,77) = 1.02; P = .31). CONCLUSIONS: Only half of eligible participants were interested in extended access to the intervention with decreasing use over time, and no evidence of added benefit. These findings have implications for implementation and payment models for this type of web-based mental health intervention. TRIAL REGISTRATION: Clinicaltrials.gov NCT02896894 . Registered retrospectively on September 12, 2016.


Assuntos
Internet/tendências , Transtornos Mentais/terapia , Serviços de Saúde Mental/tendências , Saúde Mental/tendências , Participação do Paciente/tendências , Terapia Assistida por Computador/tendências , Adulto , Aconselhamento/métodos , Aconselhamento/tendências , Feminino , Seguimentos , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Participação do Paciente/métodos , Participação do Paciente/psicologia , Estudos Retrospectivos , Terapia Assistida por Computador/métodos , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA